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Tupac murder suspect asks for release from jail to house arrest, claims past admissions of role in killing were ‘entertainment’ – ABC News

  1. Tupac murder suspect asks for release from jail to house arrest, claims past admissions of role in killing were ‘entertainment’ ABC News
  2. Lawyers for Keefe D ask Las Vegas judge to release him from jail, set lower bail KTNV 13 Action News Las Vegas
  3. Ex-gang leader seeking release from Las Vegas jail ahead of trial in 1996 killing of Tupac Shakur The Associated Press
  4. Tupac Murder Suspect Claims Past Statements About Murder Were ‘Entertainment’ in New Court Filing Rolling Stone
  5. Lawyers for man charged with Tupac Shakur murder requesting release, according to new documents KOMO News

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Felicity Huffman speaks on college admissions scandal – ABC News

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  3. Felicity Huffman Breaks Silence on College Admissions Scandal: ‘I Felt Like I Had to Give My Daughter a Future’ PEOPLE
  4. “Don’t bring us into this”: Black people react to Felicity Huffman mentioning people of color while recounting FBI raid story Sportskeeda
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Felicity Huffman Speaks on College Admissions Scandal, Recalls Daughters Woken Up “at Gunpoint”: “Nothing New to the Black and Brown Community” – Hollywood Reporter

  1. Felicity Huffman Speaks on College Admissions Scandal, Recalls Daughters Woken Up “at Gunpoint”: “Nothing New to the Black and Brown Community” Hollywood Reporter
  2. Felicity Huffman says she ‘had to break law’ in college admissions scandal to ‘give my daughter a future’ Fox News
  3. Exclusive: Felicity Huffman speaks for 1st time about college-admissions scandal ABC7
  4. Felicity Huffman Breaks Silence on College Admissions Scandal: ‘I Felt Like I Had to Give My Daughter a Future’ PEOPLE
  5. Felicity Huffman Says She ‘Had To Break The Law’ To Give Her Daughter ‘A Chance At A Future’ Pajiba Entertainment News
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Are you living in a Covid hotspot? CDC reveals counties with highest rates as virus hospital admissions rise f – Daily Mail

  1. Are you living in a Covid hotspot? CDC reveals counties with highest rates as virus hospital admissions rise f Daily Mail
  2. Why Florida is seeing the highest proportion of counties with ‘moderate’ COVID hospitalization rates Yahoo! Voices
  3. CDC Data: New Weekly COVID-19 Hospitalizations Climb 9% | Health News | U.S. News U.S. News & World Report
  4. COVID-19 continues to rise with fall respiratory season around the corner, North Texas hospitals report The Dallas Morning News
  5. New COVID data suggests San Antonio’s late-summer surge is changing course KENS5.com
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Supreme Court seems open to ending use of race in college admissions

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Conservative justices on Monday seemed open to ending decades of Supreme Court precedent allowing race-conscious admission decisions at colleges and universities, repeatedly expressing doubt that the institutions would ever concede an “endpoint” in their use of race to build diverse student bodies.

After nearly five hours of argument, the affirmative-action programs at Harvard and the University of North Carolina at Chapel Hill seemed seriously endangered. The question is how broad such a decision might be, and what it would mean for other elite colleges and flagship state universities that say relying on grades and test scores alone could result in a dramatic drop in Black and Hispanic students.

Overturning the court’s precedents that race can be one factor of many in making admission decisions would have “profound consequences” for “the nation that we are and the nation that we aspire to be,” Solicitor General Elizabeth B. Prelogar told the justices.

“The negative consequences would have reverberations throughout just about every important institution in America,” she said, listing the military, medical and scientific communities, and corporate America.

Chief Justice John Roberts and Associate Justice Samuel Alito on Oct. 31 challenged attorney Seth Waxman on Harvard’s admission policies. (Video: The Washington Post)

But the court’s conservatives took the cases to revisit decades of Supreme Court decisions that tolerated a limited use of racial classifications, and seemed unsatisfied with assertions from lawyers representing the schools that the end was near for the use of race-conscious policies. Under repeated questioning, those lawyers conceded they could not provide a date-specific answer to the question: “When will it end?”

Read live updates from Monday’s oral arguments on UNC, Harvard cases

Patrick Strawbridge, representing Students for Fair Admissions, said allowing the use of race in higher education was an outlier among the court’s decisions that should be rejected.

“Whatever factors the government may use in deciding which jurors to sit, who you may marry, or which primary schools our children can attend, skin color is not one of them,” he said.

It was the term’s most polarizing hearing so far, and the extensive debate represented an extraordinary time investment for the court where, typically, arguments span an hour. The courtroom was packed for the UNC case, which was heard first, and at least three of the justices’ spouses — Jane Roberts, Virginia “Ginni” Thomas and Patrick Jackson — were in attendance.

The court has narrowly upheld affirmative action in the past. But the court’s newfound conservative supermajority showed last term it is unafraid of upending precedent by overturning Roe v. Wade.

Justice Clarence Thomas, the court’s longest serving member and a regular critic of race-conscious policies, made clear early his rejection of the goal of racial diversity in student bodies, which is what previous courts have found a compelling interest.

“I’ve heard the word diversity quite a few times, and I don’t have a clue what it means,” Thomas said to North Carolina Solicitor General Ryan Y. Park.

When Park tried to explain the educational benefits of diversity, Thomas, who is the second Black justice to sit on the court, replied that he didn’t “put much stock in that because I’ve heard similar arguments in favor of segregation too.”

Chief Justice John G. Roberts Jr., who often tries to play a moderating role among conservatives seeking to move the law quickly, showed that the use of race might be an exception.

Roberts in the past has written the court’s conservative opinions in cases confining the Voting Rights Act and the use of race in making public school student assignments. In a forceful exchange with Harvard’s lawyer, he worried about a system in which a student would have better odds for admission “based solely on” skin color.

After repeated questions, lawyer Seth Waxman conceded that being African American or Hispanic — or in some cases Asian American — can tip the scales in favor of admission for highly qualified applicants.

“So we’re talking about race as a determining factor in admission to Harvard,” Roberts said, his voice rising.

It can be the determining factor, Waxman responded, “just as being an oboe player in a year in which the Harvard Radcliffe Orchestra needs an oboe player will be the tip.”

