Top 3 COVID-19 vaccine questions – anxiety with COVID, booster protections, and child Omicron symptoms

Dr Lucas De Toca, COVID-19 Primary Care Response First Assistant Secretary, answers the Top Three questions across our channels.


Good morning. I'm Dr Lucas de Toca and this is my first segment of the year. In which we will answer some of your questions you have been asking on our social media channels. As usual and not to change things this year I'm joined by Linda who will be doing Auslan interpreting. We are calling, sorry broadcasting from Ngunnawal country. I also want to acknowledge the traditional owners of the lands where you may be watching from.

Today we will talk about whether we are a little bit nervous now that COVID is very frequent in pretty much every state and territory and we all know people who have got an infection or ourselves had an infection recently. So, what do we do and what is it mean if we are unvaccinated or not? We will talk about protection after the booster and whether it wanes after four months and what we know but also what we don't know yet and we will also talk about omicron symptoms among children and what are the differences with adults? Before starting, I also want to give a shout out to the healthcare workers, pathology testing staff, collection sampling personnel, immunisers, everyone in healthcare working incredibly hard over the holiday period as cases have been climbing and vaccine numbers have also been climbing. Everyone has been out, often separated from families to make sure patients are looked after, that COVID-19 tests are being collected and that vaccines have continued throughout the holiday period. Thank you to our health care workers for their ongoing work.

The first question today is I'm nervous about getting COVID-19 even though I'm fully vaccinated and what things can I do to lessen my anxiety? It is completely normal. We have done a major shift in the pandemic in Australia.  Going from suppression of community transmission and very low numbers with very intent reporting of every case particularly in the states that had virtually zero COVID for quite a while. To now where we have thousands of cases every day and pretty much, we all know people who are currently sick with COVID or have had COVID. It is very normal to feel a bit stressed or a bit anxious in this pandemic shift even if you are vaccinated. The most important message is to be reminded that even though breakthrough infections do occur and the unvaccinated people rarely but can also get sick. The reality is that if you are up to date with your vaccination.  The chances of you getting severe disease, hospitalisation and death from COVID are incredibly reduced. The vaccines remain very effective at protecting from severe disease, hospitalisation and death. Of course, continue to practice COVID Safe behaviours remains as important as ever and even more so because we have so much COVID in the community now compared to before. That those behaviours that we continue to practice are very effective. Wear a face mask if indoors and follow the local state and territory advice on where to wear them. In any context which you cannot achieve good physical distancing or in an indoor environment and of course there are exemptions to masks indoors including to facilitate communication as it is really important so Linda can properly convey the message to our Auslan using viewers. But then continue to practice the other behaviours that we have been practising over the last year or so, two years nearly now. Try to stay outdoors for gatherings if you can, if you're indoors try to be in a well ventilated space with windows open if possible and try to avoid crowded spaces if possible. Continue to of course practice good hand hygiene, water and soap would be preferred but if that is not available, sanitiser is okay but make sure it is at least 60% alcohol. If you have any symptoms that are compatible with COVID, even if they very mild. It is safe to assume at this stage it is probably COVID. Stay at home follow the guidelines in your state and territory and either get a PCR or a rapid antigen test and stay isolated until you get a negative result. If you are due for your COVID vaccination you need to complete your primary course or you are due for your booster, please, please book now and make sure you're up to date with your vaccination schedule. If you are 18 years and over and you have had your second dose, four months or more ago, make sure you get your booster so you maximise your chances of protection against infection, severe disease and hospitalisation.

