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White House Suggests Flexibility In Vaccine Deadline For Federal Workers, Contractors

White House Suggests Flexibility In Vaccine Deadline For Federal Workers, Contractors

While the concept of natural immunity has often been misused by people opposed to vaccine mandates, public health officials and scientists should be open to the evidence. Research, including my team’s study of the immune responses of nearly 2,150 health care workers in Sweden after infection with SARS-CoV-2 — the virus that causes Covid-19 — and vaccination, suggests that the protection gained from infection is long-lasting and that it can be significantly bolstered by a single Covid-19 vaccine dose.

These insights should be factored into vaccine policies. For example, should vaccine mandates and passports make exceptions or accommodations for people who have already had Covid-19? Should children who have been infected receive two vaccine doses when they might be well protected with one? These are just some of the questions scientists and vaccine policymakers should be asking.

Infection, like vaccination, trains the immune system to fight off disease. In both cases, antibodies are produced by what’s known as memory B cells, which help prevent future infection. Memory T cells then support antibody production and control the infection by killing infected cells.

But the immunity provided by an infection versus a vaccination differs in many ways. For example, a Covid-19 vaccine teaches the immune system to target a specific part of the virus, the spike protein, over a few hours or days. When people are infected with SARS-CoV-2 their immune system is exposed to the whole virus for several days or weeks. This provides the immune system with significant time to build a comprehensive defense if the infected person survives. These distinctions result in broader immunity for people who are infected versus people who are vaccinated.
The White House coronavirus response coordinator, Jeff Zients, indicated that the Biden administration could be flexible as it enforces the president’s executive order requiring federal workers and government contractors to vaccinate their workers.

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The vaccine mandate aims to protect as many people from the coronavirus as possible — not to punish them by getting them fired from their jobs should they be unvaccinated by the due dates, Zients
A cheap, generically available anti-depressant may reduce the risk of severe Covid-19 disease by close to a third in people at high risk, researchers reported Wednesday.
“Given fluvoxamine’s safety, tolerability, ease of use, low cost, and widespread availability, these findings might influence national and international guidelines on the clinical management of COVID-19,” they concluded.
A related drug, Prozac, or fluoxetine, is also cheap and even more widely available, and the researchers said this drug should be studied to see if it might help.
“It is now crucial to establish whether a class effect exists and whether these drugs can be used interchangeably for COVID-19,” they wrote.
It wasn’t a perfect study, they noted. It was done in Brazil, and the patients had a higher rate of hospitalization than Covid-19 patients in other clinical trials.
“There is no standard of care that exists for early treatment of COVID-19 and various advocacy groups promote different interventions, including some of those evaluated in this and our previous trials. Furthermore, there is little understanding of who is at greatest risk of disease progression from this disease as some patients with numerous risk factors do recover quickly whereas some others with less established risk factors might not,” they wrote.
A trial among about 1,500 patients in Brazil showed those who took the drug, known as fluvoxamine, were less likely to progress to severe disease and to require hospitalization.
The drug, sold under the brand name Luvox, is a selective serotonin reuptake inhibitor (SSRI) most often used to treat obsessive compulsive disorder (OCD) and depression. But it can affect inflammation, said Dr. Angela Reiersen, an associate professor of psychiatry at Washington University in St. Louis who worked on the study, published in The Lancet Global Health.
“Fluvoxamine may reduce the production of inflammatory molecules called cytokines, that can be triggered by SARS-CoV-2 infection,” Reiersen said in a statement. The drug may also reduce blood platelets, which may affect the clotting effects of coronavirus infection.
Reierson and colleagues gave 741 volunteers with Covid-19 100 mg of fluvoxamine twice a day for 10 days while 756 volunteers got a placebo.
Among the patients who got fluvoxamine, 79 — or about 11% — needed treatment in an ER or hospital room compared to nearly 16% of those given placebos. It was a 5% decrease in absolute risk and a 32% decrease in relative risk.
More study is needed to see if the drug might be added to the treatments given to coronavirus patients, but it’s cheap. “A 10-day course of fluvoxamine costs approximately $4 even in well-resourced settings,” the researchers wrote.
An intubated coronavirus patient is seen next to a pulmonary ventilator at Ronaldo Gazolla Hospital ICU in Acari, Rio de Janeiro, Brazil, on April 30, 2020.
It’s not a cure, but if the drug can help keep patients out of the hospital, it would be useful.

As a physician in a Covid-19 care unit, I celebrate the vaccines as one of medicine’s greatest triumphs. They provide extraordinary protection against severe disease and death, and are the world’s best option for returning to a more normal life. As a scientist and lead investigator for a study on Covid-19 immunity, I have also come to appreciate the significance of so-called natural immunity acquired by those who have had Covid-19, and the power of “hybrid immunity” — the protection gained when such people also get vaccinated.

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