COVID-19 Vaccine: What to know before this weekend's games at United Center originally appeared on NBC Sports Chicago
Before the Chicago Bulls take to the court and the Chicago Blackhawks hit the ice this weekend, you'll want to know the changes to COVID-19 policies at the United Center.
As Chicago lifts coronavirus vaccine and indoor masking mandates across the city, the United Center has announced plans to ease some, but not all, of its guidelines for fans.
Here's what you need to know:
Moving forward, the United Center will continue require all attendees to present proof of vaccination, but will now give the option to show a negative COVID test to gain access to the venue.
Previously, the United Center had required proof of vaccination for entry, and did not accept a negative test.
Masks are now optional at games and events at the United Center, however the venue still says they are "recommended."
The updated guidelines will first take effect for Blackhawks fans on Thursday for their home matchup with the Edmonton Oilers, and for Bulls fans on Friday for their home matchup with the Milwaukee Bucks.
The Blackhawks will be on off Friday, then on the road Saturday, facing the Philadelphia Flyers. On Sunday, the team will return to the United Center to play the Tampa Bay Lightning.
After taking off Saturday and Sunday, the Bulls will be in Philadelphia for their matchup against the 76ers on Monday.
The Bulls play eight of their remaining 21 regular-season games at home, and hope to host playoff basketball at the United Center come spring.
The Blackhawks, meanwhile, play 14 of their remaining 28 regular-season games at home, but boast no such playoff hopes.
Though they haven't drastically changed, the United Center will continue to conduct all ticket-checks and payments in a contactless format.
The venue also has enhanced cleaning standards including disinfecting equipment, increasing frequently of cleaning and adding more sanitation stations.
75% of urbanites have had at least one dose compared to 58% of rural residents.
March 3, 2022, 6:23 PM
5 min read
The gap in COVID-19 vaccination uptake between rural and urban Americans is continuing to widen, a federal report published Thursday found.
As of Jan. 31, 2022, 75.4% of people aged five and older living in urban counties have received at least one dose of the vaccine, according to the Centers for Disease Control and Prevention.
By comparison, just 58.8% of those living in rural areas had been given at least an initial shot -- a nearly 17% difference.
However, a previous report by the federal health agency found that, in April 2021, the gap was smaller with 45.7% of urban residents given at least one dose of the COVID vaccine compared to 38.9% of rural residents.
This means that in the span of nine months, disparities based on geographic location have more than doubled.
COVID-19 vaccination percentages in rural and urban U.S. counties
The authors say the large gap is likely due to less access to health care and increased vaccine hesitancy in rural areas.
"Addressing barriers to vaccination in rural areas is critical to achieving vaccine equity, reducing disparities, and decreasing COVID-19-related illness and death in the United States," the authors wrote.
According to the new report, 46 states had higher COVID vaccine uptake in urban areas than in rural areas with just one state -- Arizona -- having higher coverage in rural areas.
Three states: Delaware, New Hampshire and Rhode Island, and Washington, D.C., have no rural counties so differences in vaccination coverage could not be evaluated.
In both rural and urban counties, women were more likely to be vaccinated than men.
Data showed 77.4% of urban women and 61.4% of rural women had received at least one dose by the end of January compared to 73.2% of urban men and 55.7% of rural men, respectively.
This is similar to the CDCs report looking at April 2021 vaccination rates, which also showed more women getting vaccinated.
Among all age groups, vaccination uptake was higher in urban counties with the largest difference being among 12-to-17-year-olds.
The report showed just 38.7% of rural teenagers had received at least an initial vaccine dose compared to 64.9% of urban teenagers.
People wait in a distanced line to be tested for COVID-19, as signs point to other tents with no line where healthcare workers waited to administer vaccines, at a mobile health unit run by Nomi Health, Dec. 28, 2021, in Miami.
However, the researchers found that there was relatively no difference in the percentage of people in rural or urban areas who received booster or additional doses, both being similarly low.
About 50.4% of fully vaccinated urban residents had received a booster shot as of Jan. 31, 2022 as had 49.7% of rural residents.
The CDC authors noted Americans living in rural counties tend to be aged 65 or older and have more pre-existing conditions.
This puts them at high risk of severe COVID-19 complications and is why rates of death from the virus are higher in rural areas than in urban areas.
Dr. Matt Feeley, part of ABC News' Medical Unit, contributed to this report.
(Precision Vaccinations)
A new study funded by the U.K. Health Security Agency and published as an Original Article by the New England Journal of Medicine on Mar 2, 2022, concluded by stating 'Primary immunization with two doses of COVID-19 vaccine provided limited protection against symptomatic disease caused by the SARS-CoV-2 virus variant known as Omicron.'
