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‘It’s Just Scaring People, and It’s Not Saving Lives’
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Michael Ejercito
Apr 23, 2022, 11:21:08 AM4/23/22
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http://www.theatlantic.com/health/archive/2022/04/covid-vaccine-is-effective-immunocompromised/629596/
‘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 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 they’re really safe. News stories highlight their struggles to
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 pandemic,
especially 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 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
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 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 infection—as
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 there’s 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
that—shot for shot—the immunocompromised achieve most of the same
benefits as healthy people. One study, published in March, looked at the
pandemic’s 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 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.
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
“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 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 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, 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. “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 who
cares 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 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 Putman’s patients have decided not to
take that risk after reading news stories suggesting that the injections
wouldn’t help them much anyway. Ironically, patients with rheumatologic
conditions, like Putman’s, 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 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 very
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.
--
This email has been checked for viruses by AVG.
https://www.avg.com
‘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 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 they’re really safe. News stories highlight their struggles to
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 pandemic,
especially 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 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
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 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 infection—as
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 there’s 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
that—shot for shot—the immunocompromised achieve most of the same
benefits as healthy people. One study, published in March, looked at the
pandemic’s 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 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.
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
“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 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 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, 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. “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 who
cares 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 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 Putman’s patients have decided not to
take that risk after reading news stories suggesting that the injections
wouldn’t help them much anyway. Ironically, patients with rheumatologic
conditions, like Putman’s, 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 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 very
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.
--
This email has been checked for viruses by AVG.
https://www.avg.com
HeartDoc Andrew
Apr 23, 2022, 11:26:16 AM4/23/22
to
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 ?
...because we mindfully choose to openly care with our heart,
HeartDoc Andrew <><
--
Andrew B. Chung, MD/PhD
Cardiologist with an http://bit.ly/EternalMedicalLicense
2024 & upwards non-partisan candidate for U.S. President:
http://WonderfullyHungry.org
and author of the 2PD-OMER Approach:
http://bit.ly/HeartDocAndrewCare
which is the only **healthy** cure for the U.S. healthcare crisis
Michael Ejercito
Apr 23, 2022, 11:53:51 AM4/23/22
to
Michael
HeartDoc Andrew
Apr 23, 2022, 12:03:44 PM4/23/22
to
Michael Ejercito wrote:
While wonderfully hungry in the Holy Spirit, Who causes (Deuteronomy
8:3) us to hunger, I note that you, Michael, are rapture ready (Luke
17:37 means no COVID just as circling eagles don't have COVID) and
pray (2 Chronicles 7:14) that our Everlasting (Isaiah 9:6) Father in
Heaven continues to give us "much more" (Luke 11:13) Holy Spirit
(Galatians 5:22-23) so that we'd have much more of His Help to always
say/write that we're "wonderfully hungry" in **all** ways including
especially caring to http://tinyurl.com/ConvinceItForward (John 15:12
as shown by http://bit.ly/RapidTestCOVID-19 ) with all glory (
http://bit.ly/Psalm112_1 ) to GOD (aka HaShem, Elohim, Abba, DEO), in
the name (John 16:23) of LORD Jesus Christ of Nazareth. Amen.
Laus DEO !
Suggested further reading:
https://groups.google.com/g/sci.med.cardiology/c/5EWtT4CwCOg/m/QjNF57xRBAAJ
Shorter link:
http://bit.ly/StatCOVID-19Test
Be hungrier, which really is wonderfully healthier especially for
diabetics and other heart disease patients:
http://bit.ly/HeartDocAndrew touts hunger (Luke 6:21a) with all glory
( http://bit.ly/Psalm112_1 ) to GOD, Who causes us to hunger
(Deuteronomy 8:3) when He blesses us right now (Luke 6:21a) thereby
removing the http://tinyurl.com/HeartVAT from around the heart
8:3) us to hunger, I note that you, Michael, are rapture ready (Luke
17:37 means no COVID just as circling eagles don't have COVID) and
pray (2 Chronicles 7:14) that our Everlasting (Isaiah 9:6) Father in
Heaven continues to give us "much more" (Luke 11:13) Holy Spirit
(Galatians 5:22-23) so that we'd have much more of His Help to always
say/write that we're "wonderfully hungry" in **all** ways including
especially caring to http://tinyurl.com/ConvinceItForward (John 15:12
as shown by http://bit.ly/RapidTestCOVID-19 ) with all glory (
http://bit.ly/Psalm112_1 ) to GOD (aka HaShem, Elohim, Abba, DEO), in
the name (John 16:23) of LORD Jesus Christ of Nazareth. Amen.
Laus DEO !
Suggested further reading:
https://groups.google.com/g/sci.med.cardiology/c/5EWtT4CwCOg/m/QjNF57xRBAAJ
Shorter link:
http://bit.ly/StatCOVID-19Test
Be hungrier, which really is wonderfully healthier especially for
diabetics and other heart disease patients:
http://bit.ly/HeartDocAndrew touts hunger (Luke 6:21a) with all glory
( http://bit.ly/Psalm112_1 ) to GOD, Who causes us to hunger
(Deuteronomy 8:3) when He blesses us right now (Luke 6:21a) thereby
removing the http://tinyurl.com/HeartVAT from around the heart
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