Roberts quickly shot back: “We did not fight a civil war about oboe players. We did fight a civil war to eliminate racial discrimination,” he said. “And that’s why it’s a matter of considerable concern. I think it’s important for you to establish whether or not granting a credit based solely on skin color is based on a stereotype when you say this brings diversity of viewpoint. It may not bring diversity of viewpoint in a particular case at all.”

Justice Samuel A. Alito Jr. and others saw college admissions as a zero-sum game: any advantage given to one student automatically meant a disadvantage to another.

If it’s “a 100-yard dash, let’s say he gets to start five yards closer to the finish line,” Alito said to lawyer David Hinojosa, representing students defending UNC’s policies.

But Justice Sonia Sotomayor fought the analogy. She said universities’ administrators are looking at whether a minority student came from a disadvantaged school, faced and overcame discrimination or came from a family without significant resources. “What the schools are doing is looking at all the factors to try to put the students at the start as equals,” she said.

Justice Ketanji Brown Jackson, the court’s first Black female justice, said she worried that if a “university can take into account and value all of the other background and personal characteristics of other applicants, but they can’t value race” it has the “potential of causing more of an equal protection problem than it’s actually solving.”

She offered the hypothetical of a student who could write an essay about why it is was important to be the fifth generation of his family to attend UNC and compared it to a Black student who would like to offer a different reason for attending: “my family has been in this area for generations, since before the Civil War, but they were slaves and never had a chance to attend this venerable institution.”

(Jackson recused herself from the Harvard case because she was a board member at her alma mater and one of her daughters currently attends the college.)

College students on why they’re for and against affirmative action

Several conservative justices repeatedly returned to the question of when — if ever — the consideration of race would no longer be necessary in college admissions. The justices pointed to the majority opinion in Grutter v. Bollinger from 2003 in which Justice Sandra Day O’Connor’s opinion said racial preferences were not likely to be needed in 25 years.

“What if it continues to be difficult in another 25 years” to create a diverse student body, Justice Amy Coney Barrett asked Park. “So what are you saying when you’re up here in 2040? Are you still defending it like this is just indefinite? It’s going to keep going on?”

In response, Park said the Grutter opinion requires “aggressive and enthusiastic adoption of race-neutral alternatives,” which university officials say have so far not been sufficient to achieve diversity on campus. “It’s a dial, not a switch. And the progress that we’ve made since Grutter has shown that at the University of North Carolina, we have dialed it down substantially.

Roberts was unconvinced. “I don’t see how you can say that the program will ever end,” he said.

At times, the justices seemed to be talking more to one another than questioning the lawyers. Justice Elena Kagan likely had her seatmate, Justice Brett M. Kavanaugh, in mind when she asked Cameron T. Norris, the lawyer representing the challengers to Harvard’s policy, whether a judge who wants a diverse set of clerks can have race in mind when making hiring decisions.

Kavanaugh has prided himself on such hiring, and his clerks say only three of the 20 he has hired at the Supreme Court are White men.

“The question is, when race-neutral means can’t get you there, don’t get you there, when you’ve tried and tried and they still won’t get you there, can you go race-conscious?” she asked.

“I don’t believe so, Justice Kagan,” Norris answered

As justices tackled broad questions in the UNC case, much of the Harvard case was more specific to allegations about discrimination against Asian Americans.

Alito brought up admissions data that the challengers alleged shows Asian Americans are unfairly penalized when Harvard rates them on personal character traits such as integrity, courage, kindness and empathy.

“Asian student applicants get the lowest personal scores of any other group,” Alito said. “What accounts for that?”

Waxman sought to play down any “slight numerical disparity” that the data showed and said the so-called personal ratings are not a major part of the process.

“It doesn’t make a statistical difference,” Waxman said.

“If it doesn’t matter, why do you do it?” Alito countered.

Waxman, Prelogar and Ryan all reminded the court that district judges had held extensive trials in both cases and had found no discrimination. But by the end of the tough questioning, Prelogar and Waxman urged the court just to send the cases back for more consideration rather than overturning precedent

Associate Justice Sonia Sotomayor argued on Oct. 31 that Reconstruction-era integration policies are relevant to current racial disparities in education. (Video: The Washington Post)

The justice also debated whether the equal protection clause of the 14th Amendment means the Constitution must be colorblind.

Challengers say that under the equal protection clause, government-run universities like UNC cannot use race as a factor in admissions decisions. Harvard is not subject to that constitutional clause, but must adhere to Title VI of the Civil Rights Act of 1964. That statute prohibits racial discrimination, exclusion or denial of benefits under “any program or activity receiving Federal financial assistance.”

Harvard, a private institution, is subject to Title VI because it receives millions of dollars in federal grants and enrolls students who pay in part with federal financial aid. UNC, a public university, is covered by both the Constitution and Title VI, which incorporates equal protection standards after Title VI.

The cases are Students for Fair Admissions v. University of North Carolina, and Students for Fair Admissions v. President and Fellows of Harvard College.

Amy B Wang, Susan Svrluga and Perry Stein contributed to this report.

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What’s at stake as the Supreme Court considers banning race in college admissions: ‘Basic fairness’

The Supreme Court is hearing oral arguments on Monday in two cases that could determine whether colleges can consider race in their college admissions process, a decision that could drastically affect how colleges admit students, and impact racial diversity far beyond higher education. 

The cases deal with the admissions policies of Harvard and the University of North Carolina at Chapel Hill. Students for Fair Admissions (SFFA) sued both schools, alleging their policies, which consider race as a factor in admissions, discriminate against Asian American applicants. 

SFFA first sued Harvard in 2014, and is now asking the Supreme Court to overturn its 2003 landmark decision Grutter v. Bollinger, which permitted race to be considered as one factor in college admissions because it believed student body diversity was “a compelling state interest.”

In writing the opinion in the Grutter case, Justice Sandra Day O’Connor wrote that “race-conscious admissions policies must be limited in time,” and added that “we expect that 25 years from now, the use of racial preferences will no longer be necessary.”

PREVIEW ANALYSIS: SUPREME COURT TO HEAR CHALLENGE TO CONSIDERATION OF RACE IN COLLEGE ADMISSIONS

The Supreme Court will hear two cases on affirmative action. 
(AP Photo/J. Scott Applewhite, File)

Now, 19 years later, the Supreme Court is revisiting whether racial preferences are, in fact, still necessary. 

