Immunocompromised People Make Up Nearly Half Of COVID Breakthrough Hospitalizations. An Extra Vaccine Dose May Help.

This article is part of TPM Cafe, TPM’s home for opinion and news analysis. It first appeared at The Conversation.

The U.S. Food and Drug Administration and Centers for Disease Control and Prevention officially recommended on Aug. 12 and Aug. 13, 2021, respectively, that people who are moderately to severely immunocompromised receive a third dose of the COVID-19 vaccine.

One reason for this recommendation is high hospitalization rates among immunocompromised people who are vaccinated. As of July 2021, nearly half of the vaccinated people hospitalized with breakthrough COVID-19 infections were immunocompromised – despite making up only 2.7% of the U.S. adult population. In comparison, the rate of breakthrough cases among vaccinated people who are not immunocompromised was less than 1%.

I am a physician scientist specializing in infections in immunocompromised patients. As someone who researches autoimmune disease and has worked on the COVID-19 vaccine trials, I agree that a third dose of COVID-19 vaccine can help protect those with weakened immune systems.

What does it mean to be immunocompromised?

People who are immunocompromised have weakened immune systems. This can result from certain diseases and their medical treatments, such as cancer, autoimmune diseases, untreated HIV, organ transplant medications and some forms of kidney disease. The common thread is that the body’s defenses against infection are impaired.

Two parts of the immune system seem to be particularly important in protecting people from getting sick with COVID-19: T cells and B cells. B cells make antibodies that can bind to and inactivate viruses. T cells kill off virus-infected cells, prevent infection from further spreading and organize the body’s overall defense response. Different types of immunocompromising conditions and treatments can either kill or decrease the effectiveness of these key immune cells.

That can result in a hampered response to vaccines. As a result, people who are immunocompromised often need to follow different vaccination guidelines from people who are not immunocompromised to best protect themselves from infection. After a bone marrow or solid organ transplant, for instance, patients are routinely revaccinated against such infections as hepatitis B.

COVID-19 is particularly dangerous for the immunocompromised

Early on in the pandemic, researchers learned that immunocompromised people infected with COVID-19 tend to have particularly severe and long-lasting infections. This leads to prolonged viral shedding, meaning that the period during which these infected people release the virus as they breathe, talk and eat is much longer. Thus, they have a higher chance of transmitting the virus to others.

Long infections with poor immune responses are also ideal environments for the virus to evolve and adapt in ways that allow it to better infect people.

While immunocompromised people were not included in the initial COVID-19 vaccine trials to avoid putting them at risk, subsequent studies revealed that the authorized two-dose mRNA vaccine regimens do not stimulate as strong a defense against COVID-19 for immunocompromised people. In particular, organ transplant recipients seem to develop fewer COVID-19 antibodies after vaccination. That’s not surprising, given that the medicines used in transplantation intentionally hamper antibody development to prevent the immune system from rejecting the donated organs. But since then, pilot trials in organ transplant recipients have shown that an additional dose of vaccine can help boost immune response.

The best protection for everyone against COVID-19 is to have as many people vaccinated as soon as possible. In the interim, a third vaccine dose can safely and effectively decrease the likelihood of severe COVID-19 in immunocompromised people. And consistently wearing masks, regardless of vaccination status and whether or not you’re immunocompromised, can also significantly reduce the spread of COVID-19.

 


Jonathan Golob is an assistant professor of Infectious Disease at the University of Michigan.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Texas House Reported A Quorum, Opening Door To Voting Restrictions

The Texas House of Representatives had a quorum for the first time in months Thursday evening, as some Democrats trickled back after weeks of absence to block a voter restriction overhaul. 

Continue reading “Texas House Reported A Quorum, Opening Door To Voting Restrictions”

What The US Didn’t Learn in Afghanistan, According To The Government’s Own Inspector General

This story first appeared at ProPublica. ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for The Big Story newsletter to receive stories like this one in your inbox.

The chaotic collapse of the Afghan military in recent months made starkly clear that the $83 billion U.S. taxpayers spent to create and fund those security forces achieved little. But a new report this week by the Special Inspector General for Afghanistan Reconstruction also reveals the depths of failure of the United States’ entire 20-year, $145 billion effort to reconstruct (or construct, in some cases) Afghanistan’s civil society.

John Sopko, the special inspector general since 2012, has long chronicled the government’s miscalculations. In his latest lacerating assessment, he concluded that “the U.S. government continuously struggled to develop and implement a coherent strategy for what it hoped to achieve.” The U.S. effort was clumsy and ignorant, the report says, calling out the hubris of a superpower thinking it could reshape a country it didn’t understand by tossing gobs of money around.

