Coronavirus Files: Boosters hold up against omicron but Black Americans hit hard in winter surge

coronavirus
March 28, 2022

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The Coronavirus Files will be on spring break next week and return on April 11.

Omicron hospitalized record number of Black adults

Recent data indicates that during the winter surge, non-Hispanic Black adults were hospitalized at higher rates than any other ethnic group, at any time in the pandemic, according to a new report from the Centers for Disease Control and Prevention.

Black adults were four times as likely as white adults to be hospitalized during the winter omicron wave.

Part of the reason is likely lower immunization rates, writes Akilah Johnson at The Washington Post. Black people made up 31% of all hospitalized, unvaccinated patients during the omicron surge. Fewer than 40% of Black Americans had receive two vaccine shots by Jan. 26, according to the CDC report.

Unequal access to health care and racism in the health care industry have driven disparities throughout the pandemic, notes Noah Y. Kim at Mother Jones.

Hospitalization rates also increased over the winter for Asian and Pacific Islander adults. Rates fell in American Indian, Alaska Native and Latino populations, the CDC reported.

Vaccines block severe illness from omicron BA.1, BA.2 too

The CDC also reported that COVID-19 vaccines did their job during the omicron BA.1 outbreak, despite the variant’s highly contagious nature, reports Katie Shepherd at The Washington Post.

Vaccines from Moderna and Pfizer, both based on mRNA technology, protected people from the worst outcomes of needing a ventilator to breathe or death. “Receiving two or three doses of an mRNA COVID-19 vaccine was associated with a 90% reduction in risk for COVID-19–associated invasive mechanical ventilation or death,” the report states.

Getting a booster enhanced protection against serious illness. Among people who contracted COVID, unvaccinated people were nine times more likely to die than people who received the initial two-dose vaccine course, and 21 times more likely to die than those who’d been boosted as well, writes Shepherd.

The mRNA vaccines’ efficacy against milder illness has been shown to wane, dropping to 78% protection against hospitalization within four months of a booster.

And the Johnson & Johnson vaccine, despite its lesser reputation, now seems to be working about as well as the mRNA formulas against infection, hospitalization and death — even among those who haven’t sought a booster shot — reports Apoorva Mandavilli at The New York Times. Not everyone is convinced this is true, she adds, and it’s not clear why it now appears more effective.

The next big test for the vaccines will be omicron BA.2, now dominating the globe and making up just over a third of U.S. cases.

While several nations are currently facing omicron outbreaks, fueled in large part by the BA.2 variant, U.S. case rates remain low. Hospitalizations are the lowest they’ve been since last summer.

Experts now predict a rise in U.S. cases due to BA.2, but nothing like winter’s surge. “Hopefully, we won’t see a surge,” the NIH’s Dr. Anthony Fauci said last week. “I don’t think we will.”

One preprint study from Qatar, not yet peer reviewed, suggests the mRNA vaccines work as well against BA.2 as they did against BA.1, though the protection afforded by boosters still wanes within months, reports Saima May Sidik at Nature.

Moderna tees up to vaccinate youngest children

Moderna announced last week that its clinical trial of two COVID-19 vaccine doses for children between 6 months and 5 years were successful, writes Molly Walker at MedPage Today: The shots were safe, and they induced antibody levels equivalent to those of vaccinated adults.

But the vaccine’s real-world efficacy against omicron, at first glance, seems less than stellar: during the winter surge, the shots were 37.5% effective against illness, which the company defined as a positive COVID-19 test plus at least one symptom, for children ages 2 to 5. For those under 2, efficacy was just slightly higher at 43.7%.

Since the trial wasn’t specifically designed to measure efficacy, those numbers aren’t statistically certain, but Moderna said efficacy was definitely more than zero, reports Carolyn Y. Johnson at The Washington Post.

The FDA originally sought vaccine efficacy levels against infection of 50% or higher, but that was before the omicron variant. Moderna said these numbers from the pediatric vaccine were comparable to the protection that two doses of its vaccine gave adults during omicron.

And children have proven comparatively resilient to coronavirus, which means there may have been less room for improvement. No children in either of the trial’s vaccinated or placebo groups became ill enough to require hospitalization, so it’s impossible to say for certain if the vaccine protected against severe disease or death, or by how much.

As for safety, while more than one in 10 of the children 5 and younger had a fever after vaccination, these were generally mild. There were no cases of heart inflammation (myocarditis) or death after the vaccination.

“40% with adequate safety data could be very meaningful, especially to higher risk individuals,” former FDA chief scientist Luciana Borio told STAT.

Moderna is also testing a third, booster shot in children of all ages, and planning to apply for authorization of the vaccine in children aged 6 to 11. The company’s vaccine authorization for teens has been stalled over concerns about a risk for myocarditis, which is less common in younger kids.

Several other nations have already authorized the Moderna vaccine for teens and kids as young as 6.

This move means Moderna could leapfrog Pfizer in the race to vaccinate younger children. Despite enthusiasm from regulators eager to protect these children, the only age group still ineligible for vaccination, Pfizer’s application was put on hold after two doses didn’t generate the level of antibody response seen in teens and adults. Pfizer is also testing a third dose, with results expected in April.

The different results from the two companies may lie in the doses used. Pfizer’s dose for the youngest children is 3 micrograms of the active ingredient, while Moderna’s is 25 micrograms.

Expiry of pandemic relief imperils school meal programs

Millions of children rely on the National School Lunch Program, which received additional funding during the pandemic. That funding is now set to expire at the end of June.

Loosened rules that allowed programs more flexibility, such as waiving the requirement that children eat together in groups, are also coming to an end.

During the pandemic, school programs could spend the extra money on fruits and veggies. Going back to the old ways will mean less funding, higher expenses and less healthy meals, reports NPR’s Allison Aubry.

For example, for students to eat as a group during the summer break, some rural districts must send busses around so the kids who qualify for school meals can eat together, on the bus. With prices rising for gas as well as food, doing so will mean less money for decent meals on the roving cafeteria.

The decision to extend the waivers lies with Congress, and thus far lobbying by nutrition advocates and school food directors has been unsuccessful.

As a result, kids could miss more than 95 million meals over the summer of 2022, said Lisa Davis, head of the national No Kid Hungry campaign.

Ending the flexible programs would have real consequences for children’s health, notes Aubry. Poor nutrition is linked to chronic conditions such as diabetes and obesity, which in turn increase the risk for severe COVID disease.

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What we're reading

  • “Congress’s epic pandemic funding failure,” by Dylan Matthews, Vox
  • “COVID funding helped historically Black colleges survive the pandemic. What happens now?” by Chelsey Cox, USA Today
  • “Americas flu-shot problem is also its next COVID-shot problem,” by Katherine J. Wu, The Atlantic
  • “Why COVAX, the best hope for vaccinating the world, was doomed to fall short,” by Adam Taylor, The Washington Post
  • “Lessons from the COVID data wizards,” by Lynne Peeples, Nature
  • “The next COVID wave is probably already on its way,” by Dr. Tom Frieden, The New York Times

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