Heads Up from University of Iowa Health Care: Why Vaccinated People Still Catch Covid-19

Some people still get Covid-19 symptoms despite being vaccinated. University of Iowa Health Care infectious disease expert, Dr. Dan Diekema, MD, MS, explains why.

COVID-19 Transmission Level Medium in Johnson County, Iowa

The CDC has reported that the level of COVID-19 transmission in Johnson County, Iowa is Medium. It’s recommended to adopt appropriate safety precautions accordingly. The Swiss Cheese Model is an easy way to remember:

Swiss Cheese Model

Learn more about how to keep yourself and others safe.

University of Iowa Participating in COVAIL Trial on Covid-19 Vaccine Boosters

University of Iowa Health Care is participating in a multi-center Phase 2 clinical trial evaluating various additional COVID-19 vaccine boosters. It’s the COVID-19 Variant Immunologic Landscape (COVAIL) trial, sponsored by the National Institute of Allery and Infectious Disease (NIAID). The trial “will test new and existing booster vaccines in various combinations to see which ones provide immune responses that cover existing and emerging COVID-19 variants.”

ACIP Meeting on Covid-19 Vaccines and Boosters Held on April 20, 2022

I got to listen to some of the presentations yesterday during the ACIP meeting on Covid-19 vaccines and boosters. My impression is that there seems to still be some discussion about what the most important goals of the vaccination program. Is it to prevent severe disease, hospitalization, and death? Or is it to prevent infection altogether?

It’s not lost on me that even mild infection with Covid-19 can lead to a chronic (“long haul”) syndrome. On the other hand, it doesn’t sound plausible that a vaccine to prevent infection would even be possible, given that so many people remain unvaccinated. That’s part of the context for the rise of variants that can lead to vaccine-resistant strains. That can lead to boosters and what some ACIP committee members are now afraid might lead to a new vogue term-“booster fatigue.”

Sena and I are now immunized as far as we can go, with 4 doses. We’re hoping for a new vaccine that is safe, effective against variants, and doesn’t involve boosting every few months.

We focus a lot on vaccines. But the other side of the risk of getting infected and sick are a part of host immunity. It gets weaker as we get older. It’s weak in those who are immunocompromised for other reasons, including things like underlying diseases and organ transplantation.

Looking at other ways to prevent disease with Covid-19, such as new medications that might counter the decline of the immune system as we age, and any other innovations are also important.

Second Covid-19 Booster Jab Done

Yesterday I got the second Covid-19 booster jab. Sena got hers shortly before I did. The pharmacy was practically deserted. Nobody is waiting in line to get this one, evidently. Sena and I are now 4 for 4 jabs with no end in sight unless somebody comes up with a new vaccine that’ll last longer than a couple of months.

No pharmacy employees wore masks. I think I was the only one in the store who wore one. I’m not sure what to think of that. We’re still wearing masks out in public.

Some infectious disease specialists are recommending you get the 2nd booster if you’re over 60, even if you don’t have serious medical comorbidities.

Keeping a watchful eye on transmission levels in the areas where you live is also important. Right now, it’s low in ours. But that could change, especially if we ignore the Swiss cheese method for protecting ourselves from Covid-19.

To Boost or Not to Boost?

To boost or not to boost? That is the question. I’m still thinking about whether or not it’s important for me to get the second booster for the COVID vaccine. What might help me decide is a little bit more information from University of Iowa Hospital epidemiologist Dr. Daniel Diekema, MD.

The Omicron subvariant, BA.2, is much more transmissible than most past variants. According to Dr. Diekema, it’s responsible for more than half of all Covid-19 cases in Iowa. On the one hand, it doesn’t cause more severe disease than the other variants, and it’s just as responsive to the current vaccines.

On the other hand, just because I’m older makes me more susceptible to severe disease and less responsive to vaccines. That’s according to studies done by Stanley Perlman. MD, PhD at the University of Iowa.

So even if the first booster dose is effective against severe COVID-19 disease, I may be better off getting the second booster sooner rather than later.

It’s also important to continue wearing a mask and practicing social distancing as well as good hand hygiene.

The Path to Asapiprant: Perspiration or Inspiration?

I just found a University of Iowa Health Care announcement about a potential novel treatment to protect older patients from the ravages of Covid-19 infection. According to the announcement:

“An experimental drug that counters immune aging, effectively prevents death in older mice with severe COVID-19, suggesting it may have potential as a therapy to protect older people who are most at risk from the disease. The new findings by researchers with University of Iowa Health Care were published recently in the journal Nature.”

