COVID-19: Weekly Update (October 10, 2022)

Analysis suggests that increasing COVID-19 booster rates could save thousands of lives and billions of dollars in medical costs.

The Centers for Disease Control and Prevention (CDC) announced it would stop reporting COVID-19 cases and deaths daily and switch to weekly reports “to allow for additional reporting flexibility, reduce the reporting burden on states and jurisdictions, and maximize surveillance resources.”

Boosters could prevent thousands of deaths

A recent analysis from the Commonwealth Fund, a private foundation, examined three possible scenarios in which the vaccination rate in the US remains the same as it was in August or significantly increases.

The model is an update from a previous analysis. It suggests that if a fall booster vaccination campaign reached coverage similar to the 2020–2021 influenza vaccination, it would prevent more than 75,000 deaths and more than 745,000 hospitalizations by the end of March 2023. Moreover, it would also generate savings of $44 billion associated with direct medical costs.

The second scenario assumes that 80% of eligible individuals age five and older will receive their booster dose by the end of 2022. According to the analysis, it would prevent approximately 90,000 deaths and more than 936,000 hospitalizations and avert $56 billion in direct medical costs over the course of the next six months.

The authors note that because of the possible emergence of an entirely new variant, the results of the analysis may underestimate the benefits of bivalent booster vaccination in terms of cases, hospitalizations, deaths, and medical costs averted.

Moreover, authors predict that relaxed COVID-19 control measures are likely “to fuel a more substantial fall surge” than suggested in the analysis. In addition, the analysis did not incorporate holiday-driven contact.

As of October 5, around 11.5 million Americans had received the updated booster shot, which targets both the initial SARS-CoV-2 virus and the Omicron sub-variants BA.4/5, according to the CDC. This represents only 5.3% of the people in the US aged 12 and older who are eligible for the booster.

This study does not appear to account for the superior protection of infection-acquired immunity against severe disease nor considers the risk of adverse vaccine-related events among those at low risk of severe COVID-19 in a thorough risk-benefit evaluation.

Altarawneh and colleagues found that previous infection alone conferred 91% protection against severe, critical, or fatal Omicron infection. In comparison, three doses and no prior infection offered 82.7% protection against the severe, critical, or fatal disease.

The authors of this large, real-world study conclude that any form of immunity (infection, vaccination, or both) provides good protection against severe disease and death. The next study provides some insight into which high-risk populations would likely benefit most from a booster.

Hospitalizations among high-risk veterans

A retrospective study published in the Journal of the American Medical Association suggests a low rate of hospitalization and death in patients who completed a COVID-19 vaccination series and received a booster.

The research included over 1.6 million patients receiving care at Veterans Health Administration facilities, who were followed up for 24 weeks — from July 1, 2021, to May 30, 2022. At that time, the Delta variant and the Omicron BA.1, BA.2, and BA.2.12.1 sub-variants were predominant in the US. Most (68.4%) of the patients were 65 years or older, and 8.2% were female. Only 3.8% were younger than 65 years and without a high-risk comorbid condition.

Over the 24 weeks, the overall incidence of hospitalizations with COVID-19 pneumonia or death was 8.9 events per 10 000 persons. Among participants with average risk, those who were 65 years or younger and had no high-risk conditions, the incidence rate was 0.9 events per 10 000 persons.

Among high-risk populations — people over 65 years with high-risk comorbid conditions (70.4% of participants) or with immunocompromising conditions (9.6% of participants), the incidence of hospitalization with pneumonia or death was 9.6 events per 10 000 persons.

Hospitalizations with pneumonia or deaths were more common among individuals 65 years or older with immunocompromising conditions (15.7 events per 10 000 persons) than those with high-risk comorbidities (2.6 events per 10 000 persons.)

Study authors note that there is a risk of measurement error and bias because unboosted or unvaccinated populations were not included. Moreover, subgroups such as nursing home residents were excluded so that “the findings could have greater generalizability”; however, the study population was predominantly white men.

Overall, the risk of breakthrough infection was higher in the average-risk population than in the high-risk population, suggesting perhaps that risk-reduction measures mitigated some of the exposures. The risk of severe disease was 3.8 to 4.7 times higher for the high-risk population than the average-risk individuals.

For clinicians and caregivers, this data suggests that vaccination, boosters, monoclonal antibodies, if indicated, easy access to testing, and linkage to care with appropriate empirical treatment are vital measures to prevent disease progression. Patients with cancer who have received immunosuppressing drugs are at elevated risk compared to those with high-risk comorbidities.

Those immunocompromised patients who received mRNA-1273 (Moderna) vs. BNT162b2 (Pfizer) had a lower cumulative incidence of hospitalization during the study. Caregivers should be in contact with the family member’s primary care provider to discuss measures to reduce risk and the plan of care as soon as the veteran tests positive.

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