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The Health 202: Recovered coronavirus patients should still get the vaccine, experts say

Research suggests most people who recovered from covid-19 are immune for at least eight months. Yet epidemiologists are largely still urging this population to get the vaccine if it’s their turn in line. 

Official guidance says vaccines should be offered regardless of whether people were previously infected. 

That’s per the Centers for Disease Control and Prevention, which also says the vaccine is safe for people who have had a prior infection. Former CDC director Thomas Frieden said he’d advise most people to get the vaccine, even if they’ve had covid-19.

But Frieden added that he doesn’t think it’s wrong for someone in a low-risk group who’d already had the illness to defer if they thought someone else could use the dose. One health system asked workers to do just that, Frieden recently noted on Twitter:

The limits on vaccine supply bolster the argument that recovered people should let others go first. 

As administration of the vaccine bottlenecks across the country, the pressure is on to get the shots in as many arms as quickly as possible. 

Researchers at the University of Colorado Boulder found that prioritizing people who don't already have natural immunity could allow health officials to get more impact from limited supplies, especially in areas where many people have already been infected, according to a modeling study that has not been peer reviewed

The researchers found that you would need to vaccinate 1 in 5 elderly people in New York to bring death rates down by 73 percent. But you can get the same result vaccinating only 1 in 6 people if you prioritize people who don’t already have antibodies to the virus, according to Kate Bubar, a PhD student in applied mathematics and quantitative biology, who co-authored the study.

And although a previous covid-19 infection isn’t a guarantee of immunity, it’s pretty good protection on its own. Researchers have found that eight months after infection, about 90 percent of patients show lingering, stable immunity. 

Still, risk can vary from person to person.  

“If I were over 70 or otherwise ill, I would certainly take the vaccine even if I'd had [covid-19]. If I were 30 and healthy, I should not be getting it now (unless a health care worker), but if for some reason I did get offered it I would probably decline,” Marc Lipsitch, an infectious-disease specialist at the Harvard T.H. Chan School of Public Health, said in an email.  

Some epidemiologists worry about the logistics of trying to weed out people with natural immunity.

It could complicate the process as health providers are already struggling to get the vaccine distributed quickly. So far around 6.7 million people have been vaccinated, even though 22.1 million doses have been distributed, according to a Washington Post analysis.

Eleanor Murray, an assistant professor of epidemiology at Boston University School of Public Health, worried that trying to verify someone's past illness would add bureaucratic hurdles. 

“Confirming whether or not someone has had COVID already adds an unnecessary layer of red tape onto vaccine prioritization. Given that the prioritization is designed to get vaccine first to those people who are most likely to get infected and/or get very sick from infection, it makes sense to reduce the barriers to vaccinating this group as much as possible,” Murray said. 

Murray also cautioned that we don't know how long people's natural immunity lasts and that it could vary from person to person. This uncertainty may be an added reason to encourage people to get the vaccine.

There’s also a risk that telling people who had covid-19 to hold off on getting the vaccine could end up feeding into anti-vaxxer narratives. Some experts are reluctant to discourage anyone from getting the vaccine if they are eligible, especially given that vaccine hesitancy is widespread. 

There's already a problem with people being offered the vaccine but not getting it. 

In Santa Rosa County, Fla., only about 40 percent of emergency responders who are eligible to get the vaccine have gotten it or signed up to do so soon. In New York, where around 30 percent of health care workers have declined the vaccine, the state’s Gov. Andrew Cuomo (D) has threatened that anyone who skips a dose now won’t be eligible for a priority vaccine later. 

The low participation rate is concerning, especially at long-term care centers. 

But not everyone who turns down a vaccine is a hardcore anti-vaxxer, Frieden cautions. He says that there is a “movable middle” of people. They aren’t going to be camping out overnight to get an early vaccine, but they may be convincible if costs and other barriers are low. Frieden says it’s crucial to keep a door open for those people, for instance, seeing whether they might be willing to schedule a shot three weeks from now instead of immediately. 

The slow pace of vaccinations has sparked a heated debate over how to stretch supplies.

A vocal group of experts has pushed for officials to consider giving as many people as possible the first dose of the two-shot regimen, even if it means risking a delayed second dose. President-elect Joe Biden has announced his incoming administration will take this approach, sending all doses out the door as quickly as possible instead of holding half back. 

“The plan, announced Friday by the Biden transition team, pivots sharply from the Trump administration’s strategy of holding in reserve roughly half the doses to ensure sufficient supply for people to get a required second shot,” our colleagues reported.

But some epidemiologists, including Frieden, argue that distribution is a bigger problem than supply at this point. Although he said he supports releasing most vaccines, he worries that some of the debates about how to stretch supply are “distractions” from the real obstacles of administration, which he blames in part on a lack of a coordinated federal plan for getting shots into arms. 

“What Operation Warp Speed has generally done is said, 'We’re responsible for getting the drugs to the states, and after that, it's their problem,' ” Frieden said. “That’s a way to facilitate finger pointing; that’s neither a plan nor a solution.” 

Ahh, oof and ouch

AHH: Blue Cross Blue Shield says it will suspend donations to lawmakers who challenged the electoral college results.

The health insurer is one of several major businesses that vowed to halt campaign donations to lawmakers who voted against certifying the electoral college results of President-elect Joe Biden’s win. Goldman Sachs, JP Morgan, Marriot and CVS Health Corp. have made similar commitments in the wake of a mob that breached the Capitol. 

“The violence at the Capitol appears to have companies scrambling to figure out how to react, as they increasingly realize that this is not an ordinary political dispute and the option of sitting on the sidelines grows increasingly unsatisfying,” The Post’s Todd C. Frankel and Jeff Stein report.

