Immunity to the coronavirus lasts at least a year, possibly a lifetime, improving over time especially after vaccination, according to two new studies. The findings may help put to rest lingering fears that protection against the virus will be short-lived.
Together, the studies suggest that most people who have recovered from Covid-19 and who were later immunized will not need boosters. Vaccinated people who were never infected most likely will need the shots, however, as will a minority who were infected but did not produce a robust immune response.
Both reports looked at people who had been exposed to the coronavirus about a year earlier. Cells that retain a memory of the virus persist in the bone marrow and may churn out antibodies whenever needed, according to one of the studies, published on Monday in the journal Nature.
The other study, which is also under review for publication in Nature, found that these so-called memory B cells continue to mature and strengthen for at least 12 months after the initial infection.
Some scientists have interpreted this decrease as a sign of waning immunity, but it is exactly what’s expected, other experts said. If blood contained high quantities of antibodies to every pathogen the body had ever encountered, it would quickly transform into a thick sludge.
Instead, blood levels of antibodies fall sharply following acute infection, while memory B cells remain quiescent in the bone marrow, ready to take action when needed.
landmark study in 2007 showed that antibodies in theory could survive decades, perhaps even well beyond the average life span, hinting at the long-term presence of memory B cells. But the new study offered a rare proof of their existence, Dr. Gommerman said.
Dr. Nussenzweig’s team looked at how memory B cells mature over time. The researchers analyzed blood from 63 people who had recovered from Covid-19 about a year earlier. The vast majority of the participants had mild symptoms, and 26 had also received at least one dose of either the Moderna or the Pfizer-BioNTech vaccine.
So-called neutralizing antibodies, needed to prevent reinfection with the virus, remained unchanged between six and 12 months, while related but less important antibodies slowly disappeared, the team found.
confirming results from other studies; the shots also ramped up the body’s neutralizing ability by about 50-fold.
Senator Rand Paul, Republican of Kentucky, said on Sunday that he would not get a coronavirus vaccine because he had been infected in March of last year and was therefore immune.
But there is no guarantee that such immunity will be powerful enough to protect him for years, particularly given the emergence of variants of the coronavirus that can partially sidestep the body’s defenses.
The results of Dr. Nussenzweig’s study suggest that people who have recovered from Covid-19 and who have later been vaccinated will continue to have extremely high levels of protection against emerging variants, even without receiving a vaccine booster down the line.
“It kind of looks exactly like what we would hope a good memory B cell response would look like,” said Marion Pepper, an immunologist at the University of Washington in Seattle who was not involved in the new research.
The experts all agreed that immunity is likely to play out very differently in people who have never had Covid-19. Fighting a live virus is different from responding to a single viral protein introduced by a vaccine. And in those who had Covid-19, the initial immune response had time to mature over six to 12 months before being challenged by the vaccine.
“Those kinetics are different than someone who got immunized and then gets immunized again three weeks later,” Dr. Pepper said. “That’s not to say that they might not have as broad a response, but it could be very different.”
India’s federal health ministry raised an alarm on Thursday, asking state governments to immediately report all cases of a potentially deadly fungal infection that appears to be spreading quickly among Covid-19 patients.
The rare condition, mucormycosis, commonly known as black fungus, was present in India before the pandemic, but it is affecting those with Covid or those who have recently recovered.
Many health experts blame the spread on a central coronavirus treatment, steroids. These drugs can limit inflammation of the lungs, but they also dull the response of the immune system, which can allow infections like the black fungus to take hold.
More broadly, Covid patients with weakened immune systems and underlying conditions, particularly diabetes, are especially vulnerable to black fungus, which has a high mortality rate.
Video of a woman saying she would jump off the roof of a hospital if it failed to arrange injections of the medication for her husband spread widely on social media early this week.
The woman, in the central Indian state of Madhya Pradesh, said, “If I don’t get the injection today, then I will jump off the roof of the hospital and commit suicide. I have no other option left.” She added that the hospital had none of the medication and said of her husband, “Where should I take him in this condition?”
amid a virulent second wave.
