Booster plans raise confusion; young children spread COVID

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Amber Dance | Courtesy Photo

LGBTQ adults embrace vaccines

A new survey by the Human Rights Campaign Foundation illuminates the state of COVID-19 vaccinations among LGBTQ individuals, filling in gaps where states’ and the nation’s lack of data collection had left them somewhat invisible. The LGBTQ+ data is “first-of-its-kind,” writes Adam Barnes in The Hill, and shows broad vaccine uptake by the community. As of the May-June study period, 92% of the U.S. respondents had received at least one COVID-19 shot, compared to 73% of American adults as of August 20. (Because the survey was distributed via LGBTQ events and media, and the organizers accepted replies from anyone who cared to participate without controlling other demographics, they note their findings are probably not fully representative of the entire LGBTQ+ community.) The high uptake in the LGBTQ community might be due to a greater prevalence of liberal attitudes and disproportionate residency in urban regions and Democrat-dominated states, suggested David Paisley, senior director of research for study partner Community Marketing & Insights. Black, Native American, Alaskan Native, Middle Eastern and North African respondents had the lowest vaccination rates at 85%. The survey also found that half of participants said the pandemic impacted their mental health, and more than half felt socially isolated, compounding existing mental health challenges in the LGBTQ+ community. The pandemic has also impacted LGBTQ youth, cutting off access to counseling and communities and sometimes forcing teens to cloister with family members that don’t support their identities or sexuality.

COVID-19 has overlapped with the ongoing HIV epidemic, and UC San Francisco researchers examined how lockdowns impacted use of protective PrEP (pre-exposure prophylaxis) treatment at a San Francisco clinic, reports Killian Meara at Contagion Live. When the city was under shelter-in-place orders, fewer people started PrEP, and many let their treatment lapse, especially younger patients. But it will take more research to determine how the delay or pause in prevention affected people, the study authors wrote.

Bring on the boosters

Last Monday, Pfizer and its partner BioNTech submitted their initial data to support emergency authorization of a booster dose to the FDA. By Wednesday, the White House had announced boosters for the general population would be available starting Sept. 20. The reasons behind the decision, according to CDC director Dr. Rochelle Walensky, include new data on waning immunity against infection over time, as well as the rise of the delta variant — the same factors leading to a summer of breakthrough cases. The situation in Israel also suggests a grim forecast for the United States and rest of the world, writes Meredith Wadman at Science: Though 78% percent of the 12-and-up population has had two shots of an mRNA vaccine (mostly Pfizer’s), the nation is seeing 65 new cases per 100,000 people per day. “If it can happen here, it can probably happen everywhere,” said Ran Balicer, chief innovation officer at Israel’s largest HMO, Clalit Health Services. “This is a very clear warning sign for the rest of the world.”

But the debate around boosters has confused even experts, writes Helen Branswell at STAT, leading to “bafflement, concern, and even anger.” The vaccines remain quite effective against severe illness. The timing also seems rushed: neither the CDC nor the FDA has yet signed off on booster shots for the general population. And third shots for Americans means fewer first shots for people in other parts of the world. For that reason, the WHO has called for a delay in boosters until at least the end of September. Epidemiologist Katelyn Jetelina of the University of Texas also professed confusion on her blog (which includes a handy timeline laying out scientific findings and institutional actions related to boosters), but praised the government for taking a proactive approach to protect Americans. NIH director Dr. Francis Collins said, “We don’t want to wait until it’s like, ‘Oh too late.’” He likened the situation to refilling your car with gas before the tank hits empty.

The current plan is to provide boosters to people who got the Moderna or Pfizer vaccines eight months after the second shot. While it’s not entirely clear why eight months is the magic number, it’s not surprising a booster would be needed, writes Jetelina. Multi-dose vaccinations are most effective at building durable immunity when separated by at least six months. Getting both doses in much faster made sense at the height of the pandemic, but also may have made boosters inevitable. A longer gap gives the immune system time to hone its antibodies, explains Amanda D’Ambrosio at MedPage Today, and her sources suggested the third shot may be the last needed.

People who got the Johnson & Johnson vaccine will have to await forthcoming data from the company’s trial of a two-dose regiment for any booster recommendations. People who participated in the trials for AstraZeneca and Novavax vaccines, which haven’t yet been approved, are also stuck in limbo for now.

Pediatric ICUs fill up

A record number of children are hospitalized with COVID-19 — nearly 2,000 as of last week. Wards are particularly full in Southern states, where vaccination rates lag, while other regions are less impacted. San Francisco, with more than 70% of the population vaccinated, recently reported no children hospitalized for COVID.

With schools in session, “this is just the beginning,” Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, told CNN’s Jake Tapper. Los Angeles Unified, one of the largest public school districts in the nation, found that eight in 1,000 students tested positive before the school year began. And more than 5,000 students are already in quarantine or isolation in Florida’s Hillsborough County.

While older children are most likely to bring the virus home, a recent study finds that kids aged 3 or younger who do contract coronavirus are more likely to spread it around their households. That’s likely due to close contact and cuddles between tots and caregivers, write Sony Salzman and Dr. Lauren R. Richter at ABC News. The finding is a bit of an unexpected twist, given that transmission by children was previously thought to be low, acknowledged pediatrician Dr. Edith Bracho Sanchez at Columbia University Irving Medical Center. But early in the pandemic, the youngest children were rarely out in the world to get exposed. “It just shows how humble we have to be when it comes to children and this virus,” Bracho Sanchez said.

Where does the virus go from here?

As the U.S. struggles with delta, it’s fair to start wondering what variants might emerge next — though impossible to predict the answer, notes Andrew Joseph in STAT. “The coronavirus appears destined to march its way through the Greek alphabet,” writes Dr. Dhruv Khullar for The New Yorker. But that doesn’t mean the virus will keep getting nastier and more transmissible forever. Dr. Roberto Burioni, a leading Italian virologist at Vita-Salute San Raffaele University in Milan, offered Khullar three possible endgames: In the best-case scenario, the virus can’t evolve around our vaccine defenses, as has happened for other diseases such as polio and smallpox. Or the coronavirus might evolve to evade our immune response, but at the same time lose some of its infectivity or lethality, still putting humanity in a better position than before. HIV underwent a similar change in the 1990s, gaining the ability to resist an antiviral drug but losing replication efficiency in the process. In the worst case, the virus evolves to evade immunity but remains a highly contagious killer — no tradeoffs involved. Fortunately, experts think this last scenario isn’t likely. “I don’t think we’ll end up with variants that completely escape antibodies or vaccine-induced immunity,” Florian Krammer, a vaccinologist at Mount Sinai’s Icahn School of Medicine, told Joseph. And even in that less likely case, Burioni said, vaccines can be updated to meet the new threat. The back-and-forth volleys between virus and vaccine-makers are still likely to end, eventually, in some sort of détente.

Amber Dance | Columnist

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