Who gets vaccinated in intensive care due to COVID-19?

Half of the people who end up in intensive care units due to a severe form of COVID-19 are not vaccinated, Prime Minister François Legault said last week. The other half, on the other hand, is vaccinated, hence the skepticism of some regarding the efficacy of the vaccine, whose protective properties, however, are constantly praised.

When we take a closer look, it appears that these people, despite being adequately vaccinated, who get hit by COVID-19 and end up in intensive care, are all immunocompromised due to organ transplant, chemotherapy, hemodialysis, or autoimmune disease. that prevented them from developing good immune defenses after vaccination, argues Dr. Madeleine Durand, a specialist in internal medicine at the Center hospitalier de l’Université de Montréal (CHUM).

No one has yet been admitted to CHUM’s intensive care unit with proper vaccinations and a healthy immune system.

In recent days, in the intensive care units of the Montreal facility, 50% of the patients with COVID-19 who were there were actually vaccinated. Of these, about half had been transferred to this unit because their condition had seriously deteriorated due to COVID-19. The other half stayed there for another medical reason, but because they tested positive on hospital admission, these patients, who often have mild or even asymptomatic COVID-19, nevertheless appear in the statistics counting COVID-19 patients. 19 who are in an intensive care unit.

“So we cannot say that the vaccine has not worked for these types of patients, because they are not in intensive care for their COVID-19, but to treat something else like intracranial hemorrhage or septic shock after abdominal surgery.” for example,” says Dr. Madeleine Durand.

On the other hand, all vaccinated people who have been critically ill in intensive care due to COVID-19 to date had an underlying medical condition that prevented them from generating enough immune defense to ward off serious infection, even when they were adequately. vaccinated These are people whom Dr. Durand describes as “unvaccinable.”

Among these people who respond worse to the vaccine are immunosuppressed people, particularly those who have undergone an organ transplant and who, therefore, must take immunosuppressants so as not to reject the organ that has been transplanted; also, people on chemotherapy for cancer, people living with HIV, people with an autoimmune disease, such as lupus or rheumatoid arthritis, people on hemodialysis who are also less able to acquire good immunity from the vaccine; as well as very old people, whose immune systems are less efficient, Dr. Durand stresses.

decreased protection

Another factor that may explain the fact that some patients who received two doses of the vaccine ended up in an intensive care unit last December is the decline in vaccine immunity seen six months after the second dose in several countries, including Israel. “If these patients had received their third dose, they likely would not have developed severe COVID,” says Dr. Durand.

“We cannot say ‘always’ in medicine, but we can say that in 99% of cases, people who develop severe COVID-19 are not vaccinated or their vaccination has been ineffective due to too long a delay since their last dose, due to advanced age or immunosuppression due to an underlying medical condition, such as an organ transplant, chemotherapy, autoimmune disease, dialysis treatments, which greatly weakened your response to the vaccine. But that does not mean that it is not worth getting vaccinated”, summarizes Dr. Durand. She claims not to have seen any vaccinated person die of severe COVID-19 without one of these different reasons.

“There is no doubt that the vaccines work,” says the CHUM specialist, while pointing out that these patients who are adequately vaccinated (double or even triple), but vulnerable due to their pre-existing medical condition, “are very dependent on herd immunity. They are not sure if others are not vaccinated.”

“We vaccinate for ourselves, but also for others because there are some among the others who, even if they do their best to protect themselves, will not have access to a good efficacy of the vaccine because their bodies will hardly produce antibodies when they are vaccinated. . All of our organ transplant recipients, all individuals on hemodialysis, all of the very elderly depend on everyone else’s vaccination! “, she remembers.

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