Categories
Health

One dose or two? Anthony S. Fauci says U.S. must stick with two-shot plan.



“We’re telling people [two shots] is what you should do … and then we say, ‘Oops, we changed our mind’?” Fauci said. “I think that would be a messaging challenge, to say the least.”

Fauci said he spoke on Monday with health officials in the United Kingdom, who have opted to delay second doses to maximize giving more people shots more quickly. He said that although he understands the strategy, it wouldn’t make sense in America. “We both agreed that both of our approaches were quite reasonable,” Fauci said.

Some public health experts and other Americans have urged policymakers to reconsider whether millions of doses intended as second shots in Pfizer’s and Moderna’s two-dose regimen could be distributed as first doses instead — to offer at least some protection to a greater number of people. The issue gained steam after regulators this weekend authorized a single-dose shot from Johnson & Johnson, and an advisory committee to the Centers for Disease Control and Prevention on Monday wrestled with the question.

Two Democratic senators on Monday also called for the Biden administration to inoculate Americans with a single dose to ensure more people get some protection before a possible spring surge of cases. “Based on conversations with health officials, we believe this approach is worthy of serious consideration,” Sens. Chris Van Hollen (D-Md.) and Martin Heinrich (D-N.M.) wrote to Jeff Zients, the White House coronavirus coordinator, in a letter shared with The Post. About 80 percent of adults have yet to get a single dose, according to CDC data.

Fauci said the science doesn’t support delaying a second dose for those vaccines, citing research that a two-shot regimen creates enough protection to help fend off variants of the coronavirus that are more transmissible, whereas a single shot could leave Americans at risk from variants such as the one first detected in South Africa. He also said there is insufficient evidence of the benefit of a single Pfizer or Moderna dose — or data showing how long the immunity conferred by one shot would last. “You don’t know how durable that protection is,” he said.

Fauci argued that Pfizer and Moderna’s commitment to provide 220 million total doses by the end of March, in addition to Johnson & Johnson’s pledge to deliver 20 million shots this month, renders moot any debate about whether to redirect vaccine supply.

“Very quickly the gap between supply and demand is going to be diminished and then overcome in this country,” he said. “The rationale for a single dose — and use all your doses for the single dose — is when you have a very severe gap between supply and demand.”

Meanwhile, Fauci said he spoke on Monday with Chris Whitty, the British government’s chief medical adviser, to discuss the U.K.’s strategy to prioritize first doses and delay second doses. The dialogue was part of a standing weekly call between the two nations’ experts. In an inversion of the debate in the United States, British doctors have complained that the U.K. was wrong to delay second doses.

“We had a really good conversation this morning,” Fauci said, noting that officials on both sides of the Atlantic acknowledged that delaying second doses posed challenges. “We agreed that there is a risk of making things worse by doing that — balanced against the risk of not getting as many people vaccinated as quickly as you can.”

“There’s no right answer to that, and when there’s no right answer … we want to go with what is scientifically, absolutely correct,” Fauci added. “We know that when you give people two doses, not only are they protected to a higher degree, but they have such a redundancy of antibody that you can protect them against even the worst variants.”

Fauci acknowledged that the United States repeatedly has shifted strategy during the pandemic — including his own reversal on whether Americans should wear face coverings — but said that the stakes are higher when it comes to communicating about vaccines.

“People are very skeptical on vaccines, particularly when the government is involved,” he said.





Source link

Categories
Health

Second vaccine dose delayed? How long people wait for coronavirus vaccine is varied



The vast majority of recipients of the two-dose Pfizer and Moderna vaccines are able to get their second shot within the recommended period, according to vaccine data reviewed by The Washington Post. Yet some people are still encountering problems navigating local programs and unplanned delays — such as bad weather or supply shortages.

More than a dozen people wrote to The Post, saying they faced barriers to getting a second appointment or were worried they would. These anxiety-inducing hurdles come as an international debate is unfolding over how to best roll out the limited vaccine supply: prioritizing fully inoculating people who have had their first dose or offering partial protection with single doses to more people.

