The U.S. Food and Drug Administration (FDA) and Center for Disease Control and Prevention (CDC) have just authorized and recommended the administering of a second COVID-19 booster of either the Pfizer or Moderna vaccine for adults aged 50 or older and for immunocompromised people 18 years or older. 
 
In both cases, the approval covers those who received their first booster shot four or more months ago. This means that a majority of myeloma patients are now eligible or will become eligible soon for a second COVID-19 booster shot. 

Why should myeloma patients strongly consider getting a second COVID-19 booster dose?

It is important to have accurate and informed expectations about the second COVID-19 booster.

1. Decline in antibodies after first COVID-19 booster 

In February 2022, it was reported that effective antibody levels — in terms of Emergency Room (ER) visits or hospitalizations — dropped from 87-91% to 66-78% after 3-4 months. It is expected that a second COVID-19 booster can bring antibody levels back to prior levels, but probably not beyond them.
 
To help avoid ER visits and hospitalizations, added protection provided by a second booster is very important for many myeloma patients and caregivers or close contacts. The broader use and benefits of a second COVID-19 booster remain controversial at this time, considering that the added benefit is minimal for healthy adults. 

2. Scarcity of Evusheld™ antibody treatment

Evusheld™ COVID-19 antibody shots provide increased protection against severe disease and are a good option for myeloma patients. However, cutbacks on government funding for COVID-19 have limited the availability of Evusheld.
 
Thus, getting a second COVID-19 booster shot is highly advised because it is more accessible compared to Evusheld COVID-19 antibody shots. However, it is also highly recommended to follow through with Evusheld when it does become available. 

3. Possible omicron BA.2 variant surge

Cases of the new omicron BA.2 variant have been steadily increasing in the past two weeks, which may lead to higher levels of community infections. 
 
Whether this will amount to a serious surge is still uncertain. There are hopes that the combination of vaccinations and a prior infection with the omicron variant (which is quite high in several communities) will reduce the spread. However, due caution is still advised. 

4. Continued need for masks

It is extremely important to keep in mind that a second COVID-19 booster cannot completely eliminate the possibility of a COVID-19 infection. COVID-19 infections can still occur. Vaccines and boosters only help increase protection from severe outcomes of COVID-19, especially for those at higher risk.  
 
Thus, masks continue to be an important consideration (albeit, as a personal choice) for myeloma patients in all situations where there is a risk of exposure to COVID-19, especially in indoor settings or when community infection levels are on the rise.
 
As I have previously discussed, use the best quality masks available (such as N95) to achieve a high-level of protection. 
 
The possibility of long COVID side effects continues to be a cause of concern, even if patients fully recover from an acute COVID-19 infection. It’s still best to avoid getting infected. 
 

The bottom line 

Getting a second COVID-19 booster is a good idea for most myeloma patients. 
 
As always, keep staying safe as we all move forward to a changed, post-COVID world. Our resilience is not only challenged by COVID-19, but also by the horrors of war. 
 
I am always struck by the remarkable resilience I witness in nature during the springtime. We will certainly need every ounce of our physical and mental energies in the coming months. 
 
A recent book, To Speak For The Trees by Diana Beresford- Kroeger, gives a welcome look at ancient Celtic wisdom, which can perhaps help guide us to a better future. 

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