Planning on Going Back To The Office, Hitting The Gym or Attending a Wedding? A Guide To Staying COVID Safe

Dr. Anthony Fauci declared last month that the U.S. is transitioning “out of the pandemic phase,” following mask mandates lifting across the country. However, that doesn’t mean COVID-19 is behind us. Surges continue in different parts of the U.S., while an estimated 300 people die every day because of the virus.

So it’s understandable that some people — at least the ones who have been trying to protect themselves and others from the highly-contagious virus for the past two years — are feeling a bit confused about what exactly they should be doing at this stage of the pandemic to stay healthy and safe.

Dr. Joseph Khabbaza, a critical care medicine specialist and pulmonologist at the Cleveland Clinic, tells Yahoo Life, “A lot of people have been given a sense that this is probably over for most of us. The answer isn’t going to be the same for every two people.”

Khabbaza says that’s because every person has to assess their own individual risk factors when it comes to getting COVID. Dr. Prathit Kulkarni, an assistant professor of medicine in infectious diseases at Baylor College of Medicine, agrees, telling Yahoo Life: “Safety precautions at this stage in the pandemic are related to one’s personal risk of having a bad outcome from COVID-19, vaccination status and one’s personal risk tolerance. All situations are slightly unique and require an individual and situational risk assessment.”

With the exception of people who are immunocompromised or elderly, though, “if you’re fully vaccinated and up-to-date on boosters, your personal odds of getting severe illness are very low, even if you come across the virus,” says Khabbaza. “Whereas for people who have not been vaccinated they may not factor in that they are at high risk for severe illness. But that’s something some people have chosen.”

How can you protect yourself in general?

In a nutshell, getting vaccinated and boosted if eligible is still the right call — especially if you’re more vulnerable to severe illness from COVID — and offers “the best protection,” says Kulkarni.

He adds: “Folks who are at higher risk for a worse outcome from COVID-19 may wish to enhance their protection from contracting COVID-19. The best way to do this is with a well-fitting mask. N95 respirator-type masks afford the greatest individual protection.”

Kulkarni says that “the folks who are potentially at the highest risk at this point in the pandemic include unvaccinated individuals, especially older persons, folks who are at higher risk but have not yet been boosted such as older persons or people living in nursing homes and people with significant immunocompromising conditions.”

Both Kulkarni and Khabbaza say it’s also important to know what the COVID rates are in your area or where you’re traveling to. “Following CDC’s tracker of COVID activity around the country can also be helpful to get a gauge for how things are going in a particular geographic area,” says Kulkarni.

Planning on going back to the office, hitting the gym or attending a wedding? Keep these precautions in mind to stay COVID safe and healthy.

Flying on a plane

With multiple U.S. domestic airlines including Delta, American and United dropping mask requirements on flights, you may be wondering how to stay safe while traveling on packed planes. The CDC states that it continues to recommend that people wear masks in indoor public transportation settings at this time. But depending on your own personal risk factors and risk tolerance, while at the airport, “if you’re able to space apart from people and avoid close sustained contact, then a mask is not going to be needed,” says Khabbaza. But when you’re in prolonged close proximity to others, it’s a good idea to mask up.

For example, Khabbaza shares that he doesn’t wear a mask while walking around the airport because he’s in motion and able to distance himself from others. However, he puts on a mask while in the security line “because of close contact.” He then takes it off walking to the gate and while sitting at the gate “because I’m away from other people.” Once on the plane, Khabbaza puts his mask back on. “Ventilation in airplanes seems to be good, but to me, it’s easy enough to minimize my risk in a setting with others by wearing a mask,” he says. “That’s where you’ll get more value for masking.”

Dr. Leana Wen, an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health, told CNN that wearing a mask in the highest-risk settings while traveling is key. “That includes during boarding and deplaning when the ventilation systems on airplanes are often not running,” she says. “Don’t drink or eat at those times.”