The United Kingdom chose the latter.

New data from the U.K. shows fewer infections after the country concentrated only on distributing first doses and holding off on giving second doses, while other recently released research found that delaying the second dose of the AstraZeneca vaccine to 90 days may be more effective and confirmed reports that a single dose may be enough to immunize people who were previously infected.

But health experts in the United States are divided about halting the distribution of second doses, with some expressing concern that a population with limited protection could deal a blow to vaccines’ effectiveness as immune-resistant variants evolve.

When Larson, a Phoenix resident, saw no available slots on Arizona’s scheduling website for her second dose, she wondered if she was going to be able to get the vaccine at all — especially within the recommended 21 days for the Pfizer-BioNTech vaccine. The suggested interval between the Moderna vaccine doses is 28 days, but the Centers for Disease Control and Prevention says there’s wiggle room for both vaccines, advising that a six-week period is acceptable.

After days of refreshing her browser and waiting on hold, she got an appointment.

“I was afraid,” Larson said, “that they were going to say, ‘Well, let’s vaccinate everyone and you’re not going to get a second dose.’ ”

The Arizona Department of Health Services said second-dose appointments are “guaranteed” and that the issues with people not receiving the follow-up email or finding available slots were resolved. The State Farm Stadium vaccination site in suburban Phoenix, the state’s first 24/7 facility, now offers second-dose appointments to people during their initial visit, spokesman Steve Elliott wrote in an email.

Health departments across the country have contended with supply snags as they attempt to ensure everyone receives their second dose: Maryland officials were accused of “hoarding” supply to guarantee people could get their booster shots, while a county health department in Iowa announced Tuesday that thousands of residents would experience delays getting their second shot because of an error in calculating how many doses they were allocated. Delaware warned its residents their second appointments would be delayed as health officials distributed first doses.

“This is an ethical dilemma we have to deal with every day,” Rick Hong, medical director for the Delaware Division of Public Health, told WHYY. “With more supply coming in, we’re hoping we can meet both missions: Get as many people vaccinated who have never been vaccinated before, as well as completing the series for those who need the second dose.”

People waiting for their second dose told The Post they worry about their protection.

There is little data available about the efficacy of vaccines when the second dose isn’t administered on schedule, but experts say there is probably no reason to believe a delay would hinder an immune response.

The limited information has sparked a discourse among public health experts who do not agree whether officials should prioritize giving more people one dose or commit to distributing second doses.

Researchers in favor of focusing efforts on offering first doses say the initial shot effectively shields people from severe infection. Canada-based researchers Danuta Skowronski and Gaston De Serres, in a letter published last week in the New England Journal of Medicine, pointed to data that shows the Pfizer vaccine’s efficacy is 92.6 percent after the initial dose and Moderna’s is 92.1 percent. Offering people some protection can keep them from becoming severely ill or dying.

Protection will also be needed if variants that are more virulent become predominant in the United States, experts say.

As a surge in cases of the deadly variant first identified in the United Kingdom is likely, second doses should be delayed while seniors older than 65 are inoculated with their first dose, according to epidemiologist Michael Osterholm, a member of President Biden’s coronavirus advisory board during the transition. In a paper published Tuesday by the University of Minnesota’s Center for Infectious Disease Research and Policy, Osterholm and other researchers estimate there would be 559,000 fewer infections, 112,000 fewer hospitalizations and 39,000 fewer deaths if second doses were deferred in favor of offering first shots to seniors.

One dose of the approved vaccines appears to be effective, possibly against known variants, which so far have occurred as a result of natural infection and not through building vaccine resistance, Osterholm told The Post.

But other experts disagree, arguing the two-dose regimen has shown to be very effective and that it’s not known how the virus could mutate if transmitted among people who are not fully protected. Reacting to the U.K. decision to delay second doses, Paul Bieniasz, a virologist at Rockefeller University, wrote in Oxford’s Clinical Infectious Diseases journal that a population that is not fully inoculated could be a breeding ground for a vaccine-resistant variant.

