COVID-19: who are the vaccinated in intensive care?

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

When we take a closer look, it appears that these people, despite being adequately vaccinated, who are struck down by COVID-19 and who end up in intensive care are all immunocompromised due to an organ transplant, chemotherapy , hemodialysis or an autoimmune disease that prevented them from developing good immune defenses following the vaccination, supports the D^D Madeleine Durand, specialist in internal medicine at the University of Montreal Hospital Center (CHUM).

No one adequately vaccinated and with a healthy immune system has yet been admitted to a CHUM intensive care unit.

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

“So we can’t say that the vaccine hasn’t worked for these kinds of patients, because they’re not in intensive care for their COVID-19, but to treat something else like intracranial hemorrhage or septic shock at following abdominal surgery, for example”, specifies the D^D Madeline Durand.

On the other hand, all vaccinated people who have been in critical condition in intensive care because of COVID-19 to date had an underlying medical condition that made them unable to generate sufficient immune defense to protect themselves. of a serious infection, even when adequately vaccinated. These are people that the D^D Durand qualifies as “non-vaccinable”.

Among these people who respond less well to the vaccine are immunocompromised people, in particular those who have undergone an organ transplant and who, for this reason, must take immunosuppressants so as not to reject the organ which has been transplanted to them; also, people on chemotherapy due to 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 with the vaccine; just like the very old, whose immune system is less efficient, underlines the D^D Durand.

Decreasing protection

Another factor that may explain the fact that some patients who received two doses of vaccine ended up in an intensive care unit last December is the decrease in vaccine immunity observed six months after the second dose in various countries, including Israel. “If these patients had received their third dose, they probably would not have developed severe COVID,” says Dr.^D 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 the long delay since their last dose, due to their advanced age or immunosuppression due to an underlying medical condition, such as an organ transplant, chemotherapy, autoimmune disease, dialysis treatments, which greatly weakened their response to the vaccine. But that does not mean that it is not worth it for them to be vaccinated, ”summarizes the D^D Durand. She claims to have seen no vaccinated person die of severe COVID-19 without one of these different reasons.

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

“We get vaccinated for ourselves, but also for others because there are some among the others who, even if they do everything to protect themselves, will not have access to good vaccine efficacy because their bodies will hardly produce no antibodies when they get vaccinated. All of our organ transplant recipients, all of the individuals on hemodialysis, all of the very old depend on the vaccination of everyone else! “, she recalls.

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