Booster shot slowdown leaves older Americans at risk
The delivery of coronavirus booster shots in the U.S. has stagnated, particularly among older populations, leaving millions of vulnerable people at risk of serious infection and death.
After bottoming out in late March and early April, COVID-19 infections are steadily rising across the country.
More worrisome, hospitalizations have also increased 20 percent over the past two weeks, though deaths have stayed relatively low, especially compared to the winter peak, according to Centers for Disease Control and Prevention (CDC) data.
Studies show the protection against infection from the initial series of vaccines starts to wane after about six months.
While younger, healthier people are still well protected against severe disease, that hasn’t been the case for older Americans. That makes booster shots important, especially as most COVID-19 mitigation measures have ended.
Health officials are urging people over the age of 50 to get a second booster, but many have yet to even receive their first.
“What we really should be worried about is getting the boosters that we need to stay up to date so with the new variants that we have, we don’t have unnecessary deaths and hospitalizations,” Food and Drug Administration Commissioner Robert Califf said on CNN recently.
According to the CDC, about 69 percent of people over the age of 65 have received a booster shot. Overall, fewer than half of eligible Americans of all ages have gotten a booster.
A recent CDC study of national nursing home vaccination data found that residents with an additional or booster dose of a COVID-19 vaccine had 47 percent greater protection against infection during the omicron variant’s prominence than those who had only received a primary series.
According to an AARP analysis of federal data, more than a million U.S. nursing home workers and more than 350,000 residents haven’t received a first coronavirus booster dose, even though they have been eligible since last fall.
There are also major geographic disparities. In Arizona, Florida and Nevada, first booster rates among residents are only around 55 percent, the AARP says.
“It’s kind of troubling. Given this is the highest-risk population, it’s exactly the population that should be getting boosted, yet they aren’t getting it, and I think the reason is we made it harder than it needed to be,” said David Grabowski, a professor of health policy at Harvard Medical School.
During the initial vaccine rollout, federal officials singled out nursing homes as a priority. They partnered with CVS and Walgreens to run vaccination clinics in facilities, which resulted in more than 8 million doses administered for residents and staff.
But with boosters, nursing homes have been responsible for scheduling vaccinations through their normal long-term care pharmacies.
“Whether you look specifically at long term care settings like nursing homes and assisted living or just out in that broader population of older adults, we’ve really failed here,” Grabowski said.
“We know boosters work. Let’s make certain we get this into as many arms as possible, especially among those who are at greatest risk,” he added.
To be sure, nursing home resident deaths have dropped considerably from the peak of the omicron wave in January. Much of that has been attributed to lasting protection of vaccines but also to new antiviral treatments available.
Grabowski said he doesn’t expect the administration to pivot its approach suddenly back to being more centralized, but he said a more targeted effort is needed.
“We’re not going to start over with a comprehensive vaccine partnership program for boosters. That’s probably not realistic, but I think it’s very realistic to think we can be very directed,” Grabowski said.
Experts have also attributed low booster uptake to messaging issues from the federal government, which now loom large as officials work to promote second booster shots for people age 50 and older.
Chaotic and at times disparate messages from administration health officials culminated in a complicated set of recommendations about who should be getting booster shots and why, which experts said helped depress enthusiasm.
The CDC initially decided against recommending broad authorization and instead recommended a booster shot for people over the age of 65 as well as anyone who was at “high risk” of exposure to the virus in the workplace.
The agency eventually decided to make everyone eligible, but by then, much of the damage had been done.
Five things to know about long COVID
COVID-19 cases are rising again — and some of them could lead to the condition known as long COVID, which brings with it myriad symptoms that can severely impact a patient’s life.
Research on long COVID remains thin, and as a result its prevalence, definition and treatment is uncertain. Signs of the condition can range of mild to debilitating, with symptoms lasting for months or even more than a year.
The National Institutes of Health (NIH) is aiming to conduct more research into the condition this summer as part of its nationwide initiative to better understand it.
Here are five things we do know about long COVID, despite the scarce definitive data.
People with asymptomatic cases can develop long COVID, too
Patients who developed severe cases of COVID-19 or had to be hospitalized are generally believed to be more likely to have long-lasting symptoms after recovering from their initial infection.
However, studies have indicated that a notable percentage of asymptomatic COVID-19 cases lead to long COVID.
One study from the FAIR Health nonprofit found that nearly 1 out of 5 people who did not experience symptoms when they initially contracted the coronavirus reported having at least one long COVID symptom about a month after their infection.
The most common symptoms observed in this study were pain, breathing difficulties, fatigue, hypertension and hyperlipidemia — which is the presence of too many lipids in the blood.
Some predisposing factors have been identified
While more research is needed, recent studies have indicated there are some conditions or factors that may predispose an individual to being more likely to develop long COVID.
Research results published earlier this year indicated that people with Type 2 diabetes, individuals with reactivated Epstein-Barr virus in their blood and those who have autoantibodies in their system are more likely to experience long COVID symptoms.
The Epstein-Barr virus is a common pathogen that many people contract during childhood. It usually remains in the body in an inactive form but can be reactivated.