Of the medication for the disease she said: “It is not one of the common over-the-counter medications. This is a toxic medication by itself. It can’t be given by all and sundry. It is not something which you can take at home. It needs strict monitoring of body parameters because it is a toxic drug.”
The federal government directive requiring state governments to immediately disclose cases follows those of many Indian states that had already required hospitals to report cases of mucormycosis.
This obituary is part of a series about people who have died in the coronavirus pandemic. Read about others here.
For nearly four decades, William R. Harris devoted his career to safeguarding his fellow citizens.
As an international lawyer and a sought-after consultant, he drafted treaties to prevent the proliferation of nuclear weapons and reduce the risk of accidental war. He modeled a framework for the government to continue functioning during a national catastrophe. He helped extend Daylight Saving Time to conserve fuel and focused officials on protecting the electrical grid from digital sabotage.
He practiced what he preached, too, making sure to get his first vaccination for the coronavirus in early February, as soon as he was eligible and the vaccine was available. He completed the regimen by the end of the month.
In late March, though, his family said, he received a jarring diagnosis: Covid-19. Mr. Harris also had chronic lymphocytic leukemia, and family members said that a few weeks after learning that he had Covid, he read an article in a scientific journal suggesting that the vaccine might not be fully effective for people with that type of leukemia.
The New York Times last month.
No vaccine is 100 percent effective, and some so-called breakthrough infections can be expected, even in healthy people who have been fully vaccinated. But those cases are rare. As of April 26, the Centers for Disease Control and Prevention reported 9,245 breakthrough cases, out of 95 million fully vaccinated Americans; 132 people died.
In a eulogy on Facebook, Mr. Harris’s daughter Darcy R. Harris described him this way: “As an international lawyer and policy wonk, his work spanned arms control treaties and verification, energy policy, space law. He was a consummate researcher, an early adopter, an innovator. On top of that, he was always working for free and helping others out.”
Dr. William A. Horwitz and Dr. Henriette Klein, both of whom were professors of clinical psychiatry at Columbia University.
He attended the Dalton School in Manhattan and, after graduating from the Choate School, now Choate Rosemary Hall, in Wallingford, Conn., earned a bachelor’s degree in history from Harvard College in 1962 and a law degree from Harvard Law School in 1966.
In 1968, he married Elizabeth Jones. Along with his wife and their daughter Darcy, he is survived by another daughter, Rebecca Harris Deane; a son, William Proctor Harris; four grandchildren; and his sister, Susan Harris Molnar.
The vaccines produced similar responses in all three groups of women, eliciting both antibody and T-cell responses against the coronavirus, the scientists found. Of particular note, experts said, was the fact that the shots produced high levels of neutralizing antibodies, which can prevent the virus from entering cells, in both pregnant and nonpregnant women.
“Clearly, the vaccines were working in these people,” said Akiko Iwasaki, an immunologist at Yale University who was not involved in the research. “These levels are expected to be quite protective.”
The researchers also found neutralizing antibodies in the breast milk of vaccinated mothers and in umbilical cord blood collected from infants at delivery. “Vaccination of pregnant people and lactating people actually leads to transfer of some immunity to their newborns and lactating infants,” said Dr. Ai-ris Y. Collier, a physician-scientist at Beth Israel who is the first author of the paper.
The results are “really encouraging,” Dr. Iwasaki said. “There is this added benefit of conferring protective antibodies to the newborn and the fetus, which is all the more reason to get vaccinated.”
The scientists also measured the women’s immune responses to two variants of concern: B.1.1.7, which was first identified in Britain, and B.1.351, which was first identified in South Africa. All three groups of women produced antibody and T-cell responses to both variants after vaccination, although their antibody responses were weaker against the variants, especially B.1.351, than against the original strain of the virus, according to the study.
“These women developed immune responses to the variants, although the asterisk is that the antibody responses were reduced several-fold,” said Dr. Dan Barouch, a study author and virologist at Beth Israel.(Dr. Barouch and his colleagues developed the Johnson & Johnson vaccine, which was not included in this study.)