While the data emerging from the U.K. offers researchers new insight into how second-dose delays influence infection numbers, more information probably won’t be gathered by the time many Americans receive their vaccinations, said Anthony S. Fauci, the nation’s leading infectious-disease expert.

“If you want to really study it — the amount of time that it will take, the amount of people you would have to put in the study — by that time, we will already be in the arena of having enough vaccines to go around anyway,” Fauci told NBC’s “Meet the Press” host Chuck Todd earlier this month.

That uncertainty was nerve-racking for Steve Fleury, 65, of Scottsdale, Ariz., who encountered problems similar to Larson’s when scheduling his second dose of the Pfizer vaccine at the same Arizona site. After he finished cancer treatment in December, his doctors advised him to get immunized as soon as he could, given his weakened immune system. When he wasn’t able to find an available second appointment, he wasn’t sure what to do. On a whim, he and his wife drove to the site without an appointment 22 days after his first shot. It worked. He said other people with jobs might not be able to do the same.

“The only reason we didn’t have to wait was we decided we’re retired, let’s just drive down there every night until they let us in and we get the second shot,” he said. “Luckily, they let us in the first night.”

New York resident Jane Barowitz, 79, was not as fortunate. She was scheduled to wait 40 days between her doses of the Moderna vaccine, and she said she wasn’t told why there was a delay. But Barowitz said that just having the first dose was a relief.

“Still having half protection feels wonderful or something short of wonderful, like breathing more easily,” she said. “The idea that we’ll have the full protection that Moderna offers is very encouraging.”

“Very,” she repeated. “I’m tearing up. We’ll be able to see our grandchildren again.”



Source link

Categories
Breaking New

Coronavirus vaccines cutting hospitalization after first dose – POLITICO



First data from England and Scotland suggests vaccines are reducing hospitalizations and deaths from COVID-19 and appear to be preventing transmission, English and Scottish public health officials reported on Monday.

Based on the latest data, scientists in England estimate that hospitalization and death rates will fall around 75 percent in those who receive a single dose of the BioNTech/Pfizer vaccine. And this may be an “underestimate,” according to Mary Ramsay, head of immunization at Public Health England, since the analysis included people vaccinated 14 days ago and therefore doesn’t measure the four weeks it takes to fully account for the increase in protection, especially in older people.

Limiting data to more than four weeks ago “would see an even more profound drop,” she said.

The news comes as the U.K. announces plans to lift lockdown restrictions — in place since before Christmas — including letting all children return to school on March 8, and allowing groups of up to six people meet outdoors starting on March 29.

In the over 80s, the jab is 57 percent effective at preventing symptomatic COVID-19 three to four weeks after the first dose. This rises to more than 85 percent after the second dose.

In this group, those who become infected after vaccination are around 40 percent less likely to be hospitalized, compared with the non-vaccinated. And they are 56 percent less at risk of dying at least 14 days after receiving the first dose. Hospitalizations and deaths rates are falling fastest in this cohort since the peak in mid-January, suggesting that vaccination is having a positive impact.

The younger vaccinated group — health care workers under 65 — showed a 72 percent protection against infection with a single dose, rising to 85 percent after the second dose. Health care workers in the study are tested every two weeks.

“Reducing the people with infection, both symptomatic and asymptomatic, is the biggest thing that will reduce transmission,” said Susan Hopkins, strategic response director to Public Health England.

While the study hasn’t yet reported data on participants’ viral loads, Hopkins said they also expect to see lower levels of the virus. The study will also follow up contacts of health care workers to see if any become positive.

The data published by Public Health England looks only at the BioNTech/Pfizer vaccine, since this has been distributed the longest. It also demonstrates it is effective at protecting against the so-called U.K. or Kent variant (B.1.1.7).

To date, more than 17.5 million people have received a first dose of either vaccine.

