Recovered coronavirus patients should still get the vaccine, experts say

Research suggests most people who recovered from covid-19 are immune for at least eight months. Yet epidemiologists are largely still urging this population to get the vaccine if it’s their turn in line. 

Official guidance says vaccines should be offered regardless of whether people were previously infected. 

That’s per the Centers for Disease Control and Prevention, which also says the vaccine is safe for people who have had a prior infection. Former CDC director Thomas Frieden said he’d advise most people to get the vaccine, even if they’ve had covid-19.

But Frieden added that he doesn’t think it’s wrong for someone in a low-risk group who’d already had the illness to defer if they thought someone else could use the dose. 

The limits on vaccine supply bolster the argument that recovered people should let others go first. 

As administration of the vaccine bottlenecks across the country, the pressure is on to get the shots in as many arms as quickly as possible. 

Researchers at the University of Colorado Boulder found that prioritizing people who don’t already have natural immunity could allow health officials to get more impact from limited supplies, especially in areas where many people have already been infected, according to a modeling study that has not been peer reviewed

The researchers found that you would need to vaccinate 1 in 5 elderly people in New York to bring death rates down by 73 percent. But you can get the same result vaccinating only 1 in 6 people if you prioritize people who don’t already have antibodies to the virus, according to Kate Bubar, a PhD student in applied mathematics and quantitative biology, who co-authored the study.

And although a previous covid-19 infection isn’t a guarantee of immunity, it’s pretty good protection on its own.Researchers have found that eight months after infection, about 90 percent of patients show lingering, stable immunity. 

Still, risk can vary from person to person.  

“If I were over 70 or otherwise ill, I would certainly take the vaccine even if I’d had [covid-19]. If I were 30 and healthy, I should not be getting it now (unless a health care worker), but if for some reason I did get offered it I would probably decline,” Marc Lipsitch, an infectious-disease specialist at the Harvard T.H. Chan School of Public Health, said in an email.  

Some epidemiologists worry about the logistics of trying to weed out people with natural immunity.

It could complicate the process as health providers are already struggling to get the vaccine distributed quickly. So far around 6.7 million people have been vaccinated, even though 22.1 million doses have been distributed, according to a Washington Post analysis.

Eleanor Murray, an assistant professor of epidemiology at Boston University School of Public Health, worried that trying to verify someone’s past illness would add bureaucratic hurdles. 

“Confirming whether or not someone has had COVID already adds an unnecessary layer of red tape onto vaccine prioritization. Given that the prioritization is designed to get vaccine first to those people who are most likely to get infected and/or get very sick from infection, it makes sense to reduce the barriers to vaccinating this group as much as possible,” Murray said. 

Murray also cautioned that we don’t know how long people’s natural immunity lasts and that it could vary from person to person. This uncertainty may be an added reason to encourage people to get the vaccine.

There’s also a risk that telling people who had covid-19 to hold off on getting the vaccine could end up feeding into anti-vaxxer narratives. Some experts are reluctant to discourage anyone from getting the vaccine if they are eligible, especially given that vaccine hesitancy is widespread. 

There’s already a problem with people being offered the vaccine but not getting it. 

In Santa Rosa County, Fla., only about 40 percent of emergency responders who are eligible to get the vaccine have gotten it or signed up to do so soon. In New York, where around 30 percent of health care workers have declined the vaccine, the state’s Gov. Andrew Cuomo (D) has threatened that anyone who skips a dose now won’t be eligible for a priority vaccine later. 

The low participation rate is concerning, especially at long-term care centers. 

But not everyone who turns down a vaccine is a hardcore anti-vaxxer, Frieden cautions. He says that there is a “movable middle” of people. They aren’t going to be camping out overnight to get an early vaccine, but they may be convincible if costs and other barriers are low. Frieden says it’s crucial to keep a door open for those people, for instance, seeing whether they might be willing to schedule a shot three weeks from now instead of immediately. 

