http://www.theatlantic.com/health/archive/2022/04/covid-vaccine-is-effective-immunocompromised/629596/
Its Just Scaring People, and Its Not Saving Lives
Stories about the pandemics continuing risks for immunocompromised
people may create unintended harms.
By Benjamin Mazer
A photo of someone in a mask, looking out a window
Igor Alecsander / Getty
APRIL 19, 2022
SHARE
As the United States nears its numbing, millionth COVID death and shrugs
its shoulders at a rise in cases, some Americans are feeling left
behind. Immunocompromised people have suffered disproportionately
throughout the pandemic, and even those who have been fully vaccinated
wonder if theyre really safe. News stories highlight their struggles to >adapt to a society that doesnt seem to care whether they survive. I
could just go outside and within two weeks, I could be dead, a
fibromyalgia sufferer told ABC News last month. She went on to say, It
kind of feels like immunocompromised people are getting sacrificed.
This dramatic coverage underscores the continuing risks of the pandemic, >especially for those who are most vulnerable: Immunocompromised people
who get vaccinated arent quite as safe as the general vaccinated
population. (The degree of added risk depends on the underlying
condition.) But well-intentioned stories on this issue sometimes
overstate the case, claiming that COVID shots for the immunocompromised
are ineffective or cannot work on everyone. That is incorrect, and
it hinders uptake of vaccines. The shots do provide these patients with
very meaningful protection as a rule, Jennifer Nuzzo, the director of
the Pandemic Center at Brown University School of Public Health, told
me. To suggest otherwise is just a complete distortion Its just
scaring people, and its not saving lives.
When the mRNA vaccines finally arrived, at the end of 2020, their value
for immunocompromised people remained unclear. Members of this high-risk >group were specifically excluded from the first trials performed by
Pfizer and Moderna. Patients and their doctors had only scientific
scraps to guide them in the months that followed: small, preliminary
studies that recorded antibody levels after shots. The initial results >werent promising at all. One study found that just 54 percent of >organ-transplant patients, who require the most powerful
immune-dampening drugs, had detectable antibodies after two vaccine
doses; and when present, these protective proteins accumulated in much
lower quantities than were observed in the general population. Some
astute patients had their own antibody levels measured and declared >themselves vaccinated but not protected when the results came up short.
Sure enough, when Omicron arrived last fall, immunocompromised people
were hit the hardest. A study conducted by Kaiser Permanente in
California showed that immunocompromised patients who had received three >Moderna doses were just 29 percent protected from Omicron infectionas >compared with the 71 percent protection afforded others. Some patients >antibody levels can still be low after three, four, or even five vaccine >doses. (Three primary doses and two boosters are now recommended for
this population.)
Yet theres a silver lining. Antibodies matter, but they matter most for >preventing illness, at any level of severity. Regarding the most
dangerous outcomes from disease, recent research from the CDC indicates >thatshot for shotthe immunocompromised achieve most of the same
benefits as healthy people. One study, published in March, looked at the >pandemics Delta wave and found that three doses of an mRNA vaccine gave >immunocompromised people 87 percent protection against hospitalization, >compared with 97 percent for others. Another CDC report, also out last
month, suggested that on the very worst outcomesthe need for a
breathing tube, or deathmRNA vaccines were 74 percent effective for >immunocompromised patients (including many who hadnt gotten all their >shots), and 92 percent effective for the immunocompetent. A >10-to-20-percentage-point gap in safety from the most dire outcomes is >consequential, especially for those who are most susceptible to the
disease. Still, these results should reassure us that the
immunocompromised are not fighting this battle unarmed.
That reassurance means all the more when so many members of the >chronic-disease community feel left for dead by the casual reversals of >pandemic funding and restrictions. But in place of measured consolation
from the experts, they find offhanded comments saying that the vaccines >dont work for them (as one public-health-school dean tweeted earlier
this month). This despairing rhetoric cant be helping to encourage >vaccination. The CDC hasnt published data on what proportion of the >immunocompromised remain unvaccinated or undervaccinated, but one survey
of 21,000 autoimmune patients taking immunosuppressive medications,
conducted by a network of rheumatology clinics, found that, as of last >September, one in four hadnt received any shots. Several clinicians
involved with this population told me that, even now, many patients are >unvaccinated.
