COVID-19 Update: November 9, 2021

The following is adapted and updated from an article originally published in InforMS Magazine in mid-October, 2021. The information contained here is current as of November 9, 2021.

While many of our lives are returning to more normalcy, the ongoing COVID-19 pandemic is largely becoming a disease of the unvaccinated. Data indicates that the Delta variant is more contagious than previous strains of COVID-19, and statistics show that unvaccinated people are making up the vast majority of cases, both minor infections and more severe courses of the disease.

 

All people in the U.S. over the age of 5 are now eligible for COVID-19 vaccination. Individuals who are 5 and older are eligible to receive the Pfizer BioNTech vaccine, and individuals 18 and older are eligible to receive the Moderna and Johnson & Johnson vaccines. In early October, Pfizer also applied to the FDA for use in children as young as five years old. The FDA and CDC have approved and authorized use of the Pfizer vaccine in children from 5-11 years old.

Continuing the practices we’ve all gotten used to – frequent handwashing, reasonable social distancing, wearing masks where appropriate – will still go a long way to protect you and your community. But by far the most effective way to protect yourself and help stop the continuing spread of COVID-19 is to get vaccinated.

BY THE NUMBERS

As of early-October, nearly 400 million vaccine doses had been given in the United States with more than 180 million individuals fully vaccinated. Worldwide, an estimated 7.3 billion doses have been administered -- so there is ample data available to make reasonable conclusions that the vaccines are safe and effective.

Colorado’s trends are similar to the country’s on the whole, with about 7.25 million doses administered and about 3.45 million people fully vaccinated. That represents about 66% of the population having had at least one dose of a COVID-19 vaccine.

Vaccination rates have slowed despite the well-publicized spread of the Delta variant — a more contagious version of the virus that became the dominant strain in the United States over the summer.

In hospitals, numbers in some areas have returned to levels seen during earlier COVID waves of 2020. Capacity continues to be strained in many facilities due to large numbers of COVID-19 patients. At UCHealth, the hospital home to the Rocky Mountain MS Center at University of Colorado, the following numbers were reported on October 1:

  • 205 patients hospitalized for COVID (81% of whom were unvaccinated)
  • 73 COVID patients in the ICU (94% unvaccinated)
  • 58 COVID patients on ventilators (94% unvaccinated)

 Updated November 4:

  • 343 patients hospitalized for COVID (78% of whom were unvaccinated)
  • 109 COVID patients in the ICU (91% unvaccinated)
  • 94 COVID patients on ventilators (92% unvaccinated)

UCHealth has also begun limiting non-emergency procedures due to capacity issues in its hospital system. Routine procedures like colonoscopies and imaging appointments are being canceled or postponed because there aren’t enough staff or space to handle those procedures safely.

Recent numbers also include more young, otherwise healthy people than in the past. Vaccination rates among people from 18 to 35 years old are generally lower than average, and as a result, younger people are making up more of the total number of cases — and getting sicker — than earlier in the pandemic.

Among those otherwise healthy younger people are pregnant women, who are known to have higher risk for more severe COVID. The CDC issued an official health advisory on September 29 urging pregnant women to get vaccinated, after tallying more than 22,000 infections requiring hospitalization and 161 deaths among pregnant women. In its advisory, the CDC says 97% of pregnant people with confirmed COVID infections — whether they were hospitalized for COVID itself or for pregnancy-related issues — were unvaccinated.

Data continues to be gathered every day, but it’s become clear as vaccinations spread that vaccinated individuals are well-protected from infection with COVID-19. Perhaps even more importantly, when “breakthrough” cases happen, vaccinated individuals seem to be at far lower risk for severe cases of COVID.

The Rocky Mountain MS Center at CU clinical team continues to recommend all patients get a COVID-19 vaccine, if they haven’t already done so. The vaccine is safe, effective and does not interfere with MS medications.

THIRD VACCINE DOSES

In late August, the CDC and FDA authorized and recommended a third dose of mRNA vaccines (Pfizer and Moderna) for some groups, including immunocompromised people. This is of special interest to MS patients because many common MS treatments act as immunosuppressants. 

According to the CDC, populations now eligible to receive booster shots are as follows:

Pfizer/BioNTech or Moderna (third dose): People who are 65 years or older; Anyone 18+ living in long term care settings; Anyone 18+ with underlying medical conditions; and anyone 18+ who works in high-risk settings. Third doses should be administered at least 6 months after your second dose.

Johnson & Johnson (second dose): People who are 18 years or older. Second doses should be administered at least 2 months after your first shot.

Vaccines work by jump-starting a person’s immune system, causing it to produce antibodies against whatever disease the vaccine is intended to fight. Those taking immunosuppressants may not get the same “jump-start” effect, meaning after a routine vaccine dose they may not be producing the same levels of antibodies as those with more normal immune responses. A third dose of these mRNA vaccines serves as a booster to heighten the immune response and help people mount more effective defenses against COVID-19.

'BOOSTER' vs. 'ADDITIONAL DOSE'

According to the National MS Society, boosters are different than an additional dose. An additional dose is intended to improve immunocompromised people’s response to their first and second dose of vaccine. A booster dose is given to people when the immune response to the first and second dose is likely to have waned over time. An additional dose can be administered as soon as 28 days following your second vaccine injection. Boosters can be administered 6 months after your second or third (additional) dose. The NMSS currently recommends a booster dose six months after a third dose.

Only Pfizer and Moderna are authorized to be used for an additional dose. Pfizer, Moderna and J & J are authorized to be used as a booster.

The RMMSC at CU recommends patients on the following common MS treatments seek a third dose of the Pfizer or Moderna vaccine:

  • Anti-CD20 disease modifying therapies (Ocrevus, Rituxan and Kesimpta);
  • S1P1 disease modifying therapies (Gilenya and its generics, Mayzent, Zeposia, and Ponvory);
  • Fumarate therapies (Tecfidera or dimethyl fumarate and its generics, Bafiertam or monomethyl fumarate, Vumerity or diroximel fumarate);
  • Lemtrada; Clabridine; Aubagio; Cellcept; and Tysabri.

These recommendations assume that you did not have a severe reaction to your first doses of the vaccine, and that you don’t have another medical reason for not taking a third dose (for example, a known allergy to components of the vaccine). As always, talk to your own provider before making any decisions that you have questions about.

As of the date of printing of this issue of InforMS, third doses of Pfizer’s vaccine have been approved for people over 65; third doses of both Pfizer and Moderna are approved for the immunocompromised. Third doses of either vaccine for the general public have not yet been approved.

SIDE EFFECTS AND SAFETY

Some side effects have been widely reported, but the actual numbers of side effects are very small. Most patients will not experience anything more than minor side effects after receiving their COVID-19 vaccinations.

It’s possible that some MS patients may experience worsening MS symptoms after receiving vaccines as they would with many other illnesses or fever, but generally these “psuedo-flares” will subside quickly. Side effects typically subside in 12 to 36 hours and respond quickly to ibuprofen and Tylenol. Editor’s note: For more information on psuedo-flares, please see Dr. Tim Vollmer’s recent video at tinyurl.com/InforMS-flares.

“Almost all my patients are now vaccinated, and we haven’t heard much about worse symptoms after vaccination,” says Alvarez. “So, these are really safe vaccines.”

COVID-19 & DMT STUDY

The research team at the RMMSC at CU will be performing a study looking at vaccine responsiveness before and after the third booster. This will help us understand the impact of the third booster in our immunosuppressed populations.

If you are interested in potentially participating, please call 303-724-4644 and leave your name and contact information.