“Overall, it’s good news,” he added. “And it increases the data that suggests that there is a substantial benefit for pregnant women to be vaccinated.”
The first dose of Russia’s Sputnik V coronavirus vaccine provides sufficient protection on its own to be used without a second injection, the country’s Ministry of Health said on Thursday, clearing the way for a faster vaccination campaign in Russia.
The new policy arose from a debate among public health officials in Russia and a number of other countries about the benefits and drawbacks of accelerating vaccinations by skipping or delaying the second dose of vaccines that were originally designed to be administered in two shots a few weeks apart.
As is the case with other two-dose coronavirus vaccines, Sputnik V provides substantial protection, at least for the short term, after the first shot.
The ministry said in a statement that people in Russia who, for various reasons, skipped their second shot of Sputnik V were still far less likely to become sick than unvaccinated people were.
Sputnik V to be 79.4 percent effective after a single shot. Russia has previously reported an efficacy of 91.6 percent after two shots.
The observational study was less precise than a standard vaccine trial, because it compared rates of infection in single-shot recipients with the general infection rate in the population, not with a control group. The ministry did not say how many single-shot recipients were studied. A separate placebo-controlled study of the issue is still underway.
The Russian vaccine uses two common cold viruses that have been genetically modified to carry genes of the coronavirus, which prime the immune system to prevent infection. Developers of the vaccine have said the second dose lengthens the period of time a recipient is immune.
In other countries, health authorities have been wary about approving a simplified single-shot approach for vaccination using vaccines that were tested in trials using two shots.
But the first shot of Sputnik V uses the same common cold virus as the single-dose Johnson & Johnson vaccine, which already has been approved for use in the United States and other countries and has been shown to be safe and effective, with an efficacy of 72 percent in the United States.
The Russian version of this single-shot approach is called Sputnik Lite.
The two-dose Sputnik V vaccine is still being offered in Russia and to dozens of other countries. Russia’s export customers could also speed up their vaccination campaigns if they follow the Russian Ministry of Health’s lead in approving a single-dose strategy.
In early 2020, dozens of scientific teams scrambled to make a vaccine for Covid-19. Some chose tried-and-true techniques, such as making vaccines from killed viruses. But a handful of companies bet on a riskier method, one that had never produced a licensed vaccine: deploying a genetic molecule called RNA.
The bet paid off. The first two vaccines to emerge successfully out of clinical trials, made by Pfizer-BioNTech and by Moderna, were both made of RNA. They both turned out to have efficacy rates about as good as a vaccine could get.
In the months that followed, those two RNA vaccines have provided protection to tens of millions of people in some 90 countries. But many parts of the world, including those with climbing death tolls, have had little access to them, in part because they require being kept in a deep freeze.
Now a third RNA vaccine may help meet that global need. A small German company called CureVac is on the cusp of announcing the results of its late-stage clinical trial. As early as next week, the world may learn whether its vaccine is safe and effective.
Novavax, a company based in Maryland whose vaccine uses coronavirus proteins, is expected to apply for U.S. authorization in the next few weeks. In India, the pharmaceutical company Biological E is testing another protein-based vaccine that was developed by researchers in Texas. In Brazil, Mexico, Thailand and Vietnam, researchers are starting trials for a Covid-19 shot that can be mass-produced in chicken eggs.
Vaccines experts are particularly curious to see CureVac’s results, because its shot has an important advantage over the other RNA vaccines from Moderna and Pfizer-BioNTech. While those two vaccines have to be kept in a deep freezer, CureVac’s vaccine stays stable in a refrigerator — meaning it could more easily deliver the newly discovered power of RNA vaccines to hard-hit parts of the world.
“It’s gone largely under the radar,” said Jacob Kirkegaard, a senior fellow at the Peterson Institute for International Economics in Washington, D.C. But now, he added, “they look pretty well positioned to clean up the global market.”
