“We reviewed the data, and found the vaccine to be safe in both children aged 5-11 and older vaccine recipients,” said Dr. Camille Nelson Kotton.

Doctors have cautious view of COVID because of lagging vaccinations



Doctors have cautious view of COVID because of lagging vaccinations

“We reviewed the data, and found the vaccine to be safe in both children aged 5-11 and older vaccine recipients,” said Dr. Camille Nelson Kotton.

BOSTON – Although Mass­achusetts has made significant progress in the pursuit of full vaccinations against COVID-19, Jewish infectious disease doctors in the Boston area urge the public to continue practicing caution.

“I think we’ve done a great job,” said Dr. Camille Kotton, the clinical director of transplant and immunocompromised host infectious diseases at Massachusetts General Hospital. “I think it’s really impressive. We still have a ways to go.”

“We really want all eligible adults to be vaccinated, as well as children ages 12 and up, for whom a vaccine is approved,” Kotton said.

As of June 26, 4,154,263 people had been fully vaccinated in Massachusetts: 3,880,655 using the Pfizer-BioNTech or Moderna vaccines, and 275,608 using the Johnson & Johnson vaccine, according to state data. The state population is just over 7 million.

Dr. Mark Poznansky, who heads the Vaccine and Immunotherapy Center at MGH, said “there are nuanced differences in safety and efficacy of each of the vaccines from the original Phase 3 trials that opened the way toward emergency-use authorization [by the Food and Drug Administration].” Yet, he added, “I think they are performing close to the way they have been determined to be performing previously. They’re safe and effective – particularly in reducing the frequency of serious disease and hospitalization.”

Surpassing the 4 million benchmark comes at a time when the state has lifted many COVID-19 restrictions since May 29. Yet challenges remain.

Poznansky, who is from the United Kingdom originally and has family there, said that nation is dealing with a “tough” situation with the recently emerging Delta variant. In a recent week, nearly 40,000 new UK cases of the variant were reported.

“It has been disheartening,” he said. “They hoped in the UK that the public health controls would be somewhat relaxed or reduced because of the vaccination rate.”

He said the variants in general are “already concerning because they vary in terms of how infectious they are and how much disease they cause.”

Experts have said about 10 percent of current COVID infections in the U.S. are the Delta variant, and it is likely to dominate by the fall among those who have yet to be vaccinated. The CDC recently classified it as a variant of concern.

In Massachusetts, said Dr. Daniel Kuritzkes, chief of the division of infectious diseases at Brigham and Women’s, “Particularly, as the economy opens up and people go back to work and tourism and business travel resume, there will likely be people from other parts of the country where vaccination is less prevalent … who may travel to the state, bring with them COVID-19, and are able to transmit it to people who are unvaccinated and may relax their own safeguards in terms of mask-wearing and the like.”

“I would not be surprised if, following the July Fourth weekend, there’s a bit of a bump in cases in Massachusetts,” Kuritzkes added. During the holiday weekend, he said, “I think there’s going to be a huge amount of travel within the state, into the state, some of which involves unvaccinated people providing opportunities for transmission.”

Overall, however, Kuritzkes said, ““I think within the state, we’re at a point where the virus is seen as on its way to becoming, if not extinct, well below what would be considered epidemic levels. The challenge, of course, is that we do still have pockets of people remaining unvaccinated.”

Doctors noted that there are individuals whose medical condition may prevent them from getting vaccinated or for whom vaccination may have limited effectiveness.

“It looks like immunocompromised [people] are less well protected, maybe less well protected against COVID-19 through vaccination,” Kotton said. “We recommend that immunocompromised people continue to be very cautious about possible exposure.”

She added, “The good news is that as the disease rate plummets, the risk is much less. We still recommend caution. Continue to wear masks, socially distance.”

Among families with children, she said, “hopefully the parents, grandparents, other family members can be vaccinated, are vaccinated, to help prevent transmission, address that risk for severe COVID.

“Otherwise,” Kotton said, “transmission between children is lower. There’s a much less risk for severe COVID.”

However, she cited a CDC study that showed that adolescents ages 12 to 17 had a hospitalization rate for the coronavirus that was about three times higher than for seasonal influenza.

“It kind of makes you think about it in a slightly different way,” she said.

In general, Kotton said, there are “a lot of concerns” about vaccinated people interacting with unvaccinated people.

“If you are going to be close to people who may have the virus, with less opportunity to make sure everyone around one is vaccinated, don’t take off your mask around unvaccinated people right now,” she said.

It’s a concern echoed by Kuritzkes.

“For the unvaccinated, my recommendation is, get vaccinated,” he said. “If you’re still unvaccinated, if you’re still hesitant about getting vaccinated, [follow] all of the same guidelines that were up before. You should wear a mask [when] out and about, particularly indoors with other people. You remain at risk for COVID-19.

“For vaccinated people,” he said, “as long as you’re not immunocompromised, or you were recently hospitalized for cancer, chemotherapy, organ transplant, or you’re not chronically immunosuppressed or on medication for certain medical complications, you can be very comfortable about being well protected from COVID-19.” However, he added, “In crowded situations that mix vaccinated and unvaccinated people, if you want to be more safe, you might consider still having a mask in a concert hall, indoor stadium, arena, something like that.”

Synagogues are on that list, too, as some have transitioned from virtual to in-person services. That’s the case for Temple Emanuel in Newton, where Kotton and Poznansky are both members. Poznansky attended a service on June 5.

“From my limited experience of guidelines in particular houses of worship, [reopening] is being done … in a very thoughtful, regulated way,” he said.

“The spigot, as it were, is being carefully turned on for in-person, vaccinated, without a mask [worship] … My experience is, it’s being done in a very thoughtful and data and science informed manner in houses of worship.”

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