She was vaccinated but got COVID. Millions face waning immunity, booster confusion

More than 4 million Ohioans like Heather Isaly, an otherwise healthy 47-year-old mother from Suffield Township, are now eligible for a COVID vaccine booster.

Isaly wanted the extra shot but didn't think she was eligible yet when she visited an urgent care in Kent last month for an earache. She went for an antibiotic and left with a positive COVID-19 test.

“I’ve gone this whole time without getting it,” she said, admitting that she’d let her guard down, not wearing a mask, thinking the vaccine had her fully covered. “It seems crazy to me. I knew I was vaccinated, but I also didn’t get my booster.”

Technically, she was following the shifting rules from the Centers for Disease Control and Prevention, which made people in her age group eligible for the booster 10 days after her urgent care visit.

After the visit, she developed a raspy, wheezy shortness of breath on her fourth day of symptoms. As she sat in a “jam-packed” waiting room at Cleveland Clinic Akron General, she saw no visible injuries in the people around her.

In the exam room, a nurse popped in every few minutes — but not to check on her.

“They were so busy that they were looking for open rooms,” she recalled this week, still trying to shake a cough.

Omicron: First cases of COVID-19 omicron variant detected in Ohio, officials say

COVID-19: More COVID-19 patients hospitalized in Northeast Ohio this week than any time in pandemic

COVID-19 vaccines: Near-death COVID-19 experience has newlyweds rethinking vaccinations

Mixed messaging, uncertainty and the initial overselling of what's still proving to be highly effective vaccines have many people confused about whether they can and should get a COVID booster. Now, public health officials and hospitals executives are seeing an unprecedented wave of patients.

They're like Isaly in many ways — between 30 and 50 years old with no underlying health conditions. But unlike Isaly, most people admitted to the hospital arrive unvaccinated.

'Unprecedented demand'

It was bad when Isaly sat in the waiting room last month at Akron General. It’s only gotten worse.

Since Thanksgiving, three of the four major hospital systems serving Summit County set new pandemic records for COVID-19 admissions. Akron General’s record of 106 a year ago fell twice this week as nonessential surgeries have been canceled or postponed, forcing many families who’ve reached their annual insurance deductibles to wait until after they reset next year.

“At AGMC, we have doubled up beds wherever we can, brought in agency and staffing, and paid bonuses and overtime. Many of you have picked up extra shifts to help,” Dr. Brian Harte, president of Akron General Hospital, told staff Wednesday.

“We have — again — brought in a morgue trailer which is currently in use on our campus,” he continued. "But judging by this morning, none of these efforts are enough for managing this unprecedented demand. You and your colleagues are exhausting yourselves trying to keep up. The same scenario is playing out at Mercy, Medina, and many hospitals in Northeast Ohio.

“And the root cause of this problem is a general community failure to get vaccinated.”

There were more patients hospitalized with COVID-19 in Northeast Ohio hospitals earlier this week than at any point in the pandemic.

On Thursday, there were 1,071 hospitalized COVID-19 patients across Northeast Central Ohio Region 5, which includes Akron, Canton, Youngstown and surrounding areas, according to Dr. John Crow, an Akron Children's Hospital physician who is coordinating the 13-county region's COVID-19 surge response.

The previous high was 1,059 last December, before vaccines were widely available.

In the Akron region, the daily hospitalization count is also nearing its all-time high of 318 last Dec. 15. On Friday, there were 305 people hospitalized with COVID in the four Akron-area hospitals, up from 295 on Thursday. That includes 151 at Summa Health, 113 at Cleveland Clinic Akron General, 28 at Western Reserve Hospital and 13 at Akron Children's Hospital.

The vaccine worked

Isaly left the hospital with clear chest X-rays and good oxygen levels.

Doctors and nurses don’t often see vaccinated patients. When they do, their symptoms are milder and they rarely end up in intensive care units, which are filled primarily, and often only, with unvaccinated patients.

Since she was vaccinated seven months earlier, Isaly was told her symptoms would subside on Day 6. They got worse on Day 5 and, as the doctor predicted, began improving the next day.