Research from Scottish universities and Public Health Scotland, meanwhile, finds that the Oxford/AstraZeneca vaccine reduced the risk of hospitalization by 94 percent four weeks after the first dose, while the BioNTech/Pfizer jab reduced the risk by 85 percent.

Overall, the vaccination program in Scotland has cut hospital admissions by more than 85 percent, according to the study.

This article is part of POLITICO’s premium policy service: Pro Health Care. From drug pricing, EMA, vaccines, pharma and more, our specialized journalists keep you on top of the topics driving the health care policy agenda. Email [email protected] for a complimentary trial.





Source link

Categories
Health

Congress coronavirus cases show one vaccine dose might not prevent infection



“Early protection against covid-19 may occur from about 12 days after dose one,” said Naor Bar-Zeev, an infectious diseases physician and epidemiologist at Johns Hopkins Bloomberg School of Public Health. People “should not really consider themselves protected really until after a week or two following dose two.”

Even though the vaccines may protect people from showing symptoms, those vaccinated could remain susceptible to infection, he said, which is why officials are urging those who have been recently vaccinated to continue to follow public health advice such as washing hands and wearing masks.

“We absolutely have to continue to wear masks and keep our distance, particularly after that first dose — and even after the second dose,” said immunologist Nicole Lieberman, a research scientist at the University of Washington.

Both the Pfizer and Moderna vaccines are about 95 percent effective after two doses, according to the companies. Pfizer’s vaccine consists of two doses, given three weeks apart and Moderna’s contains two doses given 28 days apart.

Reps. Bonnie Watson Coleman (D-N.J.), Bradley Schneider (D-Ill.) and Pramila Jayapal (D-Wash.) tested positive this week. All three of the lawmakers have said they received the first dose of coronavirus vaccine in the days before the Jan. 6 riot.

Coleman is a 75-year-old cancer survivor who said last week’s trip to D.C. was her first in months. She wrote in an op-ed for The Washington Post she was apprehensive about it because other people at the Capitol might “flout social distancing and mask guidelines.” Coleman received her first vaccine dose Dec. 29.

Schneider drives from his home near Chicago to Washington to avoid flying because his wife has a health condition that makes her more susceptible to the virus. Schneider received his first shot on Jan. 4, two days before the attack. He did not report feeling symptoms after his positive diagnosis.

Jayapal also received her first shot on Jan. 4. On the day between the shot and the lockdown she had a negative test result, a spokesman said.

“Even though the members in question have been vaccinated, their bodies hadn’t had time to react yet,” Lieberman said.

At least 10.3 million coronavirus vaccines have been administered nationwide as of Wednesday, according to Washington Post data. The shots come amid a worsening pandemic, with more than 4,000 dying of covid-19, the disease caused by the virus, on Wednesday. More than 225,000 new cases were reported.

The lawmakers were among those who huddled in a crowded room after the Capitol was put on lockdown last week. Though large, the windowless room was too full for people to stay distant, and its occupants — including some who were not wearing masks — spent hours together.

The Office of Attending Physician at the Capitol said Sunday that lawmakers may have been exposed to someone infected with the coronavirus while in “protective isolation.”

Genetic testing of the coronavirus pathogen, if the sequences matched, would help confirm if the three lawmakers’ cases are in fact related. “Without doing the sequencing to confirm who was the patient zero, we can’t know for sure,” Lieberman said.

But she and other experts said the simplest explanation, considering the circumstances, was that the virus spread in the lockdown room.

“It’s highly likely — and I think probable — that this is a superspreader event, and these lawmakers caught it from spending time in that room,” said Harvard University environmental health researcher Joseph G. Allen.

Krystal Pollitt, an environmental health sciences professor at Yale University, said that as she watched the live feed of lawmakers, even before they were moved to the secure location, “all that could go” through her mind was how dangerous the situation was for transmitting the virus.

“People are projecting their voices, not wearing masks — there’s a lot of people in the space,” Pollitt said. “You see the people sitting opposite of one another; they are right in the plume of others that are speaking.”