“The Supreme Court is going to once and for all be answering the question of whether our nation’s college and universities can consider race in the admissions process,” Kimberly Herman, general counsel for the Southeastern Legal Foundation, told Fox News Digital. 

It is “one of the most consequential supreme court cases to ever be heard in higher education,” Danielle Holley, Dean of Howard University Law School told Fox News Digital. “For selective admission universities, it would mean that if the Supreme Court finds against Harvard or UNC, those universities could no longer consider race in any way in admissions.” 

That outcome would have significant effects on diversity on college campuses, Tiffany Atkins, a law professor at Elon Law School, told Fox News Digital. 

“From my perspective as a law professor and a lawyer, this is important because it affects the students that I teach, the conversations that we have, the richness of the conversation in the classroom,” Atkins said.  

The consequences of the Supreme Court ruling in favor of SFFA would be far reaching, Atkins added, potentially affecting the pipeline for professions like doctors and lawyers. 

Yvette Pappoe, an assistant law professor at the University of D.C., said eliminating race-conscious admissions would have “devastating consequences on people of color, minorities generally,” and strongly advocated for them to continue. 

“We absolutely still need race conscious admissions programs. The whole point of affirmative action was not to reward historically advantaged groups. The whole point was to remedy past discrimination, whether intentional or not, and that has not been remedied, whether we like to admit it or not,” Pappoe said. 

TEACHERS UNIONS, MAJOR CORPORATIONS ASK SUPREME COURT TO ALLOW AFFIRMATIVE ACTION IN COLLEGE ADMISSIONS

“Banning such programs will harm students, it will harm schools, it will harm society in interrelated ways. It will not only deepen the existing racial disparities in higher education and other social institutions, it will disadvantage specifically Black candidates and other students of color in the admissions process. And then finally, it will fuel racist stereotypes about people of color, including and specifically Black women,” Pappoe added. 

In the event that the Supreme Court did rule in favor of SFFA, Pappoe predicted it would not take long for diversity on college campuses to be affected. 

“In the blink of an eye, I can see that universities that have these policies that no longer want to have the policies will now have a reason to drop these policies. It could happen in this current cycle,” she said, predicting that it could take less than a year. 

Harvard banners hang outside Memorial Church on the Harvard University campus in Cambridge, Massachusetts, U.S., on Friday, Sept. 4, 2009. 
(Photo by Michael Fein/Bloomberg via Getty Images)

Because of this, Jonathan Feingold, an associate professor at Boston University School of Law, said it should be “concerning” that the Supreme Court may do away with affirmative action on college campuses.

“For anyone who’s committed to a racial diversity on campus, it certainly should be concerning to think of a future in which the Supreme Court prohibits any university from taking race into account,” he said. “I think anyone who’s interested in a racially diverse campus, among other elements of diversity, [it] warrants concern.” 

The Supreme Court is looking specifically at education in considering these cases, but their decision could have impacts for other industries as well. 

Feingold emphasized the importance of affirmative action in employment, saying it remains “a potent mechanism to make processes just more fair and neutral, such that the people who should have been there from the beginning are there now.” 

Atkins also warned that depending on what the court says in their ruling, there could be a “domino effect” in other areas. 

“Here, we are talking about just the context of education. However, if they’re holding that the consideration of race is a violation of the equal protection clause, then I think that we will see a domino effect in other cases that could be touched,” Atkins said. 

A TIMELINE OF SUPREME COURT CASES ON AFFIRMATIVE ACTION IN COLLEGE ADMISSIONS

But, this would not necessarily be a bad thing, Heritage Foundation senior legal fellow Hans von Spakovsky told Fox News Digital. “I hope anywhere where race is being used for purposes such as awarding scholarships, hiring, will realize that they cannot do it.”

“What the folks who support this are doing is setting up the same kind of racial spoils system that our civil rights laws were intended to stop, and the only thing they are changing is who benefits and who hurts,” von Spakovsky added.   

Harvard’s policies may even violate the Civil Rights Act, Angela Morabito, spokesperson for the Defense of Freedom Institute told Fox News Digital. 

“It is painfully obvious from what Harvard and other elite institutions are doing is they are discriminating in their admissions process based on race,” Morabito said. “And under Title VI of the Civil Rights Act of 1964, it is illegal for any institution receiving federal funding to do that. It’s just not right.” 

And while supporters of affirmative action warn of a decrease in diversity on campuses, Jeremy Rovinsky, a prosecutor and former dean of the National Paralegal College, predicted that doing away with race as a consideration in admissions policies could increase the number of Asian Americans in higher ed institutions. 

“I don’t know that anyone can really predict the future… but I think that, at least in the short run… if it goes in the direction of [SFFA], then we’re going to see more Asian representation at Harvard, and more Asian representation, therefore, stemming into the corporate world from Harvard and from the top schools.” 

Edward Blum, the President of Students for Fair Admissions said if the Supreme Court rules in favor of Students for Fair Admissions, it will “restore the color-blind legal covenant to American universities and colleges.” 

“If the Supreme Court rules that race is unconstitutional, then we will go back to what the principles of what our civil rights movement is all about,” he added. “And those principles are a student’s race and ethnicity shouldn’t be used to help him or harm him in gaining admissions to a college or university.”  

Virginia’s Lieutenant Governor Winsome Sears submitted an amicus brief to the Supreme Court in the case, calling the court’s previous decision in the Grutter case “dangerous,” and noting the 25-year expiration date. Sears told Fox News Digital that it was important to create a K-12 educational system that works for everyone, so race is not necessary. 

“Ultimately, history will prove us right, because we have tried race-based discrimination, and it doesn’t work,” she told Fox News Digital. “What this is about is educational opportunity. We have to ensure that all children have access to those opportunities, so they will be able, on their own, without race-based policies, to be afforded the ability to gain entry into these universities. That’s the issue, and the children don’t have it.” 

