Let's face it, summer is over.

With cooler temperatures driving more people indoors, New Yorkers once again face a choice: either get new booster shots to harden their immunity ahead of what's expected to be an autumn/winter surge in COVID-19 cases — or take their chances with the immune defenses they already have.

This time, though, mask requirements and other preventative measures have largely been rolled back, not only in public venues and restaurants, but also for mass transit and schools.

Scientists expedited the boosters this year to match the latest dominant variants. Despite questions about the speed of the process, researchers said the shots were vetted in a manner similar to other immunizations, such as the seasonal flu vaccine that’s taken by millions of people each year.

Here's your guide to finding the updated COVID-19 boosters and what they mean for your body’s protection against the coronavirus.

Why now? Who’s eligible?

Pfft, are you kidding, Gothamist? The pandemic is over. Move on.

COVID-19 did cause far fewer deaths in New York City this spring and summer, despite new versions of the coronavirus causing a rebound in infections and hospitalizations. But to reach this point — where fatality is decoupled from infection — the city had to go through a fair amount of hurt.

During last winter’s wave, when the omicron variant caused a record level of illness for the pandemic, COVID-19 averaged about 40 deaths per day in the city. That was way less than the 131 daily death average during the city’s first surge in 2020 — but still enough to severely disrupt daily life.

New Yorkers responded last winter by seeking out the vaccine in increasing numbers. People had been slow to get booster shots after eligibility opened for all adults ahead of Thanksgiving. But by the last week of December, additional doses spiked at around 50,000 per day, according to New York City health department data.

The shots, however, take a couple of weeks to have an effect, and some people likely got sick with COVID-19 when they could have avoided it.

This combination of vaccination and infection, scientists say, built enough immunity that when newer subvariants of omicron — BA.4 and BA.5 — became dominant in the spring, it caused a surge of cases and hospitalizations without a huge rebound in fatalities. New York City has averaged about 10 COVID-19 deaths per day since the mayor’s office lifted a vaccine mandate for most public places at the start of March. At that time, about 77% of the city’s population was fully vaccinated, and 36% was boosted.

“The SARS-CoV-2 virus is drifting. That's why we went from the original strain to alpha to delta, now to omicron,” said Dr. Martin Blaser, director of the center for advanced biotechnology and medicine at Rutgers university. “This is not rocket science.”

I’m fully vaccinated, but I’m struggling to follow if I need a booster now?

That’s understandable given all the COVID policy changes over the past year. Just remember to “stay up to date,” as defined by the Centers for Disease Control and Prevention.

For most New Yorkers over the age of five, that means getting a primary series of the COVID-19 vaccines plus a booster shot.

Adults can fulfill the primary immunizations with two doses of Pfizer, Moderna or Novavax — or one dose of Johnson & Johnson. But boosters are recommended. You must wait at least two months after your initial doses to get boosted.

A similar timetable applies to adolescents ages 12-17. People under 18 can only be boosted with doses made by Pfizer under FDA rules.

Children aged 5-11 have to wait five months before a boost, and they can only receive one if they took Pfizer for their primary series. Kids in this age range who originally took Moderna doses are not recommended to get a booster at this time.

Infants, toddlers and preschoolers — ages 6 months to 4 — are also not recommended to get booster doses.

All of these schedules are slightly different if a person is immunocompromised.

Who is eligible for the updated booster shots?

The new booster shots are available to anyone over 12 who got their last booster or completed their original series of COVID-19 shots at least two months ago. The Pfizer-BioNTech booster is recommended for those 12 and older, but the Moderna version of the update is only recommended for those over 18, according to the CDC.

However, children aged 5-11 are not eligible for the new updated boosters. They will receive the earlier version of the shot.

Where are the boosters in NYC and NJ? Are the shots free?

Where do you find booster shots in New York City?

The updated booster shots are available at Walgreens and CVS, both of which recommend making an appointment online, as well as many independent pharmacies, clinics and doctors’ offices. If you have a preferred pharmacy or health care provider, call to make sure they are offering the redesigned vaccines and have them available. Some may still be waiting on their supply to arrive.

City-run clinics are also offering the boosters, although city websites have been slow to update the eligibility requirements. As of Friday, the vax4nyc website and the NYC Health + Hospitals website for scheduling COVID-19 vaccine appointments were both asking users who wanted to sign up for a second booster whether they were older than 50 or immunocompromised — requirements that no longer apply.

“The site is being updated as we speak,” Patrick Gallahue, a spokesperson for the city health department, said Wednesday, with regard to the vax4nyc site. “The updated guidelines are still quite new.”

NYC Health + Hospitals will start offering the new boosters at seven locations starting next week.

NYC Health + Hospitals will start offering the new boosters at seven locations starting next week, with more coming online as supplies arrive, the city announced on Friday. The shots will initially be available to walk-ins or by appointment at Bellevue, Elmhurst, Jacobi, Queens, Kings County and Lincoln hospitals between 7:30 a.m. and 4 p.m. Monday through Friday, and at the Gotham Health clinic on Vanderbilt Ave. in Staten Island.

You can also visit the federally run site vaccines.gov and enter your zip code to find nearby vaccine providers or call the federal hotline to find a location at 1-800-232-0233. The CDC has a WhatsApp chat that offers vaccine information in Spanish, and the New York City health department website offers information about booster shots in a range of languages.

I heard that Congress cut COVID-19 funding for vaccination. Will booster shots now cost me money?

