Category Archives: Vaccine

New booster works against dominant Covid strain

Posted on by • Posted in Coronavirus, Coronavirus Mutation, Coronavirus Omicron Variant XBB.1.5, Infectious Virus, Public Health, Public Opinion, Public Perception, Vaccination, Vaccine, Vaccine Booster, Vaccine Distribution, Vaccine Efficacy • Leave a comment

https://www.politico.com/news/2023/01/25/bivalent-covid-booster-xbb-1-5-00079451?mkt_tok=ODUwLVRBQS01MTEAAAGJjU7308C9Y8wCxfUFTmF9l2n7GDK3ejZuigdebwgFj9OOr5ffXWyONZ2UpDkMVbgp0t6zGmmGbBdM0Vd7yn0Wf61hb_mHhXcbSfFlK5F-tKyN

A new CDC study has found that the Covid-19 bivalent booster reduces the risk of symptomatic infection from the most common subvariant circulating in the U.S. right now by about half.

Additional new data, set to be published on the CDC website on Wednesday, also shows that individuals who received an updated vaccine reduced their risk of death by nearly 13 fold, when compared to the unvaccinated, and by two fold when compared to those with at least one monovalent vaccine but no updated booster.

CDC officials said during a briefing on Wednesday that the new findings were “reassuring.” But only 15.3 percent of eligible Americans — or about 50 million people — have received the new shot, which was rolled out in September.

Meanwhile, the highly transmissible Omicron subvariant XBB.1.5 — nicknamed “the Kraken” by some — is now the dominant SARS-CoV-2 strain in the U.S., projected by the CDC to make up just over 49 percent of cases in the country as of last week.

Earlier this month, the WHO said XBB.1.5 is the most transmissible variant to date, and is circulating in dozens of countries. Though a catastrophic wave has not emerged in the U.S. yet, there has nevertheless been a spike in deaths this month, with an average of 564 people dying of Covid-19 each day as of Jan. 18, compared with an average of 384 around the same time in December.

The new vaccine efficacy study, which used data from the national pharmacy program for Covid testing, found that the bivalent booster provided 48 percent greater protection against symptomatic infection from the XBB and XBB.1.5 subvariants among people who had the booster in the previous two to three months, compared with people who had only previously received two to four monovalent doses.

It also provided 52 percent greater protection against symptomatic infection from the BA.5 subvariant, though according to CDC estimates, BA.5 only accounted for about 2 percent of U.S. cases last week.

CDC officials cautioned that the findings reflected a population-level rate of protection, and that individual risk of infection varies.

“It’s hard to interpret it as an individual’s risk, because every individual is different,” said Ruth Link-Gelles, the author of the vaccine effectiveness study published in MMWR Wednesday. “Their immune system is different, their past history of prior infection is different. They may have underlying conditions that put them at more or less risk of COVID-19 disease.”

She also said it was unclear, given the limitations of the study, how long the bivalent booster protection will last.

“It’s too early to know how waning will happen with the bivalent vaccine,” she said. “What we’ve seen in the past is that your protection lasts longer for more severe illness. So even though you may have diminished protection over time against symptomatic infection, you’re likely still protected against more severe disease for a longer period of time.”

How bad is China’s covid outbreak?

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Coronavirus, Coronavirus Mutation, Infection Control, Infection Rates, Infectious Virus, Public Health, Public Opinion, Public Perception, Vaccine, Vaccine Booster • Leave a comment
https://www.washingtonpost.com/world/2023/01/12/china-covid-cases-deaths/?utm_campaign=wp_to_your_health&utm_medium=email&utm_source=newsletter&wpisrc=nl_tyh

China is in the middle of what may be the world’s largest covid-19 outbreak after authorities abruptly loosened almost three years of strict pandemic restrictions in December following nationwide protests against the measures.

The sudden dismantling of China’s “zero covid” regime — enforced through mass lockdowns, testing and contact tracing — has left the country’s health system unprepared and overwhelmed. It has alarmed international health experts concerned about Beijing’s transparency and caused diplomatic friction as countries enforce travel restrictions on arrivals from China.

How many people have been infected?

So far, there are no reliable national figures for the number of people among China’s 1.4 billion population who have been infected in the current outbreak. After admitting the difficulty of tracking infections, China’s National Health Commission stopped reporting daily tallies in December.