SUPREME COURT ADVANCING ‘WHITE SUPREMACY’ IF IT RULES AGAINST HARVARD AFFIRMATIVE ACITON POLICY: MSNBC GUEST

The Supreme Court in Washington.
(AP Photo/J. Scott Applewhite)

While the Supreme Court is not expected to announce a decision on the case until 2023, recent rulings have shown that the justices are not afraid of usurping set precedent, and even them taking the case illustrates a willingness to overturn the Grutter case. 

“I think the Supreme Court chose to hear it because the composition of the court is different,” Holley said. “That’s the only change. These plans are no different than other plans, the only difference is that the composition of the court has changed, that’s why many people believe the court is primed to strike down that long-term precedent.” 

The court choosing to take up the case led Herman to believe they may rule in favor of SFFA, overturning past precedent. “I would be hopeful that since they decided to take this case up, that they are ready to revisit their precedent from 2003 and that they’re ready to say once and for all that our Constitution does demand colorblindness and that the color of people’s skin should not be considered when being admitted to college,” she said. 

‘AMERICAN DREAM’ AT STAKE IN HARVARD RACE-BASED ADMISSIONS CASE AT SUPREME COURT, SAY ASIAN AMERICAN LAWMAKERS

David Bernstein, the Executive Director of the Liberty and Law Center at the Antonin Scalia Law School at George Mason University also said he predicted that the Court would find the Harvard and University of North Carolina admissions plans as unconstitutional. 

“I think there is any doubt about the willingness of the court to be more aggressive about this, it was dispelled by the abortion case,” he said. “When it comes to affirmative action, the elite will cry and scream and get very upset… but these sorts of policies have always been extremely unpopular in the American public, even in California.” 

Regardless of predictions, the long-term ramifications of the case will depend on how the court rules, Bernstein added.

“If they issue a really stringent opinion that completely bans the use of race in college admissions, and probably elsewhere, that could have really strong reverberations,” he told Fox News Digital. 

“If the Supreme Court issues a stringent ruling that bans the use of race entirely without any real outs, that could have a really significant effect on how race is used by the government. If, however, they continue the pattern they’ve had in the past where they say we disfavor using race by government, but here are some circumstances which they’ll use it, that loophole will be used by government entities to continue doing what they’re doing,” he added. 

Pappoe also emphasized that how broad the ramifications of the decision are will depend on how the court writes it. 

“If the court… says very specifically that admissions policies that consider race are unconstitutional, then that’s limited. But if the court comes out swinging and says policies that consider race in any capacity are unconstitutional, then of course, that leads to a much wider net,” she added. 

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In the end, it comes down to “basic fairness,” Rovinsky said. “What’s at stake is, in a sense, basic fairness, people being judged as they are, their achievements, not just the color of their skin, or their racial background.” 

Despite the speculation and predictions, Rovinsky noted “you never know how a court can decide, the best we can do is speculate.” 

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Supreme Court considers Harvard and University of North Carolina’s use of affirmative action in admissions. What you need to know



CNN
 — 

The conservative Supreme Court will meet Monday to consider whether colleges and universities can continue to take race into consideration as a factor in admissions, a case that could diminish the number of Black and Hispanic students in higher education.

Hanging in the balance is the future of admissions plans at hundreds of schools that have relied on court precedent for decades in order to achieve the educational benefits they say flow from student body diversity on campus.

Challengers in the case are targeting Harvard and the University of North Carolina arguing that their programs violate equal protection principles, dash the promise of a colorblind society, and discriminate against Asian Americans. They are urging the court to overturn precedent and they say that the schools should explore and further develop race-neutral alternatives to achieve diversity.

At least nine states have already chosen to end consideration of race in university admissions, including Arizona, California, Florida, Idaho, Michigan, Nebraska, Oklahoma and Washington, according to the National Conference of State Legislatures. Supreme Court precedent allows the consideration of race, but the court’s new composition of conservative justices did not hesitate last term to overturn decades old precedent in a case that curtailed a federal right to abortion.

A Washington Post poll found that 63% of US adults support the Supreme Court banning colleges and universities from considering a student’s race and ethnicity when making decisions about student admissions. At the same time, 64% also say that in general, programs designed to increase the racial diversity of students on college campuses are a good thing.

A conservative group, Students for Fair Admissions (SFFA) is behind both challenges.

Edward Blum, the President of SFFA, has hired a conservative boutique law firm, Consovoy McCarthy, to challenge the policies at the country’s oldest private university, Harvard and the country’s first public university, University of North Carolina. The firm is composed of several former clerks of Justice Clarence Thomas who has been a critic of affirmative action.

In 2003, Thomas wrote in one opinion: “The Constitution abhors classifications based on race, not only because those classifications can harm favored races or are based on illegitimate motives, but also because every time the government places citizens on racial registers and makes race relevant to the provision of burdens or benefits, it demeans us all.”

SSFA argues that the Harvard policy violates Title VI of the 1964 Civil Rights Act that prohibits schools receiving federal funds from discriminating based on race. He says that the UNC policy is subject to Title VI, as well as 14th Amendment’s guarantee of equal protection under the law, which covers state universities.

Lower US courts have ruled in favor of the schools finding that that the programs used race in a sufficiently limited way to fulfill a compelling interest in diversity.

The two disputes were initially consolidated, but after Justice Ketanji Brown Jackson announced she would recuse herself from the Harvard case because she had served on the school’s board of overseers, they were decoupled, so the nation’s first black female justice could weigh in on the issue in at least one case.

The University of North Carolina, established in 1789, was formally segregated for much of its history. The current challenge comes some 70 years after the first Black student was admitted.

After an eight-day trial in 2020, district Judge Loretta C. Biggs ruled in favor of the school making special mention of its history steeped in racism.

In a footnote, she noted the school’s “comparatively recent embrace of diversity,” citing Southern historian Dr. David Cecelski, who, she said provided the court with credible evidence that UNC has been a “strong and active promoter of white supremacy and racist exclusion for most of its history.” The judge noted that Cecelski put forth considerable findings that while the school has made “important strides to reform the institution’s racial outlook and policies” the efforts have fallen short of “repairing deep-seated strides to reform the institution’s racial outlook and policies.”

“The University continues to face challenges admitting and enrolling underrepresented minorities particularly African American males, Hispanics, and Native Americans,” Biggs said and noted that in 2013 enrollment of African American men in the first-year class fell below 100 students.