For CureVac’s co-founder, the biologist Ingmar Hoerr, the company’s Covid-19 vaccine trial is the culmination of a quarter-century’s worth of work with RNA, a molecule that helps turn DNA into the proteins that do the work of our cells. As a graduate student at the University of Tübingen in the 1990s, Dr. Hoerr injected RNA into mice and found that the animals could make the protein encoded by the molecules. He was surprised to find that the mice’s immune systems made antibodies against the new proteins.
only a few scientists in the world considered an RNA vaccine a serious possibility. But proponents thought it might change medicine. You could, in theory, craft an RNA molecule to immunize people against any virus. You might even be able to create an RNA vaccine to cure cancer, if you could make an RNA molecule that encoded a tumor protein.
In 2001, Dr. Hoerr co-founded CureVac to chase the idea, but for the first few years the company struggled to survive. To keep the lights on, it took orders from other labs for custom-built RNA molecules. On the side, CureVac’s scientists tinkered with their own designs for RNA vaccines.
Over time, they found subtle tweaks to RNA vaccine molecules that caused cells to make more proteins. The more potent the RNA, the lower the dose they needed in vaccines.
CureVac’s researchers also figured out how to put the RNA molecules in fatty bubbles to protect them from destruction on their journey to cells. And perhaps most important, they used a form of RNA that could stay stable at relatively warm temperatures. Instead of requiring a deep freezer, CureVac’s vaccine could be refrigerated.
In time, other companies entered the RNA vaccine business as well: BioNTech in Germany in 2008, then Moderna in Boston in 2011. Their experiments began showing that these vaccines could protect animals against an assortment of viruses. In 2013, CureVac injected human volunteers with a rabies RNA vaccine, in the first clinical trial of the technology against an infectious disease.
For years, CureVac and other RNA vaccine companies toiled on perfecting their vaccines. CureVac’s first attempt at a rabies vaccine demonstrated it was safe, but it yielded a weak response from the immune system. The company has since retooled that vaccine, and the updated version has shown promise in early clinical studies. But other efforts ended in failure. In 2017, CureVac announced that its RNA vaccine against prostate cancer offered no benefits to patients.
$1 billion to move its operations to the United States. CureVac denied the reports, but the chief executive suddenly left, to be replaced by Dr. Haas.
CureVac’s researchers moved ahead with their limited resources, designing an RNA molecule encoding a protein found on the surface of the coronavirus, called spike. Experiments on hamsters showed that it could protect the animals from the virus.
Phase 3 trial, recruiting 40,000 volunteers in Europe and Latin America. The company will get its first look at the data when 56 volunteers develop Covid-19. If most of them are in the placebo group, and few in the vaccinated group, it will be proof that the vaccine works.
with a lawsuit.
In April, the European Union finally fixed this shortfall, negotiating with Pfizer and BioNTech to get 1.8 billion doses of their vaccine between now and 2023. That arrangement has left analysts wondering how much demand will be left for CureVac.
“They’re going to miss the boat on the major, advanced-economy markets,” said Dr. Kirkegaard. “The U.S., Europe and Japan are going to be largely vaccinated using these Moderna and Pfizer vaccines.”
Dr. Haas countered that most of the bloc’s doses from Pfizer-BioNTech won’t come until next year. “CureVac sees itself as a major player in ending the Covid-19 pandemic in Europe and elsewhere,” he said.
Ursula von der Leyen, president of the European Commission, said that if the CureVac vaccine worked, it would be in the mix, thanks to two advantages: It is an mRNA vaccine, and it was created in Europe. It is also possible that individual European nations will make side deals with the company.
Billions of other people in low- and middle-income countries have yet to receive a vaccine, and experts say that CureVac may meet some of their demand. “We still need a lot of vaccine globally,” said Florian Krammer, a virologist at the Icahn School of Medicine at Mount Sinai in New York. “I think a lot of people can benefit from it.”
The vaccines from Moderna and Pfizer-BioNTech are challenging to distribute in the developing world because of the equipment and power supply required to freeze these vaccines. CureVac’s RNA vaccine can stay stable for at least three months at 41 degrees Fahrenheit, and it can sit for 24 hours at room temperature before it is used.
