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. She asked herself if the strategy of continuously boosting the population can actually defeat the virus.
Apoorva interviewed nearly a dozen experts in order to answer the question. 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. Experts agree that preventing hospitalizations is the most important thing. 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.”
Americans might also benefit from other strategies to stop the 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 on improvements to testing and surveillance, vaccines, and therapeutics, as also broad vaccine mandates, free N95 masks, and oral Covid treatment for all Americans, among others.
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.”
Rationing care, again
2020 was the first year of the outbreak. Personal protective equipment and ventilators were severely restricted. As cases rise to new heights today, new protections are under strict control: treatments to prevent severe Covid-19.
My colleagues Rebecca Robbins (Nathan Weiland), and Christina Jewett (Christina Jewett) report that there are more Covid treatment options now than ever during the pandemic. However, they are very limited in the supply of Omicron variant-specific treatments.
For patients recently infected, monoclonal antibody therapy has been the main option. But the two most common types don’t appear to work against the Omicron variant. GlaxoSmithKline’s third antibody treatment is effective against Omicron. However, the federal government ordered fewer than half a billion 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 received 1,300 Paxlovid treatments in December. This was used up in less than a week. The city does not stock any and will not have enough until April.
The Coronavirus Pandemic – Key Facts to Know
Some hospitals are running out of certain drugs. Others say they have only a few dozen treatment options. State health officials and doctors nationwide have had to decide which patients get potentially lifesaving treatments and which don’t. Johns Hopkins University employees are working fast to create algorithms that will help them allocate treatments. Some people at high risk for severe Covid may be turned away simply because they have been 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.”
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What you’re doing
I am a nurse anesthesiologist working 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. Fatigue and stress have become the norm. My husband, an interfaith minister, reminds me it’s only temporary. It’s hard to live in a community that believes nothing has changed, that viruses are hoaxes, and that mask mandates are only for other people. It’s worse today than it ever was in early 2020. No one knew what to do back then. Today, people can choose to know what to do or not.
— John Ambrose, Danvers, Mass.
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Source: NY Times