And a Cominraty (BNT162b2) orSpikeVax (mRNA-1273) booster after either the AstraZeneca (ChAdOx1 nCoV-19) or Comirnatyprimary course substantially increased protection, but that protection waned over a short period of time.
The researchers used data from the National Immunization Management Systemfrom Nov 27, 2021, to Jan 12, 2022, to estimate COVID-19 vaccine effectiveness (VE) against symptomatic illness caused bythe Omicron and Delta variants.
VE was higher against Delta throughout the study than Omicron for all combinations of the primary vaccine series and booster doses.
These researchers could not determine VE against severe illness using this study'stest-negative, case-controldesign because the number of severe Omicron cases leading to hospitalization was limited, and the natural lag between infections and poor outcomes was too long.
'Our findings indicate that vaccine effectiveness against symptomatic disease caused by the omicron variant is substantially lower than with the Delta variant,' concluded these researchers.
Dr. Lopez Bernal can be contacted at[emailprotected]. No industry conflicts of interest were disclosed.
Attacking COVID-19: Pros and cons of vaccines and treatments
A quick look at the five main COVID-19 treatments, with advantages and limitations of each.
Wochit
The Kansas health agency stopped airing television advertisements promoting the COVID-19 vaccine after some Republican lawmakers took issue with calling the shots safe and effective.
The revelation came during Janet Stanek's confirmation hearing Wednesday before the Senate Public Health and Welfare Committee. Stanek is theacting secretary of the Kansas Department of Health and Environment.
The same committee pressed Stanek on COVID-19 conspiracy theories at a January meeting. Some members contended the KDHE should be more careful about labeling COVID-19 vaccines as safe and effective.
Sen. Mark Steffen, R-Hutchinson, again raised the issue Wednesday.
"When it comes to the COVID shot ... we talked about the problem that KDHE was basically saying 'safe and effective, safe and effective, safe and effective' when we have a CDC VAERSreporting system that ties 20,000-plus deaths,and more complications, to these shots than all the other vaccines combined," he said."What have you done since we saw you last in regards to correcting that lack of a balanced approach to obtain true informed consent?"
Stanek said health officials were obtaining informed consent for vaccination.
"One thing we've done is revisited the ads, which were brought up by many of you, and we have removed the TV ads," Stanek said."We are making sure that in reviewing all of our ads that if we do have an advertisement or something that might mentiongetting thevaccine, that there is a link, and we are encouraging people to follow up with their doctor."
The Centers for Disease Control and Prevention report that COVID-19 vaccines are safe and effective. The vaccines do carry a risk of such common side effects as muscle pain.
Serious safety problems are rare, according to the CDC. Anaphylaxis, thrombosis withthrombocytopenia syndrome, myocarditis and pericarditis, andGuillain-Barr Syndrome are the four serious adverse events with evidence suggesting a link to vaccines.
"Reports of adverse events to VAERS following vaccination, including deaths, do not necessarily mean that a vaccine caused a health problem," the CDC states.
An autopsy found that a Topeka-area woman died last year of "anaphylaxis due to COVID-19 vaccination."
More: Kansas woman Jeanie Evans died of an allergic reaction to COVID-19 vaccine, autopsy shows
"The decision to stop the vaccine advertising, both digital and television, was made as daily cases were falling and we began to look at transitioning to steady state as it relates to COVID," KDHE spokesperson Matt Lara said in an email. "We stopped the advertising to allow us time to review what our next steps are and what messaging we still need to push out."
The health department continues to promote vaccination clinics statewide.
"Vaccines remain the best tool to protect people from COVID-19, slow transmission, and reduce the likelihood of new variants emerging," the agency said in a Wednesday news release.
Gov. Laura Kelly appointed Stanek to lead the state's health agency in November after ousting Lee Norman. She took over in their early days of the omicron surge.
"We've talked about educating citizens on early treatment of COVID," said Steffen, who has promoted the unproven off-label drugs ivermectin and hydroxychloroquine. "You've been in this interimpositionwhile cases skyrocketed. Did you do anything to help people understand what their early treatment options were ... any educating, any public service announcements in regards to early treatments?"
"NoPSAs," Stanek said. "Only referenceto CDC and AMA and other guidance about where they can learn more about those early treatments."
Steffen has taken issue with "federal government agencies making all our decisions for us." Hecontendedthat public health puts "the greater good over the individual" rights.
