County reviews booster rules as third shots arrive for many

San Diego County health officials on Monday answered some of the most common questions about the federal government’s recent approval of coronavirus vaccine booster shots for a select group of Americans.

Dr. Wilma Wooten, the region’s public health officer, said the booster shots should be readily available to those who qualify.

“No one needs a prescription from their doctor,” Wooten said. “If you fall into any of those categories, you can go to any of the locations that provide the vaccine.”

By categories, Wooten meant the list of people for whom third doses is now officially endorsed by the U.S. Centers for Disease Control and Prevention. The biggest by far is age. Anyone age 65 or older qualifies.

But there is also one major caveat that quickly excludes many of the nearly 2.2 million across the region now fully vaccinated: Boosters have only been approved for previous recipients of Pfizer vaccines.

The CDC recommends a third Pfizer dose only for those who received their second of two Pfizer shots at least six months ago. No similar approval exists for Moderna or Johnson & Johnson vaccines.

Boosters are also available to anyone age 18 years or older who lives in a long-term care setting or who has an underlying medical condition ranging from cancer and chronic kidney disease to stroke and substance use disorders.

The guidelines also say that all adults at least six months from their second Pfizer doses who are at “increased risk for COVID-19 exposure and transmission because of occupational or institutional setting” can hit the boost button. That, generally speaking, includes health care workers, first responders and the like.

It is unclear exactly how many Pfizer recipients in San Diego County now qualify for boosters. The county, which operates the region’s electronic vaccination registry, should be able to tease a pretty solid estimate out of the vaccination data it controls, but no such number was available at Monday’s news conference.

Nathan Fletcher, chair of the county Board of Supervisors, said the county does not anticipate a need for widespread mass vaccination centers to meet the demand for booster shots. He said there are more than 250 local pharmacies able to give boosters and county-run vaccination clinics are currently at 14 percent capacity.

In the early going of the region’s initial vaccination push, nurses often visited skilled nursing and other congregate living locations to inoculate residents. This time around, Fletcher said, many of those locations say they now have the ability to give boosters without additional assistance.

“The ones that don’t, we are working with and we will make sure they have someone there that can do that,” Fletcher said.

County officials also worked to address the inevitable special cases that surface any time the federal government announces a major new vaccination campaign.

Some have wondered whether boosters are recommended for residents who became infected after receiving two Pfizer doses — so-called breakthrough cases.

Dr. Seema Shah, medical director of the county epidemiology department, said boosters are definitely on tap for this group provided they meet the age, condition or occupation guidance.

“Ninety days from their infection is when they would get the booster,” Shah said. “So, even if they had been fully vaccinated, got a post-vaccination infection, they would still need a booster.”

A county official clarified Tuesday that Shah’s statement applies only to those who have received monoclonal antibodies to help fight off early coronavirus infection. The CDC has given no specific guidance on booster timing for those who have experienced breakthrough infections.

The CDC’s booster approvals do not include adolescents age 12 to 17 who are fully vaccinated with Pfizer doses. And the list of approved medical conditions does not include intellectual disabilities such as autism. Neurologic conditions such as dementia and Alzheimer’s disease, as well as Down syndrome are specifically listed, but others are not.

Shah said Monday the county is sticking with the CDC’s official list of medical conditions in its booster shot guidance for local health care providers.

“If it’s not explicitly in those underlying conditions, then they would not qualify,” Shah said.

That’s frustrating for Sophy Chaffee of Encinitas, the mother of Zander, 19. Her son, she said, is autistic, has an intellectual disability, epilepsy and a rare genetic disorder. Zander’s conditions do not appear on the CDC’s booster list despite solid evidence that he would benefit.

A commentary published by a New England Journal of Medicine subsidiary called Catalyst, Chaffee notes, found in March that those with intellectual disabilities “are at significantly elevated risk of contracting COVID-19 and that they will subsequently be admitted to (Intensive Care Units) and/or die in-hospital more often.”

That conclusion came after the research team conducted a cross-sectional study across 547 health providers that examined the medical records of more than 64 million patients from January 2019 through November 2020.

Having already seen many others prioritized over her son for initial vaccination in the winter, Chaffee said it has been disappointing that the list of recognized disabilities has not been broadened for boosters.

“When I asked my son’s health care provider about whether he’s eligible for a booster, they replied in an email today that the only ones eligible are those with compromised immune systems,” she said. “My point for public health leaders, researchers and health care providers, overall, is this: We in this community don’t want to be forgotten and want some more solid information about what level of elevated risk COVID-19 poses.”

The county health department listed 356 new coronavirus infections on its website Monday evening. The number continues a recent trend of lower activity that has many in the public health community cautiously optimistic that the fall will be more gentle than it was in 2020.