May Update on COVID-19

Nobody is counting vaccine doses anymore. But COVID-19 is still here, remaining among the top five leading cause of death for older and immunocompromised individuals. 

The national public health emergency in the US is set to end on May 11, 2023, with the last states to end statewide emergency orders being New Mexico on March 31 and Rhode Island on April 10, followed by Texas and Connecticut. However, recent events such as the CDC's April 24-27 Epidemic Intelligence Service conference in Atlanta have shown that the virus is still spreading. At least 35 people who attended the conference tested positive for COVID-19, as confirmed by spokesperson Kristen Nordlund. According to CDC, Atlanta has a low COVID-19 community level, along with nearly the rest of the U.S.

In February, Dr Deepti Gurdasani reported her breakthrough case, despite six COVID-19 vaccine doses. Are these repeated doses even helping? There is some evidence they might be helping solid transplant recipients. One study looked at added benefits after the 5th dose.  Another study showed the sixth dosage of vaccination still had a function in improving immunity, especially an mRNA vaccine given to transplant recipients. A patient with B cell lymphoma with profound B cell depletion after initial chemoimmunotherapy received a total of six doses of a COVID-19 mRNA vaccine. The patient developed vaccine-induced anti-SARS-CoV-2 antibodies only after the fifth and sixth doses of the vaccine once his B cells had started to recover.

But what about healthy people? In an interview with Deutsche Welle, EMA's Head of Vaccines Strategy, Marco Cavaleri, said that frequent boosting could potentially have a negative impact on immune response to COVID-19. Cavaleri suggested that receiving too many booster shots could exhaust T cells, which play a central role in fighting COVID-19, or the immune system could come to tolerate the antigen, instead of acting against it.

There “isn’t a shred of evidence” to support these ideas, said Aaron Eli Glatt, MD, MACP, clinical professor of medicine at Icahn School of Medicine at Mount Sinai.

"The idea of vaccinating every four months or even more than that is novel. It's something that you haven't seen with other types of viruses. And the idea of T cell exhaustion is the reason why you might pause," Reinhard Obst, a professor at Ludwig Maximilian University's Institute of Immunology who has facilitated research on T cell exhaustion in mice. Obst said that although there's little clinical data behind it, Cavaleri's concern makes sense.

In April 2022, a German man was caught at a vaccination center in Eilenburg, Saxony when he showed up for a Covid-19 shot for the second day in a row. It is believed he got himself vaccinated at least 87 times in a bid to sell fake vaccination certificates. It was not possible to find any information about wellbeing of this person since April 2022, however on March 4 2024, study published in Lancet described this person, a 62-year-old man, from Magdeburg in Germany, who received 217 shots of the vaccine over a span of 29 months “for private reasons.”  Apparently, he showed no side-effects and boosted his immunity to the virus compared with those who received three doses.  From November 2019 to October 2023, 62 routine clinical chemistry parameters showed no abnormalities attributable to hypervaccination and no sign of a breakthrough infection. 

A nurse in Tuscany, Italy redefined “shots on the house” after accidentally giving a patient a staggering six doses of the coronavirus vaccine — in a single shot. The female recipient is fortunately in stable condition following the mishap, CNN reported.

Thankfully, overdosing on anti-COVID serum isn’t as catastrophic as it sounds for many people - at least in the short term. There are many reports of unauthorized extra boosters in VAERS - with no side effects. In early Pfizer studies, participants received five times the normal dose without exhibiting any adverse reactions. In a similar case in April, 77 prisoners in Iowa State Penitentiary in Fort Madison were accidentally administered six COVID shots sans experiencing any major symptoms. 52 out of 77 inmates sought a $1 million payment but were denied it.

Still, many adverse reactions were reported not only after the primary (# 0969219, # 0982883) doses, but also after the 5th (eg,# 2392080), 6th (# 0938990, # 0982883, # 2606023), 7th or more (eg # 0903656, # 0907535, # 2452148) but not the previous doses in VAERS. Other anecdotal reports claim that the 6xth dose fixed the problem from the previous doses. And there are many breakthrough COVID-19 reports even after the 7th dose (eg, # 2601725). 

REFERENCES

Abedon AT, Teles MS, Alejo JL, Kim JD, Mitchell J, Chiang TPY, Avery RK, Tobian AAR, Levan ML, Warren DS, Massie AB, Garonzik-Wang JM, Segev DL, Werbel WA. Improved Antibody Response After a Fifth Dose of a SARS-CoV-2 Vaccine in Solid Organ Transplant Recipients: A Case Series. Transplantation. 2022 May 1;106(5):e262-e263. doi: 10.1097/TP.0000000000004092. Epub 2022 Feb 15. PMID: 35175241; PMCID: PMC9038246.

Sookaromdee P, Wiwanitkit V. The expected seroprotection rate after the sixth dose of the COVID-19 vaccine: a note from a clinical model on kidney transplant recipients. Journal of Istanbul Faculty of Medicine. 2022. 

Atanackovic D, Kreitman RJ, Cohen J, Hardy NM, Omili D, Iraguha T, Burbelo PD, Gebru E, Fan X, Baddley J, Luetkens T, Dahiya S, Rapoport AP. T cell responses against SARS-CoV-2 and its Omicron variant in a patient with B cell lymphoma after multiple doses of a COVID-19 mRNA vaccine. J Immunother Cancer. 2022 Jul;10(7):e004953. doi: 10.1136/jitc-2022-004953. PMID: 35851312; PMCID: PMC9295666.

Updates from our ongoing study: The COVID-19 Back-to-Normal Study (aurametrix.com)