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Colorado ready to offer COVID boosters in nursing homes starting next week — if feds sign off

Residents of Colorado nursing homes could start getting COVID-19 booster shots as early as next week if federal health officials give the green light, state officials announced Monday.

The Biden administration has pushed for third shots for all vaccine-eligible people starting next Monday, but the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention still need to review the evidence.

The wait for federal approval drew sharp words Monday from Gov. Jared Polis, who said during a news conference that two employees who recently left the FDA have “blood on their hands” for delaying third shots.

He also faulted federal health officials for their pace in authorizing vaccinations for children ages 6 to 11 and for not recommending boosters for people who received the single-shot Johnson & Johnson vaccine.

“At the very least, the FDA should get out of the way and allow people to make the choice to protect themselves,” Polis said.

But Dr. Dhruv Khullar, an assistant professor of health policy and economics at Weill Cornell Medical College in New York, said in a webinar for journalists last week that none of the current studies make an air-tight case for booster shots. It’s understandable that some leaders want to get ahead of any potential problems from waning immunity, he said, but what’s most important is getting the initial doses to as many people as possible.

“There’s no slam-dunk case that most of the population needs a booster at this time,” he said.

The current vaccines still offer strong protection against hospitalization and death, though their effectiveness against mild or moderate infections has fallen somewhat as the virus’s delta variant swept the country. Unvaccinated people in Colorado have almost four times vaccinated people’s risk of hospitalization and more than five times their risk of death.

More than 67% of eligible Coloradans are fully vaccinated. The rate is significantly higher for older people, with 83% of those over 65 at least two weeks out from their final dose.

New COVID-19 cases may have dropped last week for the first time since mid-June, though it’s difficult to be certain, because reports have lagged more lately. The Colorado Department of Public Health and Environment recorded 11,132 new cases in the week ending Sunday.

The virus is still widespread, however, and only two counties have fewer 50 cases per 100,000 people: Sedgwick and San Juan. That’s the threshold at which the CDC recommends that everyone wear masks in public indoor spaces.

Hospitalizations continued to rise, with 914 people receiving care for confirmed COVID-19 and 89 others listed as possible cases. The last time that combined hospitalizations exceeded 1,000 was Jan. 4.

If cases start a sustained decline, hospitalizations should follow in the near future, said Talia Quandelacy, an assistant professor of epidemiology at the Colorado School of Public Health. But it’s too early to be sure if the recent decline was a fluke, or if increased mixing over Labor Day weekend could push cases higher, she said.

“There does seem to be a decline in cases, at least for now,” she said. “We’ll have to see in a few days.”

If the FDA and CDC determine boosters are necessary, nursing home residents would be the first to receive them. Right now, the Colorado National Guard, homes and medical providers are working together to schedule booster clinics, said Lt. Col. Jamie Pieper, a senior adviser for COVID-19 vaccination. The plan is to finish offering those clinics before Oct. 18, she said.

The Pfizer vaccine is first in line for booster authorization. Nearly all Colorado nursing home residents received the Pfizer shot, so they can get boosters while the Moderna and Johnson & Johnson applications are still under consideration, Pieper said.

Colorado’s health provider network is able to administer more than 645,000 doses each week, which is more than enough to cover the expected demand for booster shots, as well as first and second shots for unvaccinated people, said Scott Bookman, the state’s COVID-19 incident commander. Every county now has at least one vaccine provider, whether that’s a hospital, retail pharmacy or outpatient clinic, he said.

“We hope we have that level of demand in Colorado,” he said.

The state’s plan projects that demand for boosters will grow over the next month as more people are at least six months out from their second shot. It also assumes that about 159,000 unvaccinated people will want to get shots each of the next four weeks, which is likely optimistic — it’s roughly double the number of doses given in the last week of August.

Polis estimated about 72,000 people, or 2.4% of Colorado adults, already have gotten booster shots. The CDC currently recommends them only for people who have a condition that impairs their immune system’s ability to respond to the first two doses.

It’s possible that some people will have difficulty finding a booster in the first weeks they’re offered more likely, but not to the extent they did this spring, Polis said. Shots will be available in medical facilities, retail pharmacies and possibly “small to mid-scale” drive-through sites in more populated areas, he said.

Studies are still ongoing to determine if people who received the Johnson & Johnson shot would benefit from a second dose. The FDA had asked Pfizer and Moderna to expand the number of children in their trials, to ensure they’d detect rarer side effects. Some expect it to consider authorizing the shots for kids in October.

Just hours before Colorado announced its plan to administer COVID-19 booster shots, a paper in The Lancet argued that booster shots aren’t necessary for most people, and the doses would be better used to offer first and second shots in countries where few people are protected.

The Lancet paper, which was published by 18 scientists, including the two former FDA employees the governor called out, argued that while booster doses may be needed at some point, the initial shots still offer strong protection against severe disease in people who are younger than 75 and don’t have compromised immune systems. Even the safest vaccines carry a small risk of side effects, so it’s important to be sure a third dose offers a meaningful benefit before offering it to the public, they said. While a study from Israel showed some benefit from a booster, it only followed recipients for about a week, making it difficult to tell if the third dose offered improved protection over time.

Polis countered that even if most people still have strong protection against severe disease, the state has an interest in preventing people from developing milder cases and passing the virus to others.