Should I get the new vaccine booster?

“I am a 75-year-old woman in good health with no immunocompromising conditions. With my doctor’s encouragement, I have had the first six covid vaccines, although I have had very strong reactions to all of them — fever, headache, body aches, etc. When I asked my doctor about receiving the most recent vaccine, he was dismissive of it for me. His reasoning was that even if I were to contract covid at this point, the chances of a serious case requiring hospitalization is slight. He doesn’t feel that the most recent vaccine would benefit me significantly enough to go through the side effects I experience. Your thoughts on this, please?” — Patricia from California According to an October 2023 publication from the CDC , adults older than 65 accounted for 63 percent of all covid-associated hospitalizations. Less than 1 in 4 of those had received the latest coronavirus vaccine (which, at the time of the study, was the bivalent vaccine). Previous CDC data showed that, among those 65 and over, vaccine effectiveness against hospitalization waned from 64 percent to just 27 percent four to six months after getting the shot. Protection against critical illness remained relatively strong, dropping from 69 to 50 percent. Based on these numbers, I would encourage you to have another conversation with your physician about getting the updated vaccine. The side effects might be unpleasant, but they would be better than becoming severely ill. And you should make sure to discuss Paxlovid treatment with your doctor in the event that you do contract the virus.

Which booster should I get?

“I am trying to get the latest covid booster. My previous doses have been Pfizer. All of the new boosters are difficult to find, but Pfizer is impossible to find in my area for some reason. Would it be better to continue to look for the Pfizer booster or to get the Moderna or Novavax booster?” — Denise from Pennsylvania You should get whatever booster is easily accessible to you. There is no clear benefit between Pfizer and Moderna. Some people might prefer Novavax , but a small head-to-head study of its use as a booster in people who previously received Pfizer or Moderna found no improved antibody protection over the mRNA vaccines. If you can obtain Moderna or Novavax now, I’d opt for one of these and not wait for Pfizer.

Why do people respond to vaccinations differently?

“I am 81 years old and have recently received both covid (Pfizer) and RSV shots in the same arm. I experienced no discomfort following the injections. My partner received only the covid booster but his arm ached for a couple of days. (I have never experienced more than a mild ache from any of the covid shots.) Is there a reason why some folks get adverse reactions, and some folks don’t?” — Beryl from California There are two main types of reactions to vaccines. One is local, which manifests as soreness or redness at the site of injection. The other is systemic, which shows up as some combination of fever, chills, headaches, body aches and fatigue. Both typically resolve within a day or two. It’s not known why some people experience stronger reactions than others. Some studies suggest people who have more significant reactions have a more robust antibody response . It’s also possible that some are more sensitive to the discomfort accompanying vaccine reactions than others.

Is there any thing I can do to reduce vaccine side effects?

“When my sister received the first covid vaccine, she had a very unpleasant reaction that lasted several days. Now, she adamantly refuses to get any more vaccines or boosters. I am very worried about her. She is 71 years old. Are there any medications that can reduce the severity of a reaction to the vaccine? How about Paxlovid?” — David from Michigan The CDC says that people 65 and older account for nearly 63 percent of covid-associated hospitalizations and nearly 88 percent of covid-associated, in-hospital deaths. Less than a quarter of hospitalized older adults were up to date with their vaccines. By virtue of her age, your sister is vulnerable to severe outcomes. You are right to urge her to get the updated coronavirus vaccine. Though premedication is not recommended for most people, those who anticipate a strong reaction could consider taking Tylenol, ibuprofen or both a couple of hours before the vaccine. They could continue these medications for symptom relief in the days after. Paxlovid cannot be taken for the purpose of mitigating vaccine side effects, but your sister should absolutely take the antiviral if she contracts the virus (as long as she has no medical reasons not to take it). I hope you are able to persuade her to take these steps to reduce her chance of severe illness.

Should I take Paxlovid?

