Hot topic these last couple weeks is news about the availability of a booster shot against COVID19. Due to some delays and further reviews by the FDA, the availability of these shots is again – confusing. What’s new? In this post (and the next), I will review what is known and currently recommended and run through some scenarios with my recommendations. As always, please make these decisions hand in hand with your healthcare provider. My opinions are my own and not necessarily those of the organizations I work for.
First, a pandemic update (i.e. the stats I find important). Currently in the United States, 80 million people remain unvaccinated. The latest health department data shows a 300-fold risk of hospitalization if you are unvaccinated. That is terrifying. There are some areas of the country that have seemed to peak, i.e. Florida. However, the kids just went back to school last week mostly unmasked, so let’s see how long it takes for the numbers to go back up.
Over 80% of all ICU beds across the country are full. That means, potentially, no room in the inn for your heart attack or COVID infection. I’m hearing stories of families driving from hospital to hospital looking for a bed. In more than 1 out of 4 states (25% of our country), more than 90% of ICU beds are full. That includes mine, Nevada, along with Oregon and Idaho. We are now overflowing into our surrounding states. In Idaho, where the governor is opposed to mask mandates, the state is completely overrun and is now transporting patients out of state for care, stressing neighbors like Spokane, Washington (all story links below).
For most of the vaccinated, there is a feeling of helplessness and now, even anger, building against the unvaccinated. All of the current stress and death could have been avoided if a greater number of our population had done the right thing (as they did with polio and smallpox, for instance). So if we can’t control the unvaccinated filling our hospitals, how do we avoid breakthrough infections? Booster shots? Maybe, and maybe not.
Let’s start with the positive – as of Sept 7, 2021, more than 176 million Americans have been vaccinated (out of a total population of about 330 million). That’s not bad… but not great (and, by the way, not enough to achieve “herd immunity” if you have been waiting for that!). There are many studies currently underway or freshly published that show that the immunity achieved from the current recommended dosing is more than adequate. The vaccinated continue to be protected from severe disease, ICU admission, and death. Yes, breakthrough infection is real, and now feels very common. But if you have had the vaccine and get COVID, you are most likely going to have a crappy couple days or week and then get back to work.
The vaccinated that are actually ending up in the ICU have so far been the very frail or those with underlying serious health conditions. The latest report (link below) shows that 87% of the 2675 reported deaths in vaccinated people were in people > 65 years of age. This isn’t comforting for anyone, but we also understand that with increasing age, comes increasing risk and health issues. 21% of those reported deaths (493 of the 2675) didn’t have COVID symptoms and/or were not due to the actual infection. There have been 665,000 deaths reported due to COVID19 in the United States so far — just to give you a perspective on that 2675 number in vaccinated people.
For most adults, the protection has been reliable. In South Africa, they have now reported some really good news about the one-dose J&J vaccine:
“ In the trial, called Sisonke, the researchers evaluated one dose of the Johnson & Johnson vaccine in nearly 500,000 health care workers, who are at high risk of Covid-19. The vaccine has an efficacy of up to 95 percent against death from the Delta variant, and up to 71 percent against hospitalization, the researchers reported.”
However, we are also continuing to see evidence of waning immunity over time (though this is also the subject of much discussion/argument!). Because of these concerns, the discussion around boosting immunity with a third (or second) shot started early on. Here are the current recommendations:
- No booster shot is currently recommended for adolescents or adults with healthy immune systems.
- For adolescents and adults over the age of 12 years with moderate to severe immune compromise (autoimmune diseases requiring medication, chronic steroid use, cancer patients, etc), a third dose of the Pfizer vaccine is available (announced Aug 12, 2021 through an amendment to the Emergency Use Authorization)
- For adults over the age of 18 years with severe immune compromise, a third dose of Moderna is available
- Third shots should be given at least 28 days after the second dose
That’s it. That’s the official word right now (today, September 15, 2021).
Okay, so what qualifies as “immunocompromised”? According to the CDC, people with immune compromise make up about 3% of the population. This population is at risk of getting and dying from COVID19 as their infection-fighting cells don’t work well. This includes:
- Solid organ transplant patients
- Patients receiving cancer treatment or chemotherapy for other diseases
- Patients with inherited or acquired immunodeficiency (DiGeorge Syndrome, HIV)
- Patients requiring long term steroid treatment or other medications that suppress the immune system
The CDC has reported that many of the breakthrough infections in vaccinated people that have required hospitalization have included many of the people in this category. That’s why we are absolutely recommending vaccination for this group along with a third shot.
For the rest – stay tuned for my next post!
References:
Idaho outbreak: https://www.nytimes.com/2021/09/13/us/coronavirus-hospitals-washington-idaho.html
CDC info on breakthrough cases: https://www.cdc.gov/vaccines/covid-19/health-departments/breakthrough-cases.html
Unsure if J&J will need booster: https://www.nytimes.com/2021/08/06/science/johnson-delta-vaccine-booster.html
Kris Deeter, MD, MBA: Pediatrician, Healthcare Leader 