“The stability is a real advantage,” Dr. Jackson said. C.E.P.I. is “in very active discussions” with CureVac, he said, about distributing the company’s vaccine through Covax, an initiative to distribute vaccines to low- and middle-income countries.
But CureVac is also designing a new generation of vaccines with a goal of eventually moving into markets in the United States and other wealthy nations. Because its potent RNA requires only a small dose, the company could potentially create vaccines for different variants and mix them in a single shot.
But such possibilities are meaningless until CureVac can prove that its vaccine works. Mary Warrell, a vaccine researcher at the University of Oxford, is reluctant to speculate about the fate of the vaccine before that milestone.
“Prediction during this pandemic has rarely been profitable,” she warned.
Doctors, the public and the media point to anecdotal evidence of infections even among the vaccinated. Scientists say the data is too thin and cite other reasons behind the country’s second wave.
NEW DELHI — At Sir Ganga Ram Hospital, a huge facility in the middle of India’s capital, 37 fully vaccinated doctors came down with Covid-19 earlier this month.
The infections left most with mild symptoms, but it added to their growing fears that the virus behind India’s catastrophic second wave is different. They wonder if a more contagious variant that dodges the immune system could be fueling the epidemic inside the world’s hardest-hit nation.
So far the evidence is inconclusive, and researchers caution that other factors could explain the viciousness of the outbreak, which has overwhelmed India’s capital so quickly that hospitals are entirely overrun and crematories burn nonstop. Still, the presence of the variant could complicate the taming of India’s Covid-19 disaster.
“The current wave of Covid has a different clinical behavior,” said Dr. Sujay Shad, a senior cardiac surgeon at Sir Ganga Ram Hospital, where two of the doctors needed supplemental oxygen to recover. “It’s affecting young adults. It’s affecting families. It’s a new thing altogether. Two-month-old babies are getting infected.”
is much higher. Daily new infections also surged to nearly 357,700, another record.
most common source of new infection in the United States
“While it’s almost certainly true B.1.617 is playing a role, it’s unclear how much it’s contributing directly to the surge and how that compares to other circulating variants, especially B.1.1.7,” said Kristian Andersen, a virologist at the Scripps Research Institute in San Diego.
India has just scraped the surface in terms of vaccinating its population, with less than 2 percent fully vaccinated. Experts also blame lax public behavior after last year’s first wave and missteps by Prime Minister Narendra Modi, such as recently holding large political rallies that may have spread the disease and sent a message to the people that the worst was over.
“There is a lot of jumping to conclusions that B.1.67 is the explanation for what’s happening,” said Jeffrey Barrett, director of the Covid-19 genomics initiative at the Wellcome Sanger Institute in Britain. “These other things are probably more likely to be the explanation.”
still responsive to vaccines, although slightly less so. India relies heavily on the Oxford-AstraZeneca vaccine, which clinical trials show is less powerful than the vaccines made by Pfizer-BioNTech and Moderna and could perhaps be more easily thwarted by mutations.
“For now the vaccines remain effective, but there is a trend toward less effectiveness,” said Dr. Céline Gounder, an infectious disease physician and epidemiologist at Bellevue Hospital in New York.
In India, a number of doctors point to anecdotal evidence that people who have been fully vaccinated are getting sick. Those doctors also say they are seeing children with serious symptoms, such as severe diarrhea, acidosis and falling blood pressure, even among otherwise healthy patients.
“This is very different from what we saw last year,” said Dr. Soonu Udani, head of critical care services at the SRCC Children’s Hospital in Mumbai.
report in The Wire, an Indian online publication, pointed to logistical challenges, bureaucratic red tape and the lack of funding as some of the reasons.
data from the Indian Council of Medical Research up to April 21 shows an extremely low breakthrough infection rate, though perhaps not as low as that of the United States. The data shows 0.02 percent to 0.04 percent of vaccinated people falling ill. The rate in the United States, which relies on different vaccines, is 0.008 percent.
At Sir Ganga Ram hospital, the 37 doctors who became infected after immunization had received their first dose between late January to early February and then their second dose four to six weeks after that. The hospital employs about 500 doctors.