“I am 77 and healthy. I’ve had covid once and tried to take Paxlovid, but the pills were too big for me and got stuck in my throat. I was sick for five weeks, mostly with cough, muscle aches and fatigue. What should I do if I get sick again? Can I cut the Paxlovid pill up to take it?” — Linda from Iowa I am sorry to hear your last experience with covid was difficult. Given your age, I would highly advise that you take Paxlovid. Unfortunately, the Food and Drug Administration advises that it cannot be cut up or put into powder form. What has worked for you in the past with taking pills? For instance, some people find it easier to take pills with applesauce or pudding. The Post’s Well+Being also had a recent article about tips that could help. I would really urge that you find a way to take Paxlovid if you were to become ill again. If this is truly not an option, consider asking your physician whether you could access the antiviral remdesivir, which comes as an injection or infusion. “I have atrial fibrillation. I also am being watched for recurrent bladder cancer. I cannot take Paxlovid. What are my options if I contract the coronavirus?” — Stephen from Massachusetts I assume you are on a blood thinner that would cause an adverse reaction if taken with Paxlovid. Some blood thinners, such as aspirin, can be given at the same time ; others, such as coumadin, require closer monitoring while co-administered. There are also some anticoagulants that must be stopped, and if it is too dangerous to do so, Paxlovid cannot be given. If that’s the case for you, ask your physician whether you could take molnupiravir or remdesivir. Molnupiravir, like Paxlovid, is an oral pill. Remdisivir is an injection or infusion. “I was surprised that doctors decided against prescribing Paxlovid to my 82-year-old mother when she recently contracted covid-19 for the first time. She is fully vaccinated and in good health, with no chronic conditions. Her only prescription is for daily Lipitor. The doctors at her rural hospital admitted her and prescribed three days of intravenous remdesivir instead of Paxlovid, which they said had too many side effects to be a wise choice. After all we’ve heard about the magic of Paxlovid — to the point where I had her obtain a prophylactic prescription before our overseas trip last year! — I am curious about this. (By the way, she recovered fully within two weeks.)” – Carmen from Pennsylvania Remdesivir, which is given as an intravenous infusion or a series of injections, is an option for people diagnosed with covid who are not able to take Paxlovid. It is not a first-line medication because it is relatively difficult to administer. It’s unclear to me why your mother did not receive Paxlovid during her bout with covid. The cholesterol medication Lipitor, or atorvastatin, can be paused while taking Paxlovid and resumed immediately after completing the antiviral treatment. As I wrote in a previous newsletter, Paxlovid does have side effects , but most are minor, such as changes in taste and gastrointestinal discomfort. These are typically not reasons to withhold the medication. Perhaps there is something else in your mother’s medical history that prompted doctors to give her remdesivir. For instance, she might have been quite ill by the time she sought treatment. If that were the case, remdesivir would be the right choice over Paxlovid, as the latter is not given to patients who are already ill enough to be hospitalized. In any event, it’s good you have confirmed that your mother is able to receive Paxlovid and has a “just in case” prescription on hand. And I’m very glad that she recovered. “I read your newsletter every week and, many times , you’ve recommended to people traveling overseas that they prepare in case they contract covid by asking their doctor for Paxlovid to take with them during the trip. Well, last week I had my annual physical and I asked my doctor for Paxlovid for my January cruise to South America. He refused. He said he didn’t believe in it because people might take it as a prophylactic, when they didn’t really have covid. I assured him that I wouldn’t do that, but he still refused. So my question to you is: If I can’t get Paxlovid from my doctor, where can I get it before my cruise?” — Laura from Delaware Here are some options. First, consider speaking with your doctor again. Explain that you understand the uses of Paxlovid and that you will not take it unless you test positive. Show him the National Institutes of Health coronavirus guidelines that Paxlovid is a first-line treatment for covid and ask him what his plan would be if you were to contract covid while on the cruise. Surely, he would want you to access this medication when you need it. If he still refuses a Paxlovid prescription, call the cruise operator. Large ships from major cruise lines will have a physician on board. Will this physician be able to prescribe Paxlovid, and is this antiviral treatment available on the ship that can be dispensed to passengers? If so, are there additional requirements? For instance, do passengers have to have bloodwork in advance to prove they have good renal function? If there is no option on the cruise, you could also ask around your social network. Perhaps a friend has a primary-care provider who is willing to prescribe the “just in case” antiviral treatment. You could consider a visit to this physician.

How can I get a Paxlovid prescription?

“My wife and I are 69 years old. We are scheduled to be out of the United States for several weeks this fall for a cruise. Is it appropriate to ask our primary-care physicians to give us a prescription for Paxlovid that we would fill before our trip so we have it with us in case we get covid during the trip?” — Leslie from Georgia Yes. I wrote last week about the importance of having a treatment plan in case you contract the coronavirus during travels. I’d definitely talk to your physician and try to bring Paxlovid with you, along with several covid tests. If your physician won’t prescribe Paxlovid, call your cruise company and ask what medical support they have onboard. Many cruises have a physician there and standard medications, which might include Paxlovid.

How can I reduce Paxlovid’s metallic taste?

“Lemonheads (or I’m guessing other lemon drops) were very helpful for the metallic taste from Paxlovid.” — Bonnie from Montana Thank you for this helpful advice!

Should I take molnupiravir?

