What You Should Know About COVID-19 for the Upcoming Respiratory Season

Author: Ryan Hassan, MD, MPH, Boost Oregon's Medical Director and pediatrician working at Oregon Pediatrics in Happy Valley.

It’s that time of year again: the kids are back in school and winter days are looming on the horizon. With these changes come seasonal increases in respiratory illness in our communities. We are moving from emergency responses to COVID-19 to more sustainable efforts to prevent its spread. Here’s what you need to know about keeping yourself and your family safe from COVID-19 this respiratory season.

Primary Series

As expected, COVID-19 hospital admissions are rising again this fall, especially for children and seniors (As Covid-19 hospitalizations climb, rates among seniors and children raise concern | CNN). In preparation for the winter season, Pfizer and Moderna updated their COVID-19 vaccines to target more recent Omicron COVID-19 strains. Based on preliminary data from this updated vaccine, and extensive studies of the prior vaccines, we expect the updated vaccine to be as safe and effective as prior vaccines at protecting against severe COVID-19 infections.

Unvaccinated people, including children, remain at higher risk for severe illness from COVID-19. COVID-19 was the eighth leading cause of death in children between 2020 and 2022 (Assessment of COVID-19 as the Underlying Cause of Death Among Children and Young People Aged 0 to 19 Years in the US | Public Health | JAMA Network Open | JAMA Network). Every life cut short by this preventable disease is a tragedy.

This is why we continue to strongly recommend the COVID-19 vaccine for everyone over 6 months of age. The primary series of COVID-19 vaccine is 2 doses of Moderna or 3 doses of Pfizer mRNA vaccine for children 6 months to 4 years old, and 1 dose of mRNA vaccine for everyone 5 years and older. Children under 5 who began the primary series with a previous version of the vaccine should complete the series with the updated vaccine (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html). People who complete the primary series have excellent long-term protection from severe COVID-19 disease.

Additional Doses

For those who have already completed their primary series, it may be beneficial to get a dose of the updated 2023 vaccine. However, there is less consensus on who should receive this vaccine.

Experts agree that people who are 65 and older or have health conditions impacting their immune system’s ability to fight off diseases should get a dose of the updated vaccine since they are at higher risk for severe disease. As such, we strongly recommend that all people with risk factors for severe COVID-19 infection receive a dose of the updated vaccine to reduce their risk for severe disease.

The Advisory Committee on Immunization Practices (ACIP)-- a workgroup with the Centers for Disease Control and Prevention (CDC)-- recommends that everyone 6 months and older get an updated Pfizer or Moderna mRNA COVID-19 vaccine. ACIP also recommends that people at risk for severe disease consider getting a second dose of the updated COVID-19 vaccine at least 2-4 months after their first dose of the updated vaccine. 

The World Health Organization (WHO) also recommends the vaccine for people who have never been vaccinated and those at high risk for severe disease. However, the WHO acknowledges that the benefits of additional doses may be minimal for healthy, previously vaccinated people, especially those under age 17 (WHO COVID-19 advice for the public: Getting vaccinated). The updated vaccine may provide some increased protection from mild illness, which can still be very disruptive for families. It may also provide some protection from Long COVID disease. However, there is disagreement among experts about the value and benefits of this additional dose to healthy, vaccinated children because we simply don't have the data yet (Trailhead Pediatrics COVID-19 Vaccine Information). The benefits of the additional dose for low risk people likely still outweigh the risks, but it may help to talk to your pediatrician to take into account your child’s health and situation.

As a practicing pediatrician, I try to share this information with all of my patients so they can make a fully informed decision. I am recommending the vaccine for all of my patients because of the possibility that it might reduce their risk for mild illness and Long COVID. I will be getting the vaccine for myself and my daughter for the same reasons. That said, I am not recommending it as strongly as I am other shots, such as the flu vaccine or RSV antibody, which are far more important for reducing the risk of serious respiratory illness this winter. I am grateful for the possibility that I might be able to further protect my baby from unnecessary illness with an updated COVID-19 vaccine, but I would not be very worried if she were unable to get it because she already has excellent protection from her primary vaccine series. 

If you still have questions about COVID-19 vaccines, please visit https://www.boostoregon.org/covid19 for more information, or reach out at info@boostoregon.org. We are always listening.