COVID-19 Update: Benefit of 4th Booster Could be Modest, New White House Coordinator

COVID-19 coronavirus vaccine in doctor hands

Although there is talk of a fourth shot of the Moderna and Pfizer-BioNTech COVID-19 vaccines, with both companies having made Emergency Use Authorization (EUA) requests, the data so far suggest the benefits may be modest. Continue reading for details and more COVID-19 news.

Moderna Submits Request for Additional Booster Dose

Moderna has submitted a request to the U.S. Food and Drug Administration to amend its Emergency Use Authorization (EUA) for its COVID-19 vaccine. It wants to get authorization for a fourth dose — a second booster — in adults 18 years and older. They argue that the request is broad to provide flexibility for the U.S. Centers for Disease Control and Prevention (CDC) and healthcare providers to decide who it would be appropriate for — whether due to age, immunosuppression, diabetes, obesity or other comorbidities.

Pfizer and BioNTech have also made a request for authorization for a fourth dose.

A small study in Israel published in the New England Journal of Medicine demonstrated that the four-dose efficacy of mRNA vaccines, such as Moderna's and Pfizer-BioNTech's, is modest against symptomatic Omicron COVID-19 infection. In their study, of 1,050 eligible Israeli healthcare workers, 154 were given a fourth dose of the Pfizer-BioNTech shot and 120 the Moderna. The fourth dose offered a robust immune response with no concerning adverse events. In the control group, 25.0% were diagnosed with an Omicron infection, compared to 18.3% in the Pfizer group and 20.7% in the Moderna group. In general, efficacy against symptomatic disease was about 65%. They concluded, "A fourth vaccination of healthy young health care workers may have only marginal benefits. Older and vulnerable populations were not assessed."

As Congress Wrangles Over COVID Budget, Fauci Warns of Potential Increase in Cases

The Biden Administration has requested $22.5 billion in funding to continue its COVID-19 testing and therapeutic programs, but Congress so far has been resistant. In speaking before Congress, Dr. Anthony Fauci, Biden's COVID-19 advisor and director of the National Institute of Allergy and Infectious Diseases, cautioned that countries around the world are seeing surges from the Omicron BA.2 subvariant, and the U.S. is likely to as well, that countries are easing restrictions, and vaccine protection is waning.

"We have all three of those factors right now in this country," Fauci said. "I would predict that we are going to see a bit of an increase, or at least a flattening out and plateauing of the diminution of cases. And the question is how do we deal with that?"

Jha Replaces Zients as White House COVID-19 Coordinator

Dr. Ashish Jha, dean of the Brown University School of Public Health, will be replacing Jeff Zients as the Biden Administration's COVID-19 coordinator. In some ways, he's a great choice — a knowledgeable subject matter expert with particular expertise in communication, which may be what the White House was looking for. What he doesn't have, and this has raised some concerns about critics, is extensive government experience. 

"Jha is both a medical and public health expert who has been a voice of reason and clarity during the pandemic," said Beth Linas, a research epidemiologist at RTI International, a nonprofit scientific organization. "The only thing I wonder is how another academic with limited government experience will help the nation. Government experience is a really important aspect of leading the massive federal bureaucracy."

Zients' background is in government and business. He was the director of the National Economic Council from February 2014 to January 2017 and was an executive at several companies, including The Advisory Board Company and CEB. He had no particular public health expertise.

Jha did work for four years as a medical advisor at the Department of Veterans Affairs.

What Makes Omicron BA.2 So "Catchy?"

As the initial Omicron (BA.1) surge has begun fading, the so-called "stealth" subvariant, Omicron BA.2 is rising worldwide. And researchers would like to know why. Both BA.1 and BA.2 have a common core of genetic mutations, but each has a few unique mutations. BA.2, for example, does not have a mutation that BA.1 has that makes it easier to tell it apart from the Delta variant, which is where the "stealth" terminology came from. Largely, the higher level of transmissibility comes down to two factors: immune evasion and transmissibility. Immune evasion means it's better at hiding from the immunity, either caused by previous infection or vaccines. More vaccinations or boosters or reformulated shots might be the answer if that's the case. If other factors make it more transmissible — causes more asymptomatic infections, lasts longer in the air, finds a home more easily in the nose and mouth, for example — then other approaches may be better. Although preliminary, the data suggests that it's mostly related to the first factor.

If You Haven't Caught Covid Yet, Maybe You Won't

Early on in the pandemic, it was common for experts to suggest it was only a matter of time before you caught COVID-19. Then vaccines came out, and it became possible that people would never catch the bug — until the more transmissible Delta, Omicron BA.1 and BA.2 variants started causing breakthrough infections. Models vary but suggest that 50% to 75% of people in the U.S. have been infected with Omicron. Does that mean that it's only a matter of time for the rest of the population?

First, the vaccines are highly effective against preventing hospitalization and death. And public health experts say that it's not inevitable that you will catch Covid if you haven't caught it yet. Some of this is due to behaviors, such as masking and social distancing, vaccination rates, and potentially genetics.

Dr. Jonathan Grein, director of hospital epidemiology at Cedars-Sinai in Los Angeles, said, "Some people may come into more contact with people more regularly than others. There are probably environmental reasons as well, the virus is probably transmitted more efficiently in certain circumstances like classically the indoor poorly ventilated space compared to outside."

Although a specific gene has not been associated with increased risk of COVID-19, some studies have suggested certain gene variants put people at greater risk of severe COVID-19.

That said, each variant that surges tends to do so because it's more transmissible than previous variants, which increases the likelihood of getting infected. Alternately, as things go on, the more people who are vaccinated and/or had previous infections create a lower likelihood of catching COVID-19.

Moms Spread COVID-19 to Newborns Less than 2% of the Time

Although it is possible for a mother to transmit COVID-19 to her baby before, during and after childbirth, it's not very common. A study published in BMJ found that the risk was only 1.8% and that vaginal births and breastfeeding didn't increase the risk. A research team led by the University of Birmingham's World Health Organization Collaborating Centre for Global Women's Health analyzed 140 studies that included 14,271 babies born to mothers with COVID-19. The overall COVID-19 infection rate of the babies was 1.8%. Of the 800 fetuses or babies with COVID-19 where data was available, 20 were stillbirths, 23 died during the first 28 days of life, and eight were pregnancy losses. At the end of the follow-up, 749 babies, or 93.6%, were alive.

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