Feds May Expand Second Reminders to All Adults as Anxiety Rises in Wave BA.5

The rapid rise of the BA.5 subvariant of omicron, with its enhanced immune system evasion abilities and demonstrable growth advantage, has federal officials concerned. In a flurry of activity late Monday and early Tuesday, officials doubled down on pandemic measures, renewed calls for vigilance and are considering expanding eligibility for second boosters to all adults.

During a Tuesday morning press briefing, White House COVID-19 Response Coordinator Ashish Jha laid out a battle plan against BA.5, which to date is estimated to account for 65% of cases. in the USA. Jha highlighted the efforts and tools to prevent another towering wave of infection as seen with the original omicron in January. The plan includes a stronger push to get Americans vaccinated and stimulated, as well as renewed encouragement to test, treat, mask and improve indoor ventilation.

COVID-19 cases in the United States are currently plateauing at a high level of around 117,000 new cases per day, but this is likely a significant underestimate given that many Americans are testing at home and not not report their cases. Hospitalizations and intensive care admissions, meanwhile, are on the rise, with respective increases of 17% and 21% over the past two weeks, according to The New York Times tracking. Overall, the daily average for hospitalizations has more than doubled since the end of May, with the current average nearing 38,000.

SARS-CoV-2 transmission levels are considered high in about 90% of US counties, according to a red-soaked map from the Centers for Disease Control and Prevention. The agency recommends that everyone wear masks in indoor public places in about 21% of counties, based on the agency’s milder community-level COVID-19 measure.

Current vaccines have proven to be very effective in preventing serious illnesses, hospitalizations and deaths. But to date, only 67% of Americans are fully vaccinated against the pandemic virus. Of those fully vaccinated, only 48% received a booster. This means that about 32% of Americans have had a booster, which is available to anyone ages 5 and up. In addition, people aged 50 and over or at high risk (such as immunocompromised people) are currently eligible for a second booster. But only 18.7 million people received this second reminder. That’s about 28% of people over 50 who are fully vaccinated and boosted.

On Monday night, The Washington Post reported that the Biden administration is considering expanding eligibility for second boosters to all adults. The report quotes five unnamed officials familiar with the matter, who said Jha and top infectious disease expert Anthony Fauci support the idea of ​​extending second boosters to all adults.

During Tuesday morning’s press briefing, Fauci and Jha stressed that only the Food and Drug Administration and the CDC have the ability to ultimately expand recall eligibility. The Washington Post noted that administration officials hoped to gain regulatory approval for the expansion within the next two weeks. The quick turnaround could prevent a summer extension of boosters from complicating the rollout of next-gen boosters this fall.

Boost now and later

Currently, the administration and FDA plan to roll out next-generation bivalent boosters this fall that would target both the ancestral strain and the BA.4/5 omicron subvariants. This rollout is expected to begin around October or November, about three to four months from now. In the past, recall intervals were around four to six months, Jha noted.

Jha and CDC Director Rochelle Walensky repeatedly said Tuesday that getting a booster now — or in about two weeks — wouldn’t preclude getting a bivalent booster this fall. Their thinking is simply based on the time frame and interval provided for reminders.

“While we looked at how quickly we needed to get boosts before, it’s been four, five months,” Walensky said. “We anticipate it will be a similar cadence. We would also like to point out that there are many people who are at high risk at the moment and who are waiting until October/November for their boost, while in fact, their risk is in the moment – is not a good plan,” she added. “So we really want to say ‘Now get your boost. We have all the predictions the data will suggest you will be eligible for a [bivalent] boost in the fall. We will of course continue to evaluate this data.”

At this time, there are no clinical data on the effectiveness of a second booster in healthy people under 50 years of age. It’s also unclear whether a fourth dose with current vaccines — which target the ancestral strain of SARS-CoV-2 — could skew immune responses to future variant-targeting boosters to the ancestral strain. But that hasn’t been a major concern for people already eligible for a second booster. Moreover, a majority of Americans have already been exposed to variants.

As such, many pundits have, like Jha and Fauci, embraced the idea of ​​expanding access to the second booster in the middle of the BA.5 peak. That includes virologist and vaccine expert Peter Hotez, who is dean of the National School of Tropical Medicine at Baylor College of Medicine.

“We’ve already seen the benefits in people over 50,” he told the Post. “Eventually, what is true for older people turns out to be true for younger people – it just takes longer to reveal itself.”

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