Although airlines often hand out sanitizing wipes as you board, Khabbaza explains that, from a COVID transmission standpoint, “I don’t think that would have much of a barrier.” That’s because “contact with surfaces is not as big of a mode of transmission as initially thought, if at all,” he says. That said, it doesn’t hurt to wipe down the seat and tray table for hygiene’s sake.

Kulkarni agrees, saying, “In general, wiping down surfaces via routine cleaning can be generally helpful for avoidance of transmission of several different infectious organisms.”

Eating at a restaurant

In general, it’s safer to dine outdoors when feasible. “Similar to the initial stages of the pandemic, outdoor transmission of COVID is very limited compared to indoor transmission,” points out Kulkarni.

Khabbaza says to keep in mind that “if you are choosing to dine in a restaurant, most of your risk is when you’re sitting down and eating, which is much of the time.” Putting on a mask while walking for “a few seconds to your seat” or wearing one on the way to the restroom may not change the fact that there’s a “slightly higher risk of indoor dining right now,” he says. “Theoretically, it could lower it a little bit, but you’re drinking, eating, talking and laughing when seated and not moving around — that’s where the risks are.”

Khabbaza says the safest way to dine indoors is by choosing restaurants with big open windows to further lower the risk of transmission or going to restaurants during off-hours “when they’re not full.”

Working in an office

If you’re alone in your own office or in a private cubicle, a mask likely isn’t needed. “It will be hard to transmit if far away from others and there’s a barrier with cubicles,” Khabbaza says.

But he stresses that it’s important to know your company’s policy on vaccinations and whether employees need to show proof of vaccination to better assess the risk. “If vaccination is mandatory that certainly makes things a lot safer,” Khabbaza says. “But if you’re in close sustained contact all day at work, masking is probably not a bad idea, especially in times of high cases.”

Wearing a mask can also help put co-workers and employers who are more vulnerable at ease. “If you’re working with people you know are immunocompromised or elderly, it’s OK to try to protect them with masking,” he says.

Along with distancing and good ventilation, Wen told CNN that “testing that’s done at least once a week can help catch early, asymptomatic COVID-19 cases and serve as an additional layer of protection.”

Visiting a public pool

The good news is that the virus doesn’t transmit through water, per the World Health Organization. There’s also the protective benefit of being outdoors while at a public pool. However, Khabbaza points out that “close sustained contact with someone in a pool might have some of that risk.”

If the pool isn’t crowded, it’s easy to avoid people and space apart. “But if it’s a crowded pool party, there’s a risk and masks aren’t feasible,” he says.

When going indoors, such as to the locker room, it’s a good idea to put on a mask if there are several people close by. The CDC recommends bringing extra masks and storing them in a plastic bag in case one gets wet.

Going to the supermarket

In general, supermarkets are “lower risk from a COVID standpoint because you’re not really in close sustained contact — a lot of it is walking by people,” says Khabbaza, “and you can space out in a line at the cashier.”

But if you’re concerned or immunocompromised, he says, “just wear the mask, and then you have a barrier over your nose and mouth.”

Working out at the gym

The size, crowd and ventilation matter when it comes to gyms. Small boutique gyms that rely on fans to circulate the air are going to be “a little [riskier] if crowded because there’s not much ventilation,” says Khabbaza. “In the really big gyms, spacing can be done” so you can distance yourself from others. Large gyms are also more likely to have an HVAC system for better air filtration.

“If you can space out, it’s going to be relatively safer compared to smaller gyms where spacing isn’t much of an option,” says Khabbaza.

While wiping down gym equipment isn’t essential from a COVID transmission standpoint — “it would be very hard to get it, especially if you’re not touching your face,” Khabbaza says — it’s a standard recommendation to do so before and after using gym equipment in general.

Attending an indoor party or wedding

If you’re at a high risk of severe illness, “it might be reasonable to avoid weddings at times of [COVID] surges,” says Khabbaza, who recommends wearing a well-fitting N95 mask at group events, particularly if you’re more vulnerable. “If you’re anxious about the possibility of getting it, weddings may not be best for you during times of surges.”