"Are you comfortable with the concept that individuals have to be sacrificed for the well-being of society?" he said."Like pushing vaccines so hard. You knew people were going to be injured, you knew people were being injured, and yet we didn't hear anything about that."
More: Kansas Republicans on mission to fulfill COVID special session promise with stronger legislation
Stanek said people should talk to their doctors and read CDC publications.
In January, Steffen called the KDHE vaccine ads morally and legally objectionable.
Sen. Mike Thompson, R-Shawnee, said the ads should have disclaimers about risks of adverse reactions.
"There's no effort by your agency to at least put a seed of doubt in people's mind," Thompson said, adding, "The perception is the vaccines are safe and effective," and he has "done a lot of research on this."
Jason Tidd is a statehouse reporter for the Topeka Capital-Journal. He can be reached by email at jtidd@gannett.com. Follow him on Twitter @Jason_Tidd.
Japanese drugmaker Shionogi & Co. said its experimental Covid-19 vaccine was found safe and effective in a study, creating an indigenous supply source for the Asian nation that is racing to complete a booster drive in hopes of curbing future outbreaks.
The recombinant protein-based vaccine that was being tested as a booster shot met its primary endpoint in the Phase 2/3 trials, Osaka-based Shionogi said in a statement Friday announcing the interim reports findings. There were no serious treatment-related adverse events, deaths or adverse events of special interest, it said.
COLUMBUS, Ohio (WCMH) In an effort to make COVID-19 vaccines more accessible, Equitas Health will deliver them directly to homebound residents in some central Ohio zip codes starting Friday.
The local nonprofit healthcare system will also provide residents with personal care items like laundry detergent, toilet paper, socks, blankets and toiletries from Friday to Sunday, according to a news release from the Franklin County Office on Aging.
Arranged by date, vaccines will be administered to Franklin County residents living in the following zip codes:
Friday, March 4
Saturday, March 5
Sunday, March 6
In order to receive a shot, residents in the selected areas must schedule an appointment at go.oncehub.com/HBMC or call the Franklin County Office on Aging at 614-525-5230.
As vice president and head of clinical trial experience at Pfizer, one of the most rewarding days for Judy Sewards was on May 10 of last year. It was the day the FDA granted emergency use authorization for the Pfizer-BioNTech Covid-19 vaccine to include adolescents 12 to 15 years old. It also happened to be her daughters 15th birthday.
It was such a wonderful day, Sewards recalled. My daughter said this is the best birthday present ever. They booked an appointment to get her vaccinated later that week and celebrated by taking selfies together. I was like alright, you gotta wait a month or so and then you can see people again. After that, our life changed so dramatically. I was happy to see her thriving again.
Indeed, it was a full-circle moment for Sewards, who played a critical role in the success of Pfizers Covid-19 vaccine clinical trial program. In her role, she led participant and site communications and engagement. Her days were spent ensuring Pfizer had strong relationships with the over 150 trial sites who conducted the Covid-19 vaccine clinical trials. She also helped build awareness about the clinical trials and worked with community, medical and government partners to highlight importance of participation in the trial by diverse communities and put in place new services to make clinical trial participation more convenient and comfortable for volunteers.
Know Your Value recently chatted with Sewards about getting through the pandemics darkest days and what she consequently learned about her leadership abilities. The conversation below has been edited for brevity and clarity:
Know Your Value: What has it been like for you and what has it meant for you to be working in life sciences at this particular time?
Sewards: Our purpose statement is breakthroughs that change patients lives, Over the 10 years I've worked at Pfizer, something that's always been in the backdrop for me is whatever work that we're doing, even though my arena is really around communications and experience, is that we're helping patients. But it really came into focus during the pandemic. It became so much more meaningful to me.
I felt like the world is counting on us. Society is counting on us. And whether this vaccine is successful or not, I have to do my part and do my very best in whatever I was bringing to the table during this time. There was a camaraderie, and a very shared focus amongst the team that was both emotional and in many ways just very personal as well.
Know Your Value: Speaking of the emotional and personal side of this all, you have your job, of course, but you were also juggling a lot at home with two teenagers. With the pandemic and working from home, how did that affect the lifesaving work that you do at Pfizer every day? Tell us a little bit about that experience.
Sewards: My stepdaughter was in her senior year of high school. She was applying to colleges and she had all the typical high school senior things to deal with. She also has Type 1 diabetes, and so we were especially careful and worried about her and her exposure to Covid.
