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Israeli doctors find severe COVID-19 breakthrough cases mostly in older, sicker patients

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JERUSALEM, Aug. 20 (Reuters) – Doctors in Israel’s COVID-19 wards learn which vaccinated patients are most susceptible to serious illness as concerns grow over cases where the syringes offer less protection from the worst forms of the disease.

About half of the country’s 600 patients currently hospitalized with a serious illness have received two doses of the Pfizer Inc (PFE.N) shot, a rare occurrence in 5.4 million people fully vaccinated.

Most of these patients received two doses of vaccine at least five months ago, are over 60 years old, and also have chronic conditions that are known to worsen coronavirus infection. According to Reuters interviews with 11 doctors, health professionals and officials, they range from diabetes to heart disease and lung disease to cancer and inflammatory diseases, which are treated with drugs that suppress the immune system.

Such “breakthrough” cases have become a central theme of a global debate about whether and to which people heavily vaccinated countries should give booster doses of COVID-19 vaccines.

Israel began offering booster doses to people aged 60 and over in July and has since expanded that eligibility.

Citing data from Israel and other findings, the United States said Wednesday that it would provide booster doses to all Americans from September.

Other countries, including France and Germany, have so far limited their booster plans to the elderly and people with weak immune systems.

“The vaccinated patients are older, unhealthy, often bedridden before the infection, immobile and already in need of care,” said Noa Eliakim-Raz, head of the coronavirus station at Rabin Medical Center in Petach Tikva.

In contrast, “the unvaccinated COVID patients we see are young, healthy, working people and their condition is deteriorating rapidly,” she said. “Suddenly they are given oxygen or a ventilator.”

Israel’s Ministry of Health raised new alarms this week with a report showing that the effectiveness of the Pfizer vaccine, developed with Germany’s BioNTech, against serious illnesses in people 65 and older who received their second vaccination was greater than 90% fell to 55% in January.

Disease experts say it is not clear how representative the numbers are, but agree that it is worrying that general immunization against infection is waning.

Whether this is due to the time since vaccination, the ability of the highly contagious Delta variant to evade protection, the age and underlying health of the vaccinated, or a combination of all these factors, they cannot say.

Health officials in the UK and US, two other nations with high vaccination rates and an increase in delta infections, have reported similar trends. In the UK, around 35% of people hospitalized with a Delta case in the past few weeks had received two doses of a COVID-19 vaccine. Nearly three-quarters of the breakthrough infections in the United States that resulted in hospitalization or death were in people aged 65 or older, according to federal data.

US officials said their booster plan was based on concerns that vaccines may offer less protection against serious illnesses over time, even in younger adults.

“We are carefully monitoring other countries and are concerned that we too will see what Israel sees, which will worsen infections over time,” said Rochelle Walensky, director of the US Center for Disease Control and Prevention. at a press conference on Wednesday.

The World Health Organization has repeatedly urged rich nations to refrain from providing boosters while much of the world still lacks access to their first doses of COVID vaccine.

IMMUNE REACTION

The Delta variant, identified for the first time in India, has become the dominant version of the SARS-CoV-2 virus worldwide, accelerating a pandemic that killed more than 4.4 million people.

In Israel, the number of new cases every day has risen in the single digits to around 8,000 since Delta’s arrival in June. About half of the cases – most of them mild to moderate – occur in people who have been vaccinated.

Those who were first vaccinated in Israel were at high risk, including people aged 60 and over. The immune response of some may be weakened when Delta hit Israel. But for others with underlying health conditions, the vaccine may not have worked at all.

“For some of them, the vaccine did not trigger an immune response, they had no antibodies, because of the disease itself or because they are being treated with drugs that suppress the immune system,” said Dror Mevorach, who heads the coronavirus unit at Hadassah Hospital Jerusalem. He gave examples such as chronic lymphocytic leukemia and lymphoma.

Of the 3 million vaccinated Israelis cared for by Clalit, the country’s largest healthcare provider, 600 have had major breakthroughs since June. According to Ran Balicer, Clalit’s chief innovation officer, around 75% of them were over 70 years old and at least 5 months after their second dose. Almost all of them have chronic diseases.

“We hardly see any young, vaccinated people in serious condition,” said Balicer.

In the UK, doctors described similar characteristics in vaccinated patients who became seriously ill.

“The people who come here because of their age or their comorbidities could be people who would be expected not to have quite as effective the vaccine as other age groups,” said Tom Wingfield, clinical lecturer at the the Liverpool School of Tropical Medicine.

