Please note, this blog was written in late August 2021. As this pandemic is advancing quickly, be sure to check the CDC website for the latest COVID-19 information.

Everyone was in great hopes that by this time, we would have COVID-19 in our past. We were optimistic that our lives would have returned to somewhat normal. But these wishes have not become a reality. We are still in extreme caution, especially for those who are immunocompromised from neurological disease and the secondary conditions that accompany it.

There are some things about viruses in general that we know. First is that they reproduce themselves using a host, in this case, the human body. Viruses cannot reproduce on their own. They enter the cells of living beings such as people, take over the cells and use the human’s cellular structure to reproduce. Second, the goal of the virus is to reproduce. Viruses do not have the ability to think about how or what it needs to reproduce, it just replicates as much and as fast as it can for survival. Third, to ensure a virus’s survival, it mutates to sustain itself. A few mutations do not survive, so they are not an issue. However, other mutations become even more powerful, ensuring the success of the virus.

Viruses cannot be eliminated with antibiotic medications but need immunization to control and eliminate them from entering the human body's cells. There is much false information about drugs that can increase resistance to viruses which may or may not work out as treatments in the future. Currently, monoclonal antibodies have demonstrated assistance in treating individuals with COVID-19, but this is human antibody treatment as opposed to an irradicating medication (a fine line, yet there is a distinction).

Most individuals who have been vaccinated for COVID-19 have effective immunity to it. Should their bodies become infected with this virus, the chance of fighting it is excellent without hospitalization or becoming too extremely ill. Individuals who have the vaccination have not typically needed to be hospitalized. There are some cases of individuals who are vaccinated that have become extremely ill. The number of cases is slowly growing most likely due to the mutation of the virus or variants and the individual’s underlying health condition.

New variants of the COVID-19 virus have been developing. This is what viruses do for survival. There are many subtypes of COVID-19. The original virus subtype has changed as the virus has had the time and opportunity to recreate itself or mutate. You will notice a subtle change in virus news communication. The virus used to be shown with red spikes. Now, the spikes are blue. This is because a variant is more prominent than the original virus. The change in color is a subliminal notice of the change.

Subtypes that are significantly different from earlier editions are named by Greek letters. The delta variant is raging across the world as well as in the United States. It is different from the original COVID-19 virus in that it is stronger and able to multiply much faster. Individuals who are immunized currently have resistance to the delta variant. There are many other variants as well that are covered by the current immunization. Lambda is a newer variant that is not seen too much in the US now, but it is here. How potent Lambda will be is not yet clear.

You may be wondering if there is an immunization, why doesn’t it cover all COVIDs? The reason is that the original vaccines were developed to fight the genotype of COVID-19. Just as scientists have mapped the human genome (all the DNA that makes a human), they were able to use this same proven, existing technology to map the genes of COVID. Unfortunately, some of the upcoming variants are extremely different, which is where the question arises about coverage.

To keep COVID in check, its spread needs to be slowed. As long as individuals remain unvaccinated, COVID has the chance to spread and mutate, creating even more variants and more potency. Becoming vaccinated slows the spread because mutations will not have hosts or humans to use to multiply itself.

People often wonder if the vaccine is safe. The mRNA vaccines are developed using technology that has been in existence and tested for over 25 years. In this case, a protein blocks the COVID virus from entering your body. The virus passes through your body but cannot enter your cells to replicate itself, making it less able to harm you. The Johnson and Johnson vaccine uses traditional viral technology, building your immune system to combat the virus. All are effective in protecting from the COVID virus. It is important that you discuss which is the best vaccine for you with your healthcare professional. Millions of individuals in the United States and billions around the world have successfully received the vaccines.

There are a few groups of individuals who may not have had a good immune response to the COVID vaccine. These include those individuals who have had solid organ transplants and those who are considered at the same level of immunocompromise from other issues. This group was selected as the medication they take for their condition is thought to affect the effectiveness of the vaccines. The third dose of mRNA vaccine can be administered. You do need proof that you meet these guidelines for those that are included in this group. You will need to obtain permission from your healthcare professional. This is the guideline from the CDC website.