“Your recent column about Paxlovid has me wondering if you would weigh in on the use of molnupiravir. I am not a candidate for Paxlovid due to my ongoing treatment (with drugs) for atrial fibrillation and other heart-related conditions. Both my primary-care physician and my cardiologist have approved the use of molnupiravir.” — Kristi from North Carolina Those who are unable to take Paxlovid but are still susceptible to severe covid should consider molnupiravir. This is the other oral antiviral treatment that has been shown to reduce the risk of hospitalization and death. If your primary-care physician and cardiologist have both recommended it, you should have a plan for accessing molnupiravir if you were to contract the coronavirus, and be sure to take it as soon as you test positive.

What should I do if I get a positive covid test?

“My sister called to ask whether or not her daughter should come to dinner because she had a faint pink line on two covid tests that she had just taken. I said no but would be happy to put together a care package. Was this the appropriate thing to do to keep all of us in our seventies healthy?” — Judy from Maryland Yes. Your sister’s daughter has covid. She should isolate and certainly should not be in close proximity to people who, by virtue of their age, are vulnerable to developing severe covid.

Should I still wear a mask?

“My husband and I go to lots of public performances, and I always wear a mask. Though during the height of the pandemic, he would always wear a mask when out and about, he will no longer wear one. A friend asked me what is the point of just me wearing a mask, if my husband doesn’t wear one and gets sick? Should I keep wearing a mask even if my husband doesn’t?” — Nancy from Virginia If your goal is to continue avoiding the coronavirus, you should keep masking in indoor, crowded places. Doing so will protect you, even if your husband gets sick. Interestingly, a large meta-analysis published in JAMA found that, during the time of omicron predominance, only 43 percent of household members became ill when someone in the house became infected. If your husband starts exhibiting symptoms or tests positive for covid-19, you should stay away from him, but even close contact with an infected household member does not always result in infection. To me, that’s more reason to take additional precautions yourself in crowded places, even if your husband is not following them.

How should I choose a mask?

“You and others refer to ‘well-fitting, high-quality masks.’ High-quality masks seem clear but what is well-fitting? How can I tell if my KN95 masks fit well? What do I need to confirm before purchase?” — Will from Ontario High-quality refers to N95, KN95 or KF94 masks. For people who cannot tolerate these, surgical masks are second-line. I believe there is no role for cloth masks; they just aren’t protective enough against highly contagious variants of the coronavirus. Well-fitting means that the mask forms a tight seal over your face. Most of these masks will have nose pieces that can be molded to your nose. Some will have loops over both ears while others have elastic that goes over the head. I recommend trying several kinds of masks to find what works best for you in terms of comfort and fit. If you are purchasing over the internet, you could buy a smaller pack to begin with. The right mask should feel tight over your face, leaving no exposed areas between the corner of your mask and skin. “I wear three surgical masks, each with a metal nose piece, one over the other. By doing this, am I really giving myself more protection?” — Susan from Florida Surgical masks are not designed to be worn on top of one another. The best protection is wearing a single respirator mask (N95, KN95 or KF94). People who cannot tolerate these masks can don a surgical mask with a well-fitting cloth mask over it.

Can I use an expired mask?

“I have been using KN95 masks for protection. But the remainder of my masks have passed the expiration date. Can I still use them, and are they effective to any degree?” — Norma from Nevada N95s, KN95s and other high-quality respiratory masks have expiration dates that are generally about five years after production. These masks can degrade over time. The speed of deterioration depends on storage conditions. If the masks are stored in very hot and humid environments, they could be unwearable even before the expiration date. But if they are stored at room temperature without excessive humidity and do not show external signs of deterioration, they probably still retain protective qualities despite being past the expiration date. My rule of thumb is to examine the mask. Make sure it’s intact without fraying. Check that the mask achieves a good seal and that the elastic of the ear or head straps remains strong. If the expiration date is within the past couple of years, it’s probably still fine to use.

Can I still get infected if I am wearing a mask?

“I work in a large department store and wear a mask constantly. I got sick with a mild viral infection. How did that happen? I never removed it.” — Susan from Virginia There are two possibilities: One is that you contracted the virus from somewhere other than at the department store. Perhaps you were in close contact with a household member or friend who was infected. The other is that you got the virus despite masking. This is less likely if you were consistently wearing a high-quality N95, KN95 or KF94 mask.

What safety precautions should I take in shared spaces?

“I have been careful about resuming my pre-covid activities. Locally we have an excellent theater that I would like to patronize, but the performances are in a black-box venue. My spouse and I are mid-eighties and she is [immune] compromised, so I do not want to bring anything home to her. Is a mask enough to be safe? Others in this space will likely not be masked.” — Elizabeth from Maryland Your chance of contracting covid-19 is very low if you wear a well-fitting, N95 or KN95 mask the entire time you are in the theater around others. This is what physicians, nurses and respiratory therapists do around patients known to have the coronavirus. Make sure to keep masking during the performance and any time you are in such indoor crowded spaces.

