State Dept. of Health simplifies booster eligibility
Tennessee Health Commissioner Dr. Lisa Piercey, right, talks about the continuing battle against the coronavirus pandemic during a news conference July 1, 2020, in Nashville. At left is Gov. Bill Lee. Piercey clarified state guidance on booster shots on Wednesday, Sept. 29. (AP Photo/Mark Humphrey)
If federal guidance on who needs a booster shot seems complicated and long, the state commissioner of health shortens it to two words: “should” and “may.”
Yes, if you are 65, you should get a booster, says Dr. Lisa Piercey.
The same is true of anyone living in a long-term care facility and those ages 50-64 with medical conditions such as obesity, high blood pressure, emphysema, heart disease and diabetes.
Others included in the guidance essentially get to judge their level of risk for themselves.
“If you are ages 18 to 49 with one of those medical conditions, you may have a booster if you would like,” Piercey said.
And anyone 18 and over at increased risk of exposure because they work in health care or other places of high risk may also get a third dose now.
For all, it must be at least six months since they got their second dose.
“So, that’s a lot to digest, and it’s even more complicated because it’s only the Pfizer product right now,” she said.
The Centers for Disease Control and Prevention released the recommendations last week, just a week after top scientists, including two leaving the U.S. Food and Drug Administration, said the general population did not need boosters and that more evidence was needed to justify them.
“This was another, I think, failure of communication, failure of process from our government, our public health officials,” said Dr. Jon McCullers, chief pediatrician at Le Bonheur Children’s Hospital and chair of the pediatrics department at University of Tennessee Health Science Center.
“The decision-making should have been much more straightforward, and the communications should have been simple and to the point, once we had a decision made,” he said.
Earlier guidance, for instance, said people with compromised immune systems would be eligible, but when the full guidance was released, it included all chronic conditions.
“You get the sense that the government is trying to get as many vaccine doses in as many people as they can, and I’m all for that, but the focus should really be on getting the unvaccinated vaccinated and getting those at the highest risk a booster perhaps versus the broader population, which I think is what they have been aiming at,” McCullers said.
It’s possible that giving more boosters could reduce transmission and a future wave, he said, but there is no scientific data to prove it.
Booster shots are being given at the Pipkin Building at Liberty Park and in the clinics and pharmacies that have been administering COVID vaccines.
Last Saturday, the City of Memphis gave 33 booster shots. By Tuesday, the number had risen to 208.
People are not being asked for proof of a chronic disease or where they work, Piercey said, noting the burden of documentation “is not something that we are going to pursue.”
Booster shots may be the latest thing in the fight, Piercey reminds herself often that “we are not going to boost our way out of this pandemic. The single most effective way for us to end this pandemic is to get the unvaccinated vaccinated.”
Moderna and Johnson & Johnson are expecting to have emergency-use authorization for their boosters in a matter of weeks.
Cases and hospitalizations statewide show signs of slowing, although the relief tends to be the reverse of the Delta’s rise in Tennessee.
Memphis and Jackson, hard hit in August and early September, are seeing sustained decreases, Piercey said. There is a leveling off in East Tennessee, specifically Knoxville. But the Upper Cumberland region and parts of northeast Tennessee are still battling large numbers of cases.
Baptist Memorial Hospital-Memphis is less crowded, said infectious disease Dr. Stephen Threlkeld, and the pace is “not quite as frenetic, and we are hoping it will continue.
“Unfortunately, we still have people dying and that is going to continue for a while.”
Since Sept. 23, 55 people in Shelby County have died of the virus. Piercey expects the deaths will continue long after this surge subsides largely because the victims are now younger.
“Patients who are younger typically have longer lengths of stay in the ICU. And if they are going to pass away, it’s often more delayed than with older people,” she said.
Statewide, the peak of deaths in this surge may be yet to come, she said.
Although Tennessee was expecting shortages of monoclonal antibody treatments and health officials asked last week that the therapy be reserved for unvaccinated people, they did not have to carry through.
“We spent pretty much all the month of September worried about our supply,” Piercey said.
With demand waning now, she expects an adequate supply for the 220 providers offering the COVID treatment across the state.
The U.S. Department of Health and Human Services supplies the states with doses of the treatment each week. Tennessee’s early allocation was 7,700 doses. This week’s portion will drop to 6,300, about 1,000 fewer doses than the state received last week.
“I’m again cautiously optimistic but still keeping a really close watch,” she said.
Allotment will drop to 6,000, which Piercey expects will continue through the fall.
Gov. Bill Lee’s executive order No. 84 that allowed parents to opt their children out of masking in K-12 schools will expire Oct. 5.
It is moot in Shelby County because a federal judge ruled it prevented children from being able to access their schools and ordered the county Health Department to enforce its mask mandate.
Piercey did not know whether Lee will renew the executive order.
“The governor and I speak frequently about masks. He knows that from a medical standpoint they are an effective tool. We also both recognize that there’s not a lot of appetite for mandates. Essentially, none for government mandates,” she said.
“I have no insight into how he was going to handle the upcoming expiration of the executive order, but it’s clear and he said it on multiple occasions, masks do work.”
In a state where COVID vaccination continues to be among the lowest in the nation, and where the governor has repeatedly said vaccination is a personal choice, the state Health Department could soon be in the position of having to enforce vaccination mandates in facilities that receive Medicare funding. They include nursing homes and hospitals. In Shelby County, Saint Francis hospitals have not made the vaccine mandatory for employees.
“I’m worried about the unintended consequences of these mandates as a condition of employment, particularly in areas that are already short-staffed,” Piercey said.
But as the agency that surveys for Medicare and Medicaid, the state Department of Health will have no choice but to follow the federal rule, she said.
“On behalf of our federal partners, we don’t get to make the rules or change the rules. So whatever the ultimate rules are from CMS (Centers for Medicare & Medicaid Services), our state surveyors will have to survey on those standards.”
Topics
COVID boosters Dr. Lisa Piercey Dr. Jon McCullersJane Roberts
Jane Roberts has reported in Memphis for more than 20 years. As a senior member of The Daily Memphian staff, she was assigned to the medical beat during the COVID-19 pandemic. She also has done in-depth work on other medical issues facing our community, including shortages of specialists in local hospitals. She covered K-12 education here for years and later the region’s transportation sector, including Memphis International Airport and FedEx Corp.
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