On August 12, 2021, FDA modified the Emergency Use Authorizations (EUAs) for Pfizer-BioNTechexternal icon COVID-19 vaccine and Modernaexternal icon COVID-19 vaccine to allow for administration of an additional dose (i.e., a third dose) of an mRNA COVID-19 vaccine after an initial 2-dose primary mRNA COVID-19 vaccine series for certain immunocompromised people (i.e., people who have undergone solid organ transplantation or have been diagnosed with conditions that are considered to have an equivalent level of immunocompromise). The age groups authorized to receive the additional dose are unchanged from those authorized to receive the primary vaccination series:

• Pfizer-BioNTech: aged ≥12 years
• Moderna: aged ≥18 years

On August 13, 2021, ACIP met and reviewed the data for the use of an additional dose of mRNA COVID-19 vaccine for immunocompromised people within the Evidence to Recommendation Framework. ACIP made an interim recommendation for the use of an additional dose of Pfizer-BioNTech COVID-19 vaccine (for persons aged ≥12 years) or Moderna COVID-19 vaccine (for persons aged ≥18 years) after an initial 2-dose primary mRNA COVID-19 vaccine series for moderately to severely immunocompromised people.

Healthcare professionals and public health officials should consider the following for the use of an additional mRNA COVID-19 vaccine dose after an initial 2-dose primary mRNA COVID-19 vaccine series for moderately to severely immunocompromised people:

• The currently FDA-authorized COVID-19 vaccines are not live vaccines and therefore can be safely administered to immunocompromised people.
• Studies indicate some immunocompromised people have a reduced immune response following a primary COVID-19 vaccine series compared to vaccine recipients who are not immunocompromised.
• Studies have further demonstrated that including an additional mRNA COVID-19 vaccine dose after an initial 2-dose primary mRNA COVID-19 vaccine series in some immunocompromised populations may enhance immune response.
• The clinical benefit of an additional mRNA vaccine dose after an initial 2-dose primary mRNA COVID-19 vaccine series for immunocompromised people is not precisely known. However, for people with moderate to severe immune-compromised due to a medical condition or receiving immunosuppressive medications or treatments, the potential to increase immune response coupled with an acceptable safety profile supports the recommendation for an additional mRNA vaccine dose after an initial 2-dose primary mRNA COVID-19 vaccine series.
• The additional dose should be administered at least 28 days after the completion of the initial mRNA COVID-19 vaccine series.

The clinical considerations for the use of an additional dose of an mRNA COVID-19 vaccine apply only to people who are moderately or severely immunocompromised.

More information for adults and children above age 12 is found on this FDA site.

Also, in the fall, perhaps as early as September, all individuals who have been vaccinated with the mRNA type of COVID vaccine will be eligible for a booster. This is due to the multiple variants. The thought is that your immunity can improve by 10-20% with the booster after eight months of receiving the initial vaccine doses. Data are being collected for those who received the Johnson and Johnson vaccine to establish when a booster will be provided/needed. The release about boosters can be found here.

Until a critical mass of individuals receives the COVID-19 immunizations, those who are immunocompromised from neurological disease, paralysis or have secondary complications which affect breathing (that is, everyone with paralysis from spinal cord injury or disease), diabetes, immobility, frequent infections, need to continue to be extremely cautious to protect ourselves from COVID.

Actions to protect yourself are to get the vaccine if you have not already done so. Be sure those around you also have the vaccine to reduce the risk of spreading the virus to you. Continue to wash your hands using soap and warm water for 20 seconds, clean your tires and rims, use hand sanitizer if not near a water source, change shoes before entering your home, maintain social distancing, and avoid crowds. Masks should be worn if you are over the age of two and have a hand function to remove the mask yourself. KN95 masks have been highly rated. Cloth masks might not be effective for some of the upcoming variants. This is yet to be determined. We do know that these techniques do work to keep our risks low.

Make good choices. Get a vaccine if you are able. Stay safe. People in your life need you. Nurse Linda

Pediatric Consideration:

Keeping children safe is a concern. At first, COVID did not appear as much in younger-aged individuals, but it was massive in effects when it did. When COVID-19 was first on the scene, children had significant responses, including multisystem organ failure. As more pediatric cases develop, the complications can be severe.

As children are out more and exposed to individuals who can be unknowingly transmitting COVID, strong vigilance needs to be maintained. Use the effective prevention measures above.

School has or will be starting soon. As a parent, you will need to make the best decisions for your child, infant through teens. Have a discussion with your child’s healthcare provider about their ability to stay safe in school. These are unchartered times. We must do all we can to protect our children. Nurse Linda

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.