Rep. Marjorie Taylor Greene (R-Ga.) told Fox News she and her colleagues declined the masks because they did not have symptoms.

Greene told The Washington Post in an email: “It is absolutely ridiculous and insane to blame those of us who did not have COVID or symptoms.”

But because asymptomatic people spread the virus, health officials have urged everyone to wear masks in public spaces regardless of whether they feel healthy.

Pollitt said based on rough estimates, “you could have a fairly high number of people that are infected” within 90 minutes, she said.

Even a well-functioning HVAC system would be pushed to its boundary, Pollitt said, to sufficiently exchange air and prevent transmission among unmasked people in an closed, windowless room.

“If someone is infectious in that room, others will be infected,” Allen said. “This is just another consequence of a truly shocking and unbelievable day in American history.”

Colby Itkowitz contributed to this report.



Source link

Categories
Breaking New

Therapy clown offers dose of laughter as medicine


GRAND RAPIDS, Mich. — They say laughter is the best medicine. Well, for one therapy clown in West Michigan that saying is no joke.

“Hi, my name is Nancy Greiner. I’m also known as Gracie the Clown in many venues. I’m a therapeutic healthcare clown,” said Nancy Greiner, founder of The Funnybone Foundation.

With her red nose secured, over-sized shoes and bag of tricks in hand. Gracie the Clown, or Nancy Greiner, is ready to conduct some funny business.

“Did I ever think I’d grow up to be a clown doctor? No! But it’s funny the path that life takes you,” said Greiner.

“I started working at children’s hospitals back east in Boston, Providence and Connecticut. I’ve worked in Chicago. Now, I’m looking to do that same work here in West Michigan,” said Greiner.

Through her business, the Funnybone Foundation, Nancy has been working in West Michigan senior living facilities for about four years.

“She just goes right in and starts singing and greeting them,” said Madeline Postmus, life enrichment coordinator at Green Acres Standale. “They just love that twist on their daily activity.”

But Greiner’s work isn’t always telling a funny joke or doing a silly dance.

“It may just be holding their hand, or just listening to them. A lot of them are alone. They don’t get visitors on a regular basis. Some don’t get visitors at all,” said Greiner. “So if I can just come in and just be genuine. They can tell if you really care, and I really care! It makes me happy to make them happy.”

“Sometimes it just takes you back. They’re just so meaningful. To see some of their eyes open up and they get a smile on their face,” said Madeline Postmus, life enrichment coordinator at Green Acres Standale. “Then we have some other ones who live in our memory care, who have Parkinson’s, and they just don’t really interact well with other activities either. But as soon as she starts playing a song they can move and they just get smiles on their faces and they love it.”

A true gift. The ability to connect. Something Greiner credits to her training and natural instincts.

“There is a little bit of innate. You have a sensitivity. I feel blessed that I do. I walk into a room and right away,” said Greiner. “I think it’s because of I just really look for who the person is. My mission is to make that person happy.”

Greiner visits dozens of seniors on each visit. While Greiner says each relationship is unique, one in particular stands out.

“Minetta loves her,” said Postmus.

Minetta and Greiner met about two years ago.

They connected over the loss of Minetta’s husband, Barry. Minetta says that stuck with her.

“She adds a little twist,” said Minetta. “I guess it’s good because some of us get depressed. We get lethargic. We don’t move enough, or not happy enough and she just helps with it.”

“Each time I come in and they hold my hand, and say ‘thank you’ it’s a gift! And I’m so fortunate that I get to do that all the time. That I get all these little gifts in my life. And I just want to continue this work because I believe that humor does make a difference,” said Greiner. “Connecting with people does make a difference in a genuine way. And what better place than to do it here in West Michigan?”

Greiner says similar to how the elderly have no control over living in homes, the same goes for children in children’s hospitals.

Her goal is to eventually start working in those hospitals right here in West Michigan.

For more information on Greiner and her business, The Funnybone Foundation,

click here

.





Source link