At the time, I had a middle schooler going into high school, going through the high school application process in New York City. And my daughter is incredibly social. . .spending time with friends is important to her. And I think it was just very hard for her during the pandemic, because we had to keep her at home So, we operated as this very small bubble probably for a year. We did not see very many other people, aside from our immediate family. And I think that took a toll on both girls. For example, my little one had a hard time She was so used to a full schedule of soccer, friends, activities, events - all of these things. And now she was basically relegated to her room with her computer and her iPhone and having to take a COVID test before she saw her sister. For me, just seeing how both of their lives and their relationship had been impacted by this pandemic was motivation and as a mother, I was like, I'm working for you guys.
My parents were in Ohio. My dad had some lung issues. I hadn't been able to see mom and dad for a very long time, and I just felt like the work that we were doing both across the antiviral and the vaccine, was for them in many ways too. We were lucky enough to be reunited with them this year before my dad passed away. That was a very special time for us, and in looking back, will be a lifelong precious memory.
Know Your Value: What did you learn about yourself in that high pressure environment? And what did you learn about your leadership abilities?
Sewards: I really like high pressure situations and generally thrive in them. But I think the biggest learning for me was just pacing. The Covid vaccine project was and continues to be a marathon. It's not a sprint.
One thing I learned is how critical it is to set a bold goal and then prepare really well. You need to have a really great plan, but then also to create the space and be flexible enough to adapt, be creative and reprioritize based on what the science is telling us. Ultimately, to ensure that we get to the finish line and do so in the right way.
This lesson also extended into my personal life, and my whole orientation also changed. Living in New York, I thought my life was so full. I would go to work at 7:30 a.m. and have a very busy day. Go out four or five nights a week. Everything was a sprint. My daughter was very scheduled, and there were always lots of events or activities. And the pandemic took all of that away. But it created a really nice space to actually recreate. I got the chance and the space to think about my life in a way where I could focus on the things that were really important.
It gave me space to say, "who are the important people in my life? How do I want to spend my time? How do I want to be a mother? A wife? A daughter? A friend?"
I reprioritized and also reflected. I talked to my parents much more. I made space to regularly connect with the people who were closest to me. I got a chance to really get to know the young woman my daughter was growing into. It definitely just brought my life more into focus and made it more enriching in the way that it shouldve been.
Know Your Value: There are some incredible women in leadership at Pfizer. How do you feel like the company supports you and how do you support one another? And on the flip side of that, how do you support other women in their careers?
Sewards: Pfizer is an amazing place for working women. I'm grateful for the extensive resources offered to us, the flexibility and the respect for home-life balance. And they are committed to ensuring that women are in leadership positions and advocated for.
During the pandemic, there was even more emphasis and an acknowledgement that everybody's home life is different and your home responsibilities and work responsibilities may be in conflict or blurred. I think Pfizer did a lot to offer many different services and to be very flexible on defining what working from home means I personally felt super supported.
The majority of my team and folks I work with day-to-day are women who have children at home. I think before we were in the pandemic work environment, we've may have talked about our kids and our home life, but it was very peripheral in many ways.
During the pandemic, however, I gained an appreciation and I think we all gained appreciation for each others situation as working mothers and actively supported one another through it. For example, my coworker Sarah and I have WebEx's just about every day. Simply because of the blurring of work and home time and space, I gained a greater appreciation for what she was juggling as we were going through this journey together. At times, shed have her young daughter right next to her doing remote learning. And my daughter at the same time might be asking, "I need help with this homework thing" all while we were having meetings and getting work done.
At the end of the day, because it all had to get done and we were all in this compressed space, it created an environment where we were all able to accommodate and support each other both as colleagues and as mothers. And thats a huge positive that has come out of this. In fact, many of us who worked closely together during the pandemic created this unique tribe that has now thrived passed the most critical periods. Having such shared purpose really brings you closer together.
Janet Handal was feeling optimistic when she booked her flight to Texas in early 2021. The 71-year-old New York City resident had just scheduled her first COVID-19 vaccine appointment amid news that the mRNA vaccines available in the U.S. were highly effective. She carefully counted the days until she would be safe to travel, eager to see family for the first time in over 18 months.
But that optimism was short-lived.
A blood sample taken a month after her second shot revealed that Handal had developed nearly no antibodies against COVID-19. The two vaccine doses being recommended for mRNA shots didnt confer the same robust immunity as they had for tens of thousands of vaccine trial participants. Thats because she has been on immune-suppressing drugs due to a kidney transplant she received in 2010.
It was really a punch to the gut, she says. I never imagined that I was not going to be protected [in the same way].
Handal is among the estimated 10 million people in the U.S. with a compromised immune system. Unlike everyone else, they mount a much weaker immune response to several vaccines. But when pharmaceutical companies first began testing COVID-19 vaccines in 2020 and 2021, the clinical trials excluded immunocompromised individuals and issued the same vaccination recommendations for them without conducting separate trials.