Dr. Shad, the cardiac surgeon, was reluctant to jump to conclusions about variants breaking through the immunizations. “I don’t think anyone has the serological data” to answer that, he said.
A broad lack of data plagues the scientific chase for variants and whether they are contributing to the severity of India’s crisis. Fast-moving mutations complicate the picture because it isn’t immediately clear how quickly they spread or how they respond to vaccines.
In India, the health care system wasn’t on alert for the impact of variants at home, even as they began to spread globally, said Dr. Thekkekara Jacob John, a senior virologist in the southern state of Tamil Nadu.
“We were not looking for variants at all,” he said. “In other words, we missed the boat.”
After a long year and a lot of anticipation, getting the vaccine can be cause for celebration, which for some might mean pouring a drink and toasting to their new immunity. But can alcohol interfere with your immune response?
The short answer is that it depends on how much you drink.
There is no evidence that having a drink or two can render any of the current Covid vaccines less effective. Some studies have even found that over the longer term, small or moderate amounts of alcohol might actually benefit the immune system by reducing inflammation.
Heavy alcohol consumption, on the other hand, particularly over the long term, can suppress the immune system and potentially interfere with your vaccine response, experts say. Since it can take weeks after a Covid shot for the body to generate protective levels of antibodies against the novel coronavirus, anything that interferes with the immune response would be cause for concern.
For weeks, New Yorkers have witnessed the alarming rise of a homegrown variant of the coronavirus that has kept the number of cases in the city stubbornly high. City officials have repeatedly warned that the variant may be more contagious and may dodge the immune response.
On that second point, at least, they can now breathe easier: Both the Pfizer-BioNTech and Moderna vaccines will effectively prevent serious illness and death from the variant, two independent studies suggest.
Antibodies stimulated by those vaccines are only slightly less potent at controlling the variant than the original form of the virus, both studies found.
“We’re not seeing big differences,” said Michel Nussenzweig, an immunologist at Rockefeller University in New York and a member of the team that published one of the studies on Thursday.
possible explanation: Antibodies from vaccinated people are distributed across a broader range of parts of the virus, so no single mutation has a big impact on their effectiveness — making vaccines a better bet against variants than immunity from natural infection.
The variant first identified in New York, known to scientists as B.1.526, raced through the city after its initial discovery in November. It accounted for one in four diagnosed cases by November and nearly half of cases as of April 13. The variant that brought Britain to a standstill, B.1.1.7, is also circulating widely in New York. Together, the two add up to more than 70 percent of coronavirus cases in the city.
second study, Dr. Landau’s team found that the Pfizer and Moderna vaccines are only marginally less protective against the variant that devastated Britain and against forms of the variant discovered in New York that don’t contain the Eek mutation.
Several laboratory studies have shown that antibodies induced by the Pfizer and Moderna vaccines are slightly less powerful against a third variant, one identified in South Africa, which also contains Eek. Other vaccines fared worse. South Africa suspended use of the AstraZeneca vaccine after clinical trials showed that the vaccine did not prevent mild or moderate illness from the variant that was circulating there.
“It already started out as a lower level in terms of the immunity that it generated,” Dr. Nussenzweig said of the AstraZeneca vaccine. Referring to the Pfizer and Moderna shots, he said, “We’re so lucky in this country to have these vaccines compared to the rest of the world.”
Florian Krammer, an immunologist at the Icahn School of Medicine at Mount Sinai who was not involved in either of the new studies, said he was more concerned about other countries’ vaccine programs than about the variants themselves.
“I am less concerned about variants than I was two months ago,” he said, but added: “I’m worried about countries that don’t have enough vaccine and that don’t have that vaccine rollout. I’m not worried anymore about the U.S., honestly.”
Dr. Landau’s team also tested monoclonal antibodies used to treat Covid-19 against the variants. They found that the cocktail of monoclonal antibodies made by Regeneron worked as well against the variant discovered in New York as against the original virus.