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When Anne Mills, a physician in Virginia with rheumatoid arthritis, went >public with her inoculation experience last year, she hoped to reassure
her friends in the autoimmune community that the shots are safe and >effective. Were still looking at very high response rates and very
robust protection against severe disease, she told me. Now that her
entire family is vaccinated, Mills feels better able to mentally >compartmentalize her condition, and she is working and traveling again
while maintaining some precautions. But she worries that many >immunocompromised people have gotten the message that vaccination isnt
worth it.
Michael Putman, a rheumatologist at the Medical College of Wisconsin who >cares for many patients receiving immunosuppressive medications for >autoimmune diseases, confirms that its a battle to get his patients >inoculated. The idea that the vaccines dont work for immunocompromised >people has definitely contributed to hesitancy, he told me. Many
autoimmune sufferers worry that the shots might lead to a flare-up of
their disease symptoms. Some of Putmans patients have decided not to
take that risk after reading news stories suggesting that the injections >wouldnt help them much anyway. Ironically, patients with rheumatologic >conditions, like Putmans, are generally among the most protected within
the immunocompromised cohort, as measured both by antibody production
and clinical outcomes.
A large CDC analysis of two-dose vaccine regimens within the >immunocompromised population found that rheumatologic patients saw an 81 >percent decrease in their risk of COVID hospitalization. Next came >solid-cancer patients (79 percent protection), blood-cancer patients (74 >percent), and those born with immune deficiencies (73 percent). >Organ-transplant recipients were the least safe from COVID after
vaccination, with just 59 percent of their hospitalizations prevented
after two doses. Robert Rakita, a transplant-infectious-disease
specialist at the University of Washington, told me that some of his
patients have died from COVID despite having had three or four mRNA >injections. He recommends that all vaccinated organ recipients continue
to wear a mask and avoid crowded indoor activities. But such patients
make up just 8 percent of the 7 million Americans estimated to be taking >medications that weaken their immune system. When COVID reporting
casually lumps together all immunocompromised patients, it papers over >these differences. Readers are left to think that a fibromyalgia patient
and a kidney recipient face similar risks.
For chronically ill people, political power derives in part from group >solidarity; the larger the contingent, the louder the voice. Yet in
pursuit of visibility and justice, the vaccinated but vulnerable
category may be expanded well beyond what the science suggests, to
include not only organ-transplant patients, but also people with
diabetes, asthma, obesity, or high blood pressure. According to this >paradoxical arithmetic, half of the country can end up in the high
risk category by some definition. In truth, we all remain vulnerable to >COVID; inoculation isnt 100 percent effective in any demographic. The
threat of long COVID also lingers. But the peril is far more
concentrated than generic references to chronic conditions or >comorbidities would suggest. Age continues to be, far and away, the
most powerful risk factor for becoming seriously ill from the
coronavirus. Putman, the rheumatologist, uses an example of a
64-year-old doctor counseling a 24-year-old autoimmune patient to take >precautions. The patient should probably be admonishing the doctor
instead, he told me.
When the vaccine campaign began, with shots for the oldest Americans in >nursing homes and elsewhere, news coverage emphasized seniors feelings
of joy and relief. But the immunocompromised have been described in very >different terms, even as vaccines are saving their lives too. Stories
focus on their uncertainty and fearand may end up adding to the same.
Benjamin Mazer is a physician specializing in laboratory medicine.
Michael Ejercito wrote:
http://www.theatlantic.com/health/archive/2022/04/covid-vaccine-is-effective-immunocompromised/629596/
shrugs‘It’s Just Scaring People, and It’s Not Saving Lives’
Stories about the pandemic’s continuing risks for immunocompromised >people may create unintended harms.
By Benjamin Mazer
A photo of someone in a mask, looking out a window
Igor Alecsander / Getty
APRIL 19, 2022
SHARE
As the United States nears its numbing, millionth COVID death and
struggles toits shoulders at a rise in cases, some Americans are feeling left
behind. Immunocompromised people have suffered disproportionately >throughout the pandemic, and even those who have been fully vaccinated >wonder if they’re really safe. News stories highlight their
pandemic,adapt to a society that “doesn’t seem to care whether they survive.” “I
could just go outside and within two weeks, I could be dead,” a >fibromyalgia sufferer told ABC News last month. She went on to say, “It >kind of feels like immunocompromised people are getting sacrificed.”