On that topic, how does this work? Are we going to need another booster in four months? How much does the protection from the booster last? Lots of questions but we still don't have all the answers. But we do have some clear information. What we know is that while it is uncertain how long the protection from the booster or third dose will last for. We do know that there seems to be a drop in antibodies circulating against infection three, four, five, six months after second doses. It is not unusual that after infection or a vaccine, antibody levels lower. We cannot just add more and more antibodies every time we have an infection of anything and just keep them circulating in the blood. The blood will become too thick, so it is not unusual for any disease that is circulating antibody levels actually wane over time as they process through the body. It is now very clear now, months after immunisation, months after infection from COVID-19. The levels of circulating antibodies do lower. That helps to explain why the protection against getting the disease, the protection against contracting the disease and transmitting it to others seems to wane months after vaccination. Because antibodies, which is small molecules that have circulated in your blood, are the first barrier of protection once the viruses is in your system. If the virus is circulating and it is immediately neutralised by antibodies, it cannot really infect and cause infection. That is why high antibody levels seem to be related to prevention of infection. However, that is not the only trick your immune system has. Apart from antibody production there are a lot of other responses that contribute through ensuring your immune system can fight the infection. Cellular responses or responses mediated by cells are a big part of it and we have two types of what we call adaptive immune cells that play a major role in this. There are B cells that produce antibodies and have actors memory cells that are ready to be reactivated if you get in touch with the virus again and then there is T cells that directly help fight the infection and what we know is that T cell response seems to be very high months after immunisation or infection. It might be that the waning antibody levels mean that the protection against infection lowers and that is what we are seeing especially with Omicron. A lot of vaccinated people getting the disease even though their chances are still lower than unvaccinated people, they can still get it. However, we do have more indication that despite those waning antibody levels of protection against severe disease, which seems to be mostly mediated by these T cells, remains. We are seeing it with Omicron, and we continue to see it with Delta because we still have Delta in Australia. That vaccinated people, even non-boosted people have a much lower chance of severe disease, hospitalisation and death than unvaccinated people. This is even multiplied manyfold if you get a booster the booster seems to restore your antibody level so achieve more protection against infection altogether and then further boosts your protection against severe disease. But if you have had your full course two months ago, three months ago, you're not yet eligible for your booster, don't think you are unprotected. Your antibodies may be low and you may have a higher chance than before getting an infection but you are still more protected than an unvaccinated person and you are still well protected against severe disease, hospitalisation and death. However, whenever you get your eligibility for a booster, four months after your second dose, go and get your booster and that way you make sure that you restore your immune response to the maximum possible and you reduce your chances of getting the disease or getting very sick from it.

The final question today is about Omicron and children. Are the symptoms different? Do kids get different symptoms from adults? And broadly, in terms of the types of symptoms, the answer would be no. What we know is that children tend to get a much milder version of the disease. Of course, there are exceptions to that and every illness, severe illness in a kid, let alone a death is an absolute tragedy so we want to prevent that. But it does seem this disease, either Delta or Omicron, remains very related to age. Young people can get sick, absolutely. The older you are, the higher the chances are of getting severe disease from this infection and that is why all the vaccination programs and approaches about protecting especially older people. Kids do generally get much milder disease but when they get it, the symptoms are very consistent with the symptoms we see in adults, so the usual list of symptoms. Fever, fatigue, shortness of breath, cough, runny nose, sore throat, the usual. Even loss of taste and smell as we have seen in some cases with COVID in adults. Not a completely different symptom profile but definitely a milder version generally and as with adults and since yesterday we started the vaccination program for 5 to 11-year-olds, more and more evidence shows now that vaccinated people have a much milder disease, and for the vast majority of vaccinated people who contract Omicron, the disease just runs like a cold. For a couple of days, three days and then the symptoms start to resolve, and this is what we see in the vast majority of cases we are getting now. It is now clear Omicron is milder than Delta, which doesn't mean it is completely harmless and people aren't getting sick, are going to hospital and dying from COVID but it is definitely milder and the vaccine still confers protection against severe disease. So, we are still seeing very mild difference in the outcomes of vaccinated people and unvaccinated people and even more so boosted people versus non-boosted people or unvaccinated people. So, get your booster when you are due, make sure you are fully vaccinated if you are not yet. Be assured that generally, children will have a much milder version of the disease, but the symptom profile will be similar in terms of what symptoms they get.

That is all we have today. I hope that was useful. Thank you for tuning in. Thank you for staying COVID Safe.

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  1. I’m fully vaccinated and nervous about getting COVID-19. What things can I do to lessen my anxiety?
  2. I have had my COVID-19 booster, will protection against serious COVID-19 illness last longer than 4 months?
  3. Are Omicron symptoms the same amongst adults and children?
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