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Priority for COVID-19 vaccines should be given to transplant recipients

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Since early 2019, COVID-19 has significantly impacted the world, changing the landscape of health care dramatically. Organ transplant recipients are dying from this virus at a disproportionately higher rate than the rest of the population. They need to be protected with vaccinations as soon as possible.

In the United States, the number of organ transplants has decreased during the pandemic because of limited knowledge about the immunosuppression management of COVID-19 among transplant recipients — despite the need for such life-saving procedures. This has resulted in a ballooning wait list for organ transplants and unnecessary deaths as patients await their turn. These candidates awaiting transplantation must be prioritized for Phase 1b vaccination.

As the winter season unfolds, we are witnessing a significant resurgence of the severe acute respiratory syndrome coronavirus, which causes COVID-19. As of Jan. 9, this virus has infected 22 million Americans, resulting in 369,000 deaths. In December alone, 6.2 million cases were diagnosed — in just 31 days. The new year began with death tolls reaching record highs, as Jan. 6 eclipsed previous numbers with 3,900 deaths in a single day. The virus is currently surging in 46 of 50 states, with January and February projected to be the darkest of days.

The Centers for Disease Control and Prevention reports that 30% of people hospitalized with COVID-19 need intensive care, and more than one in 10 hospitalizations end in death. Several studies have shown poor outcomes after COVID-19 in organ transplant recipients, with reported mortality to be as high as 40%. A study conducted by our group at the Hartford Healthcare Transplant Program showed organ transplant recipients with COVID-19 more likely to have a stroke and other life-threatening complications. An added threat is the U.K. variant, with its increased transmissibility impacting our communities, particularly the vulnerable high-risk populations, including transplant candidates and recipients. This is why it is important to act now for our transplant patients.

Based on the high rate of COVID-19-associated mortality in this specialized immunocompromised population, the U.S. Food and Drug Administration has unanimously approved the start of vaccinations in this high-risk population. On Dec. 8, the American Society of Transplantation Infectious Disease Community of Practice declared the vaccine safe for this part of our population. The Transplantation Society of America soon followed by publishing guidance for COVID-19 vaccinations in transplant candidates and recipients, recommending early vaccination for this group.

As a transplant infectious diseases physician, I ask for accelerated vaccination for this vulnerable population. Right now, this group of patients is disproportionately dying because of the COVID-19 disease. If vaccinations are delayed, more patients will die.

Vaccine priority is determined by the state and local health authorities. I firmly recommend that transplant candidates and recipients be included in the Phase 1b group for immediate protection.

Faiqa Cheema, M.D., is director of the Transplant Infectious Disease Program of Hartford Hospital. She is also an assistant professor at the University of Connecticut School Of Medicine. This piece was written for The Hartford Courant.

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