Siding with UNC, Biggs said “Ensuring that our public institutions of higher learning are open and available to all segments of our citizenry is not a gift to be sparingly given only to select populations, but rather is an institutional obligation to be broadly and equitably administered.” The Supreme Court stepped in to consider the case before it was heard by a federal appeals court.

The school’s admissions office consists of about 120 employees engaged in a process where in the typical cycle the school receives about 43,500 applications for a freshman class of 4,200. Generally, about half the applicants are North Carolina residents. The requirements for admissions include a common application, an essay, letters of recommendation and standardized test scores. Race is used as a “plus factor” as the school considers criteria that includes a high school’s program criteria, academic performance, testing and engagement in activities outside of the classroom as well as personal attributes such as curiosity, honesty, motivation, and impact on the community. In addition, the school considers race-neutral alternatives that would allow it to achieve diversity.

North Carolina Solicitor General Ryan Park, argued that diversity is a compelling interest at the school and that the admissions office uses a holistic approach that affords an individualized consideration of all aspects of an applicant’s background, never relying upon quotas when it considers race. He also said the school makes a good faith effort to consider race neutral alternatives.

“In UNC’s academic judgement, diversity is central to the education it aims to provide the next generation of leaders in business, science, medicine, government and beyond,” Park said in court papers.

He said that while an applicant’s race may occasionally tip the balance toward admission in an individual case “it almost always does not.” He said the school offers about $159 million in undergraduate scholarships, part of which go to students based on their family’s socio-economic standing. It also recruits from a pool of high achieving community college students.

Park also borrowed from the judicial philosophy favored by several of the current conservative justices who believe that the Constitution should be interpreted according to the original meaning of the founders. Park argued that the 14th Amendment was originally understood to allow “appropriately tailored race-conscious decision making”, an argument that Justice Jackson made in a different case earlier in the term concerning the historic Voting Rights Act. To make the connection, Park referred to historian Andrew Kull, who wrote that the framers considered and rejected proposals that would have made the Constitution explicitly colorblind.

And he cited Brown v. Board of Education, the seminal opinion holding that state laws requiring separate but equal schools violated the Constitution. He argued that UNC’s admissions policy furthers the school’s “unwavering commitment to providing equal educational opportunities to all qualified students, no matter their race.”

SSFA lawyer Patrick Strawbridge responded that the process is not holistic, and in fact the school conceals the improper use of race behind opaque procedures awarding “mammoth racial preferences” to African Americans and Hispanics. He said that the use of race so permeates the process that race becomes a predominant factor at “every stage.”

He told the justices that the lawsuit had revealed the schools “sporadic and unserious efforts” to examine the availability of face-neutral alternatives by providing data through simulations

“A white, out-of -state male who had only a 10% chance of admission would have a 98% chance if UNC treated him as an African American and a 69% chance if UNC treated him as a Hispanic,” he said.

Strawbridge argued that the Brown decision actually supports his position. “Separate but equal has no place in education,” he said but added that the court should overturn a 2003 case called Grutter v. Bollinger that upheld the affirmative action admissions policy at the University of Michigan Law School. “Because Brown is our law, Grutter cannot be,” he said.

Harvard’s program is like that of University of North Carolina, but the challenge at hand focuses particularly on the treatment of Asian American students and a charge that the school intentionally discriminates against them setting higher standards for their admission. While Harvard is a private university, it is still subject to Title VI because it receives public funds.

Its freshman class in 2019 had 1,600 students out of 35,000 applicants. Of the 35,000, 2,700 had perfect verbal SAT scores, 3,400 had perfect math SAT scores and more than 8,000 had perfect GPA’s. After a 15-day bench trial that featured 30 witnesses, the district court ruled in favor of Harvard, finding that the school did not discriminate against Asian Americans in violation of Title VI.

The 1st US Circuit Court of Appeals affirmed the district court, holding that it did “not clearly err in finding that Harvard did not intentionally discriminate against Asian Americans. “

The admissions process at the school takes into consideration several components including pre-application recruitment efforts, applications, a “first read” of application materials, and interviews. The reading procedures include guideline to assign numerical numbers to certain categories to detail the factors admissions officers should consider. Those factors include academic ratings, extracurricular ratings, athletic ratings, and personal ratings.

The personal ratings attempt to measure how an applicant impacts people around them and contributions they might make. Considerations include perceived leadership, maturity, self-confidence, likeability, courage and kindness. After SFFA brought the suit, Harvard modified its instructions to say that an applicant’s race or ethnicity should not be considered in assigning the personal ratings. Harvard has a list of so called “tip” factors including race that are used after the first read process.

Former US Solicitor General Seth Waxman, Harvard’s lead lawyer, pointed out in court papers that court precedent allows a “holistic” review of an application, and that it need not ignore race.

“Seeking the benefits of a diverse student body, universities may consider race as one among many factors,” he said.

“Our Constitution promises ‘equal protection of the laws,’ he said and added “it does not require us to disregard the commonsense reality that race is one among many things that shape life experiences in meaningful ways.”

He roundly rejected charges of any discrimination against Asian American students arguing that while the SFFA “invokes the bogeyman of discrimination” against Asian American applicants the lower courts had found “in no uncertain terms that Harvard does not discriminate.”

And he said that the lower courts had found that none of the asserted race-neutral alternatives put forward by Harvard would allow it to achieve its goals and that if it abandoned consideration of race as one among many factors, representation of African Americans and Hispanic students would decline.

Cameron Norris, the SSFA lawyer charged with arguing the Harvard case, charges the schools with ignoring precedent and the “mistreatment” of Asian American applicants.

“Its admissions process penalizes them for supposedly lacking as much leadership, confidence likability, or kindness as white applicants” he said.

He particularly attacked Harvard’s system based on so called “personal ratings.” By considering race alongside subjective criteria like “self-confidence, likability, and courage” universities invite admissions officers to rely on anti-Asian stereotypes, he said.

“No one is under the illusion that we live in a post-racial society, or that racial discrimination is a thing of the past,” Norris said in court papers. “But when elite universities place high-schoolers on racial registers and tell the world that their skin color affects what they think and know, the universities are hurting, not helping,” he said.