The data is still maintained by the Chinese Center for Disease Control and Prevention, based on counts from hospitals and local health commissions. But because mandatory mass testing has been dropped, the official figure is believed to massively underestimate the rate of infection. As of Jan. 8, there have been a little more than 500,000 confirmed covid cases since the pandemic began, according to the CDC.

Statements from local governments indicate that the true number of infections is exponentially higher. Officials in Henan province estimated this week that 89 percent of the province’s 99 million residents have been infected. In Zhejiang province, officials said the province was seeing over a million new infections a day in late December. As of Jan. 8, all 31 provinces, municipalities and regions had reported covid infections, according to the CDC.

How serious is the outbreak?

The number of deaths remains unknown, even as evidence is mounting that the true death count is much higher than what has been reported — a little more than 5,200 deaths since the pandemic began and fewer than 40 since zero-covid restrictions were lifted on Dec. 7.

As of Dec. 25, the takeup of intensive care beds in secondary and tertiary hospitals across the country was about 54 percent, but that figure has since increased to 80 percent, Jiao Yahui, director of the Department of Medical Affairs of the National Health Commission, said in an interview with state broadcaster CCTV on Sunday.

Officials reassured the public by noting that the fatality rate of the coronavirus’s omicron variant is 0.1 percent. The current outbreak has mostly consisted of the omicron subvariants BA.5.2 and BF.7, the State Council Information Office said in a news conference Monday.

The lack of testing combined with the narrow definition of what counts as a covid death — positive patients who die of respiratory failure — continue to skew the statistics. Officials have said they will investigate fatalities and release the results in the future.

What is the government saying?

Authorities say the worst of the outbreak is over for Chinese cities where infections spread quickly in December. Now, they are preparing for a new surge in rural areas around the upcoming Lunar New Year holiday that begins Jan. 21.

State media has reported that cases in most major cities have started to decline. Yin Yong, acting mayor of Beijing, told CCTV on Monday that the city had reached its peak and that authorities were turning their focus to monitoring potential new coronavirus variants or subvariants of omicron, and to mitigating the impact of covid on the elderly and other vulnerable groups.

Officials also said the peak had been reached in the province of Jiangsu in late December, while in Zhejiang, authorities said, “the first wave of infections has passed smoothly,” according to Health Times, a publication managed by People’s Daily. The state-run Farmers’ Daily said that visits to 51 villages across 31 provinces showed that most residents had been infected and had recovered.

Data released by Baidu, the main search engine in China, showed that the number of searches related to covid symptoms and medical supplies had dropped since peaking in mid-December.

Yet in Henan, officials said hospitals remain overcrowded because of a rise in critical cases in the past week. Researchers at the Institute of Public Health at Nankai University in Tianjin, using data from fever clinics, project that the nationwide peak will be between Dec. 20 and Jan. 15, with two smaller peaks in the first half of this year.

Officials have predicted a second wave over the Lunar New Year holiday, when the total number of passenger trips by residents is expected to reach 2.1 billion as pent-up demand for travel is unleashed. At this point, more contagion could spread to rural areas, where severe shortages of anti-fever drugs and medical staff have been reported.

How did zero covid affect the outbreak?

China’s pursuit of zero covid, eliminating the spread of the virus through lockdowns, mandatory quarantines, travel restrictions and mass testing, has proved to be a double-edged sword. While the approach kept infections and death rates low throughout most of the pandemic, it left the Chinese population with little natural immunity to the virus.

Many elderly residents — already skeptical of vaccines, which have had a troubled past in China — did not get vaccinated, feeling that they would be protected by the zero-covid strategy. Only 40 percent of residents above the age of 80 have had booster shots.

Under China’s covid policy, the population was immunized with domestically made vaccines that are not as effective against the omicron variant as mRNA vaccines. China has yet to approve foreign mRNA vaccines, and a domestically made one is still under production.

What does this mean for the rest of the world?

Concerns about the possibility of a new variant emerging in China have prompted countries including the United States, Japan and South Korea, and many European countries, to require extra screening for arrivals from China.

Wu Zunyou, the chief epidemiologist at the CDC, told CCTV in a report published Sunday that no new variants have emerged and that new strains are being collected every day to monitor changes.

“All the strains we found so far have already been shared with international sharing platforms,” he said. “They are the ones either reported abroad, or have been introduced to China after spreading overseas. So far, no newly emerged mutated strains have been found in China.”