This dramatic coverage underscores the continuing risks of the
high-riskespecially for those who are most vulnerable: Immunocompromised people
who get vaccinated aren’t quite as safe as the general vaccinated >population. (The degree of added risk depends on the underlying >condition.) But well-intentioned stories on this issue sometimes
overstate the case, claiming that COVID shots for the immunocompromised >are “ineffective” or “cannot work on everyone.” That is incorrect, and
it hinders uptake of vaccines. The shots do provide these patients with >very meaningful protection as a rule, Jennifer Nuzzo, the director of
the Pandemic Center at Brown University School of Public Health, told
me. To suggest otherwise “is just a complete distortion … It’s just >scaring people, and it’s not saving lives.”
When the mRNA vaccines finally arrived, at the end of 2020, their value >for immunocompromised people remained unclear. Members of this
short.group were specifically excluded from the first trials performed by
Pfizer and Moderna. Patients and their doctors had only scientific
scraps to guide them in the months that followed: small, preliminary >studies that recorded antibody levels after shots. The initial results >weren’t promising at all. One study found that just 54 percent of >organ-transplant patients, who require the most powerful
immune-dampening drugs, had detectable antibodies after two vaccine
doses; and when present, these protective proteins accumulated in much >lower quantities than were observed in the general population. Some
astute patients had their own antibody levels measured and declared >themselves “vaccinated but not protected” when the results came up
threeSure enough, when Omicron arrived last fall, immunocompromised people
were hit the hardest. A study conducted by Kaiser Permanente in
California showed that immunocompromised patients who had received
vaccineModerna doses were just 29 percent protected from Omicron infection—as >compared with the 71 percent protection afforded others. Some patients’ >antibody levels can still be low after three, four, or even five
fordoses. (Three primary doses and two boosters are now recommended for
this population.)
Yet there’s a silver lining. Antibodies matter, but they matter most
thepreventing illness, at any level of severity. Regarding the most
dangerous outcomes from disease, recent research from the CDC indicates >that—shot for shot—the immunocompromised achieve most of the same >benefits as healthy people. One study, published in March, looked at
gavepandemic’s Delta wave and found that three doses of an mRNA vaccine
immunocompromised people 87 percent protection against hospitalization, >compared with 97 percent for others. Another CDC report, also out last >month, suggested that on the very worst outcomes—the need for a >breathing tube, or death—mRNA vaccines were 74 percent effective for >immunocompromised patients (including many who hadn’t gotten all their >shots), and 92 percent effective for the immunocompetent. A >10-to-20-percentage-point gap in safety from the most dire outcomes is >consequential, especially for those who are most susceptible to the >disease. Still, these results should reassure us that the >immunocompromised are not fighting this battle unarmed.
surveyThat reassurance means all the more when so many members of the >chronic-disease community feel left for dead by the casual reversals of >pandemic funding and restrictions. But in place of measured consolation >from the experts, they find offhanded comments saying that the vaccines >“don’t work” for them (as one public-health-school dean tweeted earlier
this month). This despairing rhetoric can’t be helping to encourage >vaccination. The CDC hasn’t published data on what proportion of the >immunocompromised remain unvaccinated or undervaccinated, but one
wentof 21,000 autoimmune patients taking immunosuppressive medications, >conducted by a network of rheumatology clinics, found that, as of last >September, one in four hadn’t received any shots. Several clinicians >involved with this population told me that, even now, many patients are >unvaccinated.
RECOMMENDED READING
Bales of hay dressed up to look like a bride and groom
The Pre-wedding Parties Where Couples Charge Admission
JULIE BOGEN
An excavation of human remains
An Ancient Case of the Plague Could Rewrite History
SARAH ZHANG
The Way American Parents Think About Chores Is Bizarre
JOE PINSKER
Read: America is zooming through the pandemic panic-neglect cycle
When Anne Mills, a physician in Virginia with rheumatoid arthritis,
whopublic with her inoculation experience last year, she hoped to reassure >her friends in the autoimmune community that the shots are safe and >effective. “We’re still looking at very high response rates and very >robust protection against severe disease,” she told me. Now that her >entire family is vaccinated, Mills feels better able to mentally >compartmentalize her condition, and she is working and traveling again >while maintaining some precautions. But she worries that many >immunocompromised people have gotten the message that vaccination isn’t >worth it.