That said, most weddings take place at “big venues where you can space out a bit,” he says. “If you’re spaced out and in a mask, you should be very good about minimizing your risk.” But Khabbaza says that the best protection is being up-to-date on COVID-19 vaccines and boosters, which makes the odds of severe illness “extremely low, assuming you have a normal immune system,” he says.

You can also go one step further to assess the risk of attending a larger social gathering: Dr. Preeti Malani, chief health officer at the Division of Infectious Diseases and Geriatric Medicine at the University of Michigan, told NPR that before a big event, “ask if people must be vaccinated and/or tested to attend and if they have to show proof or are on the honor system.”

Staying at a hotel

While you don’t need to wear a mask when you’re in your own hotel room, you might want to put one on while riding the elevator if it’s crowded or if you’re staying at a big hotel with longer elevator rides that stop at multiple floors. “A short elevator ride will be on the lower end [of the risk spectrum], but not impossible,” says Khabbaza. “But transmissibility becomes higher when in close contact.”

A 2021 study found that in elevators without proper ventilation, an infected person coughing can transmit viral particles “all across the elevator enclosure.”

Another option to stay safe: If you don’t want to mask, wait for the next empty — or mostly empty — elevator if it’s feasible, or take the stairs, suggests Khabbaza.

By:

Source: Planning on going back to the office, hitting the gym or attending a wedding? A guide to staying COVID safe now.

Further reading:

Monkeypox: Doctors warn of ‘massive impact’ on sexual health services as staff self-isolate (Yahoo) | https://uk.news.yahoo.com/monkeypox-d…

Monkeypox outbreak linked to superspreader event at adult sauna (Yahoo) | https://news.yahoo.com/monkeypox-outb…

MISCExplainer: What to Know About Monkeypox (Visual Capitalist) | https://www.visualcapitalist.com/expl…

Human monkeypox: an emerging zoonosis (Lancet) | https://www.thelancet.com/journals/la…

First monkeypox genome from latest outbreak shows links to 2018 strain (NewScientist) | https://www.newscientist.com/article/…

Monkeypox virus evades antiviral CD4+ and CD8+ T cell responses by suppressing cognate T cell activation (PNAS) | https://www.pnas.org/doi/10.1073/pnas…

FDA approves first live, non-replicating vaccine to prevent smallpox and monkeypox (FDA) | https://www.fda.gov/news-events/press… Nov 3, 2021

ACIP Meeting – Orthopoxviruses Vaccines (CDC) | https://youtu.be/4SCUOppgtxE Israel reports first case of monkeypox, suspects others (ABC) | https://abcnews.go.com/Health/wireSto…

New York officials investigate case of suspected monkeypox (Miami Herald) | https://www.miamiherald.com/latest-ne…

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What We Know About Long COVID So Far

While the World Health Organization says long COVID starts three months after the original bout of illness or positive test result, the Centers for Disease Control and Prevention sets the timeline at just after one month.

Among the many confounding aspects of the coronavirus is the spectrum of possible symptoms, as well as their severity and duration. Some people develop mild illness and recover quickly, with no lasting effects. But studies estimate that 10% to 30% of people report persistent or new medical issues months after their initial coronavirus infections — a constellation of symptoms known as long COVID.

People who experience mild or moderate illness, as well as those without any underlying medical conditions, can nonetheless experience some debilitating long-term symptoms, including fatigue, shortness of breath, an erratic heart rate, headaches, dizziness, depression and problems with memory and concentration.

Such lingering medical issues are so varied that one study by a patient-led research group evaluated 203 symptoms that may fluctuate or even appear out of the blue after people seem to have recovered.

As Dr. Ziyad Al-Aly, the chief of research and development at the VA St. Louis Healthcare System and a clinical public health researcher at Washington University in St. Louis, said, “If you’ve seen one patient with long COVID, you’ve seen one patient with long COVID.”