The World Health Organization has called on China to share more real-time data on the outbreak. Michael Ryan, the health emergencies director, said at a news conference in Geneva on Wednesday that the WHO “still believes that deaths are heavily underreported from China.” He added: “We still do not have adequate information to make a full comprehensive risk assessment.”

Beijing has criticized travel restrictions on people arriving from China imposed by other countries as “ridiculous” and politically motivated. It has threatened countermeasures and this week suspended short-term visas for Japanese and South Korean citizens.

XBB.1.5 variant becomes dominant COVID strain in US

Posted on by • Posted in Coronavirus, Coronavirus XBB.1.5 Subvariant, Hospital Capacity, Infection Control, Infection Control Plan, Infection Rates, Infectious Virus, Nurses Shortage, Vaccination, Vaccine, Vaccine Booster, Vaccine Supply • Leave a comment

https://mailchi.mp/ad2d38fe8ab3/the-weekly-gist-january-6-2023?e=d1e747d2d8

Surging from less than 5 percent of cases in the first week of December, XBB.1.5 now makes up over 40 percent of all COVID infections in the US. The new variant appears to demonstrate a high level of immune evasion, and is around 40 percent more contagious than the next most virulent strain, though illnesses caused by XBB.1.5 do not seem to be more severe. Weekly rates for new COVID-related hospital admissions are now higher than at any point since February 2022, despite case counts remaining lower than the peak of the summer wave in July 2022 (although it is likely that the vast majority of cases are now identified through home testing, and not reported, making the data unreliable). 

The Gist: While the new variant seems to be less likely to create a COVID spike of the magnitude we experienced last winter, hospitalizations rising faster than case counts bears watching. That’s especially true given the current staffing situation in most hospitals, which makes each COVID admission and each caregiver call-out for illness a cause for concern. 

Only 15 percent of eligible Americans have received the most recent bivalent booster, leaving the population more vulnerable to this and future variants. Plus, additional funding to support the fight against COVID does not seem to be forthcoming from the new Congress. Beset with surges of COVID, flu, and RSV admissions, hospitals must hope that the end of the holiday season brings some relief.

The current “tripledemic” is putting pressure on hospitals  

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Coronavirus, Coronavirus Mutation, Flu Season, Flu Shot, Flu Transmission, Flu-Related Hospitalizations, Health System, Hospital, Hospital Industry, Misinformation, Pediatric Care, Personal Protective Equipment (PPE), Public Health, Public Opinion, Public Perception, Tripledemic, Vaccination, Vaccine, Vaccine Booster, Vaccine Distribution • Leave a comment

https://mailchi.mp/e44630c5c8c0/the-weekly-gist-december-16-2022?e=d1e747d2d8

Hospitals across the country are being hit with a spike in respiratory syncytial virus (RSV) and influenza cases, while still dealing with a steady flow of COVID admissions, in what’s been dubbed a “tripledemic”. The graphic above uses hospitalization data from the Centers for Disease Control and Prevention (CDC) to show that each disease has been sending similar shares of the population to hospitals across late fall, with flu hospitalizations having just overtaken COVID admissions after Thanksgiving.

These numbers reflect that we’re experiencing the worst RSV season in at least five years, and we’re set to endure the worst flu season since 2009-10. As RSV is most severe in very young children, its recent surge has revealed another capacity shortage in our nation’s hospitals: pediatric beds. From 2008 to 2018, pediatric inpatient bed counts fell by 19 percent, as hospitals shifted resources to higher revenue services. 

This strategy has now come to a head in many parts of the country, as RSV has driven pediatric bed usage rates to a recent high. (The Department of Health and Human Services’ pediatric capacity data only dates back to August 2020.) With three straight weeks of declining RSV hospitalizations, there is reason to hope that pediatric care units will soon feel a reprieve. However, flu season has yet to reach its peak, prompting calls for a return to widespread mask-wearing and a renewed emphasis on flu shots, given that more than half of Americans have not yet gotten vaccinated this season. 