Delta has sparked a new surge in U.S. coronavirus cases and deaths, especially in states where vaccination rates remain low. In vaccinated patients who become infected, there is evidence that older people are more affected.

In Texas, 92% of breakthrough vaccine cases that resulted in death were in people over the age of 60, and 75% had a known underlying disease that put them at high risk from COVID-19, according to a public health department spokesman.

Initial data from Israel suggest that the booster injections given in the past few weeks reduce the risk of infection in the elderly compared to those who received only two doses. Continue reading .

Israeli doctors say vaccinated patients recover faster even without boosters.

“The vaccinated patients I treated usually left the intensive care unit in about three days. It took the unvaccinated patients a week or two to stabilize, ”said Yael Haviv-Yadid, director of intensive care at Sheba Medical Center near Tel Aviv.

Even if the vaccine didn’t stop her getting sick, it could have relieved her illness, said Alex Rozov, director of the coronavirus ward at Barzilai Medical Center in Ashkelon.

“Our cautious impression is that the vaccinated patients have an easier disease course – with antibodies, the treatment is more effective.”

Additional reporting from Alistair Smout and Josephine Mason in London, Carl O’Donnell in New York; Editing by Michele Gershberg and Dan Grebler

Our Standards: The Thomson Reuters Trust Principles.

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Pandemic

Mayor Bronson in quarantine after head of Anchorage Community Development Authority tests positive for COVID-19

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Mayor Dave Bronson is in quarantine after coming into close contact with Mike Robbins, executive director of Anchorage Community Development Agency, who has now tested positive for COVID-19.

The mayor’s office confirmed on Monday that Robbins was infected with the virus and that Bronson is under quarantine.

Mayor spokesman Corey Allen Young said Bronson was following the city’s COVID-19 containment policy and would be in quarantine for six days and will be tested for the virus on day six.

Nobody else in the mayor’s office came in close contact with Robbins, Young said.

“Nobody else has tested positive or shown any signs of symptoms,” he said via email, adding that the mayor works from home.

Bronson was in close contact with Robbins at a Visit Anchorage event last week. Two other members of the administration were in attendance but had no long close contact with Robbins, Young said.

This is the second time this month that the mayor has been quarantined after close contact with a COVID positive member of his administration. Community leader Amy Demboski and community attorney Patrick Bergt tested positive for the virus earlier this month.

[Anchorage Assembly calls on Mayor Bronson to enforce mask mandate]

On Monday, Bronson gave the Anchorage Chamber of Commerce an “Address of the State” – from Zoom – during the organization’s “Make it Monday” forum.

“Please again accept my apology for not being there in person as I am falling (under) quarantine protocols,” Bronson told the audience.

The mayor has avoided strongly encouraging the wearing of masks or advocating vaccinations, both of which have been shown to reduce virus transmission and the risk of serious illness. Instead, he often leaves Dr. Michael Savitt – his Chief Medical Officer at the Anchorage Department of Health.

Speaking at the chamber’s forum on Monday, Bronson said the city health department’s top priority is coordinating the city’s response to COVID-19, including “advanced testing, targeted vaccinations and monoclonal antibody treatments for improved and targeted treatments, especially in our underserved communities . ”

Now “we are working to return to pre-COVID-19 service levels while returning to all of the traditional services that the Anchorage Department of Health normally provides,” Bronson said.

The health department has also focused on the city’s mass housing, including communal housing in the Sullivan Arena and out-of-community housing, he said.

Combating homelessness remains a top priority for his government, said the mayor.

“We continue to work with the congregation to develop adequate service capacity for those affected by homelessness in our city and will shortly be launching an initiative to reduce the scare-mongering on our streets,” said Bronson.

The pandemic was largely a footnote in Bronson’s Monday statements to the chamber. He highlighted his government’s other priorities: working with the Assembly to approve a budget for the next year; Replacing aging docks, broken piles and other infrastructure challenges in Port of Alaska modernization program; and promoting economic growth in the city, among other priorities.

The news of Robbin’s positive test result – and Bronson’s quarantine – comes as Anchorage struggles with persistently high virus transmission rates across the community, part of a spike that increased dramatically in late summer and was fueled by the highly contagious Delta variant.

Bronson had a mild bout of COVID-19 last fall and suffered long-term symptoms, he said.