Autoantibodies are antibodies produced by the immune system that attack an individual’s own healthy tissue. Many autoimmune disorders are caused by autoantibodies, and more than 32 million people in the U.S. are believed to have autoantibodies, according to the NIH.
Researchers say it is wrong to conclude that long COVID just hits sickly people. It is also occurring in healthy individuals with no preexisting conditions who had asymptomatic cases.
The prevalence of long COVID is still being determined
How many people get long COVID? Due to the current lack of extensive research, it’s not clear.
Early studies estimated that a minority of between 10 to 30 percent of COVID survivors would develop long-term symptoms. Some later studies indicated that a majority of patients — nearly 2 out of 3 — would experience long COVID.
The NIH has noted that one factor making it difficult to identify the rate at which long COVID occurs is that its wide variety of symptoms can often resemble other conditions and diseases. Long COVID cannot be tested for.
The time frame of long COVID is also still being deliberated, which affects the rates that are reported.
While some health officials consider a patient to be COVID long-haulers if they still have symptoms three to six weeks after infection, other researchers have considered the condition to be more extended, looking at individuals experiencing symptoms roughly six months after their initial infection.
Long COVID can be considered a disability in some cases
According to guidance from the Equal Employment Opportunity Commission (EEOC), people who have COVID or have previously been diagnosed with the coronavirus can be considered disabled under federal civil rights law if the symptoms cause “physical or mental” impairment that limits major life activities.
Whether or not someone can be considered disabled due to being infected with COVID-19 should be taken on a “case-by-case” basis, the EEOC said when it updated its guidance.
While the usual symptoms are fatigue, breathing issues and brain fog, other symptoms have had debilitating effects on long-haulers.
One British study found that people who had COVID cases severe enough to warrant critical care experienced the equivalent of 20 years of cognitive aging. The participants in the study were infected about six months beforehand on average and scored significantly lower in cognitive tests when compared to the general population.
COVID-19 antivirals may be a potential treatment for long COVID
Jim Heath, a researcher leading a consortium on long COVID for the NIH’s research initiative, told The Hill that antivirals would “almost surely” help with long COVID.
Heath noted that most evidence of antivirals helping long COVID is anecdotal, with the drugs having only been authorized for use in December of last year.
“So it’s a little early to tell, but we know that viral load in the blood of these viruses is important for long COVID and that disease severity does play a role,” Heath said. “Unless two plus two doesn’t equal four, you would expect that those are actually reasonable treatments for at least a set of patients.”
However, Heath noted that long COVID presents itself in a wide variety of symptoms and the antivirals likely wouldn’t help everybody with the condition.
Some research has come out to support Heath’s view.
A small, preprint study conducted by researchers from the University of California, San Francisco found that long COVID symptoms were lessened in participants who took Pfizer’s Paxlovid several weeks after testing positive for the coronavirus.
However, using antivirals like Paxlovid or Merck and Ridgeback’s Molnupiravir to treat long COVID would technically be off-label use. Coronavirus antivirals are meant to be administered within days of symptom onset, according to the Food and Drug Administration’s emergency use authorization.
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FDA authorizes booster for children ages 5-11
The Food and Drug Administration (FDA) on Tuesday authorized a booster dose of the Pfizer-BioNTech COVID-19 vaccine to children between the ages of 5 and 11, extending booster doses to the youngest age group yet.
Experts have stressed the importance of booster shots for older age groups as a key way to increase protection in the face of waning immunity over time from the initial shots, as well as the increased evasiveness of the omicron variant currently circulating.
Now, children 5-11 will be eligible for boosters for the first time.
Data released by Pfizer last month found a 36-fold increase in the level of neutralizing antibodies against the omicron variant, compared to two doses.
“These data reinforce the potential function of a third dose of the vaccine in maintaining high levels of protection against the virus in this age group,” Pfizer said then, adding: “The vaccine was well tolerated with no new safety signals observed.”
Still, uptake for even the initial two shots for children 5-11 has been lagging, indicating that many parents will not get booster shots for their children either.
Only 28 percent of children 5-11 have received the first two shots, according to data compiled by the Centers for Disease Control and Prevention.
While COVID-19 is less severe on average in children, there still can be some severe cases and even deaths.
Between 0.1 and 1.5 percent of child COVID-19 cases resulted in hospitalization, according to data from the American Academy of Pediatrics.
There is still no vaccine authorized for children under 5, a source of frustration to some parents.
It is possible that move could come in June, given that FDA advisory committees are set to meet then to consider vaccination for the youngest children.
The FDA has pointed to the low vaccination rates in older children to show that it must be thorough in its review for the youngest age group and seek to instill confidence in vaccines.
“While it has largely been the case that COVID-19 tends to be less severe in children than adults, the omicron wave has seen more kids getting sick with the disease and being hospitalized, and children may also experience longer term effects, even following initially mild disease,” FDA Commissioner Robert Califf said in a statement.
“Vaccination continues to be the most effective way to prevent COVID-19 and its severe consequences, and it is safe,” he added.
The booster shot is intended to be received at least five months after the initial doses.
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