Twitter no longer policing COVID misinformation

Posted on by • Posted in Coronavirus, Coronavirus Misinformation, Irresponsible, Misinformation, Mislead, Misleading, Mistrust, Public Health, Public Opinion, Public Perception, Social Platform, Vaccination, Vaccine, Vaccine Booster, Vaccine Distribution, Vaccine Efficacy, Vaccine Hesitancy Rate, Vaccine Safety, Vaccine Supply • Leave a comment

https://mailchi.mp/0622acf09daa/the-weekly-gist-december-2-2022?e=d1e747d2d8

Amid a flurry of policy changes initiated by Elon Musk since his takeover of the social media company last month, Twitter has ceased its formal efforts to combat COVID misinformation. To date, Twitter had removed over 100K posts for violating its COVID policy. The company will now rely on its users to combat disinformation through its “Birdwatch” program, which lets users rate the accuracy of tweets and submit corrections. Many of the 11K accounts suspended for spreading COVID misinformation, including those of politicians like Rep. Marjorie Taylor Greene (R-GA), have also been reinstated. 

The Gist: We’ve seen the damage caused by inaccurate or deliberately misleading COVID information, which has likely played a role in the US’s lower vaccination rates compared to other high-income countries. Around one in five Americans use Twitter, far fewer than Facebook or YouTube, but the platform is seen as highly influential, both for the reach of its content and also its moderation decisions. 

This policy change is worrisome, not only because COVID is still taking the lives of hundreds of Americans daily, but also because COVID misinformation catalyzes broader healthcare misinformation, including antivax sentiments and an overall mistrust of medical experts.

A tripledemic hurricane is making landfall. We need masks, not just tent hospitals

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Coronavirus, Coronavirus Mutation, Flu Season, Flu Shot, Flu Transmission, Flu-Related Hospitalizations, Health Policy, Infection Control, Infectious Virus, Pandemic, Public Health, Public Health Crisis, Public Health Emergency (PHE), Vaccination, Vaccine, Vaccine Booster, Vaccine Distribution, Vaccine Efficacy • Leave a comment
A tripledemic hurricane is making landfall. We need masks, not just tent hospitals

A viral hurricane is making landfall on health care systems battered by three pandemic years. With the official start of winter still weeks away, pediatric hospitals are facing crushing caseloads of children sick with RSV and other viral illnesses. Schools that promised a “return to normal” now report widespread absences and even closures from RSV and flu in many parts of the country, contributing to parents missing work in record numbers. With this year’s flu season beginning some six weeks early, the CDC has already declared a flu epidemic as hospitalizations for influenza soared to the highest point in more than a decade.

A storm of these proportions should demand not only crisis clinical measures, but also community prevention efforts. Yet instead of deploying public health strategies to weather the storm, the U.S. is abandoning them.

Even before the arrival of the so-called tripledemic, U.S. health systems were on the brink. But as the fall surge of illness threatens to capsize teetering hospitals, the will to deploy public health measures has also collapsed. Pediatricians are declaring “This is our March 2020” and issuing pleas for help while public health efforts to flatten the curve and reduce transmission rates of Covid-19 — or any infectious disease — have effectively evaporated. Unmanageable patient volumes are seen as inevitable, or billed as the predictable outcome of an “immunity debt,” despite considerable uncertainty surrounding the scientific underpinnings and practical utility of this concept.

The Covid-19 pandemic should have left us better prepared for this moment. It helped the public to understand that respiratory viruses primarily spread through shared indoor air. Public health practices to stop the spread of Covid-19 — such as masking, moving activities outdoors, and limiting large gatherings during surges — were incorporated into the daily routines of many Americans. RSV and flu are also much less transmissible than Covid-19, making them easier to control with common-sense public health practices.

Instead of dialing up those first-line practices as pediatric ICUs overflow and classrooms close, though, the U.S. is relying on its precious and fragile last lines of defense to combat the tripledemic: health care professionals and medical facilities.

Warnings and advisories recently issued by U.S. public health leaders, clinical leaders, politicians, and the media have consistently neglected to mention masking as a powerful short-term public health strategy that can blunt the surge of viral illness. Instead, recent guidance has exclusively promoted handwashing and cough etiquette. These recommendations run counter to recent calls to build on improved understanding of the transmission of respiratory viruses.

In the U.S.’s efforts to “move on” from thinking about Covid, it has created a “new normal” that is deeply abnormal — one in which we normalize resorting to crisis measures, such as treating patients in tents, instead of using common-sense public health strategies. Treating Covid like the flu — or the flu like Covid — has effectively meant that we treat neither illness as if it were a serious threat to health systems and to public health. Mobilizing Department of Defense troops and Federal Emergency Management Agency personnel to cover health system shortfalls is apparently more palatable than asking people to wear masks.