How doctors currently diagnose long COVID

There is little consensus on the exact definition of long COVID, also known by the medical term PASC, or post-acute sequelae of COVID-19. While the World Health Organization says long COVID starts three months after the original bout of illness or positive test result, the Centers for Disease Control and Prevention sets the timeline at just after one month.

Some researchers and health care providers use other time frames, making efforts to study and quantify the condition more difficult, said Al-Aly, who has conducted many studies on long-term post-COVID issues.

When patients experiencing persistent symptoms go to their doctors, tests like electrocardiograms, chest X-rays, CT scans and blood work don’t always identify physiological problems, Al-Aly said. Researchers are working to pinpoint certain biological factors, called biomarkers, that correlate with persistent COVID symptoms. These could include signs of inflammation or certain molecules produced by the immune system that might be measured by blood tests, for example.

Long COVID is defined as symptoms that cannot be explained by an alternative diagnosis and last at least two months following an initial COVID-19 infection. It is usually after three months (12 weeks) of persistent symptoms when a patient is suspected of having long COVID.

Long COVID can affect anyone of any age, including children and adolescents. Even if you had mild or no symptoms when you were first infected, you can be impacted by long COVID.

For some, long COVID symptoms can be more severe than the acute COVID-19 infection itself. According to the World Health Organization (WHO), symptoms can persist from the initial illness or begin after recovery, and they may come and go or improve over time.

Long COVID can interfere with a person’s ability to perform normal, everyday activities, like work and household chores. With children, it can affect their ability to do their schoolwork. While it cannot be predicted how long a given patient may experience long COVID, some research has shown that patients can get better over time.

Long COVID Symptoms

Long COVID symptoms are different from acute COVID symptoms. Conditions can include, but are not limited to:

  • Persistent cough
  • Loss of (or changes in) taste and smell
  • Depression
  • Difficulty breathing or shortness of breath
  • Sleeping problems
  • Lightheadedness
  • Diarrhea
  • Fatigue
  • Anxiety
  • Chest pain
  • Palpitations
  • Headache
  • Joint and muscle pain
  • Poor appetite

How Does Long COVID Affect Children?

Some common symptoms seen in children include fatigue, headache, trouble sleeping and concentrating, muscle and joint pain, and cough. As with other medical conditions, young children may have trouble describing the problems they are experiencing.

According to the Centers for Disease Control and Prevention (CDC), information on long COVID in children and adolescents is limited, so it is possible other symptoms may be likely in younger age groups.

If your child is suffering from long COVID and is unable to complete their normal school assignments, it might be best to ask school administrators about accommodations such as extra time to complete tests and assignments, rest periods throughout the school day and modified class schedules, says the CDC.

What Causes Long COVID?

It is unknown why people experience long COVID. The cause is still an active area of research. Some experts believe the cause is potentially due to the body’s hyper-inflammatory immune response to a new germ.

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Source: What We Know About Long COVID So Far

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Future COVID Variants Will Likely Reinfect Us Multiple Times a Year, Experts Say

For more than a year now, the original COVID-19 vaccines have held up remarkably well — even miraculously so — against a Greek alphabet of new variants: Alpha, Beta, Gamma, Delta.

But now experts say something is changing. Since the start of 2022, the initial version of Omicron, known as BA.1, has been spinning off new sublineages — BA.2, BA.2.12.1, BA.4, BA.5 — at an alarming pace.

Earlier variants did this too. But it never really mattered, because their offshoots “had no functional consequence,” according to Eric Topol, founder of Scripps Research Translational Institute. “They did not increase transmissibility or pathogenicity.”

Today’s rapidly proliferating Omicron mutants are different, however. They all have one worrisome trait in common: They’re getting better and better at sidestepping immunity and sickening people who were previously shielded by vaccination or prior infection.

The virus, in other words, is now evolving faster — and in a more consequential way — than ever before. Given the increasing speed of immune evasion, and what this pattern portends for the future, experts warn that the time has come to rethink our reliance on the vaccine status quo and double down on next-generation vaccines that can actually stop infection.

