A top emergency doctor explains why she is not reinforced

Dr. Celine Gounder is an infectious disease specialist and epidemiologist at NYU and Bellevue Hospital. Courtesy of Celine Gounder

  • A top infectious disease doctor in New York City says she has not yet received a third boost, although she is eligible.

  • Dr. Celine Gounder, however, recommends that her elderly mother receive reinforcement, at least two weeks before a vacation trip.

  • “And if you learn that getting a third dose at six months isn’t as good as waiting a year?” she said.

Dr. Celine Gounder is one of the leading doctors of infectious diseases in the United States, and she cares for sick patients in one of the nation’s largest hospitals.

As a front-line worker with an increased risk of catching COVID-19, she is entitled to receive an accelerator of COVID-19 vaccine for a few weeks now. But she has not.

“I didn’t get a third dose,” she told Insider. “I, personally, wait and see what science shows about long-term immunity and what could make more sense.”

She is confident that her two initial shots still provide her robust and long-lasting protection against severe illness, hospitalization and death due to COVID-19. There is only one person in her family whom she urged to strengthen as quickly as possible.

Why she cares more about strengthening her mom

“My mom is the only person in our family who, in my opinion, really needs a third dose – is an elderly person,” Gounder said.

Older people, who naturally have weaker immune systems, generally need more frequent and stronger vaccinations. Currently, there is limited evidence that extra shots are really necessary for all adults, especially in the immediate term.

Gounder told her mom to time her accelerator with her vacation travel plans.

“What I told her was: wait until two weeks before Thanksgiving, because we don’t really know what that means in the long run,” Gounder said. “So you get your top antibodies for Thanksgiving.”

Studies have found that accelerating shots from Pfizer and Moderna tend to send people’s antibody levels rising to new heights, peaking about two weeks after their third sting. And according to recent data from Israel, there is evidence that accelerations are helping to curb the spread of the virus, at least for a while.

Most people are still very well protected against severe COVID-19 for at least 6-8 months after vaccination, studies find.

Gounder said she is upset with younger people she spoke to who decided to step up, and “tends to think that when they get the boost, they are then forever protected and they don’t have to worry about it again.”

“These are not vaccines that provide sterilizing immunity,” completely eliminating the risks of infection and disease in all its mildest forms, Gounder said.

She cites recent studies that find memory B cell responses that can produce new neutralizing antibodies as needed remain intact six to eight months after vaccination, even if antibody levels decrease.

“And if you learn that getting a third dose at six months isn’t as good as waiting a year?” she said.

Dr. Rachel Presti, medical director of the Infectious Disease Clinical Research Unit at the University of Washington in St. Louis. Louis, studies just that, measuring people’s memory responses to vaccination over time, along with her colleagues.

Presti says, generally speaking, for “people who are under 50” who have been fully vaccinated with Pfizer or Moderna, “it’s not clear you get a lot of a blow from another dose.”

But Presti also believes that people can make their own decisions about accelerations. For example, if a young person vaccinated “nine months ago” travels to visit an elderly family during the holidays, or lives with someone immunocompromised, they may choose to strengthen “to maximize” protection, at least for a while, she said.

Gounder does not take that approach. Awaiting results from studies like Presti’s, Gounder is taking other proactive measures to prevent coronavirus infection – masking indoors, eating outdoors, and generally avoiding society inside.

Acceleration too soon could hinder the learning of our immune system, some new research suggests

Presti says it’s quite unlikely that extra acceleration will hurt, but some of her most recent research suggests that a man’s lymph nodes “continue to work to perfect their immune response to the original vaccine six months later.”

It is possible that interrupting that process, by accelerating too soon, could be counterproductive.

“There’s that small risk that if you get too many, they might not work,” she said of overly frequent accelerations.

The science here is still evolving – Presti says immunologists are trying to figure out the optimal time for doses “as we go.”

But she is pretty sure that someday, accelerations will be recommended for all adults.

This is because many experts, including Presti, suspect that the initial time of first and second doses, separated by only three to four weeks, may have been too short to provide a truly lasting, robust immune response. In this sense, acceleration shots can be seen more as the final stage in an initial a series of vaccinations.

“More space between the first and second dose would be better, but even with what we got, it might still be okay,” Gounder said.

The privileged ones are getting stronger – but that won’t help prevent the spread of the virus

Experts all agree that giving extra shots won’t work very well if some people still don’t get shots.

“I think we need to step back and just ask what we’re actually doing?” Gounder said. “It’s almost like people lining up to buy the new one, whatever it is.”

Gounder laments that the United States has favored this universal approach to vaccination, treating booster doses as new iPhones, rather than public health tools.

“They are the most privileged who will get as much as they want, and the less privileged they are, the more vulnerable they are not,” she said.

Whether people notice it or not, that rejects everyone in the long run.

“If you give dose after dose after dose to an individual, but there is a lot of circulation of viruses around them in the community, they are still at risk,” Gounder said. “I don’t think that’s really gone through yet.”

Read the original article on Business Insider

Leave a Comment