The tripledemic has already claimed its first child deaths in the U.S., adding to a large ongoing death toll from Covid. Allowing health systems to reach the brink of collapse will lead to many more preventable deaths among pediatric and other vulnerable patients who can’t access the care they need.

By any accounting, these losses are shocking and tragic. But they should strike us as particularly abhorrent and shameful because the tripledemic is a crisis that leaders, health agencies, and institutions have, in a sense, chosen. Over the past year, the Biden administration and its allies have repeatedly encouraged the public to stand down on public health measures, with the President even stating in September that “the pandemic is over.” By moving real risks out of view and failing to push for more robust measures to mitigate Covid, these messages have put the country on a path to its present circumstances, in which pediatric RSV patients are transferred to hospitals hundreds of miles away because there is no capacity to treat them in their own communities.

Living with viruses should mean embracing simple public health measures rather than learning to live with staggering levels of illness and death. Leaders in public health and medicine should issue timely and appropriate guidance that reflects the latest science instead of second-guessing the prevailing winds in public opinion. Instead of self-censoring their recommendations out of fear of political consequences, they should continue to promote the full range of public health strategies, including masking in crowded indoor public places during surges.

The tripledemic should bring renewed urgency to policies that will reduce the toll of seasonal illness on health, education, and the economy. Improvements in indoor air quality in public spaces, including schools, child care centers, and workplaces, can limit the spread of diseases and have many demonstrated health and economic benefits, yet the U.S. continues to lack standards to guide infrastructure or workplace safety standards. Paid leave enabling workers to stay home when they are ill can reduce the transmission of disease as well as loss of income, yet the U.S. is one of the only high-income countries without universal paid sick leave or family medical leave.

Greater effort must also be made to increase vaccination coverage for flu and Covid and bring an RSV vaccine online as quickly as possible. Only about half of high-risk adults under 65 received a flu shot last year, a gap that can be closed with more energetic vaccination campaigns. Reducing annual flu deaths using a broader range of strategies enabled by the pandemic — rather than pegging Covid deaths to them — should be the goal.

Amid the many sobering stories of the tripledemic, there is some good news. As the experience of Covid-19 has shown, it is possible to limit the toll of respiratory viruses like flu and RSV. However, this work requires resources, appropriate policies, and political will. Americans don’t need to accept winter disease surges and overrun health systems as an inevitable new normal. Instead, the country should see the tripledemic as a call to reinvigorate public health strategies in response to these threats to the health of our communities.

China’s COVID storm

Posted on by • Posted in Coronavirus, Coronavirus Mutation, Health Policy, mRNA-based Vaccines, Pandemic, Pandemic Unwinding, Pandemic Wind Down, Public Health, Vaccination, Vaccine, Vaccine Booster, Vaccine Distribution • Leave a comment

https://www.axios.com/2022/11/26/china-covid-outbreak-lockdown-economy

A new COVID calamity is hammering China, with a surge in infections prompting a return of lockdowns, including in some manufacturing areas that supply the West.

  • China reported a record number of infections this week, amid lockdowns and mass testing that are fueling unrest and darkening the country’s economic outlook. Schools in Beijing returned to online teaching.

Why it matters: In addition to the human misery for the world’s most populous country, the effects will be felt around the globe, Axios China author Bethany Allen-Ebrahimian reports from Taipei.

  • Supply chains are likely to be disrupted, causing prices to rise in an already rocky global economy.

Rare protests broke out today in China’s far western Xinjiang region. Crowds shouted at hazmat-suited guards after a deadly fire triggered anger by prolonged COVID lockdowns, Reuters reports.

  • “End the lockdown!” shouted protesters in the Xinjiang capital Urumqi, where an apartment fire killed 10.

What’s happening: The moment of truth for China’s zero-COVID policy has finally come.

  • Either party leaders will need to plunge much of the country into draconian lockdowns, as we saw at the beginning of the pandemic — or they’ll decide it’s time to learn to live with COVID.

Reality check: China’s doctors have warned Xi Jinping that the healthcare system isn’t prepared for the huge outbreak likely to follow the easing of strict anti-COVID measures, the Financial Times reports.

  • Chinese-made vaccines, which don’t use the mRNA technology employed by many produced by the West, aren’t as effective compared to those made in the U.S. And China has worrisomely low vaccination rates among older people.
  • But the number of cases in China is actually still very low for anywhere but China.

The big picture: “Zero COVID” restrictions have damaged the economy and undermined people’s trust in government.

