As Fall Arrives, So Do the Viruses. . .

By Andrew Jameson, MD, FACP, FIDSA, AAHIVS, Specialty Medical Director, Trinity Health Medical Group and Section Chief, Infectious Diseases, Trinity Health Grand Rapids

Each fall, health care professionals brace for the all-too-familiar seasonal surge of illnesses caused by viruses. 

As a member of the Michigan Advisory Council for Immunizations, I can say that now, more than ever before, much of the suffering from viral illnesses is avoidable, particularly because of the effective immunizations available for seasonal influenza and COVID-19. That’s the good news. 

However, there is some new confusion this year due to changes recently introduced by the Food and Drug Administration (FDA) and Centers for Disease Control (CDC) to COVID vaccine guidelines, including significant restrictions to who qualifies for the shot. 

So, let’s try to clear up some of the questions and confusion. 

COVID-19

The threat of COVID infections has not gone away. COVID is still spreading, and while some groups are at higher risk for severe illness, no one is guaranteed to have a mild infection.

When the CDC last updated their variant tracker in early June, the variant NB.1.8.1, nicknamed Nimbus, accounted for most cases in the U.S. We saw an uptick in cases – a late summer upswing – as we have every summer since the pandemic, but this Nimbus variant didn’t appear to make people sicker than other recent strains. It did, however, have a new and unique symptom: severe sore throat, referred to as ‘razor blade throat’.  

Now, the Nimbus variant has essentially died off and the latest variant data says that 75% of current COVID cases in the U.S. are caused by the Stratus variant. This variant is characterized by the classic COVID symptoms of congestion, low grade fever, and lethargy.

There’s good news here, too: the recently approved COVID vaccine is a nice match to this Stratus variant, so the shot will offer very good protection against severe illness caused by it.

Will I be able to get a COVID shot this fall?

It depends on your age and health. The FDA has approved this updated COVID vaccine – but with significant new restrictions. 

Currently, COVID vaccines are approved only for people 65 and older, and for people younger than 65 who have at least one of these underlying medical conditions or behaviors that puts them at higher risk for severe illness from COVID: 

• Asthma
• Blood cancers
• Cerebrovascular diseases
• Chronic kidney disease
• Some chronic lung diseases
• Some chronic liver diseases
• Cystic fibrosis
• Type 1 and 2 diabetes
• Gestational diabetes
• Disabilities, including Down syndrome
• Heart conditions
• HIV
• Mood disorders, including depression and schizophrenia
• Dementia
• Parkinson’s disease
• Obesity
• Physical inactivity
• Current or recent pregnancy
• Primary immunodeficiencies
• Current or former smoking
• Solid organ or blood stem cell transplant recipients
• Tuberculosis
• Use of immunosuppressive drugs

Those younger than 65, pregnant women and children with no underlying medical conditions or behaviors on this list aren’t eligible for the vaccine under the current FDA approval, even if they live with someone at high risk of severe illness. 

What if I’m not eligible but want a COVID vaccine?

Your best chance of getting the shot is at your local health department (Kent County, Ottawa County) or at your doctor’s office.  

This is because it’s legal and common for doctors to prescribe medications off-label, meaning for uses the FDA. hasn’t approved. But there’s no guarantee your doctor will do so and it’s not clear yet whether all insurers will cover the shot.

To help make it easier for those who want a COVID vaccine to get the vaccine, some states are now forming a ‘health alliance’ that would review scientific data and make recommendations for their residents, saying that the federal agency responsible for issuing such guidance has become ‘a political tool that increasingly peddles ideology instead of science.’ 

We’ll have to see if Michigan joins this approach.

When will COVID vaccines be available?

Now.

Moderna and Pfizer shipped their updated vaccines almost immediately upon FDA approval, so your doctor’s office, local pharmacy, and local health departments have them.

Are COVID shots still free?

Yes, for people who meet the new eligibility criteria and have health insurance.

For people who get off-label vaccinations, the picture is murkier. It would then be up to individual insurers to decide whether to cover it. 

When is the best time to get the shot?