The experimental drug is called Asapiprant. I’m far from knowing anything much about immunology but the path to this discovery reminds me of the work of Ed Wasserman who wrote a book I’ve not yet read but probably should, As If By Design: How Creative Behaviors Really Evolve (2021, Cambridge University Press).

I first found out about Dr. Wasserman from an episode of The University of Iowa’s virtual events of Uncovering Hawkeye History. The title for this one was “Endless Innovation: An R1 Research Institution (1948–1997).” This event series was designed to highlight notable elements of UI’s 175-year history.  

Anyway, in a nutshell, Wasserman’s theory is that innovation is often more about perspiration rather than inspiration. He says it’s often a combination of the 3 C’s: Context, Consequence, and Coincidence. And while I was noodling around on the web, it struck me that this might fit how the Asapiprant innovation developed.

To be sure, the University of Iowa was a critical part of the story of how Asapiprant eventually became an important agent to protect the elderly from immune system aging and thereby decrease the mortality from Covid-19 disease.

I found out the agent was originally called S-555379. It was developed by Shionogi & Co., Ltd as a possible treatment for hay fever several years ago. I think that would be the Coincidence.

But in 2011, Stanley Perlman MD, PhD, professor of microbiology and immunology in the UI Carver College of Medicine, published a paper, which I think is part of the Context:

Zhao J, Zhao J, Legge K, Perlman S. Age-related increases in PGD(2) expression impair respiratory DC migration, resulting in diminished T cell responses upon respiratory virus infection in mice. J Clin Invest. 2011 Dec;121(12):4921-30. doi: 10.1172/JCI59777. Epub 2011 Nov 21. PMID: 22105170; PMCID: PMC3226008.

This paper was cited by Shionogi in the company’s announcement of their license agreement with BioAge Labs, Inc., posted on January 26, 2021:

“It is known that age-related declines in immune function are significant risk factors that increase morbidity and mortality from infectious diseases2. Therefore, it has been suggested that restoring immune function may reduce the severity of various infectious diseases, including COVID-19. The DP1 receptor has been identified as a drug discovery target that improves age-related declines in immune function in an original AI-driven analysis of longitudinal omics data in humans conducted by BioAge. In addition, in a study conducted at the University of Iowa by Dr. Stanley Perlman in which an existing DP1 receptor antagonist was administered in an aged mouse model of SARS coronavirus (SARS-CoV) infection, the mortality rate of mice was improved and a significant decrease in viral load in the lungs was observed3. Based on these exciting study results, we have concluded a license agreement in expectation of development of this compound as an immunopotentiator for the elderly by drug repositioning.”

And I think part of the Consequence is that BioAge, Inc. has announced that the drug, the name of which was changed to BGE-175 and now called Asapiprant is about to undergo Phase 2 clinical trials for treating older patients hospitalized with COVID-19.

Whether you call it perspiration or inspiration, I think it deserves our admiration.

Featured image picture credit: Pixydotorg.

My Opinion So Far of the 2nd Covid-19 Booster

My title for this post indicates my opinion of the Covid-19 vaccine 2nd booster. I missed nearly all of the FDA Advisory Committee meeting last Wednesday but got the last hour of the discussion of the questions:

“Following the scheduled presentations and open public hearing, the VRBPAC will be asked to discuss and provide input on the following topics (no voting questions):


• What considerations should inform strain composition decisions to ensure that available COVID-19 vaccines continue to meet public health needs, e.g.:
-Role of VRBPAC and FDA in coordinating strain composition decisions
-Timelines needed to implement strain composition updates
-Harmonization of strain composition across available vaccines


• How often should the adequacy of strain composition for available vaccines be assessed?


• What conditions would indicate a need for updated COVID-19 vaccine strain composition, and what data would be needed to support a decision on a strain composition update?


• What considerations should guide the timing and populations for use of additional COVID-19 vaccine booster doses?”

I think the Stat News summary is helpful. There is a link to the recorded meeting. Sorry, it was over 8 hours long and I don’t think I can sit through that much technical difficulty—which was reportedly more of a problem than usual.

I’m a little disappointed that the duration of the protection from the 2nd booster might be only about 8 weeks, according to the Israeli presentation. Then what? FDA Director Peter Marks frankly calls the 2nd booster a “stopgap” measure. We need a new vaccine, not a series of boosters of the same old, same old.