Michael Putman, a rheumatologist at the Medical College of Wisconsin
immunocompromisedcares for many patients receiving immunosuppressive medications for >autoimmune diseases, confirms that it’s a battle to get his patients >inoculated. “The idea that the vaccines don’t work for
injectionspeople has definitely contributed to hesitancy,” he told me. Many >autoimmune sufferers worry that the shots might lead to a flare-up of >their disease symptoms. Some of Putman’s patients have decided not to >take that risk after reading news stories suggesting that the
withinwouldn’t help them much anyway. Ironically, patients with rheumatologic >conditions, like Putman’s, are generally among the most protected
the immunocompromised cohort, as measured both by antibody production
and clinical outcomes.
an 81A large CDC analysis of two-dose vaccine regimens within the >immunocompromised population found that rheumatologic patients saw
(74percent decrease in their risk of COVID hospitalization. Next came >solid-cancer patients (79 percent protection), blood-cancer patients
takingpercent), and those born with immune deficiencies (73 percent). >Organ-transplant recipients were the least safe from COVID after >vaccination, with just 59 percent of their hospitalizations prevented >after two doses. Robert Rakita, a transplant-infectious-disease
specialist at the University of Washington, told me that some of his >patients have died from COVID despite having had three or four mRNA >injections. He recommends that all vaccinated organ recipients continue
to wear a mask and avoid crowded indoor activities. But such patients
make up just 8 percent of the 7 million Americans estimated to be
overmedications that weaken their immune system. When COVID reporting
casually lumps together all “immunocompromised” patients, it papers
patientthese differences. Readers are left to think that a fibromyalgia
vulnerable toand a kidney recipient face similar risks.
For chronically ill people, political power derives in part from group >solidarity; the larger the contingent, the louder the voice. Yet in >pursuit of visibility and justice, the “vaccinated but vulnerable” >category may be expanded well beyond what the science suggests, to
include not only organ-transplant patients, but also people with
diabetes, asthma, obesity, or high blood pressure. According to this >paradoxical arithmetic, half of the country can end up in the “high >risk” category by some definition. In truth, we all remain
veryCOVID; inoculation isn’t 100 percent effective in any demographic. The >threat of long COVID also lingers. But the peril is far more
concentrated than generic references to “chronic conditions” or >“comorbidities” would suggest. Age continues to be, far and away, the >most powerful risk factor for becoming seriously ill from the
coronavirus. Putman, the rheumatologist, uses an example of a
64-year-old doctor counseling a 24-year-old autoimmune patient to take >precautions. The patient should probably be admonishing the doctor >instead, he told me.
When the vaccine campaign began, with shots for the oldest Americans in >nursing homes and elsewhere, news coverage emphasized seniors’ feelings >of joy and relief. But the immunocompromised have been described in
different terms, even as vaccines are saving their lives too. Stories >focus on their uncertainty and fear—and may end up adding to the same.
Benjamin Mazer is a physician specializing in laboratory medicine.The only *healthy* way to stop the pandemic, thereby saving lives, in
the U.S. & elsewhere is by rapidly ( http://bit.ly/RapidTestCOVID-19 ) finding out at any given moment, including even while on-line, who
among us are unwittingly contagious (i.e pre-symptomatic or
asymptomatic) in order to http://tinyurl.com/ConvinceItForward (John
15:12) for them to call their doctor and self-quarantine per their
doctor in hopes of stopping this pandemic. Thus, we're hoping for the
best while preparing for the worse-case scenario of the Alpha lineage mutations and others like the Omicron, Gamma, Beta, Epsilon, Iota,
Lambda, Mu & Delta lineage mutations combining via
slip-RNA-replication to form hybrids like
http://tinyurl.com/Deltamicron that may render current COVID vaccines/monoclonals/medicines/pills no longer effective.
Indeed, I am wonderfully hungry ( http://tinyurl.com/RapidOmicronTest
) and hope you, Michael, also have a healthy appetite too.
So how are you ?
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