  • That’s a stark about-face from the height of the pandemic. Then, many Chinese people felt the tight central control had protected them better than any other governance model in the world.
  • But it’s that very model that has plunged China into its current predicament. Xi tied his reputation, and the party’s legitimacy, to the success of “zero COVID.”

Between the lines: Chinese leaders made a huge, politically motivated mistake. They resisted the import of Western-made mRNA vaccines (including Pfizer and Moderna) for its citizens. These vaccines were only recently made available to foreigners.

  • That’s likely because of Beijing’s big vaccine diplomacy push: Chinese officials touted their own vaccines as the best and safest.
  • It was politically unpalatable to admit “defeat,” and allow Chinese people to get more effective — but Western-made — jabs.

China faces dilemma in unwinding zero-COVID

Posted on by • Posted in Coronavirus, Coronavirus Mutation, Health Policy, Intensive Care (ICU), Pandemic, Pandemic Wind Down, Public Health, Vaccination, Vaccine, Vaccine Booster, Vaccine Distribution • Leave a comment

https://www.axios.com/2022/11/28/china-dilemma-unwinding-covid-zero

China is facing an increasingly precarious situation as new COVID cases soar and the population seems to be hitting a breaking point with the government’s stringent zero-tolerance policies.

Why it matters: The world’s most populous nation has massive vulnerabilities heading into this winter, starting with the fact the vast majority of its population has yet to be exposed to the virus and has little ‘natural immunity.’

  • China’s vaccines didn’t work well compared to those distributed in the West, and the government refused to approve foreign vaccines and doesn’t have a version to combat Omicron.
  • Vaccine uptake was particularly low among the elderly.
  • And now, public outrage over new COVID lockdown restrictions has fueled rare protests, Axios’ Herb Scribner writes, with residents demanding the government to lift restrictions quickly and some calling for President Xi Jinping’s resignation.

State of play: Overall, China’s number of reported COVID cases and COVID deaths are far lower than other nations, but there have been recent reported spikes in overall numbers of cases and some new deaths.

  • It came after the Chinese government announced some easing of its zero-COVID policy, such as reducing mass testing and quarantine requirements, earlier this month.

Reality check: China’s doctors have warned that the health care system isn’t prepared for the huge outbreak likely to follow any easing of public health measures, Axios’ Bethany Allen-Ebrahimian writes.

  • That includes worries the nation doesn’t have enough ICU bed capacity to handle such outbreaks, according to the Financial Times.

Between the lines: Another concern is the potential evolution of a new, more dangerous variant if there’s a huge surge of infections, Christian Drosten, Germany’s most prominent virologist, told Bloomberg.

  • “Xi Jinping knows very well that he can’t simply let the virus loose,” Drosten said. “The Chinese population first needs to be as well vaccinated as we are.”

Be smart: China’s officials are scrambling to address the vaccine problem.

  • For instance, they are launching more aggressive vaccine drives and limiting movement among at-risk groups, including the elderly, the Washington Post reports.
  • They’ve also approved the use of the first inhaled COVID-19 vaccine in dozens of cities earlier this month in a bid to boost uptake, WSJ reported. Experts have said the vaccine, which was found to stimulate a mucosal response, may create more durable protection against the virus, although more data is needed.
  • But they have yet to open up the availability of mRNA vaccines from Pfizer-BioNTech and Moderna, opting to focus on their own, per the Post.

The bottom line: China’s zero-COVID policy has kept cases in China relatively low compared to the rest of the world.

  • But even as the societal and economic consequences of shutdowns become apparent, it faces a very difficult path ahead in unwinding strict public health policies.

Can updated boosters prevent another Covid-19 surge? Why some experts are skeptical.

Posted on by • Posted in Centers for Disease Control & Prevention (CDC), Clinical Research, Coronavirus, Coronavirus Mutation, Coronavirus Omicron Variant BA.5, Health Policy, Infectious Virus, Public Health, Public Health Strategy, Public Opinion, Public Perception, Vaccination, Vaccine, Vaccine Booster, Vaccine Distribution, Vaccine Efficacy, Vaccine Safety, Vaccine Supply • Leave a comment
https://www.advisory.com/daily-briefing/2022/11/21/booster-protection?utm_source=member_db&utm_medium=email&utm_campaign=2022nov21&utm_content=member_headline_final_x_x_x_x&elq_cid=4838956&

Most experts agree that updated bivalent Covid-19 boosters provide additional protection against serious illness and death among vulnerable populations—but evidence suggests that increased booster uptake may not prevent a “wave of Covid” infections this winter, Apoorva Mandavilli writes for the New York Times.