The studies are reassuring, but they indicate that the Eek mutation is one to watch, said Jesse Bloom, an evolutionary biologist at the Fred Hutchinson Cancer Research Center in Seattle.
“This could certainly be a step toward the virus becoming somewhat more resistant to infection- and vaccine-mediated immunity,” Dr. Bloom said. “I don’t think it’s something that people need to immediately become alarmed about, but it definitely impresses us as important.”
Dr. Bloom led the analysis comparing vaccine-induced antibodies with those produced by natural infection. He found that the most powerful antibodies bind to multiple sites in a key part of the virus. Even if a mutation affects the binding in one site in this region, antibodies that target the remaining sites would still be protective.
Antibodies induced by the vaccine cover many more sites across this region than those from natural infection — and so are less likely to be affected by a mutation in any one site.
The study looked only at antibodies stimulated by the Moderna vaccine, but the results are likely to be the same for the Pfizer-BioNTech vaccine, he added.
“This could potentially be a good thing as the virus is creating mutations,” Dr. Bloom said.
For more than a year, Dr. Andrew Wollowitz has mostly been cloistered inside his home in Mamaroneck, N.Y.
As chief of emergency medicine at Montefiore Medical Center in the Bronx, Dr. Wollowitz, 63, was eager to help treat patients when the coronavirus began raging through the city last spring. But a cancer treatment in 2019 had obliterated his immune cells, leaving him defenseless against the virus, so he instead arranged to manage his staff via Zoom.
A year later, people in Dr. Wollowitz’s life are returning to some semblance of normalcy. His wife, a dancer and choreographer, is preparing to travel for work at Austria’s National Ballet Company. His vaccinated friends are getting together, but he sees them only when the weather is nice enough to sit in his backyard. “I spend very little time in public areas,” he said.
Like his friends, Dr. Wollowitz was vaccinated in January. But he did not produce any antibodies in response — nor did he expect to. He is one of millions of Americans who are immunocompromised, whose bodies cannot learn to deploy immune fighters against the virus.
as high as 55 percent.
Most people who have lived with immune deficiencies for a long time are likely to be aware of their vulnerability. But others have no idea that medications may have put them at risk.
“They’ll be walking around outside thinking they’re protected — but maybe they’re not,” said Dr. Lee Greenberger, chief scientific officer of the Leukemia and Lymphoma Society, which funds research on blood cancers.
The only recourse for these patients — apart from sheltering in place until the virus has retreated — may be to receive regular infusions of monoclonal antibodies, which are mass-produced copies of antibodies obtained from people who have recovered from Covid-19. The Food and Drug Administration has authorized several monoclonal antibody treatments for Covid-19, but now some are also being tested to prevent infections.
Convalescent plasma or gamma globulin — antibodies distilled from the blood of healthy donors — may also help immunocompromised people, although a version of the latter that includes antibodies to the coronavirus is still months from availability.
compassionate use program. (Regeneron released trial results this week showing that the cocktail reduces symptomatic infections by 81 percent in people with normal immune systems.)
It’s unclear how many immunocompromised people don’t respond to coronavirus vaccines. But the list seems at least to include survivors of blood cancers, organ transplant recipients, and anyone who takes the widely used drug Rituxan, or the cancer drugs Gazyva or Imbruvica — all of which kill or block B cells, the immune cells that churn out antibodies — or Remicade, a popular drug for treating inflammatory bowel disease. It may also include some people over age 80 whose immune responses have faltered with age.
“We’re extremely concerned and interested in trying to see how we might be able to help those particular patients,” said Dr. Elad Sharon, an immunotherapy expert at the National Cancer Institute.
As the pandemic spread, doctors who specialize in treating blood cancers or who care for immunocompromised people expected at least some of their patients to encounter difficulties. Dr. Charlotte Cunningham-Rundles, an immunologist at Icahn School of Medicine at Mount Sinai in New York, has about 600 patients who are almost entirely dependent on getting regular doses of gamma globulin to stay safe from pathogens.