The slow pace of vaccinations has sparked a heated debate over how to stretch supplies.

A vocal group of experts has pushed for officials to consider giving as many people as possible the first dose of the two-shot regimen, even if it means risking a delayed second dose. President-elect Joe Biden has announced his incoming administration will take this approach, sending all doses out the door as quickly as possible instead of holding half back. 

“The plan, announced Friday by the Biden transition team, pivots sharply from the Trump administration’s strategy of holding in reserve roughly half the doses to ensure sufficient supply for people to get a required second shot,” our colleagues reported.

But some epidemiologists, including Frieden, argue that distribution is a bigger problem than supply at this point. Although he said he supports releasing most vaccines, he worries that some of the debates about how to stretch supply are “distractions” from the real obstacles of administration, which he blames in part on a lack of a coordinated federal plan for getting shots into arms. 

“What Operation Warp Speed has generally done is said, ‘We’re responsible for getting the drugs to the states, and after that, it’s their problem,’ ” Frieden said. “That’s a way to facilitate finger pointing; that’s neither a plan nor a solution.” 

Cartoon – Pandemic Leadership

Cartoon – Leadership Today | HENRY KOTULA

COVID-19 Goes Viral on College Campuses

COVID-19 Goes Viral on College Campuses

Freshman Sarah Anne Cook carries her belongings as she packs to leave the University of North Carolina at Chapel Hill, on August 18, because of a COVID-19 outbreak. All in-person undergraduate learning was canceled.

On August 10, students at the University of North Carolina at Chapel Hill (UNC) began the fall semester in person. Freshman Jasmine Baker was cautiously optimistic — as an incoming student in the Hussman School of Journalism, she was excited to experience college and get to know her suitemates. But she also worried that the university’s health and safety protocols would not prevent the spread of the coronavirus on campus.

She was right. Just one week after classes started, UNC announced that all undergraduate classes would move to remote learning for an indefinite period following a surge of COVID-19 cases. The case positivity rate on campus jumped from 2.8% to nearly 14%, Colleen Flaherty reported in Inside Higher Ed. After the second week, the positivity rate skyrocketed to 31%.

Baker, an out-of-state student, learned about the change in learning plans while attending an in-person class. “The email was very vague about housing,” she told Slate. “There were no specifics. Everyone kind of started freaking out. . . . We learned about it at the same time the professors did.” To top it off, she and a roommate soon tested positive for COVID-19. “We were all in such close quarters,” Baker said. “I know people that barely left their dorms, and they still ended up catching it.”

The situation at UNC is not unique.New York Times tracker has revealed at least 88,000 COVID-19 cases and 60 deaths at American colleges since the pandemic began. Photos and videos of students flouting public health guidelines at indoor parties or other gatherings have gone viral. Some university administrators have condemned the socializing as “reprehensible” and reprimanded students for “disrespectful, selfish, and dangerous” behavior.

Experts like Julia Marcus, PhD, MPH, an epidemiologist at Harvard Medical School, and Jessica Gold, MD, MS, a psychiatrist at Washington University, saw this coming from a mile away.Students will get infected, and universities will rebuke them for it; campuses will close, and students will be blamed for it,” they warned in the Atlantic over the summer. “Relying on the self-control of young adults, rather than deploying the public-health infrastructure needed to control a disease that spreads easily among people who live, eat, study, and socialize together, is not a safe reopening strategy.”

If you put 10,000 [students] in a small space, eating, sleeping, and socializing together, there’ll be an explosion of cases. . . . I don’t know what colleges were expecting.

—UNC epidemiologist Whitney Robinson

As the Editorial Board of the Daily Tar Heel, UNC’s student newspaper, wrote one week into the semester, “Reports of parties throughout the weekend come as no surprise. Though these students are not faultless, it was the University’s responsibility to disincentivize such gatherings by reconsidering its plans to operate in person earlier on.” The local health department recommended that UNC implement remote learning for the first five weeks of the fall term, but administrators ignored that advice.