COVID-19 shots are still publicly funded and free for everyone, regardless of their insurance — for now. Funding for the federal government to purchase and distribute the vaccines may run dry as soon as January, according to Biden administration officials. Transitioning the shots to the commercial market would likely mean that coverage for future COVID-19 shots would be provided by a patient’s individual insurance plan.

What about access in New Jersey?

New Jersey Gov. Phil Murphy announced on September 2nd that more than 800 sites across the state were expected to have the updated booster shots available within the coming days.

Jerseyites can enter their zip code and the type of shot they're looking for on the state’s vaccine finder website to locate nearby providers. Appointments can then be made by calling the individual provider or visiting them online.

Who needs the updated booster? Do they work?

Who needs the updated booster?

Researchers say pretty much everyone will benefit from a booster at some point — but the degree of the benefit depends on a few things.

First is a person’s risk for severe disease. By now, people know that COVID-19 presents a bigger danger to older adults. During an advisory meeting last week, CDC officials presented a breakdown of deaths among people older than 50 who had received either a first or second booster. It shows a second booster provides better protection against mortality than being fully vaccinated or having a single booster.

This chart shows death rates by vaccination status and receipt of first and second booster doses among people older than 50 from April 3–July 2, 2022.

Photo by CDC

The second point is whether or not you care about being infected — and how bad you want that infection to feel. As Gothamist reported last December, even a mild case of omicron can knock a person out for a few days — which has repercussions for missing work and lingering conditions like long COVID.

Wait, I thought the COVID-19 vaccines and boosters don’t really stop infections?

That’s not quite right.

A quick refresher: When it comes to stopping the coronavirus from setting up shop in your body, your immune system relies heavily on antibodies. They keep the germ from entering our cells.

But the coronavirus is naturally and constantly mutating to avoid this defense. It’s a perpetual arms race.

“It's inevitable that we will have to update the vaccine,” said Dr. Paul Bieniasz, a virologist and a professor at The Rockefeller University in New York City who studies how this process works.

Bieniasz said what happened for many New Yorkers is that they were infected two years ago by the original coronarius variant — and their immune systems responded by making antibodies to target that version of the virus.

This first batch of antibodies, however, didn’t sit still. Research by his lab and others shows this initial shield keeps refining itself for six months — and over time it gets better and better at blocking that original variant.

“It became true six months to a year after people had been either infected or immunized or both that those antibodies became resilient to individual mutations,” Bieniasz said. As a testament to that, very few re-infections were reported in New York during the first 20 months of the pandemic.

The booster shots keep that process moving forward, Bieniasz said. Each time you get one, the body gets a temporary blockade against infection. The same happens with catching a new variant, but that comes with the chances of becoming sick.

“The less infection there is that's around, the less people will die,” Bieniasz said.

Ok, sure. But why the rush this summer to update the vaccines to fight BA.4/BA.5?

The problem is that omicron’s emergence disrupted the arms race between the coronavirus and our immune systems’ antibodies.

New mutations that occur in the context of omicron are now having a larger effect on the virus and its ability to get around our defenses against infection, according to recent research from Bieniasz’s lab.

“Each of those mutations is basically taking a subset of antibodies off the table in terms of protection,” he said.

But I heard the new boosters weren’t even tested in humans before authorization, only in mice? How do we know that the shots work?

It’s true that scientists haven’t finished clinical trials with the new COVID-19 booster shots that are currently in circulation. Pfizer and Moderna say those human tests remain ongoing.

But the new boosters are what’s known as “bivalent” vaccines, meaning the shots target two versions of the virus — the original strain from 2020 and recent versions of omicron (BA.4 and BA.5). Human safety trials had been conducted with earlier iterations of the bivalent vaccine that genetically targeted BA.1, the predecessor of BA.4 and BA.5. The underlying formula isn’t sufficiently different from the original vaccine to expect any issues, said Blaser from Rutgers.

This summer’s process also mirrors what happens with the seasonal influenza vaccine. Given the manufacturing process is essentially the same year to year, the annual flu shot doesn’t undergo clinical trials in humans — and that’s been the case for several years. Likewise, the seasonal flu vaccine targets multiple strains of influenza at the same time.

“These days, the usual [flu] vaccine is a trivalent vaccine. It's got parts of three different viruses,” Blaser said. “Two are from influenza A strains, and one is from influenza B.”

It’s also commonplace to measure the effectiveness of the flu vaccine after it’s already given out — which is part of the plan for the new COVID-19 bivalent boosters.

Mice are also regularly used to measure antibody responses to the flu vaccine, and those measurements tend to mirror what happens in people.

Based on the available data so far, Pfizer, Moderna and the U.S. Food & Drug Administration expect the COVID-19 bivalent vaccines to reinforce the immune system against the coronavirus.

“The work with mice has been proven year after year to be a very good predictor of the response in humans,” Blaser said.

Well, I don’t really care if I get infected. What’s the worst that could happen?

Prior to COVID-19, people headed into the winter season without masks or other precautions against respiratory disease. For protection against the flu, for example, society relies almost solely on vaccination, which can help ease the burden the virus takes on society.

Flu vaccination uptake by communities, however, has historically been low — with only 40% of adults and 60% of kids taking annual flu shots in recent memory. The CDC estimates that influenza caused up to 52,000 deaths and 700,000 hospitalizations in the U.S during bad years.

But COVID-19’s impact is far worse. As of this week, the disease has already killed more than 200,000 Americans since the start of 2022.

“We're in a bit of a complicated situation, because we have a population of people that have extraordinarily variable degrees of immunity — extraordinarily variable histories in terms of exposure,” Bieniasz said. “It becomes very difficult to give advice.”