When a new vaccine comes out, the recommendation for an immunocompromised patient is the same as that for everyone else, says Deepali Kumar, a transplant infectious diseases physician at the University of Toronto. It isnt until later that those recommendations are adjusted, in part because the burden of providing data for immunocompromised individuals falls on the shoulders of independent scientists, not the vaccine makers, and it can take months to years to conduct the studies. Its a long-standing issue, she says.
Even now it remains unclear whether more vaccine doses will help protect the severely immunocompromised. The U.S. Food and Drug Administration authorized a third dose in August 2021 for certain immunocompromised people. Some transplant recipients have since been vaccinated with a fourth shot and a smaller subset have secured a fifth dose. But Kumar says more may not always be better, and additional studies are needed to prove that further doses are effective.
The irony is that the third dose may not have been authorized if not for people like Handal taking matters into their own hands.
Without robust protection from two shots, Handal knew her weak immune system meant greater chances of severe disease or death from exposure to the SARS-CoV-2 virus. So she and some others like her got a third COVID-19 shotwell before the FDA authorized its use. But not all immunocompromised people did, making things tricky in May 2021 as the Centers for Disease Control and Prevention was saying no masks for the fully vaccinated.
I know three people myself who were transplant recipients whove died because they listened to the message of take your masks off, Handal says. Many, many, many, of us just decided we were going to get our [additional] vaccines early because we knew we werent protected.
When our bodies receive a COVID-19 shot, the immune system springs into action. It stimulates the production of antibodieswhich can bind to the virus and prevent it from infecting cells. It also activates specialized immune cells called T cells, as well as memory cells that remember how to respond when a COVID-19 infection occurs.
But those immune responses are blunted in immunocompromised people, including those taking immunosuppressive drugs for autoimmune diseases, organ transplants, cancers, HIV infections, and other conditions.
When a transplant patient receives an organ from another human, their immune system sees it as foreign and immediately tries to reject it. To counter these attacks doctors use immunosuppressants to dial down the activity of the patients immune system and stop it from attacking the new organ. Its always this really careful balance in leaving some of the immune system intact, obviously, and wanting to leave it suppressed enough so it doesnt cause harm, says Dorry Sergev, a transplant surgeon at Johns Hopkins University. But it also reduces the ability to respond to the vaccine.
Several studies have suggested that two shots of an mRNA vaccine were grossly inadequate for several immunocompromised individuals, particularly kidney transplant recipients. One study published in May 2021 found that 46 percent of 658 kidney, lung, liver, and heart transplant individuals in the U.S. had no antibody response after receiving one or two doses of the mRNA vaccines. Compared to everyone else, transplant patients vaccinated with two doses had an 82-fold higher risk of breakthrough infections and 485-fold increased risk of hospitalization or dying.
Following a third shot, one study found that 77 out of 197 people with kidney transplants developed COVID-19-specific antibodies after producing none from two doses. In another study, 26 out of 60 organ transplant recipients who were given the third dose produced antibodies at levels nearly equivalent to those seen in people with healthy immune systems whod gotten two doses.
But for some immunocompromised people, such as those who are older or taking certain immunosuppression drugs or high doses of it, even the third or fourth vaccine dose has proven limited.
I have two patients whove had the fourth dose critically ill with COVID-19 because they didnt mount a sufficient antibody response even with the fourth dose, says Ayelet Grupper, a nephrologist at Israels Tel Aviv Medical Center. And its getting more complicatedIm not sure what level of antibodies are needed to fight against Omicron and new variants that might come.
Sergev has been measuring post-vaccination antibody responses among organ transplant recipients, including Handal, since last year. While her blood work indicated an increase in antibody levels following a third dose in April 2021, the response was still weak compared to that seen in people with healthy immune systems.
So in October 2021six months after her third doseHandal got a fourth. Some of Sergevs patients still didnt mount a robust immune response and needed a fifth shot. In a recent study, he recorded an increase in antibodies at dose five among some patients who didnt have a sufficient response at four. There are people out there who need two doses, there are people out there who need five doses, and there people in between, Sergev says.
But, theoretically, too many doses of the same vaccine could create a problem of tolerance, he says, meaning a potential lukewarm immune response following multiple vaccine doses. Your body can say, I know this vaccine, I dont need to do anything.