“As difficult [as] it is to mentally confront, we must plan on something worse than Omicron in the months ahead,” Topol wrote on May 15. “We absolutely need an aggressive stance to get ahead of the virus — for the first time since the pandemic began — instead of surrendering.”

The brewing storm of BA sublineages isn’t all bad news. COVID cases have been rising nationwide since the beginning of April, nearly quadrupling over the last six weeks to more than 90,000 per day on average. Yet both COVID deaths (about 300 per day) and ICU patients (about 2,000 total) are still at or approaching record lows — even though other countries with bigger gaps in previous exposure or vaccination have been hit hard, and even though new research shows that Omicron and its spinoffs are not, in fact, intrinsically less severe or deadly than prior variants, contrary to early assumptions.

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Source: Future COVID variants will likely reinfect us multiple times a year, experts say — unless we invest in new vaccines

Critics by:

The new variants have not altered the fundamental usefulness of the Covid vaccines. Most people who have received three or even just two doses will not become sick enough to need medical care if they test positive for the coronavirus. And a booster dose, like a previous bout with the virus, does seem to decrease the chance of reinfection — but not by much.

At the pandemic’s outset, many experts based their expectations of the coronavirus on influenza, the viral foe most familiar to them. They predicted that, as with the flu, there might be one big outbreak each year, most likely in the fall. The way to minimize its spread would be to vaccinate people before its arrival.

Instead, the coronavirus is behaving more like four of its closely related cousins, which circulate and cause colds year round. While studying common-cold coronaviruses, “we saw people with multiple infections within the space of a year,” said Jeffrey Shaman, an epidemiologist at Columbia University in New York.

If reinfection turns out to be the norm, the coronavirus is “not going to simply be this wintertime once-a-year thing,” he said, “and it’s not going to be a mild nuisance in terms of the amount of morbidity and mortality it causes.”

Reinfections with earlier variants, including Delta, did occur but were relatively infrequent. But in September, the pace of reinfections in South Africa seemed to pick up and was markedly high by November, when the Omicron variant was identified, Dr. Pulliam said.

Reinfections in South Africa, as in the United States, may seem even more noticeable because so many have been immunized or infected at least once by now.

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Why Some People Get COVID More Than Once


Although the federal government does not collect data on COVID reinfections, and nor do health authorities in WA and Queensland, Victoria recorded almost 10,000 reinfections between late December 2021 and late March 2022. This compares with just 108 known reinfections in Victoria during the previous two years. NSW plans to release state reinfection data soon.

As the Omicron sub-variant BA.2 continues to fuel more infections, the spectre of repeat infections is well and truly upon us. Current vaccines were designed to protect against the original strain of SARS-CoV-2, and while the shots are crucial in shielding us from severe illness and death, they are less effective in preventing infection by newer variants.

 Unfortunately, natural immunity gained from a Delta infection also won’t stop us getting infected with Omicron. We learnt this with the rise of Omicron in South Africa late last year, when a population with relatively high natural immunity from previous coronavirus infections still fell victim to the merciless Omicron wave.

Reinfections have become something of a hallmark of Omicron. Since the rise of this highly transmissible strain, the number of people reinfected with coronavirus has spiked, in a pattern that is unique to the strain. Imperial College London researchers estimate a reinfection with Omicron is 5.4 times greater than with the Delta variant.

A letter published in The New England Journal of Medicine indicated that a previous COVID-19 infection was 90 per cent effective at preventing an infection with the Alpha, Beta or Delta variants, but only 56 per cent effective against Omicron.

In England, where Omicron has driven a spike in reinfections, provisional data from the UK Health Security Agency shows 10.7 per cent of all positive COVID-19 cases were reinfections in the last week of March.

The data shows that the number of weekly reinfections jumped from 20,000 to 50,000 in just one month, with reinfections occurring across all age groups, despite high vaccination levels. (A reinfection was counted when someone tested positive on two tests taken more than 90 days apart.)