Lack of Guidelines for Safe Return

Throughout the summer, even as COVID-19 hot spots emerged across the country, President Donald Trump aggressively pushed for schools to reopen in person. Without federal guidance on how to do this safely, university administrators were left to cobble together their own plans for preventing coronavirus from spreading into the community.

“I don’t think there are two universities that have the same protocol,” Irwin Redlener, director of the Pandemic Resource and Response Initiative at Columbia University, told Politico. “It’s national chaos.

Universities have a strong financial incentive to reopen in person. Many are hoping to recover revenue from housing fees and out-of-state tuition payments that were lost when the pandemic forced them to suspend in-person classes in March. But as many universities have learned in recent weeks, reopening in person comes at a cost to the health of students, faculty members, and the surrounding community.

The New York Times reviewed 203 counties in which college students comprise at least 10% of the population and found that about half experienced their worst weeks of the pandemic after August 1, around the time students returned to campus. An analysis by USA Today revealed that communities with a significant college student population represent 19 of the 25 largest current coronavirus outbreaks in the US.

What has happened on campus hasn’t stayed on campus,” Shawn Hubler and Anemona Hartocollis wrote in the New York Times.

California Fares Better Than Other States

While California is not represented on USA Today’s list of big outbreaks, it is dealing with surges on some campuses. According to the New York Times campus tracker, there are nearly 2,600 coronavirus cases at 57 schools in California. (Because there is no national tracking system for coronavirus cases on college campuses, the New York Times is believed to have the most comprehensive count available.)

I expect this will blow up outbreaks in places that never had outbreaks, or in places that had outbreaks under control.

—Boston University epidemiologist
Eleanor Murray

With 444 confirmed cases, San Diego State University tops the list among California schools, followed by the University of Southern California with 358 cases and UC San Diego with 237. By comparison, North Carolina has nearly 5,200 coronavirus cases at 42 schools, including 1,150 cases at UNC.

California’s relative success at mitigating the spread of COVID-19 on campus can be attributed in part to the conservative reopening plans of many schools. The California State University (CSU) system, California Community Colleges, and University of California (UC) schools moved nearly all fall classes online. UC Berkeley is fully remote for the fall semester. Stanford University planned to have half of its undergraduate students on campus during different quarters, but it switched to mostly remote learning as coronavirus cases continued to rise in the Bay Area over the summer.

Even a hybrid learning model, however, has failed to stave off new coronavirus cases on campuses. Chico State University and San Diego State University, both part of the CSU system, became the first and second California campuses to pause in-person classes after COVID-19 cases spiked, Ashley Smith reported for EdSource.

Resources are a factor in prevention efforts. Chico State’s health center doesn’t have coronavirus tests for students. San Diego State, which has more resources, has two coronavirus testing sites on campus. Across the CSU system, only 2 out of 23 campuses (CSU Maritime Academy and Humboldt State University) have tested all students living in dorms, according to CalMatters. The UC system, which has a budget roughly four times that of the CSU system, is testing all students living in dorms across all 10 campuses. (The UC system has restricted on-campus housing to students who have no alternative housing options.)

An Avoidable Situation

With the academic year off to a rocky start and students being sent home amid coronavirus outbreaks on campuses, experts across the country are nervously tracking the spread of the virus. “I expect this will blow up outbreaks in places that never had outbreaks, or in places that had outbreaks under control,” Eleanor Murray, ScD, MPH, an epidemiologist at Boston University, told Ed Yong in the Atlantic.

COVID-19 surges on college campuses were preventable. “If you put 10,000 [students] in a small space, eating, sleeping, and socializing together, there’ll be an explosion of cases,” Whitney Robinson, PhD, an epidemiologist at UNC, told Yong. “I don’t know what colleges were expecting.”