Expert Panel Tackles Boosters, Younger Patients, Rising COVID Cases

Editor’s Note: Find the latest COVID-19 news and advice in Medscape Coronavirus Resource Center.

It has been 18 months since a public health emergency was declared in the United States over SARS-CoV-2, and questions still swirl around the crisis, as evidenced by a panel of experts on Tuesday trying to find solutions. tough answers.

Even as the debate over when and why COVID-19 booster shots are needed continues, how safe is it for fully vaccinated people to get a third dose? As cases and hospitalizations increase in some young people and in parts of the country, are deaths really going down or just being delayed? Could the Delta variant possibly worsen the symptoms of “long-haul” COVID-19?

Experts from the Centers for Disease Control and Prevention (CDC) and the Infectious Diseases Society of America addressed these and other uncertainties during a press briefing on July 13.

Dr Jay C. Butler

But first, a snapshot of the current pandemic situation in the United States. “After several months of declining cases, followed by an extended plateau period, we are seeing an increase in the number of cases in many parts of the country,” said Jay C. Butler, MD, deputy director of infectious diseases at the CDC.

Arkansas, Florida, Missouri, Nevada and Utah, for example, are seeing a larger increase in cases than elsewhere, Butler said. “Therefore [its] areas where the CDC works closely with state, local, or tribal health officials to help cope with outbreaks. “

Nationally, reported cases of COVID-19 are around 15,000 per day, up from around 10,000 just a few weeks ago. The nationwide test positivity rate “is also climbing a bit,” to 3.5%, Butler said.

Currently, we have not seen an increase in the number of deaths, “he added,” but I would like to warn that the number of deaths is usually a few weeks behind any increase in the number of cases. . “

As an example, in Utah, the average number of weekly cases recently increased by 2.5 times, Andrew T. Pavia, MD, said at the press conference.

Dr Andrew T. Pavie

“it did not reach the levels of January or December”, but the difference in cases is “quite significant”, added Pavia, head of the division of pediatric infectious diseases at the Faculty of Medicine of the University of the Utah to Salt Lake City.

Pavie added that Utah’s intensive care units “are operating at over 100% capacity again,” but have yet to open any ancillary units.

Given the recent numbers, Pavia shared Butler’s concern that death rates could rise in the coming weeks.

How safe is a third dose of the vaccine?

Butler stressed that the available COVID-19 vaccines continue to be effective in protecting against serious illness and death. “We are seeing a breakthrough infection in those vaccinated. However, we do not see evidence that earlier vaccination during the period of vaccine availability is causing this.

“In other words, we see no evidence at this time that immunity wanes in people who are vaccinated,” Butler said.

Even so, controversy continues to revolve around the need and timing of a booster injection. This issue has even pitted a vaccine maker, Pfizer, against U.S. health officials. High-level meetings this week have left American scientists not convinced of an urgent need.

Meanwhile, a reporter asked: How safe is it for fully vaccinated people to seek out a third or booster vaccine on their own?

“This is an important question,” said Butler, adding that the CDC is collecting data on any possible safety concerns regarding booster injections.

Rare vaccine side effects and local reactions to COVID-19 vaccination tend to occur more frequently after a second dose, he said.

“We are therefore very interested in whether or not a third dose may or may not be associated with a higher risk of side effects, especially some of these more serious but very rare side effects,” he said.

Why timing matters

Pavie pointed out that there is a balance associated with the timing of a booster injection.

The premature and widespread administration of boosters “would use up a lot of the vaccine that much of the world needs, and divert our efforts from getting people their first dose of the vaccine,” Pavia said.

“But if we wait too long, a lot of people will become sensitive again,” he added.

“This is an area where people want answers before they have data,” Pavia said. The National Institutes of Health have several ongoing studies evaluating a third dose, including people who continue with the same brand or change vaccines in a “mix-and-match” fashion, he added.

“We hope to get answers soon,” Pavie said.

Butler added that the researchers are also evaluating the safety and effectiveness of a third dose in “the two groups of greatest concern to us.” Recall studies in people over 75 who are most at risk of COVID-19, as well as in people who are immunocompromised, are also in progress.

The United States Food and Drug Administration and the CDC’s Advisory Committee on Immunization Practices will likely use the results of these and other trials “to determine if, when and for whom recalls would be indicated,” Butler said. .

Cases are moving to the youngest

Infection and hospitalization rates are highest among people aged 15 to 45, Pavie noted.

“Even though we are seeing a higher proportion of cases in young people, I don’t think we are seeing more serious illness in children who acquire COVID-19,” Butler said.

Pavie agreed that COVID-19 tends to be less severe in children compared to adults and especially the elderly. However, he added, “as someone who cares for very sick children, it drives me crazy to hear over and over again that the virus is not serious for children.”

“In all respects, the impact is greater than the impact of influenza“Pavie added. If COVID-19 vaccines prove to be safe and effective for children aged 6 to 11 and younger children, it would be foolish not to vaccinate them.

“If your child is the one who ends up in the intensive care unit for a week, or if your child develops a long COVID and fails a school semester and does not make it to college or loses their scholarship athletics, “Pavia said,” there’s nothing sweet about that. “

Unanswered questions

A reporter asked: Now that the Delta variant is booming in the United States, how could this affect efforts to achieve collective immunity?

“If you talk to a hundred infectious disease specialists, you’ll probably get a hundred different answers to this question about herd immunity,” Butler said. Partly because of the ever-changing picture of the pandemic, “I think this is a very difficult number to estimate with any degree of certainty.”

Another potential issue that remains to be seen is whether the Delta variant could alter the ‘long-haul’ recovery of COVID-19.

“Certainly, there are ongoing studies evaluating the long COVID that will be overlaid on data from emerging variants,” Butler said.

However, it is too early to discern any difference in the results, he added. “The Delta variant has only been with us a few weeks.”

SOURCE: A July 13 press conference sponsored by the Infectious Diseases Society of America.

Damian McNamara is a Miami-based journalist. It covers a wide range of medical specialties, including infectious diseases, gastroenterology and intensive care. Follow Damien on Twitter: @MedReporter.

For more news, follow Medscape on Facebook, Twitter, Instagram, Youtube, and LinkedIn.