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 | | Daily reported coronavirus cases in the United States, seven-day average.The New York Times |
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Rethinking 'forever boosting' |
A few months ago, my colleague Apoorva Mandavilli was reporting on the booster rollout when an expert mentioned to her the possibility of "immune exhaustion," in which boosting too much could backfire. |
When Israel began offering a fourth dose of the vaccine to some high-risk groups last week, "it made the question much more pressing," Apoorva told me. Taking a step back, she wondered: Can the strategy of continually boosting the population actually beat the virus? |
To answer the question, Apoorva spoke to nearly a dozen experts. She found that the possibility of "immune exhaustion" isn't much of a concern among immunologists. Some told her that they weren't seeing the "weird little memory cells" that would indicate the problem. |
But, Apoorva told me, "all of the people I spoke to said, 'We can't just boost forever.' We could — in theory — but we really should not. There are smarter, more effective, more efficient ways of getting to what we need." |
In practice, vaccinating the entire population every few months is unrealistic because Americans, it seems, won't queue for the shots. While about 73 percent of American adults are fully vaccinated, only about a third so far have gotten a booster — and progress on the extra shots has stalled. |
The approach also doesn't make much sense scientifically. Omicron's ability to cause breakthrough infections made it clear that preventing all infections is a lost cause, Apoorva said. What really matters, experts say, is preventing hospitalizations and deaths. And two or three doses of the vaccine already prevent the worst outcomes, in part because other parts of the immune system — like T cells and B cells — are holding steady against the virus. |
The experts told Apoorva that there are also better strategies than "forever boosting." |
- The next generation of vaccines could combine multiple variants in order to cover a broader range of viral versions.
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- Current vaccines could also be combined with boosters of nasal or oral vaccines, which are better at preventing infection.
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- Allowing more time between doses might strengthen immunity, a lesson scientists have learned from immunizing against other pathogens.
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Americans may also be better served by adopting strategies other than vaccines to control spread of the virus. |
Today, six health experts on President Biden's transition team called for Biden to adopt an entirely new pandemic strategy — one that does not have a "single-minded focus on vaccines" and that is geared to the "new normal" of living with the virus indefinitely, not to wiping it out. |
The former advisers have quietly continued to meet over Zoom, their conversations often turning to frustration with Biden's coronavirus response. Their critique called for improvements to testing, surveillance, vaccines and therapeutics, as well as broad vaccine mandates and free N95 masks and oral Covid treatments for all Americans, among other things. |
One of the experts, Dr. Luciana Borio, a former acting chief scientist at the F.D.A., told The Times: "From a macro perspective, it feels like we are always fighting yesterday's crisis and not necessarily thinking what needs to be done today to prepare us for what comes next." |
In 2020, during the initial outbreak, ventilators and personal protective equipment faced strict rationing. Today, as cases soar to new heights, new protections are under tight controls: treatments to stave off severe Covid-19. |
While there are more Covid treatments now than at any point of the pandemic, the supplies of those that work against the Omicron variant are extremely limited, my colleagues Rebecca Robbins, Noah Weiland and Christina Jewett report. |
Monoclonal antibodies have been the primary option for recently infected patients. But the two most common types don't appear to work against the Omicron variant. A third antibody treatment, made by GlaxoSmithKline and Vir Biotechnology, is potent against Omicron, but the federal government has ordered fewer than half a million courses. |
Pfizer's antiviral pill, Paxlovid, was recently authorized by the F.D.A. and shows great promise — particularly against Omicron cases — but supplies are being depleted. New York City, for example, received about 1,300 treatment courses of Paxlovid in December, which it used up within a week. The city does not have any in stock, and supplies will not be plentiful until April. |
Some hospitals have run out of certain drugs. Others report having only a few dozen treatment courses on hand. State health officials and doctors nationwide have had to decide which patients get potentially lifesaving treatments and which don't. At Johns Hopkins University, employees are rushing to develop algorithms to help allocate treatments. Some people at high risk of severe Covid are being turned away because they are vaccinated. |
"There is simply not enough to meet the needs of everyone who is going to have Covid in the upcoming weeks and be at risk of severe complications," said Dr. Natasha Bagdasarian, Michigan's chief medical executive. "I don't think there is a way to make sure it gets to all the right people right now." |
What else we're following |
I work as a nurse anesthesiologist in Massachusetts. For the past two years I have "lived" in an N95 at work, except for my lunch break, when I sit alone on a bench in the corridor for sips of coffee and a bite of yogurt. Stress and fatigue have become the norm. My husband, an interfaith minister, reminds me it's only temporary. The hardest thing is living in a community that believes that nothing has changed, viruses are hoaxes and mask mandates are for other people. It's worse today than it ever was in early 2020. Then, no one knew what to do. Today, people know what to do and choose not to. — John Ambrose, Danvers, Mass. |
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