Even so, 44 of her patients became infected with the coronavirus; four died, and another four or five had long-term illnesses. (Chronic infections may offer opportunities for the virus to evolve into dangerous variants.)
registry to provide information and antibody tests to people with blood cancers. And several studies are assessing the response to coronavirus vaccines in people with cancer, autoimmune conditions like lupus or rheumatoid arthritis, or who take drugs that mute the immune response.
What You Need to Know About the Johnson & Johnson Vaccine Pause in the U.S.
On April 13, 2021, U.S. health agencies called for an immediate pause in the use of Johnson & Johnson’s single-dose Covid-19 vaccine after six recipients in the United States developed a rare disorder involving blood clots within one to three weeks of vaccination.
All 50 states, Washington, D.C. and Puerto Rico temporarily halted or recommended providers pause the use of the vaccine. The U.S. military, federally run vaccination sites and a host of private companies, including CVS, Walgreens, Rite Aid, Walmart and Publix, also paused the injections.
Fewer than one in a million Johnson & Johnson vaccinations are now under investigation. If there is indeed a risk of blood clots from the vaccine — which has yet to be determined — that risk is extremely low. The risk of getting Covid-19 in the United States is far higher.
The pause could complicate the nation’s vaccination efforts at a time when many states are confronting a surge in new cases and seeking to address vaccine hesitancy.
Johnson & Johnson has also decided to delay the rollout of its vaccine in Europe amid concerns over rare blood clots, dealing another blow to Europe’s inoculation push. South Africa, devastated by a more contagious virus variant that emerged there, suspended use of the vaccine as well. Australia announced it would not purchase any doses.
In one such study, British researchers followed nearly 7,000 people with Crohn’s disease or ulcerative colitis from 90 hospitals in the country. They found that less than half of patients who took Remicade mounted an immune response following coronavirus infection.
were protected after a single dose of the Pfizer vaccine and only 27 percent after a single dose of the AstraZeneca vaccine. (In Britain, the current practice is to delay second doses to stretch vaccine availability.)
Likewise, another study published last month indicated that fewer than 15 percent of patients with cancers of blood or the immune system, and fewer than 40 percent of those with solid tumors, produced antibodies after receiving a single dose of the Pfizer-BioNTech vaccine.
And a study published last month in the journal JAMA reported that only 17 percent of 436 transplant recipients who got one dose of the Pfizer-BioNTech or Moderna vaccine had detectable antibodies three weeks later.
Despite the low odds, immunocompromised people should still get the vaccines because they may produce some immune cells that are protective, even antibodies in a subset of patients.
“These patients should probably be prioritized for optimally timed two doses,” said Dr. Tariq Ahmad, a gastroenterologist at the Royal Devon and Exeter NHS Foundation Trust who was involved in the infliximab studies.
He suggested that clinicians routinely measure antibody responses in immunocompromised people even after two vaccine doses, so as to identify those who also may need monoclonal antibodies to prevent infection or a third dose of the vaccines.
Wendy Halperin, 54, was diagnosed at age 28 with a condition called common variable immunodeficiency. She was hospitalized with Covid-19 in January and remained there for 15 days. But the coronavirus induced unusual symptoms.
“I was having trouble walking,” she recalled. “I just lost control of my limbs, like I couldn’t walk down the street.”
Because she was treated for Covid-19 with convalescent plasma, Ms. Halperin has had to wait three months to be immunized and has made an appointment for April 26. But despite her condition, her body did manage to produce some antibodies to the initial infection.
“The take home message is that everybody should try and get the vaccine,” said Dr. Amit Verma, an oncologist at Montefiore Medical Center.
The gamble did not pay off in Dr. Wollowitz’s case. Without antibodies in his system to protect him, he is still working from home — a privilege he is grateful for. He was an avid mountain biker and advanced skier, both of which carry risk of injury, but with the coronavirus, he is playing it safe.
In anticipation of returning to his normal lifestyle, Dr. Wollowitz is tuning his bicycles. But he said he foresaw himself living this way till enough other people are vaccinated and the number of infections in the city drops.
“I’m not exactly sure what that date is,” he said. “I’m really waiting to get back out.”