[What’s bringing people to Anchorage’s COVID-19 vaccine clinics: Work mandates, high case counts and good timing]

The Mayor firmly opposes COVID-19 restrictions, including the city’s current Masking Ordinance, which the Anchorage Congregation passed earlier this month. Bronson vetoed the ordinance requiring the wearing of masks in indoor public spaces, but the congregation quickly voted to lift the veto.

Bronson and most of his administration have attended congregational meetings unmasked since he took office. The Emergency Mask Ordinance exempts Bronson and its administration from the requirement, and members said the ordinance was not about getting the mayor to wear a mask, but rather about protecting public health and safety.

Bronson has spoken out against vaccination regulations and against vaccination regulations for staff in local hospitals. In his campaign, at Congregation gatherings and other public forums, he downplayed the severity of the pandemic and its impact on hospitals.

Robbins did not immediately respond to a request for comment. Young didn’t immediately respond to a question about whether Robbins had symptoms.

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Gov. Pritzker to Give COVID-19 Update, Discuss Pediatric Vaccinations Monday – NBC Chicago

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NOTE: NBC Chicago will be streaming the governor’s address live starting at 1:30 p.m. CT. See it live in the player above.

Illinois Governor JB Pritzker is expected to give a COVID-19 update on Monday, which is expected to be a day before an FDA panel on pediatric vaccination to discuss whether Pfizer child-size vaccinations for children ages 5 through 11 years should be recommended or not.

The governor is expected to speak from the Thompson Center in Chicago at 1:30 p.m.

The governor’s address comes shortly after the White House announced that children ages 5-11 can get a COVID-19 shot at their pediatrician office, local pharmacy, and possibly even school, which the plans state Elementary school children will be listed for the expected approval of the Pfizer shot in a matter of weeks.

This week will be an important step in getting COVID vaccines approved for such age groups.

The Food and Drug Administration’s panel of experts will discuss Tuesday whether the Pfizer shots are ready for the roughly 28 million children ages 5-11.

Federal health officials said late Friday that child-sized doses of Pfizer’s COVID-19 vaccine appeared to be highly effective in preventing symptomatic infections in elementary school children and did not cause any unexpected safety issues.

In their analysis, FDA scientists concluded that the vaccine’s benefits in preventing hospitalizations and death from COVID-19 would outweigh any serious potential side effects in children in almost any scenario. But the agency’s reviewers stopped asking for Pfizer’s shot to be approved.

If the FDA approves the syringes, the Centers for Disease Control and Prevention will make additional recommendations on who should be given them in the first week of November. Children could start vaccinations early next month – with the first children in line, fully protected until Christmas.

Full-strength Pfizer syringes are recommended for ages 12 and up, but pediatricians and many parents are eagerly awaiting protection for younger children in order to contain infections from the extra-contagious Delta variant and keep the children in school. Both Moderna’s and J & J’s vaccines can only be used in people aged 18 and over, although Moderna is also researching its vaccines in elementary school children.

While children are at lower risk of serious illness or death than the elderly, COVID-19 has killed more than 630 Americans under the age of 18, according to the CDC. Almost 6.2 million children contracted the coronavirus, more than 1.1 million in the last six weeks when the Delta variant increased, says the American Academy of Pediatrics.

Doctors at Advocate Children’s Hospital said last week that while children’s cases tend to be less severe than adults, “more children are hospitalized with severe COVID-19 infection than earlier in the pandemic”.

The group also warned that multiple cases of a life-threatening COVID-19-related illness called Pediatric Multisystem Inflammatory Syndrome have been reported in the Chicago area, and that experts are still unaware of the long-term effects of COVID-19 on children.

The Biden government has bought enough child-sized doses – in special orange-capped vials to distinguish them from the adult vaccine – for the country’s 5-11 year olds. When the vaccine is approved, millions of doses, along with child-sized needles, will be shipped across the country in an instant.

More than 25,000 paediatricians and general practitioners have already signed up to receive the syringes in little arms.

Pfizer and Moderna are also investigating vaccinations in even younger toddlers up to 6 months old. Results are expected later in the year.

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Wasted COVID-19 vaccine doses exceed 50% for some Erie County providers

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UPMC Hamot and Albion Pharmacy wasted almost the same number of COVID-19 vaccine doses. Hamot disposed of 384 unused doses while Albion Pharmacy disposed of 376 doses.

The difference is that Hamot received 66,105 doses of vaccine, which is only 0.6% of its vaccine wasted, while Albion Pharmacy received 550 doses of vaccine, of which 68.4% was wasted.

