August 2021 COPD Foundation COVID-19 Q&A

Posted on August 08, 2021   |   

This series of questions and answers on COVID-19 was authored by Stephanie Williams, BS, RRT and reviewed by Dr. David Mannino, Medical Director and Co-Founder of the COPD Foundation.

This article was updated on August 18, 2021


If a person received the COVID-19 vaccine, will a booster shot be needed, and when?

The Department of Health & Human Services (HHS) and other U.S. medical experts released a joint statement on August 18, 2021, announcing that a COVID-19 vaccine booster shot is recommended eight months after receiving the second dose of the Pfizer or Moderna mRNA vaccine.

The booster shots will be available starting September 20, 2021, subject to the Food & Drug Administration (FDA) conducting an independent evaluation and determination of the safety and effectiveness of a third dose and the Centers for Disease Control (CDC) Advisory Committee on Immunization Practices (ACIP) issuing booster dose recommendations following a thorough review of the evidence.

Immunocompromised patients can receive a third dose sooner than the general public. Visit the CDC website for details and eligibility.

People who have taken the Johnson & Johnson (J&J) vaccine may also need a booster. The CDC expects to provide data and recommendations on the J&J Covid-19 vaccine in the next few weeks.

Why do some vaccines only need boosters after a few years, but others need to be given more frequently? For instance, the Tdap (Tetanus, Diphtheria, and Polio) vaccine vs the influenza vaccine?

Some viruses don’t mutate as much over time. Examples of these would be polio, mumps, and measles. You most likely had these vaccines administered when you were young and have only had to have one or two booster shots since then.

Other viruses change frequently. An example of this would be influenza. The flu virus changes from flu season to flu season. So, in order to have the most protection against the flu, a flu vaccine is needed every year. We are finding that we will most likely need COVID vaccine boosters to provide the maximum protection.

This need for boosters should not be viewed as different from the way other vaccines are administered. Babies and young children have immunization schedules that we follow, and school-aged children receive boosters at various times in their school careers. We will likely need to follow similar immunization schedules and then receive boosters every so often in our fight against COVID.

How do variants happen?

A virus survives because it makes copies of itself inside the cells of its host. This is process is called replication. Think of how a copy machine works. There is an original document that is scanned and then copied onto another page. Sometimes, as it is making copies, some of the information is changed. Have you ever seen copies print out that have smudges, or ink blots that make it hard to read? This is a similar way to think of virus replication. Some of these changes (even slight ones) make the virus unable to function or makes it unable to make other copies of itself. Sometimes, these changes make a version of the virus that is easier to copy, making it easier to transmit to another host. When this happens, that is a new version or variant of the virus.

When a virus enters a host, it takes time before the body senses the intruder and tries to fight it off. In the time before the body fights back, those viruses have made millions of copies of themselves and are able to be spread to other people before the person even realizes they are sick.

Is the Delta variant a stronger version of the virus?

So far, it doesn’t look to be stronger, but it is much easier to transmit. And an infected person may have more copies of the virus that are being spread around when they talk, sneeze, cough, or exhale. If the person is infected and isn’t showing symptoms, they can still be spreading the virus to people who are near them.

One other important thing to understand is that vaccinated people can still be infected with the virus, but not show symptoms. The vaccine is a way to boost the body’s immune response to quickly recognize and destroy the virus if it ever entered the host (infected a person). While the presence of a vaccine will likely keep a person from feeling sick, or becoming seriously sick, a vaccinated person can still spread the infection to unvaccinated people who will likely show symptoms – even serious ones.

Are there other variants that might be a problem?

When the World Health Organization (WHO) or Centers for Disease Control and Prevention (CDC) recognize a new strain or variant that could potentially be a problem, they call them Variants of Concern, or VOC. The WHO has been keeping an eye on a variant they are calling “Lambda”. It has been the cause of about 80% of the infections in Peru and is now spreading through South America. This particular strain is currently being labeled a Variant of Interest (VOI), but don’t be fooled into thinking it is not serious. The current vaccines do not seem to be as effective against this Lambda variant. It is likely that we will be hearing more about Lambda in the coming weeks.

Why do vaccinated people need to wear masks?

There are a few reasons. Here are some of them:

  1. It can slow/stop the spread of the variants which we discussed above.
  2. It not only protects the mask wearer, but all of the people that person comes in contact with. This is especially important if the person is frequently in close contact with children, older adults, or those who cannot be vaccinated.
  3. Prevention of breakthrough infections. There has been an increase in breakthrough infections happening in people who have been vaccinated. While the likelihood of severe infection is lower in vaccinated people, the risk of infection at all is considerably lower when people are masked.

Why do some vaccines only need boosters after a few years, but others need to be given more frequently? For instance, the Tdap (Tetanus, Diphtheria, and Polio) vaccine vs the influenza vaccine?

Some viruses don’t mutate as much over time. Examples of these would be polio, mumps, and measles. You most likely had these vaccines administered when you were young and have only had to have one or two booster shots since then.

Other viruses change frequently. An example of this would be influenza. The flu virus changes from flu season to flu season. So, in order to have the most protection against the flu, a flu vaccine is needed every year. We are finding that we will most likely need COVID vaccine boosters to provide the maximum protection.

This need for boosters should not be viewed as different from the way other vaccines are administered. Babies and young children have immunization schedules that we follow, and school-aged children receive boosters at various times in their school careers. We will likely need to follow similar immunization schedules and then receive boosters every so often in our fight against COVID.

Are people vaccinated against COVID still getting COVID?

The answer is yes, there are cases of breakthrough infections, but what we need to pay attention to is that in places where vaccinations are happening at higher rates, the death rates and rates of serious infection are going down.

While we may not be able to prevent the breakthrough infections completely, we can certainly reduce the risk of serious illness or death.


We have come a long way during the course of this pandemic. Just think – we have seen the hospitalization rates decrease and death rates fall. We know this has been an exhausting time, and that we all just wish for things to be "normal" again.

Our ask is that you remain committed to wearing a mask, practicing physical distancing, continue hand-washing practices, and if you are able to be vaccinated, get the shots. Let’s all do our part to reduce the spread of the virus and the risk of infection.

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  • Thank you, Stephanie and Dr. Mannino, for this excellent article! The analogy of a copy machine gave me a much better understanding of how variants happen, and why vaccines work the way they do. Thank you!
    Reply