Feeling unprotected, several of his patients have lived far more isolated lives during the pandemic than everyone else. Essentially youve been living under house arrest, Handal says. You havent been able to participate in your familys lives or be with your friends. Getting additional shots hasnt been easy either. It created dissonance for almost everyone who chose to do it, Handal says, especially if the shots were not yet officially authorized by the CDC and FDA.
We are building the plane as we fly it, Sergev says, and weve been doing that through the entire pandemic.
Scientists are conducting clinical trials and are exploring alternative strategies to boost the immune response for the immunocompromised.
Sergev, for instance, is leading a randomized clinical trial involving kidney and liver transplant recipients who have failed to produce antibodies after two, three, or four mRNA vaccine doses and giving them an additional dose. In some participants hes also reducing their immunosuppressive medication one week before and two weeks after giving them the additional COVID-19 shot to see if such an adjustment improves the immune response, similar to what researchers have observed in people with autoimmune diseases.
At the University of California, Davis, Transplant Center, Aileen Wang is leading a similar clinical trial specifically with kidney transplant recipients for whom the second or third mRNA vaccine doses werent adequate. Before and after giving an additional shot, she and her colleagues plan to halve the dose of one immunosuppressive drug called mycophenolate, which prevents the recipients body from rejecting a transplant organ.
Grupper, who isnt involved in these studies, feels the research will be informative. But she emphasizes the delicate balance between increasing a transplant recipients immune response to the vaccine while still preventing organ rejection. Monitoring clinical trial participants health closely is key, she says.
As this work continues and researchers recruit more participants, transplant recipients may have to wait at least another three months, if not more, to find out if Sergev, Wang, and their colleagues approach is successful.
In the meantime, as COVID-19 continues to be a serious risk for many immunocompromised individuals, theyre also struggling to access Evusheldthe only monoclonal antibody authorized for prevention of COVID-19 in people who cant take the vaccine due to a severe allergy or an immunocompromised condition. The intramuscular injection must be given once every six months while the virus circulates, and supplies are extremely limited. Last week the FDA revised its initial dosing regimen in light of Omicron to a higher dose.
People have driven hours, sometimes eight to 10 hours, to get the injection, Handal says. Alongside finding ways to access additional vaccine doses, were also strategizing about how to get Evusheld.
With several states rolling back masking mandates and pushing for a return to normalcy, Handal and others remain frustrated. We know were not safe, she says, and there isnt adequate treatment if you get sick. Shes planning on getting her fifth dose very soon.
Mar 02, 2022 12:00 AM
Author: University of Utah Health Communications
The virus that causes COVID-19 impacts everyone differently. Most people will experience mild to moderate symptoms, or possibly no symptoms at all. But a large population is more vulnerable than most, and the outcome of infection can be quite devastating.
Older adults, people with chronic illness, people who are immunocompromised, and people with disabilities are most at risk of getting severely sick with COVID-19. They also have a higher risk of becoming hospitalized or dying from the virus. While COVID-19 vaccines help protect the vast majority of people, they may not work as well for these groups.
Immunocompromised patients have some deficit to their immune system, either because they are taking medication that compromises the immune system or because they have an innate condition. These patients are at higher risk of not responding to the vaccine, says Hannah Imlay, MD, an infectious diseases physician who takes care of immunocompromised patients at University of Utah Health. You need an immune system to help with that, and many of these patients have some deficit.
While these groups may not generate a good response to the vaccines or experience a higher rate of breakthrough symptomatic infection, COVID-19 vaccines still offer some protection against the virus. COVID-19 vaccines help decrease disease severity and death. This is why the vaccines are highly recommended for these groups.
Early in the pandemic, it was recognized that immunocompromised patients specifically those with organ transplants, cancer chemotherapy, stem cell transplants, and autoimmune conditionsdid not respond as well to the primary two-dose vaccine series as other people. In order to receive a good level of protection, a third dose is now recommended and part of the initial primary series.
Immunocompromised patients have a higher risk with any vaccine strategy," Imlay says. Whether its two, three, or four doses, we cant change that. What we can do is try and change the vaccine strategy to make immunity as good as possible.
A fourth dose, the booster shot, is also recommended three months following the initial three-dose vaccine series for immunocompromised patients. At this time, anyone age 12 years and older are eligible to receive a booster shot.
Preventive medications for COVID-19 are available for immunocompromised patients. Pre-exposure prophylaxis can help prevent a patient from getting SARS-CoV-2 before theyve been exposed to the virus. Evusheld, a monoclonal antibody therapy, was recently authorized by the FDA and has shown to prevent patients from getting symptomatic COVID-19 infection. Evusheld is really targeted at people who dont get much protection from vaccination, Imlay says.