Can the drug companies coordinate their efforts to come up with a new vaccine that will target the most prevalent variants of concern? Frankly, I doubt it, especially if they have to get going on the production in June and there doesn’t seem to be consensus on what variants would be important by the time the new vaccine would be needed, which is this fall. The virus mutates quickly and not in predictable ways.

I think we’re well past the idea of getting a vaccine that will lead to a sterilizing immunity, especially since it sounds like a product that stimulates nasal mucosa IgA antibodies would be necessary—if you can keep from sneezing the product back out on your sleeve. If the vaccines keep me out of the hospital, I guess I’d be happy with that. It looks like immunity will wane no matter what you do and there doesn’t seem to be a correlate of protection nor any guarantees on durability.

Counting hospitalizations for Covid as a way of tracking infections might be misleading since many hospitals are now not counting them if they’re not the primary reason for admission.

While I think getting the 2nd booster is fine as a stopgap measure for now, and I’ll likely get it, I’m hoping for a new vaccine in the coming months.

Reminder: FDA Advisory Committee Meeting Today on Covid-19 Vaccine Boosters

Just a reminder; today the FDA Advisory Committee will meet from 8:30 AM to 5:00 PM, ET today to discuss Covid-19 vaccine boosters. I’ll be unable to post a “play by play” as I have in the past because I have something else on my schedule.

Especially noteworthy is the Briefing Document in the meeting materials, entitled:

“Considerations for COVID-19 Vaccine Booster Doses and Process for COVID-19 Vaccine Strain Selection to Address Current and Emerging Variants.”

Section 7 starts on page 17, “Topics for VRBPAC Discussion.” The important issue is determining strain composition of Covid-19 vaccines and what goes into consideration for the optimal use of additional booster doses.

April 6, 2022 Update:

“Topics for VRBPAC Discussion


Following the scheduled presentations and open public hearing, the VRBPAC will be asked to discuss and provide input on the following topics (no voting questions):


• What considerations should inform strain composition decisions to ensure that available COVID-19 vaccines continue to meet public health needs, e.g.:
-Role of VRBPAC and FDA in coordinating strain composition decisions
-Timelines needed to implement strain composition updates
-Harmonization of strain composition across available vaccines


• How often should the adequacy of strain composition for available vaccines be assessed?


• What conditions would indicate a need for updated COVID-19 vaccine strain composition, and what data would be needed to support a decision on a strain composition update?


• What considerations should guide the timing and populations for use of additional COVID-19 vaccine booster doses?”

Permissive Recommendation for Covid Vaccine 2nd Booster?

I have a question about the permissive recommendation by the CDC for the 2nd Covid vaccine booster. Does that mean I should get the booster or that I can get it if I just want one?

There’s an important distinction between “should” and “can.” According to the AMA, the CDC gave permissive recommendation, which means that it’s not saying you should get it, but that you can if you so choose:

“The CDC’s action is commonly known as a “permissive recommendation,” meaning that certain people may get the second booster if they wish to get it, though the agency itself is not yet officially urging them to do so.”

There are a couple of recently updated tables on the CDC website in which the language is clearly permissive about the 2nd booster dose.  One is dated April 2, 2022, Stay Up to Date with Your Covid-19 Vaccines. The other is dated April 1, 2022, Covid-19 Vaccine Boosters.

Some of us may be finding it challenging to get the booster scheduled right now. I wonder if that means even those providing the booster might be wondering who should or should not get one.

Does vaccine supply have a bearing on the issue? Or is there significant uncertainty about the necessity for the 2nd booster?

I wonder if experts are waiting for further guidance from the scheduled FDA Advisory Committee meeting on April 6, 2022.

That’s this coming Wednesday. I’d like to listen to the meeting as I have in the past, but I have a schedule conflict that day. That’s not the only conflict I have.

No officials are clearly saying that I should not get the 2nd booster. On the other hand, neither are they clearly saying I should.

Maybe I’ll wait for an FDA update after the April 6 meeting. And I wonder if that will lead to a CDC Advisory Committee meeting.

Update April 5, 2022: Here’s a link to a new article on CDC Director Rochelle Walensky’s remarks intended to clarify the confusion about this issue of whether the 2nd booster is needed or not. It turns out it all depends (as it usually does). If I’ve been infected with Omicron in the last 2-4 months, then I might not need one, at least for now.

The catch is that my immunity is waning. I might still need the 2nd booster. I’m old enough that it might be a good idea to get it. On the other hand, I’m probably still going to need another jab come autumn. Dr. Walensky says this is “a personal judgment call.”

I’m still waiting for the FDA Advisory Committee’s conclusions on April 6, 2022.

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