The vaccine primes the body to attack the virus, instead of wasting precious time recognizing a foreign invader and jumpstarting natural antibody production, Summit County Health Commissioner Donna Skoda explained. The quicker the body responds, the less likely the patient develops symptoms or needs hospitalized.

Isaly quarantined in her bedroom until just before Thanksgiving. Meanwhile, the rest of the family tested negative and her two children in college got their boosters. She’s scheduling hers now.

Mixed messaging

When the COVID-19 boosters were first approved by the Food and Drug Administration, "they had categories,” Skoda said.

First up for the booster: the 65-and-older population and people in tight living quarters like prisons and nursing homes. Then came the 50-64 group with underlying health conditions.

“Fast-forward three weeks and broad guidance comes out that everyone over 18 years of age seek it regardless of health status," said Skoda.

Today, Skoda recommends the booster for all adults if two months have passed since their single dose of the Johnson & Johnson vaccine or six months since their second Pfizer or Moderna shot.

But confusion continues with each new headline, including the coverage of the more contagious, and possibly milder, omicron variant.

“Because of the mixed messaging, I’ve got people who call me and say, ‘I’m going to wait because they may need to put something else in this to fight a new variant,’ ” said Skoda, who advises not to wait if you're eligible to get a booster.

How effective are vaccines months later?

The other concern is that people hear about breakthrough cases and question the vaccines, which have held up despite losing some of their potency in the first few months.

Early on, media and health officials touted the vaccines as 90% or better at preventing illness, and even better at preventing hospitalization or death.

A study released in October of 3,436,957 people who got the Pfizer vaccine showed the effectiveness against infection dropped from 88% to 47% within five months of full vaccination. For the delta variant, infection rates dropped from 93% to 53%, which is still above the 50% threshold for FDA approval.

These aren't one-and-done smallpox or mumps vaccines. Chance of breakthrough infection increases with time, but the Pfizer study showed that six months after full vaccination, only 7% of fully vaccinated people sought hospitalization.

Deaths 2.4 times higher in low vaccine counties

The CDC reported in September that unvaccinated people are testing positive for COVID 5.4 times more often and dying 14 more often than vaccinated patients.

Public health officials follow the science. Definitive mortality and case data wasn't available when the vaccines were rolled out. But Skoda thinks there was enough clinical research when the boosters were approved to head off speculation by painting a more nuanced picture.

“Folks think the vaccine is perfect and we should never get sick with it,” said Skoda. “But if I’m 100% honest, we oversold the vaccine. We kept saying, 'It’s 90% effective, you’re going to be safe.' And then people started getting sick and they said, 'Oh hell, it doesn’t work. Why do this?'”

While immunity expectedly wanes, the last five months make a strong case that vaccines are saving lives.

A Beacon Journal analysis of Ohio Department of Health data finds that since July 1, one in 1,008 residents have died of COVID in the 21 Ohio counties where fewer than 40% of people are vaccinated. In the 23 counties with 50% or higher vaccination rates, one in 2,433 people have died of COVID.

The upshot is that counties with lower vaccination rates are losing 2.4 times more patients in this delta surge.

But vaccination rates haven’t changed much since May, when children ages 12 to 15 became eligible for the shot. There’s been a modest uptick in first shots since children ages 5 to 11 became eligible last month.

Of the 6,261,891 Ohioans fully vaccinated through November, 80% have been so for more than six months. Their immunity is declining.

While 53% of Ohio is fully vaccinated, only 16% have received a booster. The difference suggests that as many as 4.3 million Ohioans are living in that gray area, vaccinated now for six months or more and either unsure, unable or unwilling to get a booster.

The FDA approved the Pfizer booster Sept. 22 for adults compromised by health or work. The extra dose of Moderna was approved next. Restrictions for underlying health conditions and occupational hazard were lifted Nov. 19, a week after Islay went to urgent care with an earache.

On Thursday, the FDA approved the Pfizer booster for 16 and 17 year olds.

Reach Doug Livingston at dlivingston@thebeaconjournal.com or 330-996-3792.

This article originally appeared on Akron Beacon Journal: 4.3 million vaccinated Ohioans eligible for COVID booster