Solicitor General Elizabeth Prelogar supports both Harvard and the University of North Carolina, urging the justices to reject the invitation to ignore court precedent stemming from the Court’s 1978 decision in Regents of the University of California v Bakke where Justice Lewis F. Powell Jr. recognized that the nation’s future “depends upon leaders trained through wide exposure to the ideas and mores of students as diverse as this Nation of many peoples.”

She noted that court precedent has played a vital role in bringing diversity in higher education that has had rippling effect in the work force.

“The Nation’s military leaders, for example, have learned through hard experience that the effectiveness of our military depends on a diverse officer corps that is ready to lead an increasingly diverse fighting force,” she said in court briefs.

Judge Jackson in remarks: I am the dream of the slave

She said court precedent has proven “eminently workable, carefully limiting the consideration of race and requiring use of race-netural alternatives to the extent possible.”

And she, too cited, Brown.

“Nothing in Brown’s condemnation of laws segregating the races to perpetuate a caste system calls into question admissions policies adopted to promote greater integration and diversity,” she wrote.

A friend of the court brief filed on behalf of the NAACP Legal Defense Fund also questions the challengers’ suggestion that Brown mandates a result in SSFA’s favor.

“Petitioner would transform Brown from an indictment against racial apartheid into a tool that supports racial exclusion, prevents further advancement in the Nation’s progress towards racial integration, and deepens persistent inequalities in educational opportunities,” the brief said.

The Asian American Legal Defense and Education Fund is also supporting the school, rejecting the charge that race-conscious admissions policies discriminate against Asian Americans or perpetuate harmful stereotypes against them.

“The Asian American community is vast and varied, including first-generation college students and children whose parents’ professions secured their immigration; children of working-class refugees and multigenerational Americans; speakers of over 300 languages; aspiring entrepreneurs, artists, teachers, and more,” they argued. They say that Students for Fair Admission relies on “manipulated date” to attempt to demonstrate that Asian Americans with high test scores are admitted at lower rates than other racial groups.

Two groups, however, the Asian American Coalition for Education and the Asian American Legal Foundation, support SFFA with a particular emphasis on the “personal ratings” used by Harvard that the groups say assigns an “artificially low” rating to Asian American applicants during the admissions process to “counter their otherwise above-average metrics and ‘balance’ the racial makeup of its student body.”

“Through use of the personal rating, Harvard essentially imposes a racial hierarchy, where African Americans are the most desirable, followed by Hispanics, followed by whites, and with Asians at the very bottom as the least favored and the least likely to be admitted,” they said.

David E. Bernstein, a University Professor at George Mason University’s Antonin Scalia Law School also supports SFFA. He calls into question Harvard’s racial categories, deeming them “arbitrary and irrational.”

“Harvard cannot explain why roughly 60% of the world’s population should be grouped together as ‘Asian” despite vast differences in appearance, language, and culture,” he added.

CORRECTION: This story has been updated to specify that Jackson is the nation’s first female black justice.

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Stanford limited Jewish student admissions in 1950s, university admits

Stanford University apologized on Wednesday after an internal task force confirmed the school had limited the admission of Jewish students during the 1950s and then “regularly misled” those who inquired about it afterward.

The university’s president, Marc Tessier-Lavigne, called the restrictions “appalling anti-Semitic activity,” in a university-wide note, adding that “this ugly component of Stanford’s history, confirmed by this new report, is saddening and deeply troubling.”

The practices were first reported on a blog by historian Charles Petersen, who wrote last year in a post titled “How I Discovered Stanford’s Jewish Quota” that a memo in the school’s archives amounted to “a historical smoking gun.”

Petersen found a 1953 letter to J.E. Wallace Sterling, then the president of Stanford, from the assistant of the admissions director, Rixford Snyder, in which it was noted that the incoming freshman class would have a “high percentage of Jewish boys.” Snyder, the assistant wrote, “thought that you should know about this problem, since it has very touchy implications.”

The memo lamented that “the University of Virginia has become largely a Jewish institution, and that Cornell also has a very heavy Jewish enrollment.” It warned that if Stanford were to accept “a few” applicants from two heavily Jewish high schools in Los Angeles, “the following year we get a flood of Jewish applications.”

Such a dilemma, the memo said, forced them to “disregard our stated policy of paying no attention to the race or religion of applicants.”

The report by the task force — which was assembled nearly a year ago — found in its review of annual reports from the registrar’s office that from 1949 to 1952, Stanford enrolled 87 students from the two schools, Beverly Hills High School and Fairfax High School. From 1952 to 1955, however, only 14 students were enrolled from those schools. The report said that records “do not indicate any other public schools that experienced such a sharp drop in student enrollments over that same six-year period or any other six-year period during the 1950s and 1960s.”

Tessier-Lavigne, the current president, said the practices — as well as “the university’s denials of those actions in the period that followed” — were “wrong,” “damaging” and “unacknowledged for too long.”

Arguments in a case over modern-day quotas at an elite institution are set to be heard at the Supreme Court this month. A group of Asian Americans is suing Harvard — which also limited its admissions of Jewish students early in the 20th century — alleging that the university unfairly discriminated against them by capping admissions as a sort of “racial balancing” of its students. Harvard denies the allegations. The plaintiffs have cited Harvard’s past quotas on Jewish students as evidence in their case.

Before Asian Americans sued Harvard, the school once tried restricting the number of Jews

Petersen, the historian, had written that the only previous comment he could find from the admissions office on the topic was a statement in 1996 to the Stanford Daily, the school newspaper, in which an admissions official said such allegations were simply “rumors” and that “assertions of the existence of quotas are only based on the convictions of the few Jewish members of the Stanford community in the ’40s and ’50s.”

“Either the admissions office was lying,” Petersen wrote, “or else they didn’t look that hard.”

Rabbi Jessica Kirschner, executive director of Hillel at Stanford, said in an email that “for the people who knew there was something wrong despite official denials, hearing the symbolic head of the university speak the truth out loud and apologize is validating, and maybe even healing.”

She said the university’s response Wednesday was “an example of what productive institutional apologies look like,” noting how “a new generation of Stanford leadership took evidence seriously, commissioned a strong task force, and did not flinch when its findings did not reflect well on the institution.”

Sophia Danielpour and Ashlee Kupor, co-presidents of the Jewish Student Association at Stanford, said in an email that while they were “disappointed” about this aspect of the university’s history, they were “also appreciative that Stanford allowed a thorough discovery process and issued a real apology.”