Some House Democrats hope to impeach President Trump for a second time for high crimes and misdemeanors. Here is what that accelerated process might entail. (Video: The Washington Post)

Some lawmakers who had initially planned on objecting to the electoral college results changed their minds after the violence at the Capitol, which was incited by false claims of election fraud from President Trump and others. But 139 Republican representatives and eight Republican senators voted against certifying the results.

Blue Cross Blue Shield, which provides health insurance for more than 100 million people, accused those lawmakers of voting “to undermine our democracy.”

Democrats plan to pass a resolution calling on Vice President Pence and the Cabinet to use the 25th amendment to remove Trump. House Speaker Nancy Pelosi (D-Calif.) has promised the next step will be to move forward with articles of impeachment against the president for inciting the assault on the Capitol but did not specify a timeline. Some Democrats, however, worry that impeachment proceedings could make it harder for Biden to hit the ground running with an ambitious legislative agenda when he takes office. 

OOF: Lawmakers may have been exposed to the coronavirus during the Capitol lockdown, according to the Office of Attending Physician.

“On Wednesday January 6, many members of the House community were in protective isolation in room located in a large committee hearing space,” Brian Monahan, the attending physician to Congress, wrote in an email that was sent to members of Congress on Sunday morning. “The time in this room was several hours for some and briefer for others. During this time, individuals may have been exposed to another occupant with coronavirus infection.”

“Two House aides confirmed to The Washington Post that Monahan was referring to a room where scores of House members were taken to during the riot,” The Post’s Paulina Firozi, Amy B Wang and Mike DeBonis report. “Video first published by Punchbowl News on Friday showed maskless Republicans — including Reps. Andy Biggs (Ariz.), Michael Cloud (Tex.), Markwayne Mullin (Okla.) and Scott Perry (Pa.) — refusing masks offered by Democratic Rep. Lisa Blunt Rochester (Del.) while in the room.”

Rep. Jake LaTurner (R-Kan.) disclosed Thursday that he had received a positive coronavirus test but a spokesperson said that he was not in the lockdown area in question. Separately, Rep. Charles J. “Chuck” Fleischmann (R-Tenn.) said on Sunday that he tested positive for the virus after coming into contact with another infected member of Congress with whom he shares a residence. Fleischmann also said that he was not in the lockdown area on Wednesday.

“Members of Congress qualified for priority access to the coronavirus vaccine, and many — but not all — have received at least the first shot of a two-dose regimen. Some congressional staffers have received the coronavirus vaccine as well,” our colleagues write. 

Public health experts have warned that the storming of the Capitol could be a superspreader event.

OUCH: Florida’s vaccine rollout has become a free-for-all.

“Florida is in an alarming new upward spiral, with nearly 20,000 cases of the virus reported on Friday and more than 15,000 on Saturday. But the state’s well-intended effort to throw open the doors of the vaccine program to everyone 65 and older has led to long lines, confusion and disappointment,” the New York Times’s Patricia Mazzei, Eric Adelson and Kate Kelly report.

Although the Centers for Disease Control and Prevention recommended following vaccinations of health-care workers and nursing home residents with shots for people over 75 and essential workers, Florida, along with Texas, Oklahoma and Hawaii, moved to vaccinate people 65 and older before essential workers. But as states seek to distribute a limited supply of vaccines to a broad swath of people, often with little federal support, the rollout has at time seemed chaotic.

In Florida people have ended up camping out overnight for vaccines offered on a first-come-first-served basis. Even so, the Florida Division of Emergency Management announced that its testing and vaccination site at Hard Rock Stadium in Miami Gardens would close for much of Monday because of a College Football Playoff national championship game. 

Some experts worry that the process of signing up for a vaccine — which may require quickly snagging an opening on a computer or waiting outside in the cold — may make it harder for some of the most vulnerable seniors, including those over 75, to access the vaccine. 

Florida has 4.4 million people over the age of 65, but as of Friday had administered only 402,000 doses. Despite the demand, it has used only about 30 percent of the vaccine doses it has received.

Elsewhere in healthcare

The Trump administration approved a dramatic overhaul of Tennessee’s Medicaid financing.

Tennessee became the first and only state to convert its Medicaid funding to a block grant, after federal officials approved the plan in the final days of Trump’s tenure in the White House.

“But a TennCare block grant does not align with the health care proposal of President-elect Joe Biden, who instead campaigned on plans to improve and expand Obamacare. Biden may reverse the Tennessee block grant decision before it has any effect,” the Tennessean’s Brett Kelman reports.

Tennessee’s Medicaid program provides insurance to around one in five Tennesseans and is currently funded by open-ended federal contributions. Under the block grant plan, however, the state would get a capped amount of money annually. While federal funding may still increase if enrollment spikes, it would not necessarily increase with other expenses. The plan also gives the state more control over the program and allows it to keep half of any money saved to reinvest in government program.

Tennessee is one of few states to decline Medicaid expansion under the Affordable Care Act, which has left thousands without insurance. Republican officials have touted the new model as an alternative that will help reign in cost.

The mortality rate for Black babies is dramatically lower when they are delivered by Black doctors.

A group of researchers combed through records of 1.8 million Florida hospital births between 1992 and 2015 looking for clues that might explain why mortality rates are disproportionately high for Black babies. “They found a tantalizing statistic. Although Black newborns are three times as likely to die as White newborns, when Black babies are delivered by Black doctors, their mortality rate is cut in half,” Tonya Russell writes for The Post.

Physician race did not have an impact on maternal mortality and the effects were strongest in complicated cases and when hospitals delivered more Black babies.

Black babies had a mortality rate in 2018 of 10.8 deaths per 1,000 live births, compared to a rate of 4.6 White babies per 1,000 live births. The researchers say that more research is needed to understand the disparity in outcomes, but it may underscore the importance of combatting implicit bias in medical practice.

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