Coronavirus Files: Booster efficacy wanes; new antibody may help fill treatment gap

coronavirus
February 21, 2022

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Society is woefully unprepared for the wave of people disabled by long COVID

Some commentators see a return to normal just around the corner at last and the CDC is reportedly preparing looser mask guidelines. But life may never go back to normal for a growing group of people left with lingering health problems from the coronavirus.

“Two years in, the debilitating tail of the pandemic has revealed itself in the form of tens of millions of people living with long COVID,” writes Laura Spinney at Nature.

There were 1.2 million more people with disabilities in the U.S. in 2021 than 2020, notes the Center for American Progress (CAP). At least some of those people are suffering from long COVID, which the federal government has labeled a disability.

But policymakers and employers are underprepared. And people with long COVID may not know they’re eligible for accommodations, struggle to prove those needs amid skepticism, and face stigma. 

It may be particularly difficult to get long-term disability benefits for self-reported, difficult to measure problems such as brain fog, writes Allen Smith at the Society for Human Resource Management. Responsibility to prove disability falls on the person making a claim for benefits, not their employer or insurer.

Solid data on long COVID remains scarce, and researchers have few answers on the long-term prognosis of those afflicted. But recent estimates cited by Spinney “indicate that disability is likely to account for the lion’s share of COVID-19’s burden, and might disproportionately affect women, especially those who were infected young.”

Notes CAP, “People who are disabled and are also members of another marginalized group — such as disabled LGBTQI+ people — often bear the brunt of barriers to economic security.”

Since COVID-19 infections have been more prevalent in populations of color, long COVID is likely to follow a similar pattern. Vulnerable groups face ongoing barriers in accessing care and affording specialized treatments.  

New antibody treatment approved, but treatment disparities remain

The FDA authorized a new monoclonal antibody treatment, bebtelovimab, to protect high-risk patients from severe COVID, including the omicron variant, reports Andrew Joseph at STAT. Its maker, Eli Lilly, expects to ship 300,000 courses of treatment in February. 

There are currently more than 100,000 U.S. cases on average being diagnosed every day, though not all have the risk factors that would warrant antibody treatment. 

The new treatment should help assuage the fact that two other antibody treatments have failed against omicron, while compensating for shortages of a third that does work.

These treatments are in addition to the three authorized antivirals, paxlovid, molnupiravir and remdesivir, which have held up against omicron.

Access and equity remain a problem, writes Phil McCausland at NBC News. Antibody treatments have more often gone to white patients than people of color.

The antiviral pills, paxlovid and molnupiravir, are free and easy to use, but require a physician’s prescription. That doctor’s visit must be scheduled quickly for the drugs to help, and the appointment can be too expensive — or just unavailable — for low-income or uninsured people.

“I got 500 bottles of molnupiravir just sitting there in my pharmacy,” pharmacist Pete Nagel told NBC. “I’ve had four or five different patients die from COVID when I’ve had the pills to help them and couldn’t give it to them.”

Pharmacists are allowed to order and administer the antibodies, via four injections. Some advocates say they should be able to prescribe antiviral pills as well.

The pills are in short supply, and the FDA says those prescriptions should be in doctor’s hands so physicians can assess patients’ risk for severe COVID and for potential drug interactions or side effects.

Booster protection wanes, and other vaccine news

About 28% of the U.S. population is fully vaccinated and boosted, but fewer people than ever are getting boosted, reports Jacqueline Howard at CNN. 

Those who have received an mRNA booster — from Pfizer or Moderna — can’t expect the extra protection to last for long, according to new CDC data. As with the initial series of two shots, protection against the need for doctor visits or hospitalization started high and waned within about four months of receiving the booster. 

“How long that third shot’s protection lasts is a critical question facing public health officials because many people received their third dose months ago,” notes Lena H. Sun in The Washington Post. The NIH’s Dr. Anthony Fauci said a fourth dose down the line might be necessary, perhaps based on people’s age or other risk factors.

The boosters people got in recent months did seem to hold up against the latest variants, which is good news because omicron-specific boosters didn’t work any better than the original formulations in early animal studies, reports Emily Waltz at Nature. 

Nevertheless, human trials with omicron-specific shots are underway, with results expected within months.

Meanwhile, even the first doses of vaccine for children younger than 5 remain in limbo; Pfizer’s data show the company’s dose for young kids is less effective against the omicron variant, report Jared S. Hopkins and Stephanie Armour at The Wall Street Journal.

But recent CDC data suggest that when expectant mothers get vaccinated, their babies are protected after birth. 

Another change in vaccine guidelines may be coming. The CDC is considering extending the time between the first and second doses of the mRNA vaccines to eight weeks, writes Julia Ries at Healthline. 

While maximizing protection within just a few weeks made sense during vaccine trials and the early rollout, the longer interval may boost efficacy while reducing risk for the heart condition known as myocarditis.

Other nations have already extended the interval between shots. While such a change would be a “seismic policy shift” in the U.S., write Drs. Michael Daignault and Monica Gandhi in MedPage Today, they say the change is “long overdue.”

From the Center for Health Journalism

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What we’re reading

  • “How COVID changed the world” is the theme of Scientific American’s March issue.
  • “Coronaviruses are ‘clever’: Evolutionary scenarios for the future of SARS-CoV-2,” by Donald S. Burke, STAT
  • “Whatever happened to Biden’s Pandemic Testing Board?” by Bianca Fortis, ProPublica
  • “Vaccine scientists have been chasing variants. Now, they’re seeking a universal coronavirus vaccine,” by Carolyn Y. Johnson, The Washington Post
  • “Nasal vaccines could help stop COVID-19 from spreading — if scientists can get them right,” by Jaime Ducharme, Time
  • “Just how bad is it to be in ICU with COVID? Far more miserable than people realize, experts say,” by Karen Weintraub, USA Today
  • “The last pandemic aid anybody wants to need,” by Tara Siegel Bernard, The New York Times
  • “Was a 19th century global pandemic a case of COVID 1.0?” by Randy Dotinga, MedPage Today

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