Can bivalent boosters prevent another surge of infections?

While the Biden administration’s plan to prevent another surge of Covid-19 infections relies on increasing Americans’ uptake of the updated booster doses of the Pfizer–BioNTech and Moderna vaccines, some experts doubt the strategy.

According to John Moore, a virologist at Weill Cornell Medicine, boosters provide additional protection to vulnerable populations—including older adults, immunocompromised individuals, and pregnant people—who should get boosted to prevent severe illness and death.

However, the benefit is not as clear for healthy, younger Americans who “are rarely at risk of severe illness or death from Covid, and at this point most have built immunity through multiple vaccine doses, infections or both,” Mandavilli writes.

“If you’re at medical risk, you should get boosted, or if you’re at psychological risk and worrying yourself to death, go and get boosted,” Moore said. “But don’t believe that will give you some kind of amazing protection against infection, and then go out and party like there’s no tomorrow.”

Separately, Peter Marks, FDA‘s top vaccine regulator, noted the limited data available data for the updated boosters.

“It’s true, we’re not sure how well these vaccines will do yet against preventing symptomatic disease,” he said, especially as the newer variants spread.

However, Marks added, “even modest improvements in vaccine response to the bivalent boosters could have important positive consequences on public health. Given the downside is pretty low here, I think the answer is we really advocate people going out and consider getting that booster.”

How much additional protection do updated shots provide?

While Pfizer-BioNTech and Moderna recently reported that their bivalent boosters produced antibody levels that were four to six times higher than the original vaccine, their results were based on BA.4 and BA.5 antibodies, instead of the more prevalent BQ.1 and BQ.1.1 variants.

According to Mandavilli, “[a] spate of preliminary research suggests that the updated boosters, introduced in September, are only marginally better than the original vaccines at protecting against the newer variants — if at all.”

These small studies have not been reviewed for publication in a journal—but they all came to similar conclusions.

“It’s not likely that any of the vaccines or boosters, no matter how many you get, will provide substantial and sustained protection against acquisition of infection,” said Dan Barouch, head of Beth Israel Deaconess‘ Center for Virology and Vaccine Research, who helped develop Johnson & Johnson‘s vaccine.

Notably, Barouch’s team recently discovered that BQ.1.1 is around seven times more resistant to the body’s immune defenses than BA.5, and 175 times more resistant than the original strain of the coronavirus. “It has the most striking immune escape, and it’s also growing the most rapidly,” he said. BQ.1 will likely follow a similar pattern.

“By now, most Americans have some degree of immunity to the coronavirus, and it does not surprise scientists that the variant that best evades the body’s immune response is likely to outrun its rivals,” Mandavilli writes.

The new vaccine increases antibodies, but the fact it is bivalent may not be significant. In August, a study by Australian immunologists suggested that any kind of booster would offer extra protection. In addition, the study noted that a variant-specific booster would likely not be more effective than the original vaccine.

“The bulk of the benefit is from the provision of a booster dose, irrespective of whether it is a monovalent or bivalent vaccine,” according to the World Health Organization.

Florian Krammer, an immunologist at the Icahn School of Medicine at Mount Sinai, noted that despite recent research, which evaluated immune response soon after vaccination, immune response may improve over time.

“We will see with larger studies and studies at a later time point if there is a good or a significant benefit, but I think it’s certainly not worse,” he added. “I don’t see much risk when you get the vaccine, so you might as well get the benefit.”

“What we need to do right now to get us through the next few months when I think we are in yet another wave of incipient wave of Covid,” Marks added. “And then we need to look forward, and lean into how we’re going to do things differently moving forward.”

Will we see an increase in vaccine uptake?

Currently, FDA allows the booster dose at least two months after a Covid-19 infection or previous does. However, some studies suggest boosting too early could have negative consequences. “Lengthening the interval between boosts to five or six months may be more effective, giving the immune system more time to refine its response,” Mandavilli writes.

Still, “adding yet another shot to the regimen seems unlikely to motivate Americans to opt for the immunization,” no matter the schedule, she adds.

“Each new booster we roll out is going to have a lower and lower uptake, and we’re already pretty close to the floor,” said Gretchen Chapman, an expert in health behavior at Carnegie Mellon University.