Other early COVID-19 therapies are available for immunocompromised patients. Pfizers paxlovid antiviral pill and the Sotrovimab antibody infusion are COVID-19 treatments for certain patients whove been infected with the virus.
Getting fully vaccinated is the best and easiest thing you can do to protect vulnerable groups. Wearing a well-fitted face mask will also help stop transmission of any respiratory infections circulating in the community.
These are physicians, students, teachers, children, and people that work in the community just like everybody else, Imlay says. Its a population that needs to be protected and needs to be protected by the rest of our actions.
Its especially important for immunocompromised people to invest in high filtration face masks, such as an N95, especially when out in public or in an indoor setting. According to Imlay, fit, filtration, and comfort are the most important elements to an N95 mask.
Covid-19 case counts are falling in the United States and many parts of the country are starting to relax.
Cities like Washington, DC, and New York are lifting vaccine mandates for many public indoor spaces. National public health officials are easing up, too. The Centers for Disease Control and Prevention now advises that communities with low levels of transmission can forgo universal masking.
As spring draws near, is it finally time to feel hopeful? Is it possible the worst of the pandemic is behind us?
The US public seems to think so. A March 1 poll from the Kaiser Family Foundation found that majorities across the political spectrum think the darkest days of Covid-19 are over.
However, weve been fooled before. Over the past two years, wishful thinking has proved nave time and time again. Initial hopes that the vaccines would be a ticket to freedom were dashed by waning immunity and the emergence of more contagious variants. How much further the virus will evolve from here is impossible to predict.
Many of us just dont know what to think about the future. How will we know when things are really getting better? Is there still the chance that things will get worse?
In our search for clarity, we turned to eight experts in public health, virology, infectious disease ecology, medical anthropology, and medical history with a simple question: Is the worst of the pandemic over, and if not, how will we know when it is?
We heard a lot of measured optimism, but also uncertainty. While the pandemic situation might be easing in the United States and other countries, much of the world still remains unvaccinated and highly vulnerable. And the unpredictability of both viral evolution and human behavior means we need a healthy dose of humility as we move into the future, the experts told us. Brighter days are likely ahead, but the unknowns continue to cloud a clear view of the future.
Overall, most of the experts said, with some reservations, that in the US and much of Europe, the most destructive waves of Covid-19 are in the rearview mirror.
I am hopeful that the worst of the pandemic is now behind us, said Dr. Megan Ranney, an epidemiologist and physician at Brown Universitys School of Public Health.
Her optimism stems from a variety of factors, chief among them the widespread immunity in the US, whether acquired through vaccination or infection.
In addition to immunity, there are new, effective Covid-19 treatments available like monoclonal antibodies and antiviral drugs which can help infected people avoid hospitalizations and death. Also, the broader availability of high-quality masks and air filters and a better understanding of ventilation, social distancing, and other mitigation strategies puts us in a better position to reduce transmission than we were earlier in the pandemic.
And even though immunity wanes over time, protection against the most severe disease and death will remain for quite a long time, Dr. A. Marm Kilpatrick, an infectious disease researcher at the University of California Santa Cruz, writes in an email, citing CDC data. So people may continue to get infected with SARS-CoV-2, but the worst outcomes might be largely behind us.
Everyone we spoke with even the optimists said the threat of new variants is still very real. Just as the infectiousness of delta and omicron caught researchers by surprise, new variants may evolve and cause us to reset our expectations for the future.
I just dont like to underestimate the virus, Dr. Kari Debbink, a virologist and immunologist at Johns Hopkins, said.
Theres been some hopeful speculation that perhaps, in the future, the virus will evolve to become less deadly. However, thats not a rule: It is not an iron law of virology that newer variants are necessarily weaker or less virulent than a prior variant, said Dr. Nirav Shah, Maines chief epidemiologist and president of the Association of State and Territorial Health Officials. It can absolutely go the opposite direction.
Variants are more likely to emerge in parts of the world where vaccination rates are lowest; the more infections that occur, the more chances the virus has to replicate and change. Thats why its so important to vaccinate as many people as possible against the virus.
But momentum might be stalling. Shah said that while raising vaccination rates in India and sub-Saharan Africa would reduce the risk that a new variant of concern would emerge, the appetite for vaccines in these regions varies. There are also supply chain hurdles and personnel shortages hampering the effort to reach the most remote and most vulnerable people.
The best we can do to prepare for new variants is to be on the lookout for them.
The most concrete way to identify variants of concern is through genomic surveillance, regularly scanning virus samples from infected people for mutations. But the US still has a patchwork system for finding variants, according to Dr. Shweta Bansal, an infectious disease ecologist at Georgetown University. As a consequence, new variants arising in the US may not be found right away.