The new report is a sweeping look back over America’s two decades in Afghanistan, which left 2,443 U.S. servicemembers and more than 114,000 Afghans dead. The watchdog agency has, for 13 years, consistently and accurately pointed out consequential flaws of the many reconstruction programs at play.

ProPublica also examined some of the same issues along the way in a series called “GI Dough.” In 2015, we decided to add up the waste and did an extensive analysis of the causes behind it. Our reporting found at least $17 billion in likely wasted taxpayer dollars at the time. (And that was just out of the small percentage of total spending SIGAR had scrutinized at that point.) To help put those squandered funds into context, we created a game readers could play to see what the money could have bought at home.

The efforts to create a new government and military from scratch were overly ambitious, ProPublica found in 2015. They failed to consider the needs and abilities of Afghans. There was a disregard for learning from past mistakes. (Take for example, soybeans.) And the goals were far too “pie in the sky” for one of the world’s poorest nations, a country still racked by violence. What was happening in Afghanistan was strikingly similar to the failures endured in Iraq just a few years prior.

For its part, SIGAR has dissected a wide variety of breakdowns in its decade-plus of tracking the Afghanistan effort. These reports are not just about a $25 million building no one wanted or would ever use, a $200 million literacy program that failed to teach would-be soldiers how to read, a $335 million power plant the Afghans couldn’t afford to run or even the $486 million spent on planes that couldn’t fly and ended up as scrap metal. What the reports often really highlight is that the underlying assumptions were wrong.

The SIGAR reports form a penetrating body of real-time analysis that reveals little appetite to change course and whose warnings seem to have gone unheeded. Adequately answering the questions SIGAR raised in each report would have forced a wholesale reexamination of the U.S. presence in the country. That never happened.

“This was not a matter of ignoring what was said as much as not wanting to come to grips with the issue, and it was a deliberate choice not to deal with the problems,” said Anthony Cordesman, a policy expert at the Center for Strategic and International Studies. “It wasn’t even a triumph of hope over experience; it was a triumph of political expediency over meaningful policy making.”

According to Cordesman, no one wanted to “preside over a very visible American defeat,” one that would undoubtedly leave behind a destabilized Afghanistan and potential national security disaster. There was, too, he said, a strong contingent of true believers who kept making the argument that success was almost in hand: “I think they were in a state of denial.”

Then there were the military generals and other top officials described in The Washington Post’s revelatory “Afghanistan Papers” in 2019, who were far more interested in spinning a tale of near victory to the public. In addition to assurances that the insurgency was on its heels, officials often trotted out statistics about lower infant mortality rates, increased life expectancy and vastly improved educational opportunities for girls. SIGAR acknowledged such “bright spots” in this week’s report, but concluded that those achievements were not worth the sizable investment and, more important, aren’t sustainable without a continued U.S. presence. In other words: It was all temporary.

SIGAR found that there was a persistent, troubling disconnect between what U.S. officials wanted to be true and what was actually happening. “By spending money faster than it could be accounted for, the U.S. government ultimately achieved the opposite of what it intended: it fueled corruption, delegitimized the Afghan government, and increased insecurity,” the report says. But officials pressed on with “reckless compromises,” including unrealistic timelines for progress, and “simply found new ways to ignore conditions on the ground.”

Diplomatic agencies more suited to the task of nation building were muscled aside by the Pentagon, which was better resourced but lacked the requisite expertise. The State Department and U.S. Agency for International Development, SIGAR reported, didn’t have enough staff to “meaningfully perform that role.”

“If the goal was to rebuild and leave behind a country that can sustain itself and pose little threat to U.S. national security interests,” the report says, “the overall picture is bleak.”

SIGAR’s analysis of the future is equally forbidding. The U.S. is exiting Afghanistan, but history shows we’ll likely jump into nation building again. SIGAR’s report notes that it’s the “11th lessons learned report” in the series, but the heading for the report makes it quite clear that, if the U.S. government is the student, the message hasn’t sunk in. It’s called “What We Need to Learn: Lessons from Twenty Years of Afghanistan Reconstruction.”

 

Give This a Try!

Every day is a good day to try out a two-week free trial of Prime Ad Free (AF). But today is an especially good day. Just click here to give it a test drive – super easy, free, no obligation. We’re hoping to get to 700 members trying the trial by the end of today – as of this morning we’re at 640.

Top Election Official Rips Arizona GOP’s Sham Election ‘Audit’ In Scathing Preview

A lot of things happened. Here are some of the things.

