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UPMC: Vaccine remains critical

No rush to receive COVID booster shots unless immune system compromised

The most important advice regarding COVID-19 vaccinations is what experts have been giving for months: If you’re not vaccinated, get a shot, said two UPMC doctors.

While attention this week was on booster shots, Donald Yealy, UPMC’s chief medical officer, and Graham Snyder, UPMC’s medical director of infection prevention and hospital epidemiology, emphasized increasing the number of people vaccinated remains paramount during a virtual news conference Friday.

As for booster shots, “It’s important to put in context the changing guidance,” Snyder said. “For any given dose, the biggest impact is in those not vaccinated yet.”

Beyond that, the most critical advice is for one small group to get a booster shot — the immunocompromised, representing about 3% of the population, Yealy said.

A booster shot for such people can help “prime the immune system,” making them ready for exposure to the virus, Snyder said.

Those immunocompromised people should get their boosters quickly, Yealy said.

For others who’ve been vaccinated and who are now in line for boosters, there’s no “rush,” Yealy said.

“People who got a vaccine series of Moderna or Pfizer (or Johnson & Johnson) are well-protected today, except if they’re in one narrow category (the immunocompromised),” Yealy said.

The CDC’s booster recommendations only apply to those who’ve been fully vaccinated with Pfizer at least six months ago.

Such people should get a booster if:

* They’re at least 65.

* They’re at least 18 and live in a long-term care setting.

* They’re 50 or older with an underlying medical condition.

People may get a booster if they’re 18-49 with an underlying medical condition or if they’re at increased risk of exposure and transmission because of their occupational or institutional setting.

The provision for boosters for those whose occupations put them at increased risk was included in the guidance only after CDC Director Rochelle Walensky overruled her agency’s Advisory Committee on Immunization Practices late Thursday.

Keeping up with the science in some respects is easy, as with the unchanging recommendation to get vaccinated, Snyder said.

Things aren’t so obvious with other matters, like the boosters, where what’s required is weighing whether a benefit is justified by the necessary expenditure of resources, Snyder said.

Reports that an increasingly growing percentage of people hospitalized for COVID-19 are vaccinated might be deceptive, the doctors said.

Some may be hospitalized mainly for other reasons, even if they have tested positive for COVID, Yealy said.

And as more people get vaccinated, meaning fewer unvaccinated people in the population, “breakthrough” cases will tend to become a higher proportion of COVID-19 hospitalizations, Snyder said.

A better gauge for effectiveness of the vaccines are “high-quality studies” by the CDC that show that even if “there are some signals that (protection) might be tapering,” vaccines “still do really well in preventing hospitalization and death,” Snyder said.

UPMC’s experience has shown that the chance of needing intensive care or breathing support or dying from COVID-19 is five to 15 times greater for the unvaccinated, Yealy said.

Still, vaccinated people need to be aware they can infect others.

On a community level, vaccines help suppress transmission, “but on an individual level, we can’t rely on it to prevent you from being contagious if you are exposed,” Snyder said.

The main job of the vaccine is to prevent serious illness, not prevent transmission, Snyder said.

So it is important to mask and keep distance in many circumstances, especially among people who are vulnerable to complications and people who are unvaccinated — including people you live with, Snyder said.

It’s necessary to get tested if you get any of the symptoms associated with COVID-19, even if you’re vaccinated, Yealy said.

Those who test positive should consider inquiring about monoclonal antibody treatment, which protects against disease for people who are infected, provided they do it within 10 days, the doctors said.

“Vaccination is not an impenetrable shield,” Yealy said. “It’s just a really good insurance policy against the bad things.”

All UPMC hospitals are seeing an increase in demand for care, both for COVID-19 and — in many cases — for procedures that might have been put off due to the pandemic, Yealy said.

But the system is not in danger of “collapse or an inability to take care of the sickest patients,” Yealy said.

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