“When we first ordered the vaccine, the only way to order it was to get 450 doses from Pfizer,” said Megan Dreher, manager of Albion Pharmacy. “We didn’t have any special refrigeration to store it, so the vaccine was only good for six weeks. There just wasn’t much demand. We even tried to get to schools.”

COVID-19 vaccine waste was a major issue earlier this year when demand was high and the vaccine was in short supply. Hamot and other providers have taken exceptional measures to use each dose, including driving to people’s homes after a vaccine clinic closed for the day to give extra doses.

Now there are enough vaccines and the demand has decreased. Still, vaccine providers don’t want to waste doses.

“I continue to believe that vaccine waste is a big deal,” said Melissa Lyon, director of the Erie County’s Department of Health. “This is a very powerful vaccine and we don’t even want to waste a single dose.”

More:COVID-19 vaccine required for Penn State Behrend faculty, staff until December 8th

The county health department disposed of 4,192 of its doses – 14.4% of the 29,060 received – without administering them. According to the Pennsylvania Department of Health, this is the highest number of wasted doses of any vaccine supplier in Erie County.

A total of 1,414 of these doses were spoiled, while a further 2,771 doses were not administered after opening the vial. Other ways to waste doses are if the vial is broken or if the vaccine is drawn but not given within a period of time, usually two to 12 hours, depending on the type of vaccine.

“One thing that happened was when the state ordered walk-ins to be accepted in vaccination clinics,” Lyon said. “That took control out of you to avoid any waste. If someone wanted a dose, you had to open a vial (with six or ten doses), even if no one else got a syringe. “

More:Erie Hospitals See More Breakthrough COVID-19 Patients, With Nearly 30% Fully Vaccinated

Officials from Adagio Health, a Pittsburgh-based health organization whose clinics primarily serve women and low-income residents, offered a similar explanation for the high percentage of wasted vaccine doses in their Erie County offices.

Its Erie and Edinboro offices disposed of 1,695, or 59.2%, of their combined 2,860 cans.

“When we completed our training with the state health department about the vaccine, they emphasized the importance of putting doses in people’s arms,” ​​said Natalie Crouse, senior director of clinical operations at Adagio Health. “Vaccinating one person and having to dispose of the other five doses in one vial is better than leaving the vial in the refrigerator and letting all six doses expire.”

Larger vaccine providers have wasted little vaccine

Other providers have been able to staff clinics and complete walk-in appointments without wasting a lot of vaccine.

Saint Vincent has set up remote clinics in addition to providing COVID-19 vaccines in the hospital and recently in its doctor’s offices and emergency centers. It wasted 894, or 1.3% of its 70,205 doses.

“Remember, some of those doses weren’t actually wasted,” said Steve Henderson, director of Saint Vincent Pharmacy. “If you look at the ‘other’ category of wasted cans, it includes inexplicable ones. The Food & Drug Administration approved six doses from each Pfizer vial, but none of them contain six doses, so you had to report one as unaccountable. “

Hamot has kept the percentage of doses wasted low, in part because it has the vast majority of its vaccination clinics in one location – the UPMC Health Plan Operations Center, 380 E. Bayfront Parkway.

“But we have held remote clinics and have been very vigilant from the start,” said Jason Chenault, Hamot’s director of emergency, hospital and critical care services. “We continue to focus precisely on the dosages and how many are planned. When we have additional doses, we reach out to the appropriate people to administer them.”

Here’s a look at the number and percentage of wasted vaccine doses from Erie County vendors who disposed of at least 200 doses without administering them:

  • Albion Pharmacy – 376 doses wasted, 68.4% of all doses received
  • Adagio Health, Erie, and Edinboro offices – 1,695, 59.2%
  • Erie County Jail – 269, 22.8%
  • Millcreek Manor Pharmacy – 1,601, 19.4%
  • Erie County Department of Health – 4,192, 14.4%
  • Millcreek Community Hospital – 1,450, 13.7%
  • St. Vincent Hospital – 894, 1.3%
  • UPMC Hamot – 384, 0.6%

Nationwide, vaccine providers wasted 0.28% of their doses, according to the state health ministry.

One way to avoid waste in the future is for vaccine manufacturers to sell syringes filled with a single dose of the vaccine, Lyon said.

“It’s more expensive to make, but it would reduce waste,” said Lyon.

Contact David Bruce at dbruce@timesnews.com. Follow him on Twitter @ETNBruce.

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