Health experts widely consider the COVID-19 vaccine to be the best tool for combating severe illness and death from the coronavirus.
Unvaccinated Texans are 17 times more likely to die of a COVID-19 related illness than those who are fully vaccinated, according to the Texas Department of State Health Services. They’re also two times more likely to contract the virus.
But for some groups, including people older than 65 and people who are immunocompromised, the COVID-19 vaccine offers less protection than it does for younger people without immune-suppressing health conditions.
A January study released by the Centers for Disease Control and Prevention found that age, immunosuppression and other underlying conditions are risk factors for severe COVID-related outcomes, a fact that could impact the way doctors treat vaccinated people suffering with COVID-19.
The Dallas Morning News spoke to four Texas COVID-19 experts to learn more about why some people are more susceptible to COVID-19 complications, even when vaccinated. The experts are:
- Erin Carlson, associate clinical professor and director of graduate public health programs at the University of Texas at Arlington’s College of Nursing and Health Innovation
- Dr. Joseph Chang, chief medical officer at Parkland Health and Hospital System
- Dr. James Cutrell, infectious diseases fellowship program director at the University of Texas Southwestern Medical Center
- Catherine Troisi, infectious disease epidemiologist with the University of Texas Health Science Center at Houston:
Why are some populations still at risk for COVID-related complications after being vaccinated?
The immune system is the key to fighting off coronavirus infections. The COVID-19 vaccine triggers a person’s immune system to generate protective antibodies that protect cells against the virus, said Chang.
People who have naturally weaker immune systems do not produce the same number of antibodies that a normal person would, he said, making the vaccine less effective. Immune systems tend to weaken with age. Those with pre-existing conditions that affect the immune system are already at a disadvantage.
“This is why boosters were initially approved for older and immunocompromised individuals first,” Chang said. “Their antibody levels were lower to begin with, so boosting them was more important.”
Additionally, some patients with underlying diseases are less able to physically tolerate milder disease from COVID-19, even if they have a good antibody response from the vaccine.
The virus can “exacerbate their underlying medical conditions and lead to complications that require hospitalization,” said Cutrell.
What other preventive measures can be taken to protect high-risk populations?
While some groups, like those over 65 years old and those who are immunocompromised, may not develop as effective immune responses from the COVID-19 vaccine, it’s still critical that they get vaccinated, experts say. Some protection is better than no protection.
It’s also critical for people interacting with high-risk populations to help insulate them from the virus. People with normal immune systems play a role in preventing those with weaker immune systems from getting infected.
“That means we prevent community transmission by vaccinating everyone and following public health measures such as masking, social distancing, improved ventilation,” said Troisi.
Even though breakthrough infections among vaccinated people are more common with the omicron variant than previous strains, they’re still relatively rare, said Carlson.
Breakthrough infections in people with fully functioning immune systems are also often less severe.
“A vaccinated person will not be able to transmit the virus as readily or severely as an unvaccinated person because fully vaccinated people do not shed as much virus — like the virus in one’s mucus and saliva — as someone who is unvaccinated,” Carlson said.
It’s also important for immunocompromised individuals to control other health issues that could make a COVID-19 infection worse. People with diabetes, for instance, will likely fare better against the virus with controlled blood sugar levels.
“COVID can be fought off much more easily if a person has only one health problem and not five or six,” Chang said.
How does the shortage of COVID-19 treatments impact people at high risk for COVID-19 complications?
Once a person contracts COVID-19, there are a handful of outpatient treatment options available to try and lessen the severity of the infection. The monoclonal antibody sotrovimab and COVID-19 pills by pharmaceutical companies Pfizer and Merck are all somewhat effective at treating the virus.
But those medications are in short supply, a reality that could have detrimental effects for high-risk patients.
“The lacking supply of drugs, combined with the laissez-faire attitude that much of the public has about COVID, forces people with weakened immune systems to continue to shelter from daily life to avoid potentially devastating consequences of a breakthrough infection,” Carlson said.
Studies have shown that COVID-19 drugs can make more of a difference in vulnerable populations than in healthier ones, Chang said. “At Parkland, we absolutely should and do prioritize these kinds of patients for these treatments,” he said.
A number of federal and local health organizations, including the Dallas County Medical Society, released guidelines for allocating treatments to people who are most likely to benefit from them in times of high demand and low supply.