Now. 

The COVID vaccine matches the current Stratus variant that is circulating, so getting your shot now means that even if you do get COVID later, your symptoms will be less severe, and you are less likely to transmit the virus to people around you. 

Can children be vaccinated for COVID?

It depends.

The FDA approved Moderna’s newest vaccine for children 6 months and older who have at least one of the underlying medical conditions (see above list) that would put them at higher risk for severe illness from COVID.

The FDA approved Pfizer’s vaccine only for children 5 years and older, and Novavax’s vaccine only for children 12 and older, in both cases also with the underlying medical conditions limitation.

Children without at least one of the underlying medical conditions that put them at higher risk for severe illness from COVID would have to be given the vaccine off-label by their pediatrician. A pediatrician can legally do this, but there is no guarantee they will.

How long does the COVID vaccine last and are there side effects?

The shot will provide substantial protection against severe illness from COVID through the full winter virus season and will make the virus less transmissible to those around you if you do get it.  

Some people may have sore arm or flu-like symptoms from the shot, but these usually clear up in a day or two. Serious side effects from the vaccine are rare. 

INFLUENZA

Last winter, influenza activity peaked in Michigan in mid-February, and it was one of the worst flu seasons in several years. 

In fact, 2024 was the first year since the pandemic that hospitalization rates for flu were higher than for COVID. It also was the worst year since 2004 for pediatric mortality from influenza with 14 child deaths in Michigan from flu. This was likely due to a massive drop in flu vaccination rates.

How can I protect myself from flu?

Flu season typically runs from November to March each year, but there’s no way to tell exactly when it will begin. 

The CDC recommends that everyone 6 months and older gets an annual flu shot to help prevent flu and its complications. A flu shot is particularly important for people who are at higher risk of serious complications from flu.

You can get a flu vaccine now, before flu season begins, at most major retail pharmacies like Walgreens, CVS and Walmart, as well as local health departments and doctors’ offices. 

If you are eligible for the COVID vaccine and are at higher risk of getting seriously ill from RSV (see below), you can also get these vaccines at the same time as your flu shot.   

RESPIRATORY SYNCYTIAL VIRUS (RSV)

RSV is one of the most common respiratory illnesses. Most people who get infected develop mild symptoms, such as coughing and wheezing, a runny nose, fever, loss of appetite and congestion. 

However, adults 75 and older and babies are at higher risk of getting seriously ill from RSV. People with compromised immune systems and underlying chronic medical conditions are also more likely to die from the virus.

Is there a vaccine for RSV, who should get it and when? 

Yes, the RSV vaccine is very effective at lowering the risk of hospitalization and serious illness. 

While RSV typically begins spreading in the fall, with cases peaking around mid-winter, the virus that causes it does not mutate or change each year, like flu and COVID viruses do. Therefore, the RSV vaccine is a one-time shot that you can get any time.

The CDC recommends a single dose of RSV vaccine to protect all adults ages 75 and older. CDC also urges people 50 and older to get vaccinated if they are at higher risk for getting very sick. This includes those who live in nursing homes or have conditions like chronic heart, lung, and liver disease; compromised immune systems; severe obesity; or diabetes with accompanying organ damage.

To protect infants and some young children, CDC recommends the maternal RSV vaccine for pregnant women during weeks 32–36 of pregnancy, or a long-acting infant RSV antibody (for babies given after birth. 

What else can I do to stay safe?

Viruses spread when people who are infected cough or sneeze, and droplets linger in the air or on surfaces. Frequently washing hands with soap and water, disinfecting surfaces like doorknobs, and maintaining good ventilation in enclosed spaces can help stop the spread. 

Limiting contact with people who are experiencing respiratory symptoms is also a good idea. And wearing a mask not only protects you, but if you have symptoms, protects your loved ones. 

Final words 

As a medical expert, I support what the scientific research and results data have proven: to best protect yourself from serious illness caused by these viruses, get the vaccines. 

We are in a much better place with protection against serious illness from these viruses now because of these vaccines. I encourage people to talk to their doctor and to get these vaccinations.