We are now entering the booster phase of the pandemic, apparently. Sorry, but I am already there: here's the story.
All the way back in March, Liz and I signed up for vaccines just as soon as we could. For both of us, here in Kentucky, that was the beginning of March (2021). As it played out, the fastest route seemed to be through Walgreens. Online, Walgreens would only schedule you for the first dose (either Moderna or Pfizer) if they could find a second dose for you after 3-4 weeks. We were "motivated," as the real estate agents say, so the fact that neither dose one nor dose two would be happening at the same Walgreens, nor at any Walgreens we had ever been to, was not a major deterrent for us. I got my shot first (Pfizer), without incident, at a place near the airport. Also near the best Vietnamese restaurant in this part of the country. Liz got hers about three hours later, maybe two miles away, over by Churchill Downs.
We both had appointments for our second shots (3/31/21), established at the time of our initial appointments. We counted down the days. Liz was first, at yet another Walgreens, way out on the West Side. We reported for our assignation, only to find that this Walgreens had only the Moderna vaccine, as did almost all of the Walgreens in Louisville. After some discussion, we found that the very pharmacy at which I received my first jab was still dispensing the Pfizer vaccine (by the way, there is very little reason to think that you couldn't do just fine by having Pfizer-Moderna or Moderna-Pfizer, nevermind J&J in combination with itself or either of the others).
Liz and I headed South to the 'Pfizer' Walgreens, and she got in line for the shot. Meanwhile, I called around to see if my appointment, later in the afternoon but far to the East, was an appointment for the M or the P. After some pleasant time on hold, I found, unsurprisingly, that my appointment was for the Moderna vaccine. So I held for the District Supervisor, who told me that the Pfizer vaccine was indeed available, but only at the very Walgreens whose parking lot was my current location. After a few more minutes of holding, I was inserted into the queue, and did in fact get my second shot (as did Liz). I hope no one else was displaced.
Sadly, the Vietnamese restaurant has closed, another pandemic victim.
Lately, of course, the Delta variant has caused massive havoc. In particular, folks like me with suspicious immune systems have been found to be deficient in our immune responses. This is not a surprise--myeloma is a disease of the system that makes antibodies, so the fact that antibody titers in people with myeloma are depressed is no big news. But that also relates to whether patients are being treated, and how they're responding to treatment, and many other factors, so there's no way to be sure--except to do the test.
The first thing I did was to volunteer for a study sponsored by the Leukemia and Lymphoma Society (myeloma counts as a kind of leukemia as far as they are concerned). I filled out an online questionnaire and waited for them to send a kit for the blood draw. Still waiting.
At Liz's suggestion, I asked my GP to do a covid antibody test. He ordered a semi-quantitative spike protein assay from Quest, which sounded right to me. A day or two later, I got a notification that the test result was in. It was negative, and--so much for the quantitative part--no number was attached. A few minutes later, the Leukemia and Lymphoma Society sent me a link to the preprint of their paper announcing the results of the study I'd enrolled in (you can find the published version here). Amazingly, 95% of myeloma patients tested positive for antibodies after vaccination. So what was wrong with me? Maybe it was the test.
Digging through the description of methods, I found the LLS study had used a different assay, from Roche, apparently designed more specifically to measure vaccine response than the Quest assay I got.
But I also asked the GP if he could order a booster shot for me. This was late July, and he replied that he couldn't do that, but he also couldn't stop me from doing it on my own (not his exact words, but that's the gist). So I found out who had Pfizer vaccine in stock, signed up online, and got the shot.
It also turned out to be easy to order up the Roche test for myself. LabCorp was offering the test and would supply an in-house physician to order it on behalf of anyone who wanted it. Liz was interested, too, so we both signed up. Two weeks after my unofficial booster, we did the test, and got results the next day.
We both tested strongly positive for antibodies, which put our minds at ease on that front. Of course, it would have been better to do the test both before and after getting the booster, so we could know if any of the difference between results had to do with the test itself rather than the booster, but oh well.
A week or two later, immune-compromised people like me became officially eligible for boosters, and now it seems everybody should get them after 8 months. I'm aware that the FDA does not consider any current antibody test worthy of approval for the purpose of assessing vaccine response, but anecdotally I can say that the Roche test has been helpful for us. Of course, it's not the whole story. For example, T-cells might be at least as important as antibodies in anti-covid immune response, but have rarely been measured. A couple of recent studies appear to show that antibody levels do strongly predict overall immune response, though, so maybe that concern can be set aside.
Then there's the ethical issue of whether third vaccine doses for the relatively wealthy should preempt first vaccine doses for the developing world. As a matter of policy, I'm sympathetic to the view that getting doses to the largest number of people as rapidly as possible, everywhere in the world, should be the highest priority. Personally, though, I am looking around me here in Kentucky, where there is plenty of vaccine available, but the vaccination rate is stuck right around 50% and seemingly going nowhere, and the rate of new infections is going through the roof again, while thousands of vaccine doses spoil every day.
So my plan is to donate enough to UNICEF to provide a large number of vaccine doses to people who need them, letting the professionals figure out where the need is greatest. Maybe that's a good way to strike a balance. Time will tell, I hope.