Waning immunity is playing a part, along with the easing of restrictions. But the potent variable here is the rise of the BA.2 variant of Omicron, which is rapidly becoming the dominant strain globally.

A non-peer reviewed Swedish study suggests Omicron BA.2 could be more contagious than the original BA.1 strain due to its higher viral loads in the nose and throat. (The first case of a new recombinant variant combining BA.1 and BA.2, known as XE, was detected in New South Wales on April 9. Watch this space.)

The good news as far as reinfections go, is that catching the same variant twice is fairly unlikely. So if you got sick with Omicron BA.1, you’re probably in the clear when it comes to catching BA.2.

A more likely scenario is being reinfected after having Delta or an earlier strain. You’re more likely again to get infected if you’ve had no prior COVID infection at all, and that likelihood increases further if you’re unvaccinated.

While reinfection is no fun, the plus side is that it gives you excellent immunity when coupled with vaccination. The combination triggers a broader range of antibody and white cell responses in your system, meaning you are less likely to suffer serious illness on reinfection.

A preprint study from Qatar confirms that the best defence against Omicron BA.1 or BA.2 infections is a prior infection plus two vaccinations and a booster shot. This reduces the risk of infection by 77 per cent, compared with 52 per cent if you got three doses but had no prior infection, the study found.

Senior research fellow at the Kirby Institute’s infection analytics program Dr Deborah Cromer says COVID-19 may follow the trajectory of other respiratory viruses, such as the flu, when it comes to reinfection.

“People will get the flu once, but that doesn’t mean they won’t get the flu again,” she says. “They probably won’t get the flu twice in one season, but obviously, there are people who do. And if you’ve had the flu vaccine, it doesn’t mean you won’t get the flu, but your symptoms will probably be less severe.

“I think what we’re talking about is a respiratory virus that will keep changing, but if people’s immunity levels keep being maintained at a high level, then it should hopefully not be too severe.”

That’s pretty much how the 1918 Spanish flu petered out. The first couple of years of that pandemic were the worst in terms of severe sickness and death, but as the virus changed and spread over the following decades, it continued to infect people but was far less dangerous.

The key problem in Australia, though, is a lack of good data. As more people rely on rapid-antigen tests, there are fewer samples available for sequencing. ANU infectious diseases physician Peter Collignon says we need systematic surveillance to monitor infections and genomic sequencing to better understand how reinfections will impact us.

“Instead of having a one in 1000 chance of dying, is there one in 10,000 if you’re reinfected? What’s your chance of getting into hospital? And how is it proportionate to your socio-economic condition and your age? We need that sort of data to be able to plan for the future.”

Timna Jacks

By: Timna Jacks

Source: Why some people get COVID more than once

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Fourth Shot Protects Against Severe Omicron Outcomes; COVID May Increase Risk of Rare Eye Blood Clots

The following is a summary of some recent studies on COVID-19. They include research that warrants further study to corroborate the findings and that has yet to be certified by peer review.

Fourth vaccine dose protects vs Omicron for at least a month

A fourth dose of the COVID-19 vaccine from Pfizer and BioNTech provided significant added protection against severe disease, hospitalization and death for at least a month in older individuals, according to a study conducted when the Omicron variant was dominant.

The estimated effectiveness of the fourth dose during days 7 to 30 after it was administered compared with a third dose given at least fourth months earlier was 45% against infection, 55% for symptomatic disease, 68% for hospitalization, 62% for severe disease and 74% for death, the research team reported on Wednesday in The New England Journal of Medicine.

The study compared 182,122 individuals aged 60 and older who received a fourth dose and 182,122 very similar people who had received a third dose but not a fourth.

“The results of our real-world study suggest that a fourth vaccine dose is, at least initially, effective against the Omicron variant,” the researchers said. “Additional follow-up will allow further assessment of the protection provided by the fourth dose over time.”

