Philadelphia reimplemented its indoor mask mandate on April 18, a preemptive action to mitigate the county’s rising COVID cases — up 81% from two weeks ago, according to the Centers for Disease Control and Prevention — and subsequent rise in hospitalizations.
The FDA’s March 29 approval of a second booster shot for those over age 50 was yet another measure to try to quell the pandemic’s impact.
“We believe that things aren’t at a crisis level right now, but that if we take action now, we can head off the worst of this wave,” Philadelphia Department of Public Health Media Coordinator Matthew Rankin said. “We don’t yet know if BA.2 is going to cause a real surge in Philadelphia or just a brief increase in cases.”
Though the large public health bodies have been quick to sound alarm bells, for Jewish Philadelphians, new public health protocols are old hat, an indication that the pandemic is becoming endemic and something with which people are learning to live.
“When it’s recommended either by the state or the health department I’ll do it, no matter what other people are doing,” said Deena Pollock, an East Falls resident, of the mask mandate.
Pollock is planning on receiving her second booster but admitted it won’t change much for her. She’s already dining at indoor restaurants but would be reluctant to travel in an airplane even after getting the shot.
It’s a balance Pollock has found over the past two years of being “sad, but not depressed.” She attends Golden Slipper Gems events and volunteers virtually, and while COVID still provides an underlying fear, Pollock has learned to live with it.
According to Dr. Eric Sachinwalla, an infectious disease physician at Einstein Healthcare Network, Pollock’s story is similar to others he’s heard.
Those interested in getting a second shot — who only represent a small fraction of the U.S. population according to PDPH — are already more likely to take precautions against COVID-19, undermining the necessity of the booster.
“There’s a lot of debate about what should be the best approach from a public health perspective,” Sachinwalla said. “Should we be focusing on getting the people who are at high risk fourth doses, or should we really be focusing on getting the people who are at zero doses started on getting first, second, third doses? And there’s merit to both of those arguments.”
Dr. Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, who is Jewish, offers additional skepticism about the second booster, describing it as “low risk, low benefit.”
For those over 70 with pre-existing conditions, the booster provides additional protection for a short time. But for those under 70 who are relatively healthy, it does very little, as a third dose also serves to prevent serious infection and hospitalization.
Though interest in a second booster isn’t necessarily detrimental, it’s also a false solution to ending the pandemic for those trying to avoid infection altogether.
“The biggest problem in all this is that we haven’t defined what the goal of the vaccine is,” Offit said. “The goal of the vaccine should be to prevent serious illness, which is mediated by memory cells, which really aren’t boost-able.”
These memory cells, or t-cells, will take time to develop, and a booster, especially one with the same formula as the initial three shots, will do little to assist in their development.
The lack of communication in the purpose of the vaccine has set unrealistic benchmarks of what success is defined as during a pandemic. Cases are no longer a good indicator of risk, as so many are mild. Soon, the prevalence and severity of COVID will likely start to mirror the seasonal flu, but Offit predicts that the number of cases and hospitalizations will stay relatively low for now.
“We’re going to have to have a fundamental shift in how we think about this virus because right now we are intolerant to mild infection,” Offit said.
Jill Caine, past president of Golden Slipper Gems, offers a glimpse of a possible future. She received her second booster to provide additional protection for herself and the older population she works with but has noticed a trend among her old friends: They have begun to take more risks after their second boosters, going on flights around the country on vacation.
They’re in their twilight years, Caine said, and they aren’t willing to spend any more of their lives waiting around.
“This is something that we’re probably going to have to live with for the rest of our lives,” Caine said. “And you can’t be in your house for the rest of your life. You have to start living again.”