Booster shot messaging, vaccines for kids, delta’s peak and more
Each week, Chronicle health reporters field questions about the latest on COVID-19, vaccines and pandemic life. In this week’s COVID Help Desk, we explain why the messaging keeps changing for booster shots, whether parents can really expect vaccines for 5- to 11-year-olds by Halloween, whether Houston has entered the post-peak of the delta variant surge and how to safely attend a football game. The messaging keeps changing for booster shots. What’s the deal?
On Aug. 18, the U.S. Department of Health and Human Services and Centers for Disease Control and Prevention together announced all Americans would be eligible for a booster starting Sept. 20 if they are eight months post-second dose.
However, the CDC’s independent Advisory Committee on Immunization Practices has not approved any plan to distribute boosters to the general public. After a six-hour meeting Friday, the ACIP recommended against approving a booster shot of the Pfizer-BioNTech vaccine for people 16 and older. The vote was 16-2.
The ACIP can only make recommendations and cannot make the final U.S. Food and Drug Administration decision on boosters. Typically, the FDA takes the recommendation of the advisory committee.
“The CDC is saying ‘Hold on, we don’t have the data to support the need for boosters,’ which is causing some tension between the agency and the White House,” said Dr. Catherine Troisi, an epidemiologist with UTHealth School of Public Health. “I don’t think anyone disagrees that certain groups, especially the immunosuppressed, need to have a booster. It’s the rest of us that there is a
difference of opinion.”
Troisi explained the White House is working on data from highly-vaccinated Israel, which indicates that immunity wanes after six months in older people and those who had other medical conditions.
This week, the FDA released an analysis by Pfizer on the need for booster shots of the PfizerBioNTech vaccine. The pharmaceutical company has requested the agency’s approval of a third dose of the vaccine to be given about six months after the second dose in people ages 16 and older. So far, the FDA has not approved booster shots.
Since the science is so new, researchers do not know what level of antibodies a person needs to be protected from COVID-19, Troisi added. Vaccines have shown to lower the chance of hospitalization and death, but fully vaccinated people can experience breakthrough infections.
Will vaccines be available for children ages 5-11 by Halloween?
Texas Children’s Hospital is one of several U.S. hospitals working with Pfizer on COVID vaccine trials for children and adolescents under the age of 16.
Dr. James Versalovic, interim pediatrician-inchief, said the hospital is in the final stages of trials for children ages 5-11. The goal is to have it finished by the end of September, so Pfizer can apply for emergency use approval from the FDA.
“Early to mid-October (authorization) would be the goal and getting vaccines to school-age children first,” Versalovic said. “By the end of October, we’re confident we will have everything, but we need to be cautious.”
Last spring, the FDA asked participating hospitals to expand enrollment of children in the trials for additional reassurance after reports showed some young people experienced myocarditis, an inflammation of the heart, following their vaccination.
Dr. James McCarthy, chief physician executive for Memorial Hermann Health System, said more people in a vaccine trial will increase the likelihood of adverse side effects.
“We learned many lessons in 2020, like how to do parallel phases to expedite vaccine trials while not compromising safety of effectiveness information. We made sure the trial is as effective as it can be,” Versalovic said. “During a public health crisis, time is of the essence.”
Versalovic is confident that Moderna vaccine trials for 12- to 17-year-olds will be finished soon, giving parents more options for their teenagers. He expects that the simultaneous trials of 2- to 5-year-olds and 6-month to 2-year-olds to wrap up in December, with shots becoming available by early 2022.
Are we past the peak of the delta variant surge in Houston?
So far, the delta variant has fueled a month of Houston-area COVID hospitalizations over 3,000, according to the Texas Department of State Health Services.
But Texas Medical Center records show positive case rates may be slowly declining. According to TMC’s daily report, 1,939 people tested positive Tuesday in the Greater Houston area, a decline that may be related to COVID testing site closures as a precaution before Hurricane Nicholas.
Also Tuesday, the medical center admitted 310 new COVID-19 patients compared to the average 328 per day last week. Hospitals in the TMC remain at 90 percent capacity.
Dr. Wesley Long, a microbiologist and medical director of diagnostic microbiology at Houston Methodist, has been tracking and analyzing the virus and its variants through the hospital’s COVID-19 genome sequencing operation.
While Long sees the increase slowing, he hesitates to say Houston is past the peak of the surge.
“It’s like cresting the top of the wave, you don’t know what the backside of the wave is going to look like,” Long said. “In the beginning of this fourth wave, there were some people hopeful it would go up quickly and come down quickly. That’s not the case.”
The fourth wave’s peak has been broader than previous waves, which spiked and declined within about 25 to 30 days, Long explained. The big question with the delta wave is whether it will plateau at a high rate of hospitalizations or have a slow decline.
“It’s hard to know how other things like holidays and school will affect the case count,” he said. “It’s really important to keep masking, social distancing and staying home if you’re sick because it’s important to bring the fourth wave under control.”
How can a fully vaccinated person safely enjoy a football game in-person?
With the delta variant’s high transmission rate, the safest thing for anyone to do is watch the football game from home or follow it online, Long said.
But if you’re a vaccinated person who is determined to experience a football game in-person, the key is calculating risk and making wise decisions, Long said.
“What are the trade-offs if you do go to the game? Is anyone in your house immunocompromised? Can you afford to miss school or work? Are you at a higher risk because of comorbidities?” Long asked. “Everyone has to think about their own situation.”
If it’s a high school football game without assigned seating, try to sit in an area far away from other groups. Wear a mask even if the game is outdoors, he said.
Schedule a molecular PCR COVID test, which looks for genetic material and is considered to be the most accurate test to diagnose an active infection, and test at least three days after the game even if you show no symptoms. Being fully vaccinated helps prevent hospitalization and death from COVID, but breakthrough infections are possible, especially at indoor stadiums or situations where multiple groups are interacting without masks.
“Sitting next to someone who is infected and shouting, you may have a breakthrough infection,” said Troisi at UTHealth. “You have to weigh whether going to that football game is really important to you. If you’re fully vaccinated, you could get a breakthrough infection and you might be sick for a week, and you can feel pretty miserable.”
According to the CDC, 14,000 of the 176 million fully vaccinated Americans have experienced a vaccine breakthrough infection that required hospitalization.