They said they hope the findings spur “concrete changes,” including awareness of the Jewish high holidays in relation to the academic calendar and of a “blind spot” in the school’s diversity and inclusion efforts “that doesn’t always include religious minorities.”

In his note to the school, Tessier-Lavigne wrote that Stanford will implement a number of recommendations from the task force, including addressing the “deeply regrettable” scheduling of the start of Stanford’s fall quarter during Rosh Hashanah, the Jewish new year, which happened last month. Stanford will also create an ongoing Jewish advisory committee, he said.

Tessier-Lavigne added that “it would be natural to ask whether any of the historical anti-Jewish bias documented by the task force exists in our admissions process today. We are confident it does not.”

April Bethea contributed to this report.

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Hospital admissions surge as multiple respiratory viruses circulate among kids: ‘We’ve got a full house’ | Health care/Hospitals

Children’s hospitals in Louisiana are coping with a surge in admissions and ER visits due to a handful of respiratory viruses. While it’s not unusual to see viruses surge as the weather gets colder, it is rare to be dealing with so many at once, leading to hospitals that are brimming with sick kids.

“We’ve got a full house,” said Dr. Mark Kline, physician in chief at Children’s Hospital New Orleans. “We stay at capacity.”

Hospitals are seeing an unusual constellation of these viruses. Rhinovirus and enterovirus, which typically cause symptoms associated with the common cold, are responsible for most of the illness. The two viruses are indistinguishable from one another on the tests most hospitals use. Tests given at Children’s for these viruses are coming back positive 40% of the time – an “extraordinary figure,” said Kline.

In Baton Rouge, it’s even higher at about 50%, said Dr. Michael Bolton, a pediatric infectious disease specialist at Our Lady of the Lake. The Acadiana area has not yet seen the same upticks, but there’s a sense that it’s inevitable.







Families gather outside a Children’s Hospital vaccine bus in the parking lot of Rouses on Tchoupitoulas Street in New Orleans on Wednesday, August 31, 2022.




“I am expecting it soon, as kids are in school unmasked and those viruses are around,” said Scott Hamilton, medical director of Ochsner Lafayette General’s pediatric emergency room.

The Centers for Disease Control and Infection issued a health advisory earlier this month about the increase. Further testing showed that there has been an uptick of a particular strain of enterovirus called D-68 that causes polio-like paralysis. Most hospitals don’t have the testing for that strain, and Kline said Children’s in New Orleans has yet to see a case.

Influenza A is also showing up earlier and at higher numbers than typical, with about 19% of tests coming back positive at Children’s. Flu season typically doesn’t start gearing up until October. Adenovirus, another cold- or flu-like illness, is showing up in about one in ten kids at Children’s.

Respiratory syncytial virus, or RSV, is also plaguing children and worrying parents. While enterovirus and rhinovirus are the most diagnosed, kids with RSV are more likely to be admitted to the ICU, said Bolton. The number of tests coming back positive for RSV is about 1 in 5 at OLOL recently.

The only silver lining, physicians say, is that COVID cases remain low among kids right now, though it’s unclear if that will last throughout the winter. At Children’s, tests come back positive for COVID about 2% of the time. At the peak last summer, it was around 30%.

‘I don’t think we can get any more full’ 

The recent surge in illness is more than any previous COVID increase. In July 2021, children’s hospitals saw a swift spike in admissions due to COVID. They’re more full now than they were then. 

“Last summer when we got to an inpatient census of 160, we felt like we were full. The census this afternoon is at 182,” Kline said Thursday.

And it’s not just in Louisiana. Kline said children’s hospitals in Birmingham, Atlanta and Texas are full, too, according to colleagues there.

The sheer number of viruses pelting the pediatric systems at once comes at a time when hospitals are typically preparing staff to care for patients during the winter, their busiest season.

“Kids invariably are going to be exposed and get infected with some of these things over time,” said Kline. “When four or five are co-circulating, it’s a strain on the health system.”

Like many hospital employees experienced over the last few years, an influx of patients can lead to exhaustion among staff. Hospitals typically count on a slower summer to prepare and regroup for the respiratory virus season from October until spring.

“If you’re on the go the entire time, you’re on your feet, you’re at the patient’s bedside, you don’t get that respite of, ‘This what I did well today, this is what I can do better tomorrow,’” said Bolton. Instead, workers are just trying to get through the day, knowing they have to come back to the same busy day tomorrow.

It’s not clear what is causing the spike, but returning to pre-pandemic habits without masks as school starts up may be a factor. A lack of immunity from decreased exposure to viruses over the last few years may also be contributing. 

“There’s sort of a cohort of young children out there at this point who have not become infected with these viruses over last couple years,” said Kline. “Now that masks have been dispensed with, these viruses are finding a lot of susceptible hosts.”

Pediatricians recommend children stay up to date on their vaccinations, including COVID-19 and the flu shot. 



Read original article here

Durability of BNT162b2 vaccine against hospital and emergency department admissions due to the omicron and delta variants in a large health system in the USA: a test-negative case–control study

Introduction

The SARS-CoV-2 omicron (B.1.1.529) variant was originally identified in Botswana and South Africa in November, 2021. Compared to the original SARS-CoV-2 strain (Wuhan-Hu-1), omicron (including BA lineages of B.1.1.529) has more than 30 mutations in its spike (S) protein. Many of these mutations are in the receptor-binding domain and have been shown to correspond with a high degree of transmissibility and neutralising antibody escape.
1
  • Viana R
  • Moyo S
  • Amoako DG
  • et al.
Rapid epidemic expansion of the SARS-CoV-2 Omicron variant in southern Africa.

Subsequently, omicron was declared a variant of concern by WHO on Nov 26, 2021, and has since rapidly become the dominant SARS-CoV-2 variant globally.

2
WHO
COVID-19 weekly epidemiological update, edition 74. Published Jan 11, 2012.

Preliminary studies have shown that two doses of the BNT162b2 (Pfizer–BioNTech) mRNA vaccine do not sufficiently neutralise the omicron variant. Additionally, although levels of neutralisation against omicron after three doses of BNT162b2 are substantially higher than those seen after two doses, they are lower than those observed for the wild-type strain and for the delta (B.1.617.2) variant.
3
Pfizer
Pfizer and BioNTech provide update on omicron variant.

