Doctors in Israel’s COVID-19 wards are learning which vaccinated patients are most prone to severe conditions, amid mounting fears that the vaccinations provide less protection against the disease’s more severe forms.
Approximately half of the 600 individuals currently hospitalized with serious sickness in the country have got two doses of the Pfizer shot, an unusual occurrence in a population of 5.4 million fully vaccinated people.
The majority of these individuals had two vaccine doses at least five months ago, are over the age of 60, and have chronic conditions that are known to worsen a coronavirus infection. According to Reuters interviews with 11 doctors, health specialists, and officials, they vary from diabetes to heart disease and lung disorders, as well as malignancies and inflammatory diseases treated with immune-suppressing medications.
Such “breakthrough” cases have become key to a global debate over whether and to whom highly immunised countries should administer booster doses of COVID-19 vaccines.
In July, Israel began providing booster dosages to persons aged 60 and up, and has subsequently expanded that eligibility.
The US announced on Wednesday that booster doses would be offered to all Americans beginning in September, citing data from Israel and other discoveries.
Other nations, including as France and Germany, have so far restricted their booster plans to the elderly and persons with compromised immune systems.
“The vaccinated patients are older, unhealthy, often they were bedridden before infection, immobile and already requiring nursing care,” said Noa Eliakim-Raz, head of the coronavirus ward at Rabin Medical Centre in Petach Tikva.
In contrast, “the unvaccinated COVID patients we see are young, healthy, working people and their condition deteriorates rapidly,” she said. “Suddenly they’re being put on oxygen or on a respirator.”
The Israeli Health Ministry issued a new warning this week after research revealed that the effectiveness of the Pfizer vaccine, produced in collaboration with Germany’s BioNTech, had plummeted from more than 90 percent to 55 percent among persons aged 65 and older who received their second dose in January.
Disease specialists say it’s unclear how representative the data are, but they believe they’re troubling given indications that overall vaccine protection against illness is waning.
They are unable to determine whether this is due to the length of time after vaccination, the capacity of the more contagious Delta variant to evade protection, the age and underlying health of those vaccinated, or a combination of all of these factors.
Similar trends have been recorded by health experts in the United Kingdom and the United States, two countries with high vaccination rates and an increase in Delta cases.
In the United Kingdom, over 35% of those hospitalised with a Delta case in recent weeks had gotten two doses of a COVID-19 vaccine. According to federal data, nearly three-quarters of U.S. breakthrough infections that resulted in hospitalization or death occurred among persons 65 and older.
Officials in the United States stated that their booster plan is motivated by concerns that the immunizations will give less protection against serious disease over time, particularly among younger persons.
“We are watching other countries carefully and (are) concerned that we too will see what Israel is seeing, which is worsening infections over time” among vaccinated people, U.S. Centers for Disease Control and Prevention Director Rochelle Walensky said at a press conference on Wednesday.
The World Health Organization has frequently advised wealthier countries to avoid offering boosters while much of the worlds is still waiting for their first dose of COVID vaccine.
IMMUNE RESPONSE
The Delta form, which was discovered in India, has become the dominant version of the SARS-CoV-2 virus worldwide, hastening a pandemic that has killed over 4.4 million people.
Since Delta’s entry, daily new cases in Israel have risen from the single digits in June to approximately 8,000. Approximately half of the cases — the majority of which are mild to moderate – are in persons who have been vaccinated.
Those who were vaccinated first in Israel, notably those aged 60 and up, were at greater risk. Some people’s immune systems may have been compromised by the time Delta hit Israel. However, for some who have underlying health issues, the vaccine may not have worked at all.
“For some of them the vaccine did not trigger an immune response, they had no antibodies, because of the illness itself or because they are treated with medication that suppresses the immune system,” said Dror Mevorach, who heads the coronavirus ward at Hadassah hospital in Jerusalem. He cited examples such as chronic lymphocytic leukemia and lymphoma.
Since June, 600 of the country’s 3 million vaccinated Israelis covered by Clalit, the country’s largest healthcare provider, had seen serious breakthrough infections. According to Ran Balicer, Clalit’s chief innovation officer, around 75% of them were over the age of 70 and were at least 5 months post-second dose. Almost all of them suffer from chronic ailments.
“We are hardly seeing young vaccinated people in severe condition,” said Balicer.
Doctors in the United Kingdom described comparable symptoms in vaccinated patients who became seriously ill.
“In those people who come in, because of their age, because of their co-morbidities, they might be people that you would expect that the vaccine is not quite so efficacious as other age groups,” said Tom Wingfield, a clinical lecturer at the Liverpool School of Tropical Medicine.
Delta has driven a fresh increase in coronavirus illnesses and deaths in the United States, particularly in states with low immunisation rates. There is evidence that elderly adults are more vulnerable to infection among vaccinated patients who become ill.
According to a public health agency spokesperson, 92 percent of the vaccination breakthrough instances that resulted in death in Texas were in adults over the age of 60, and 75 percent had a known underlying illness that put them at high risk from COVID-19.
According to preliminary data from Israel, booster shots given in the last few weeks reduce the risk of infection in older adults compared to those who had only two doses.
Even without boosters, Israeli experts maintain that immunized patients recover faster.
“The vaccinated patients I’ve treated usually left the ICU in about three days. The unvaccinated patients took a week or two until they stabilized,” said Yael Haviv-Yadid, head of the critical care ward at Sheba Medical Centre near Tel Aviv.
Even if the vaccine did not prevent them from becoming ill, it may have reduced the severity of their disease, according to Alex Rozov, head of the coronavirus ward at Barzilai Medical Centre in Ashkelon.
“Our cautious impression is that the vaccinated patients suffer an easier course of illness – the treatment is more effective among those who have antibodies.” (Additional reporting by Alistair Smout and Josephine Mason in London, Carl O’Donnell in New York; Editing by Michele Gershberg and Dan Grebler).
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