What safety precautions should I take while traveling?

“I am 72 years old and had a successful kidney transplant in 2019. My wife, 62 and a retired RN, and I are fully vaccinated. We both mask and social distance and have not have covid yet. We do not go indoors except for medical and dental visits and careful necessary shopping. We used to be regular international travelers before the pandemic and VERY much would like to begin international travel together again. We are trying to evaluate the risks involved in flying from Chicago to western Europe. We feel we can handle the risks involved once we got there by staying out of cities and away from crowds and indoor restaurants. But it is very difficult to adequately access the risk in the flights. Can you help?” — Robert from Illinois By virtue of your being a transplant recipient and presumably on immunosuppressant medications, you are in the category of people vulnerable to severe illness from covid. It is advisable to take continued precautions. I’m less worried about the flight than most other indoor settings. Once the ventilation system on the plane is running, there is good air exchange. The highest risk times are when the plane is at the gate. Make sure you are wearing a well-fitting N95 or equivalent mask while you are boarding and deplaning and when you are standing in crowded areas. Once the plane is in the air, it’s still advisable to continue to mask, out of an abundance of caution, though your risk is much lower. Keep your individual air nozzle turned on full. You could probably unmask to eat and drink, but keep the time you are unmasked short. As you said, once you are at your destination, stay away from indoor crowded settings, including indoor restaurants. If you go to museums, train stations and other indoor places, make sure to wear your mask. And I’d advise you to pack coronavirus tests and have a plan with your physician for what happens if you become ill. If you are eligible for antiviral medications, try to bring it with you or at least know how to access it where you will be. I hope you and your wife are able to go to Europe and have a terrific time there!

What precautions should I take with children?

“Is an infant considered a ‘vulnerable person’ for purposes of contracting covid? My daughter and her baby are coming to live with us for a few months. What precautions should we take to protect this 3-month-old?” — Mike from Maryland Infants are more vulnerable to severe effects from a variety of contagious respiratory illnesses. This is for several reasons: First, they have limited immunity. Babies have some antibodies from their moms, but for many illnesses, each exposure is their first. Second, babies have small lungs, and their airways can easily become plugged. Third, they have less physiological reserve. Dehydration, for instance, can occur quickly. So, yes, an infant is considered vulnerable to severe effects from covid-19. One study from the Centers for Disease Control and Prevention showed that 44 percent of children younger than 4 who were hospitalized with covid were babies younger than 6 months. Infants are also more vulnerable to flu, respiratory syncytial virus (RSV) and a multitude of other infections. I advise you and others in your household to take additional precautions about a week before spending time with the baby. Limit your time in indoor spaces with others. Mask while in crowded public places. Wash your hands carefully before touching the baby, and stay away if you have symptoms. I would also encourage your daughter to develop a plan for medical care in your area if her child becomes ill. Is her primary-care provider reachable for telehealth visits? If in-person assessment is needed, is there a pediatric ER near you that they could go to? Most important, of course, enjoy time with your daughter and grandchild. Congratulations!

What makes someone more likely to get covid?

“Is there something that makes certain people more susceptible to covid? My family has had all of the vaccinations and boosters. My husband and I have each had covid once, my son not at all. And my daughter is currently ill with her fifth infection — all contracted at school, though none of her friends ever seems to get sick. What could explain this, and could we be doing anything else to protect her? I worry about the toll from these repeated infections.” — Katherine from New York There are several hypotheses for why some people seem more susceptible than others. In a recent study in Nature , researchers identified a mutation that increased a person’s chance of having asymptomatic infections by nearly tenfold. Others have linked the likelihood of illness and severe disease to gene variations and even blood type . In an otherwise healthy person, especially one who is vaccinated, reinfection probably won’t result in severe illness. Every time there is an infection, there is the possibility of post-covid condition, though this has to be weighed against the downside of restricting in-person activities, which, in your daughter’s case, could be significant. Most people have decided they will tolerate the consequences of repeated infections and not take additional precautions. For them, and for everyone, the emphasis can be on improving overall health. Regular exercise, good nutrition, reduced stress and adequate sleep can help optimize the immune system and reduce infections.

Opinion Your questions about covid-19, answered by Dr. Leana Wen

By Leana S. Wen

Contributing columnist|

Updated December 15, 2023 at 4:30 p.m. EST|Published January 31, 2022 at 1:25 p.m. EST

(Astrid Riecken for The Washington Post)

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