Ultimately, “[w]e should not spend a lot of political capital trying to get people to get this bivalent booster, because the benefits are limited,” Chapman added. “It’s more important to get folks who never got the initial vaccine series vaccinated than to get people like me to get their fifth shot.” 

Covid deaths and hospitalizations are falling in the U.S.

Posted on by • Posted in Coronavirus, Coronavirus Mutation, Coronavirus Omicron Variant, Hospitalizations, Immunity, Intensive Care (ICU), Mortality, Vaccination, Vaccine, Vaccine Booster, Vaccine Efficacy • Leave a comment

https://www.nbcnews.com/health/health-news/covid-deaths-hospitalizations-are-falling-us-rcna57205?mkt_tok=ODUwLVRBQS01MTEAAAGIH7CR3GvQnozIcaeoQ72Du6FkyH_RU4fskQH4B_8YE_uUhu25zWfcIBrbiiEsOLCEU_NbYaoaucRiFjWyLUJf9A7tQtKTvj-AbwCZgEAvR-aL

Even as new omicron strains take over, Covid is no longer driving a majority of patients into the hospital. Still, doctors worry the virus could re-emerge as immunity wanes.

As the flu and RSV (respiratory syncytial virus) have spread rapidly this fall — inundating and overwhelming hospitals and their staff across the country — Covid has not.

In fact, Covid-related deaths and hospitalizations have fallen in recent months, despite the emergence of new omicron subvariants that evade immunity from previous infections and vaccination.

According to NBC News data, Covid deaths have fallen consistently since Aug. 31, when the seven-day average of daily Covid deaths was at 571. A month later, on Sept. 30, the number fell to 475. By Halloween, 365 were dying per day, on average, from Covid.

As of Nov. 14, the number had fallen to 316.

This week, the Centers for Disease Control and Prevention is expected to release new data on Covid-related mortality, finding that death rates began to decline in March 2022.

The overall hopeful sign of declining deaths could indicate yet another new Covid phase, doctors suggest. Fewer people sick enough to be hospitalized with Covid means that fewer people are dying of the illness.

The average number of Covid hospitalizations per day has decreased by 27.9% since Aug. 28, according to NBC News data.

Even better, Covid, it seems, is no longer sending a majority of patients into intensive care units.

“There has not been an increase in patients admitted to the hospital specific for Covid-related disease,” said Dr. Hugh Cassiere, director of critical care services at Sandra Atlas Bass Heart Hospital at North Shore University Hospital, part of Northwell Health in New York City.

Patients in his ICU with Covid were admitted with unrelated medical issues, and were subsequently found to be Covid-positive, Cassiere said.

“Not to say that it’s gone, but Covid has become a coincidental disease,” he said.

Dr. Vin Gupta, a pulmonologist and an affiliate faculty member at the University of Washington in Seattle, attributes the decline in deaths and severe Covid cases to a level of “baked-in immunity,” including vaccination, prior infection or a combination of the two.

While Covid-related hospitalizations are not currently increasing, Gupta warns that they could during the winter as immunity, especially from previous infection, diminishes.

“If you had Covid, say six to four months ago, you’re going to have less protection against hospitalization than if you were vaccinated,” Gupta said. “The duration and the robustness of protection wanes a lot more quickly if all you rely on is natural immunity.”

With that in mind, data from the Institute for Health Metrics and Evaluation, a research center within the University of Washington, suggest that Covid hospitalizations and deaths could tick up again in “mid-January at the earliest,” said Gupta, a medical analyst for NBC News and MSNBC.

Despite the encouraging decline in Covid deaths, another school of thought suggests that Covid has simply morphed into a new kind of fatal illness.

“Before everyone was vaccinated or had been infected, 80 or 90% of Covid looked exactly same. They had terrible pneumonia. They were in the ICU on respiratory support,” said Dr. Jeremy Faust, an emergency medicine physician at Brigham and Women’s Hospital and an instructor at Harvard Medical School in Boston.

Now, he said, “Covid deaths don’t all look the same.” While “baked-in immunity” may keep the most severe cases at a minimum, it is clear that Covid can wreak havoc on the body long after the infection has cleared.

“Somebody could have Covid and have a heart attack, and the primary cause of death is listed as a heart attack because that’s what really brought them to the hospital,” Faust said.

But, he added, “we’ll never know to what degree Covid triggered that heart attack.”