COVID cases vs. vaccination rates

Cases of COVID-19 are higher in states with low vaccination rates. Deaths and hospitalizations have increased much more slowly, likely reflecting the protective effect of the vaccine against serious illness.

COVID booster shots have been approved for high-risk people who got a Pfizer shot at least six months ago — with approval of boosters for Moderna and Johnson & Johnson vaccine recipients expected this week or next.

The Gila County Health Department recently began offering the free booster shots for high-risk people who received the Pfizer vaccine at least six months ago. For now, that includes those older than 65, nursing home residents, people with certain underlying medical conditions and high-risk jobs like health care workers and teachers, paramedics, police, firefighters and others.

Advisory panels have already recommended the federal Food and Drug Administration authorize boosters for the other two vaccines as well, with most people in Gila County having received the Moderna vaccine. Authorization may come this week or next and the county is already developing a waiting list for those vaccines.

Studies show the booster shots have the same mild and fleeting side effects as the second shot in the original series. That’s mostly limited to a sore arm, fatigue, headaches and sometimes flu-like symptoms. More serious long-term effects like an inflammatory response may be related to the vaccine, but the effects are far less serious than infection.

Meanwhile, new research has demonstrated that people who have recovered from a COVID infection probably have longer-lasting immunity against a greater variety of strains than do people who have received two vaccine doses. However, even those who have recovered from infection get even stronger protection if they also get at least one shot of the vaccine months later.

Those findings suggest that places like Gila County may be closer to the protection of “herd immunity” than calculations based solely on vaccine rates suggest.

Some 17% of the county’s population has recovered from infection. In addition, 44% have been vaccinated. If you add those two together, then some 61% of the total population have strong protection against infection — and even more protection against serious illness or death. That’s still far short of the threshold of herd immunity, when most clusters will die out after a handful of infections. Most experts say that COVID is so infectious we may need to get to 80% or more before herd immunity takes effect.

The booster shots — including for those who have recovered from infection — promise even better protection, especially in the face of new strains that have caused a fresh surge. Even so, disease experts stress that it’s much better to get the vaccine than to gain protection through an infection — given the risk of death and long-term, debilitating illness caused by the disease. The average hospital stay for COVID costs about $60,000 and perhaps 1% of those infected have died.

The World Health Organization has criticized the U.S. plan to roll out booster shots for wide swaths of the population, noting that the world remains critically short of vaccines and that many countries have vaccination rates below 5% for lack of supply. Some 4 million people have died of COVID worldwide, including more than 700,000 Americans, making the third leading cause of death in the past two years — behind heart disease and cancer.

The Gila County Health Department is making appointments for booster shots now, but only for high-risk people who got a Pfizer shot more than six months ago. Some experts predicted the authorization will extend to both Moderna and Johnson & Johnson next week.

However, private doctors can also provide the booster shots. Many pharmacies are also offering booster shots. Doctors can also mix and match vaccines when it comes to boosters, based on some evidence suggesting mixing vaccines may actually provide stronger protection. That’s especially true when it comes to people who originally had the one-shot Johnson & Johnson vaccine.

The growing support for the value of the booster shots stems from research on the long-term response of the immune system to both an infection and the vaccine. Both an infection and the vaccines immediately stimulate a flood of fast-acting antibodies. Those antibodies fade away as time passes. However, the body also produces immune system B-cells, which remember infections and live much longer than the antibody-producing cells. These B-cells continue evolving, which leads to much longer-lasting and layered immune system response to future infections. The booster shot causes a fresh surge in the short-lived antibodies — but also stimulates growth in the population of memory B and T cells, which live in the lymph nodes. This appears to provide not only a short-term boost, but even stronger long-term protection. The immune systems of people who have recovered from infection apparently produce more of these B and T cells initially than people who just get the initial vaccine series — but also appear to get that added boost from a later vaccine booster shot, according to a summary of research in the journal Nature.

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