Israeli doctors find severe cases of COVID-19 progression, especially in older and sick patients

JERUSALEM, Aug. 20 (Reuters) – Doctors in Israel’s COVID-19 wards are learning which vaccinated patients are most vulnerable to serious illness amid growing concerns about cases where shots offer less protection against the worst forms of the disease.

About half of the country’s 600 patients currently hospitalized with serious illnesses have received two doses of the shot from Pfizer Inc (PFE.N), a rare occurrence of 5.4 million people fully vaccinated.

Most of these patients received two doses of vaccine at least five months ago, are over 60 years old, and also have chronic diseases that exacerbate a coronavirus infection. They range from diabetes to heart disease and lung disease, as well as cancers and inflammatory diseases that are treated with drugs that suppress the immune system, according to Reuters interviews with 11 doctors, health professionals and officials.

These “advanced” cases have become the focus of a global debate over whether highly vaccinated countries should give booster doses of COVID-19 vaccines and to which people.

Israel began offering booster doses to people 60 and older in July and has since expanded that eligibility.

The United States, citing data from Israel and other findings, said Wednesday it would make reinforcement doses available to all Americans starting in September.

Other countries, including France and Germany, have so far limited their reinforcement plans to the elderly and people with weak immune systems.

“Vaccinated patients are older, unhealthy, often in bed before infection, immobile and already in need of nursing care,” said Noa Eliakim-Raz, head of the coronavirus room at Rabin Medical Center in Petach Tikva.

In contrast, “the unvaccinated COVID patients we see are young, healthy, working, and their condition is rapidly deteriorating,” he said. “Suddenly they’re put on oxygen or a respirator.”

The Israeli Ministry of Health has raised a new alarm this week with a report showing the effectiveness against serious diseases of the Pfizer vaccine, developed with the German BioNTech, which appeared to have dropped from more than 90% to 55% in people aged 65 and over who received the second blow. in January.

Disease experts say the representativeness of the figures is unclear, but agree on the concern of the evidence given that the overall protection of the vaccine against infection is declining.

They cannot say whether this is due to the amount of time elapsed since inoculation, the ability of the highly contagious Delta variant to evade protection, the age and underlying health of vaccinated people, or the combination of all. these factors.

Health officials in the United Kingdom and the United States, two other countries with high vaccination rates and an increase in Delta infections, have reported similar trends. In the UK, around 35% of people hospitalized with a Delta case in recent weeks had received two doses of a COVID-19 vaccine. According to federal data, nearly three-quarters of advanced infections in the United States that led to hospitalization or death were from people 65 and older.

U.S. officials said their reinforcement plan is based on the concern that over time, vaccines will provide less protection against serious disease, even among younger adults.

“We are closely watching other countries and (we are concerned) that we are also seeing what Israel is seeing, which worsens infections over time” among vaccinated people, said Rochelle Walensky, director of the Centers for Disease Control and Prevention of the USA.

The World Health Organization has repeatedly urged rich nations to refrain from providing boosters, while much of the world has not yet accessed its first doses of COVID vaccine.

IMMUNE RESPONSE

The Delta variant, first identified in India, has become the dominant version of the SARS-CoV-2 virus worldwide, accelerating a pandemic that has killed more than 4.4 million people.

In Israel, new daily cases have gone from single digits in June to about 8,000 since the arrival of Delta. About half of the cases, most of them mild to moderate, are found in vaccinated people.

The first to be vaccinated in Israel were at high risk, including people 60 and older. The immune response of some may have been weakened by the time Delta struck Israel. But for other people with underlying health conditions, the vaccine may not have started at all.

“For some of them, the vaccine did not elicit an immune response, they had no antibodies, because of the disease itself or because they are treated with drugs that suppress the immune system,” said Dror Mevorach, who heads the coronavirus room of Hadassah Hospital in Jerusalem. He cited examples such as chronic lymphocytic leukemia and lymphoma.

Among the 3 million vaccinated Israelis covered by Clalit, the country’s largest health care provider, 600 have suffered serious advanced cases since June. About 75% of them were over 70 years old and spent at least 5 months after their second dose, according to Ran Balicer, Clalit’s director of innovation. Almost all have chronic diseases.

“We barely see young people vaccinated in serious condition,” Balicer said.

In the UK, doctors described similar characteristics among vaccinated patients who fall seriously ill.

“In those people who enter, because of their age, because of their morbidity, there may be people who expect the vaccine to be less effective than other age groups,” said Tom Wingfield, clinical professor. of the Liverpool School of Tropical Medicine.

Delta has driven a further increase in coronavirus cases and deaths in the United States, especially in states where vaccination rates remain low. Among vaccinated patients who become infected, there is evidence that older people are more affected.

In Texas, 92% of advanced cases of vaccines that caused death occurred in people over 60 and 75% had a known underlying disease that put them at high risk for COVID-19, according to a department spokesman. of public health.

Initial data in Israel suggest that booster shots administered in recent weeks reduce the risk of infection in the elderly compared to those who have only received two doses. Read more.

Even without boosters, Israeli doctors say vaccinated patients tend to recover faster.

“The vaccinated patients I treated used to leave the ICU after three days. The unvaccinated patients took a week or two to stabilize,” said Yael Haviv-Yadid, head of the critical care ward at the Sheba Medical Center, near Tel Aviv.

Even if the vaccine didn’t stop them from getting sick, the disease may have attenuated them, said Alex Rozov, head of the coronavirus room at Barzilai Medical Center in Ashkelon.

“Our cautious impression is that vaccinated patients suffer from an easier disease: treatment is more effective among those with antibodies.”

Additional reports by Alistair Smout and Josephine Mason in London, Carl O’Donnell in New York; Edited by Michele Gershberg and Dan Grebler

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