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L.A. County and San Francisco encourage all adults to get booster shots

A woman receives a COVID-19 vaccination booster shot.
Altadena resident Nicole Fahey, who is six months pregnant, receives a Pfizer-BioNTech vaccination booster shot from nurse Veronique Vida on Nov. 3 at Eugene A. Obregon Park in Los Angeles.
(Gary Coronado / Los Angeles Times)

Los Angeles County and San Francisco health officials are encouraging all fully vaccinated adults to get a COVID-19 booster shot.

L.A. County Public Health Director Barbara Ferrer and San Francisco Public Health Director Grant Colfax have added their endorsements to those of a growing number of health officials in California who are suggesting that virtually all adults are already eligible for boosters under the guidelines issued by the U.S. Centers for Disease Control and Prevention.

Ferrer said she recommends that any vaccinated adult get a booster as long as at least six months have passed since the second dose of the Pfizer-BioNTech or Moderna vaccination series, or at least two months have passed following a Johnson & Johnson vaccination.

“The only exception would be a person who lives in a bubble: You’re in your house, you telework, you never leave, you don’t live with anybody, you don’t really have a lot of risks, nor are you creating a lot of risk. But I don’t know anybody living in that world,” Ferrer said during a briefing Friday.

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With winter coming, health officials in California and other areas are pushing harder for COVID-19 booster shots.

Some young adults have returned to workplaces or are “certainly out and about enjoying all that L.A. County has to offer, and we’d like them to continue to do that,” Ferrer said. However, she warned, “they do have waning protection. And unfortunately, if they get infected, they can infect others who really could end up with very serious illness.

“So, yes, I do recommend that, if it’s your time — because you’re six months out from that second dose of Pfizer or Moderna, two months out from receiving Johnson & Johnson, you’re 18 or older and you’re not living in that bubble — please come in and get your booster,” Ferrer said.

Some who look at the eligibility criteria on the state’s scheduling website, myturn.ca.gov, might think they don’t qualify for a booster.

But Ferrer and other health officials have pointed out that one of the criteria, being “at high risk for COVID-19 exposure due to occupation or institutional setting,” applies to virtually every adult.

Some health officials, including in California, are increasingly pointing out that eligibility criteria can be interpreted in a more expansive way.

That criterion, Ferrer said, can apply to:

  • Going to work and being around other people;
  • Living with people who cannot get vaccinated, such as babies or young children, or who are at high risk of serious illness should they get infected, such as the elderly or those who are overweight or pregnant, are a current or former smoker or have high blood pressure, diabetes, asthma, depression or an alcohol- or drug-use disorder; and,
  • Being in a community that has been hit hard by COVID-19 or is seeing high numbers of coronavirus cases — “which, at this point, is all over L.A. County,” Ferrer said.

She said she thinks this interpretation is in alignment with the guidance outlined by the CDC.

Her counterpart in San Francisco echoed her approach.

“We are taking an expansive approach to COVID-19 boosters, realizing that people are at risk of getting COVID or spreading it as we enter the busy holiday season,” Colfax said in a statement.

“We are already seeing an uptick in cases, and that could mean hospitalization for some vulnerable people, even if they are fully vaccinated,” Colfax added. “We have been stressing that boosters are essential for higher risk individuals, but now it’s become apparent that we need many more people to receive a booster dose so that we can protect ourselves, our families and friends, and our community.”

Additionally, Ferrer pointed out, there’s ample supply of booster shots, and officials are concerned that those who were vaccinated more than six months ago may start to experience weakened immunity to COVID-19.

As Europe copes with a COVID surge, battle lines are forming between the vaccine-willing and vaccine-resistant. Sound familiar?

Increasing the uptake of booster shots, getting unvaccinated people to begin the regimen and wearing masks in indoor public spaces and crowded outdoor spots are essential strategies to stave off a winter COVID-19 surge, Ferrer said.

“Certainly around the country and across parts of the world, the colder weather has already brought significant increases in cases and, unfortunately, in hospitalizations. It would be foolish to not heed the warning inherent in these increases,” Ferrer said. “Our ample supply of vaccinations allows us to offer the initial series to everyone 5 and older and boosters for those with waning protection, putting us in a better position to prevent the tragic heartbreak we experienced last winter.”

In a letter this week to local health agencies and vaccine clinics, California State Health Officer and Director of Public Health Dr. Tomás Aragón wrote that adults can determine they are at high risk of exposure simply by living “in geographic areas that have been heavily impacted by COVID.”

To vaccine providers, Aragón directed: “Do not turn a patient away who is requesting a booster,” as long as enough time has passed since the initial vaccination.

Experts at the Centers for Disease Control and Prevention have set aside herd immunity as a national target for ending the pandemic.

Health officials in Santa Clara County, Northern California’s most populous, offered the same interpretation at a recent press conference and have since seen increased demand for boosters.

“Pretty much everybody is eligible,” said Dr. Sara Cody, the county’s health officer and public health director. “We really encourage everyone to get out and get their booster shot.”

The San Francisco Department of Public Health said some people seeking booster shots may still see a narrower set of eligibility criteria while trying to book appointments.

“As the systems are updated, people should choose the least restrictive of the criteria that applies to them. Many work and residential settings pose the risk of exposure to COVID,” the agency said in a statement.

California’s messaging marks a shift from just a few weeks ago, when officials placed greater emphasis on urging elderly individuals and those with weakened immune systems to get boosters. That was partly based on the CDC’s official recommendations that among people vaccinated with Pfizer-BioNTech or Moderna, groups who should get boosters include anyone 65 and older, those 50 and over with certain underlying conditions and adults who live in long-term care settings. The CDC also recommended that all adult J&J recipients get a booster.

Vaccination rates are up, but there’s fear Black and Latino men will continue waiting until they almost die from COVID-19 or watch people they know die before getting vaccinated.

The CDC made the boosters available to other specified groups but stopped short of officially recommending them. Among these groups are younger adults with an underlying condition and those age 18 to 64 who live or work in settings that put them at increased risk. As the CDC guidance notes, that risk “can vary across settings and be affected by how much COVID-19 is spreading in a community.”

While California is relying on an interpretation of the CDC guidelines to essentially throw the doors open, federal officials, for their part, are evaluating whether to officially expand eligibility.

Pfizer and BioNTech recently asked the U.S. Food and Drug Administration to allow boosters of their COVID-19 vaccine for anyone 18 or older. Results from a new study found that a booster dose resulted in a relative vaccine efficacy of 95% when compared with people who did not receive a booster.

Demand for booster shots in L.A. County has climbed significantly in recent weeks, Ferrer said. However, administration of first doses has remained relatively low.

With only one week since 5- to 11-year-olds were eligible for COVID-19 vaccines, Orange County health officials are reporting ‘a very healthy demand.’

During the first week of November, L.A. County administered 182,000 booster shots or additional doses to immune-compromised people and slightly more than 43,000 first doses of vaccine and 42,000 second doses.

At this pace, L.A. County won’t achieve its goal of fully vaccinating at least 80% of residents age 12 and up until next year. Hitting that goal is one of the county’s criteria to lift its mask mandate for indoor public areas.

About 73% of Angelenos in that age range have completed their initial inoculation series, county data show.

Progress in getting unvaccinated people their shots, Ferrer acknowledged, is “plodding ahead much more slowly than we would wish.

“The single most important thing that we can do as a community to reduce our risk for another winter surge is to decrease our numbers of unvaccinated people,” she said, adding that this includes getting newly eligible children vaccinated.


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