COVID-19 update: Get your booster

With the holidays upon us and concerns about the pandemic at the forefront of most people’s minds, IDF provided the latest facts about the virus and what it means for the PI community.

Dr. Manish Butte, Chair and Professor in the Department of Pediatrics at the University of California Los Angeles (UCLA) and Division Chief of Pediatric Immunology, Allergy, and Rheumatology at UCLA, presented the IDF Forum, “COVID-19: What We Know Now.”

Not much has changed as far as what we do know, he told listeners, but as information trickles in about the new omicron variant, the public will need to shift from the more laid-back approach to the virus taken in the summer to a much more vigilant stance.

While extensive information is lacking on omicron, studies so far indicate that the variant is much more transmissible than other variants and that vaccinations are not as effective against omicron. Not enough data exists to determine whether or not omicron is expected to produce more severe or milder disease, said Dr. Butte. Members of the PI community should receive their vaccinations, and seek the booster shot as well.

“Even those who didn’t make good B cell responses made good T cell responses. This is actually a very good sign. This tells us that maybe even those with CVID (common variable immunodeficiency) who can’t make B cell responses can still make T cell responses,” said Dr. Butte.

Those with CVID and those who take rituximab, which reduces the effectiveness of the vaccine, can test their spike-specific antibodies, neutralizing antibodies, and T-cell-specific responses after vaccination, and Dr. Butte shared the testing codes should members of the community decide to evaluate their immune responses.

Other precautions that members of the PI community can take include:

• Ensure members of the household and visitors are vaccinated
• Practice social distancing
• Visit with people outside
• Wear an N-95 mask and face shield
• Avoid crowded indoor and outdoor spaces

These practices are important for the PI community and especially for those who are older than 65 or have other risk factors such as obesity, diabetes, hypertension, coronary artery disease, renal disease, pulmonary disease, and malignancy.

In addition, those with T cell defects, combined immunodeficiencies, severe combined immunodeficiency (SCID), or a PI that affects both T cells and B cells are more likely to get severe COVID than those who have pure antibody defects, explained Dr. Butte.

What causes severe disease? In a normal immune response, a person produces Type 1 interferon, which slows down the virus and stops the virus from spreading and making viral proteins. Then the T cells are activated within 3 to 6 days after the virus enters the body and clear out what’s left of the virus.

“In the meantime, T cells help B cells make antibodies. It takes weeks to make antibodies. That’s why we have vaccines so that the B cells are already primed so that when you get infected there are already antibodies in your respiratory fluids that are blocking the virus and slowing down how much can infect your cells, leaving plenty of room for your Type 1 interferon to clear up all those problems,” explained Dr. Butte.

Severe disease develops in some people because they cannot make enough Type 1 interferon. Because this virus has a strong ability to spread, it spreads throughout the lungs and causes hypoxia (low oxygen content in the blood), blood clots, and injuries to the lungs and other organs.

“When T cells do show up on days 5 or 6, that’s when people get really sick. The T cells start to do their job and you end up with leakage in your lungs and you drown in your own fluids and have a cytokine storm, and a very high fever,” explained Dr. Butte.

“The only treatment at this stage is immune suppression to try to slow down that T cell response by giving steroids, for example, IL6 blockers to keep the infections from being too drastic.”

Older people are more at risk because they have Type 1 interferon blocking antibodies, slowing down the body’s ability to sound the alarm that infection is coming.

“That turns a mild infection into a life-threatening infection,” said Dr. Butte.

Dr. Butte also discussed the use of monoclonal antibodies both in the treatment of COVID-19 disease and as a prophylaxis. Some persons with PI cannot make active immunity to vaccines and need other kinds of protection.

“Monoclonals will work as a preventative. That is a very important thing,” said Dr. Butte.

Those who will need monoclonal antibody prophylaxis include:

• PI patients with defective humoral immunity
• Patients who receive rituximab
• Bone marrow transplant recipients (for at least one year)
• Solid-organ transplant recipients

In addition to the prophylaxis, another layer of protection against the virus is on the way, said Dr. Butte. He said that studies performed by several pharmaceutical companies are reporting increases in COVID-19 antibodies in their immunoglobulin products and that by March patients should benefit from those antibodies.

“In a few months, we are going to be in a much better place with our whole PI community,” said Dr. Butte.

Watch the IDF December 2021 COVID-19 Update.