This Audit Is Bad And You Should Feel Bad

Arizona Secretary of State Katie Hobbs released an analysis of the state Senate GOP’s incoming report from its so-called “audit” of the 2020 election results carried out by Cyber Ninjas, a firm led by a pro-Trump conspiracy theorist.

  • In her 46-page analysis, Hobbs ripped the “audit” for:
    • “lack of security and chain of custody procedures”
    • “lack of transparency”
    • “lack of consistent, document quality control practices, policies, and procedures”
  • There are “numerous examples of failures” in Cyber Ninjas’ review process, Hobbs said.
    • “Any one of these issues would deem an audit completely unreliable, but the combination of these failures renders this review meritless.”
  • Hobbs pointed out that the primary reason for the audit was Republicans’ refusal to accept the election results that led to Trump’s solid defeat.
    • As a result, they held an audit that “undermined public confidence in accurate and secure elections that were conducted in 2020.”
  • Stephen Richer, Maricopa County’s GOP county recorder and top elections official, also released a fiery prebuttal to the audit flatly rejecting his fellow Republicans’ stolen election narrative.
    • “Nobody stole Maricopa County’s election. Elections in Maricopa County aren’t rigged,” he wrote.
  • The audit report is expected to be released soon.

Oregon Requires Teachers To Get Vaccinated

All teachers and other staff in Oregon’s K-12 schools, both public and private, must be vaccinated for COVID-19, Gov. Kate Brown (D) announced during a press briefing yesterday.

  • Washington, California and Hawaii have similar vaccine mandates for teachers but vary between allowing weekly testing as an alternative to receiving the vaccine and whether university educators are included in the mandate, as is the case with Washington.

School Board Member Peddles Wack COVID-19 Conspiracy Theories

David Banks, the vice chair of Georgia’s Cobb County school board, has been emailing parents mind-boggling conspiracy theories about the virus from his official account.

  • The emails allege, among other things, that White House COVID-19 expert Anthony Fauci paid a Chinese lab to research COVID-19, and that vaccines for the virus have toxic chemicals that “penetrate the brain with injury, and infect the entire human body.”
  • CNN also received an email on “useless” masks from Banks’ account that cited a “study” that was actually just tweets from some entrepreneur in Texas.
  • “Nothing has been debunked,” Banks told a parent who had replied to his email by debunking the misinformation he was pushing.

A Harrowing Image

The city of Jacksonville, Florida confirmed to local outlet First Coast News that this Reddit photo of several COVID-19 patients curled up in agony in the Jacksonville Public Library while awaiting Gov. Ron DeSantis’ (R) touted monoclonal antibody treatment is real:

Texas Lt. Gov. Dan Patrick Goes Fully Mask Off

COVID Hits Vaccinated Senators

Sens. Roger Wicker (R-MS), Angus King (I-ME) and John Hickenlooper (D-CO), who have all been fully vaccinated, announced yesterday that they tested positive for the virus.

  • All of them reported experiencing only mild symptoms.
  • That’s four senators in total who have had breakthrough cases of COVID-19. Sen. Lindsay Graham (R-SC) was the first in early August.

Wow!

A jaw-dropping 95% of eligible voters in Georgia are now registered to vote, according to newly released data from the U.S. Election Assistance Commission.

  • Georgia now has one of the highest registration rates in the country. Only eight other states had higher rates.
  • Automatic voter registration at driver’s license offices was the main driver of the dramatic increase from the registration rate in 2016.

GOP Congressman Challenges Internet Rando To Literally Fight Him, Coward

Rep. Clay Higgins (R-LA) got into a Facebook pissing match with some guy in Alaska named Joel Dolphin (yes, really), during which the congressman invited Dolphin to choose a fighting arena for a throwdown when he travels to Alaska with Rep. Don Young (R-AK) next year.

  • “Locate us a ring, or a dojo,” Higgins wrote. “I’ll give you a few rounds to make your point. Be seeing you.”
  • The Republican lawmaker ended his missive with an internet mic-drop: “Higgins out.”

Meanwhile In New York

GOP New York City mayoral candidate Curtis Sliwa is out here courting the coveted pigeon vote:

Do you like Morning Memo? Let us know!

Man Who Claimed To Have Bomb Surrenders To Police Near Capitol

A man who parked a pickup truck outside the Library of Congress Thursday and threatened to detonate a bomb has surrendered to law enforcement.

Capitol Police chief Tom Manger identified the suspect as Floyd Ray Roseberry of North Carolina.

Roseberry appears to have posted videos to a now-deleted Facebook page Thursday morning in which he addresses President Biden and describes calling in a bomb threat.

A standoff stretched into the afternoon as law enforcement negotiated with Roseberry. It remains unclear whether the vehicle contained a bomb.

Follow our coverage below: