Two Jabs, Pregnant, and ‘Omicold’: Now What?

It’s an increasingly common scenario. You have received the two-jab primary series of one of the COVID-19 mRNA vaccines (Pfizer-BioNTech or Moderna), or one shot of the Janssen viral vector vaccine that was initially approved as a single jab. You are gearing up to get another dose, called a booster, but is really now the third shot of the primary series. You are doing this for good reasons. From reading The Pulse, you know that COVID-19 increases the rate of preterm birth substantially, that having COVID-19 makes a woman three times more likely to give birth to a preterm infant compared with a woman who does not have COVID-19. It also increases the likelihood that the newborn will be admitted to the neonatal unit. Even when dealing with variants like Omicron that are able to escape the immune response of vaccination —such that you can be vaccinated and be hit with mild COVID-19, due to the virus causing upper respiratory tract (cold) symptoms— the antibodies that an otherwise healthy person will make as a result of vaccination will neutralize the very part of the virus that otherwise would enable the virus infect your body cells, beginning with cells in your lungs. Data that have come in from Israel, and from some other sources, show us that the third dose makes a big difference.

But now you have become infected with SARS-CoV2 (the virus that causes COVID-19. It’s almost certainly the Omicron variant. At the start of the pandemic, we first discussed the R0 (pronounced “R naught”), representing the average number of people that an already-infected individual infects.  We were talking about the variant that first spread the pandemic to multiple countries as having an R0 of about 2.5. For perspective, we mentioned a particularly contagious virus, the measles virus, having an R0 as high as 18 among unvaccinated people. To continue with that perspective, the Omicron variant has an R0 of at least 10. That’s how far the virus has evolved, despite some relatively encouraging information that Omicron apparently causes less severe disease in people who do become infected, in comparison with previously dominant variants, such as delta. More people are getting severely ill, however, because of the Omicron variant being more contagious, plus there also is a very high number of people hit with mild disease, focused on the upper respiratory tract. In people who have been vaccinated and have no other health issues, this type of mild COVID-19 may last only a few days. It’s less likely, and will not last as long, if you have received your third dose.

But what if you haven’t received your third dose and then you are hit with a SARS-CoV2 infection? Suppose you were about to get that third jab, while you were pregnant, and then you were hit with omicold. Reading The Pulse, you may be very aware that pregnancy is a risk factor in COVID-19, that the benefits of vaccination far outweigh the risks. But, if you are already infected with omicold, now what? Will a third jab do you any good? To begin, we must point out that there aren’t many data addressing specifically the issue of a third dose vaccine jab, following COVID-19 in pregnant women who have had the two-jab primary series. But there are a few things adding up. As of the writing of this post in late January 2022, some data have become available suggesting that, in the case of the delta variant, immunity resulting from getting infected and having the disease, is stronger than immunity obtained from a vaccine jab. This does not mean that it is good to get the disease, because many people who do get COVID-19 die, or suffer long-lasting effects, particularly if they were not vaccinated. All that it means is that, if you got COVID-19 and lived to tell the story, that experience is stronger compared with the immunity obtained from vaccination in a person who never got COVID-19. Getting the disease and at least one vaccine dose produces the best immunity of all. It’s not clear yet, if the same will turn out to be true with respect to Omicron. Given all that we know about immunology, however, it’s likely that having omicold, once you have already had two vaccine jabs, will boost your immunity at least as much as a third shot would boost it. It would have been better to have received that third shot, before catching the Omicron variant. That way, your omicold would have been more mild, or you may not have become symptomatic at all. But now that you have had omicold, as far as your immune system goes, if you have no other health issues that would blunt your immune response, the omicold is your booster. There is probably no hurry to run out and try to obtain the third shot at this point. You would not be allowed to get it immediately anyway, but once you are allowed, it may turn out not to be so urgent. That is, unless you have other health risk factors, apart from pregnancy, such as obesity, heart failure, diabetes, or treatment for cancer or organ transplantation. Such people are up to their fourth jabs anyway. If you do not have other health issues, and have just gotten over omicold, a third jab certainly will boost your immunity and will not hurt to get it. It is extremely safe. But there may be details coming on the most optimal timing of a booster, following a symptomatic infection, so stay tuned to this issue.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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