Dr. Monica Gandhi, Professor of Medicine and Associate Chief in the Division of HIV, Infectious Diseases, and Global Medicine at the University of California, San Francisco (UCSF) joined the LeadingAge Coronavirus Update Call on September 1, 2021. She responded to questions from Ruth Katz and from callers.

Q: This summer has been quite the roller coaster ride with the surge of COVID-19 coming from the delta variant. Have we seen the worst or will this continue into the fall?

A: It has been terrible, but I think that the cases are beginning to come down. We are in between the situations of India and the U.K. We have states that are highly vaccinated and there are some states with low vaccination rates. The hospitalization rates are following the proportion of vaccinated versus non-vaccinated populations. These vaccines work. Unvaccinated areas are having much more difficulty. Where I see hope is that the virus goes everywhere. It is very transmissible and causes a lot of immunity which is the only way out of the pandemic. Lockdowns will not eliminate it. We live with it by ensuring that anyone who can get sick from COVID doesn’t get sick with it.

Q: Boosters are going to be available in the coming weeks. You have talked recently about how we should equitably and ethically prioritize these boosters. Can you give us some insight on how this should be implemented?

A: Older people are more susceptible to serious illness, and we should be giving boosters to people who are immunocompromised and also older people. The CDC updates their information on breakthrough infections and hospitalizations and death, so they can analyze data to identify who needs boosters. People in long term care will likely be the next group for boosters after the immunocompromised. It is more important to get unvaccinated people vaccinated globally than to give boosters to young people in the U.S. Giving boosters to older people makes sense in the same way in which we give higher dosages of flu shots to older people.

Q: What about boosters and healthcare workers who may be younger?

A: Healthcare workers are likely to be on the list for boosters and here is why. T-cells protect you against severe disease and I believe we are seeing ongoing T-cell protection. Antibodies will absolutely come down with time and that may make a person more susceptible to getting the virus in the nose and it may take a few days for the body to bring those virus numbers down. That is the reason to give boosters to healthcare workers who may transmit the virus to vulnerable people during that time.

These groups should be prioritized for boosters:

• Immunocompromised people
• Older people with medical conditions
• People in LTC facilities
• Healthcare workers

We should not be hasty to give boosters to immuno-competent people.

Q: It seems as if we are hearing many different things about boosters…

A: We are in a mixed messaging situation with regard to boosters over the past few weeks. The federal government and other experts need to get on the same page and send clearer messages. Recent messaging has terrified vaccinated people and not terrified unvaccinated people. We need to get away from doom-based messaging.

Q: I read a piece by a respiratory therapist who described in detail what it is like to have severe COVID. It seems as if hearing that information would increase motivation for vaccination. What have you seen that works to get people vaccinated?

A: Vaccination is increasing in part because people are seeing the effects of the delta variant, and also because vaccine mandates work in helping people get vaccinated.

Q: For some that are vaccine hesitant, they are seeing the rise in breakthrough cases as a reasoning that the vaccine does not work. What do we know about the protection from the vaccines and what should our members tell those who make this argument?

A: You can Google “CDC breakthrough infections” and look at their statistics. There are 171million vaccinated people in the U.S. and the number of people who were hospitalized because of COVID has been 6,059. That is a rate of .003% and those people went into the hospital and got treated and our treatments have gotten better. The death rate is .0006 – 6 in a million vaccinated people died.

Q: Will we need yearly boosters?

A: T cells last a long time as do memory B cells. They have biopsied the lymph nodes of those who have gotten vaccinated to look for B cells and they were present. Several studies now show that memory B cells can make antibodies against whatever variant is in front of them. I talked before about a study of people 90-100 years old who had survived the 1918 influenza epidemic. They found that memory B cells still existed in their lymph nodes and could make strong neutralizing antibodies. So no, at this point I don’t believe we will need annual boosters.

Q: Should we focus on hospitalizations and deaths rather than positive tests?

A: Yes, particularly in vaccinated people those are the more important numbers. Denmark and Germany are focusing on hospitalizations and deaths rather than cases.

Q: If fully vaccinated people are exposed to COVID does it boost their immunity?

A: Yes, and it involves hybrid immunity. If the virus is present the memory B cells will attack it and that will have a boosting effect.

Q: What is your outlook on approval of a vaccine for children?

A: The Pfizer CEO has said that the data from studies of 5-11 year old children would be ready in late September, so it is likely that Emergency Use Authorization would be granted in October if the data indicates safety.