However, other trends can signal that a concerning new variant is taking hold. If scores of previously vaccinated or infected people start to get sick, it could suggest a variant has developed that can evade the immune response. Scientists will be closely monitoring changes in case numbers, hospitalizations, or excess deaths in the US or in other countries.
Public responses to policy are another important determinant in the future of the pandemic. Weve learned a ton in terms of behavior, and how people tend to kind of react to policies of controlling viruses, said Bansal.
But its unclear that the institutions responsible for crafting policy and messaging are equipped to overcome social divisions that have hampered widespread preventive efforts. Were obviously not having a great discussion about civic values and responsibility, and I thought we would by this point, said Dr. Sarah Cobey, a University of Chicago infectious disease researcher and modeler.
On the other hand, the Covid-19 pandemic created dozens of natural social science experiments as states and cities deployed different tactics. Thats given researchers real-world feedback on what kinds of messages and policies motivate people to use preventive measures like social distancing and mask-wearing, pointing the way toward more effective public health strategies.
With transmission now receding throughout the US, policymakers are now taking off-ramps from intense preventive measures, loosening mask requirements, vaccination mandates, and restrictions on gatherings. But weve seen that movie before, said Bansal, and the virus has a way of roaring back.
We really should be taking advantage of this hiatus to build up our preparedness capacity, she said.
Others agreed that the best way to avoid another disastrous transmission surge is to get ready for it but theyre not convinced were doing that effectively: Im fearful that the country wants to be done with Covid-19 and thus, many of the things that we need to do to prepare for the next wave are not being done, said Shah. He would like to see broader use of wastewater testing as an early warning system, and assurance that our rapid test and PPE supply chains are robust and responsive to transmission surges.
Ranney agreed that improving preparedness was critical to ensuring the worst is behind us, and that ensuring good systems for early outbreak detection are key. Improving global and local vaccination rates, developing and scaling up access to Covid-19 treatments, and getting community buy-in around preventive measures are also important, she said.
When we asked experts is the worst over? some responded with a question of their own: For whom?
Even as the peak of the pandemic crisis fades into the rearview mirror for some, others generally those already marginalized by poor access to healthcare and other vulnerabilities will still be living with its worst effects.
The pandemic being mostly over for me might not mean that its over for somebody else, said Debbink. She worries that declaring the worst is over kind of allows people to disregard those who are still at great risk. That includes immunocompromised people and those living in parts of the world with limited vaccine access. There are millions and millions of people that dont even have access to a vaccine yet, she said and the worst might still be to come for them.
Plus, she said, we dont really know the long-term toll that long Covid symptoms will continue to take on people. With each person that gets infected, you still have this huge group of people that may suffer long-term impacts, she said. For them, the worst might not be over, but just beginning. At this point, we have no idea if long Covid symptoms are going to be permanent.
The global view is particularly sobering. The US has high levels of infections and vaccinations, but are probably yet to see their most damaging waves, or would require ongoing harsh restrictions to delay surges of transmission, Dr. Adam Kucharski, an infectious disease epidemiologist at the London School of Hygiene & Tropical Medicine, wrote in an email.
The SARS-CoV-2 virus will likely cause human disease well into the future, and in that sense, it may yet do more damage than it has already done. But because those effects will be distributed over a longer period of time, we may not perceive them to be as severe as the waves of hospitalization and death we have experienced over the past two years. I think were going to be living with it for a very, very long time so in that sense, the worst isnt behind us, Cobey said.
The worst of the pandemic is probably behind us in the US. But the virus is still infecting, hospitalizing, and killing people. How much longer that will continue has to do with variables that are hard to predict right now: the duration of immunity over the course of years, and risks even further afield, like the chances of a new variant emerging from wildlife like deer.
Because sanguine pandemic predictions have so often been proved terribly wrong, few of our experts were willing to forecast sunny skies without qualification. Historically, though, we know that all pandemics eventually end, and this one will as well, said Dr. J. Alexander Navarro, assistant director of the Center for the History of Medicine at the University of Michigan. That day is likely sooner rather than later, but we will have to see what the future has in store for us.
And we may not even recognize the end of the pandemic as we pass it. Instead, it may require some historical distance before we can look back and find a point that may have been an exit. There will not be a particular day or week or month when we wake up and say Im sure glad thats over, said Dr. Maureen Miller, a medical anthropologist at Columbia University. Even the pandemic end date, like everything else Covid-19, will likely be the subject of heated debate.