A recently published study that looked only at rates of breakthrough infections and serious illness after the fourth dose found that efficacy waned quickly versus infection but held steady versus severe illness.

COVID-19 may increase risk for rare eye clots. Patients with COVID-19 may have an increased risk of rare vision-threatening blood clots in the eye for months afterward, new findings suggest.

Because SARS-CoV-2 infections increase the risk of blood vessel obstructions at other sites in the body, researchers studied nearly half a million COVID-19 patients to see whether they would develop clots in the veins or arteries of the retina, the nerve tissue at the back of the eye that receives images and sends them to the brain.

Over the next six months, 65 patients had a retinal vein occlusion. While that number is low, it reflects a statistically significant 54% increase compared with pre-COVID infection rates, according to a report published on Thursday in JAMA Ophthalmology.

Retinal artery clots were 35% more common after COVID-19 than before, but that difference might have been due to chance. The clots most often occurred in patients with other conditions that increased their risk of blood vessel problems, such as diabetes, high blood pressure, and high cholesterol.

By: Nancy Lapid

Source: Fourth shot protects against severe Omicron outcomes; COVID may increase risk of rare eye blood clots

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Critics:

By: Mary Van Beusekom

Compared with a third vaccine dose, a fourth dose of the Pfizer/BioNTech COVID-19 vaccine lowered the risk of infection, symptomatic infection, hospitalization, severe illness, and death 52% to 76%—depending on the measure—amid the Omicron surge among older adults.

Protection against infection waned, however, after 5 weeks, but not protection against severe COVID-19. The findings were published yesterday in the New England Journal of Medicine.

Seven to 30 days after the fourth COVID-19 dose, vaccine effectiveness (VE) relative to the third dose was estimated at 45% against infection (95% confidence interval [CI], 44% to 47%), 55% against symptomatic illness (95% CI, 53% to 58%), 68% against COVID-19 hospitalization (95% CI, 59% to 74%), 62% against severe disease (95% CI, 50% to 74%), and 74% against death (95% CI, 50% to 90%).

Fourteen to 30 days after the fourth dose, VE was 52% (95% CI, 49% to 54%) against infection, 61% (95% CI, 58% to 64%) against symptomatic illness, 72% (95% CI, 63% to 79%) against hospitalization, 64% (95% CI, 48% to 77%) against severe disease, and 76% (95% CI, 48% to 91%) against death.

In the fourth week after the fourth dose, the adjusted infection rate was lower by a factor of 2.0 (95% CI, 1.9 to 2.1) than that in the three-dose group and lower by a factor of 1.8 (95% CI, 1.7 to 1.9) than that among controls.

The difference in absolute risk for COVID-19 hospitalization 7 to 30 days after a fourth vaccine dose, relative to a third, was 180.1 per 100,000 people (95% CI, 142.8 to 211.9), while it was 68.8 cases per 100,000 (95% CI, 48.5 to 91.9) for severe disease. A sensitivity analyses of VE against infection had similar results as those in the primary analysis.

Starting in the fifth week after the fourth dose, the rate ratio (RR) for infection began to fall. The adjusted rate of infection in the eighth week after the fourth dose was comparable to that of internal controls. The RR for the three-dose group relative to the four-dose group was 1.1, while the rate ratio for the internal control group, compared with the four-dose groups, was 1.0.

The RRs comparing controls with fourth-dose recipients were larger and lasted longer for severe disease. In the fourth week after the fourth dose, the adjusted rate of severe disease was lower by a factor of 3.5 than in three-dose recipients and a factor of 2.3 than in internal controls.

The adjusted rate of severe illness in the fourth week after the fourth dose was 1.6 cases per 100,000 person-days, compared with 5.5 cases per 100,000 in three-dose recipients and 3.6 cases per 100,000 in internal controls. The adjusted rate differences were 3.9 fewer cases per 100,000 person-days and 2.1 fewer cases per 100,000 than the three-dose group and internal controls, respectively.

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