4
  • Cele S
  • Jackson L
  • Khoury DS
  • et al.
Omicron extensively but incompletely escapes Pfizer BNT162b2 neutralization.

5
  • Nemet I
  • Kliker L
  • Lustig Y
  • et al.
Third BNT162b2 vaccination neutralization of SARS-CoV-2 omicron infection.

6
  • Schmidt F
  • Muecksch F
  • Weisblum Y
  • et al.
Plasma neutralization of the SARS-CoV-2 omicron variant.

7
  • Muik A
  • Lui BG
  • Wallisch A-K
  • et al.
Neutralization of SARS-CoV-2 Omicron by BNT162b2 mRNA vaccine-elicited human sera.

However, early data suggest that T-cell responses induced by previous SARS-CoV-2 infection and by the BNT162b2 vaccine are not significantly altered against omicron.

8
  • De Marco L
  • D’Orso S
  • Pirronello M
  • et al.
Preserved T cell reactivity to the SARS-CoV-2 Omicron variant indicates continued protection in vaccinated individuals.

9
  • GeurtsvanKessel CH
  • Geers D
  • Schmitz KS
  • et al.
Divergent SARS-CoV-2 omicron-reactive T and B cell responses in COVID-19 vaccine recipients.

10
  • Liu J
  • Chandrashekar A
  • Sellers D
  • et al.
Vaccines elicit highly cross-reactive cellular immunity to the SARS-CoV-2 omicron variant.

11
  • Tarke A
  • Coelho CH
  • Zhang Z
  • et al.
SARS-CoV-2 vaccination induces immunological T cell memory able to cross-recognize variants from alpha to omicron.

12
  • Keeton R
  • Tincho MB
  • Ngomti A
  • et al.
T cell responses to SARS-CoV-2 spike cross-recognize Omicron.

Although these findings suggest that protection against severe SARS-CoV-2 infection with omicron is likely to be better preserved than that against less symptomatic infection in most individuals, the extent of the impact on vaccine effectiveness and potential waning is unclear.

Research in context

Evidence before this study

We searched PubMed, medRxiv, and press coverage up to March 1, 2022, using the terms “BNT162b2”, “vaccin*”, “COVID-19”, “effective*”, “impact”, “model”, “omicron”, and “delta” for preprint and published studies, without applying any language restrictions. Due to the timing of publications, most reports were unable to describe vaccine effectiveness or durability against SARS-CoV-2 infection with the omicron (B.1.1.529) variant. Available data as of March 1, 2022, suggest that two doses of an mRNA vaccine provide reduced protection against the omicron variant and symptomatic COVID-19 compared with the delta (B.1.617.2) variant, and moderate protection against severe SARS-CoV-2 infection. The effectiveness of a third dose against infection with the omicron variant or symptomatic COVID-19 has been estimated to be higher than that of two doses, but with waning observed in the first few months. Only a few reports have estimated the effectiveness of a third dose against hospital admission due to the omicron variant, with an even smaller number evaluating the durability of a booster dose against severe outcomes. Studies evaluating the longer-term effectiveness of two and three doses of BNT162b2 against the omicron variant, especially for severe outcomes, are urgently needed.

Added value of this study

In this case–control study covering a large, diverse population in the USA, we show that in the first 3 months after receipt of a third dose, the BNT162b2 vaccine provided 85% protection against hospital admission due to the omicron variant but less protection thereafter. Three doses of BNT162b2 were also effective at preventing emergency department admissions due to the omicron variant (albeit slightly less effective than preventing hospital admissions); however, the protection afforded by three doses also waned over time for this milder form of SARS-CoV-2 infection. These are some of the earliest data showing the effectiveness of three doses of BNT162b2 against SARS-CoV-2 infection due to the omicron variant, while also highlighting that this protection is likely to wane after 3 months, even for hospital admissions.

Implications of all the available evidence

In the future, additional doses of current, adapted, or novel COVID-19 vaccines might be needed to maintain high protection against severe SARS-CoV-2 infection and maintain sufficient vaccine-induced pressure on future SARS-CoV-2 outbreaks.

Estimates of the real-world effectiveness of BNT162b2 (and other COVID-19 vaccines) against infection caused by the omicron variant are limited to data from South Africa
13
  • Collie S
  • Champion J
  • Moultrie H
  • Bekker L-G
  • Gray G
Effectiveness of BNT162b2 vaccine against omicron variant in South Africa.

and the US Centers for Disease Control and Prevention (CDC),

14
  • Thompson MG
  • Natarajan K
  • Irving SA
  • et al.
Effectiveness of a third dose of mRNA vaccines against COVID-19-associated emergency department and urgent care encounters and hospitalizations among adults during periods of delta and omicron variant predominance – VISION Network, 10 States, August 2021-January 2022.

15
  • Ferdinands JM
  • Rao S
  • Dixon BE
  • et al.
Waning 2-dose and 3-dose effectiveness of mRNA vaccines against COVID-19–associated emergency department and urgent care encounters and hospitalizations among adults during periods of delta and omicron variant predominance — VISION Network, 10 States, August 2021–January 2022.

16
  • Danza P
  • Koo TH
  • Haddix M
  • et al.
SARS-CoV-2 infection and hospitalization among adults aged ≥18 years, by vaccination status, before and during SARS-CoV-2 B.1.1.529 (omicron) variant predominance — Los Angeles County, California, November 7, 2021–January 8, 2022.

and preprint reports from the UK,

17
UK Health Security Agency
SARS-CoV-2 variants of concern and variants under investigation in England. Technical Briefing 34: update on hospitalisation and vaccine effectiveness for Omicron VOC-21NOV-01 (B.1.1.529).

the USA,

18
  • Tseng HF
  • Ackerson BK
  • Luo Y
  • et al.
Effectiveness of mRNA-1273 against SARS-CoV-2 omicron and delta variants.

Canada,

19
  • Buchan SA
  • Chung H
  • Brown KA
  • et al.
Effectiveness of COVID-19 vaccines against Omicron or Delta infection.

Qatar,

20
  • Chemaitelly H
  • Ayoub HH
  • AlMukdad S
  • et al.
Duration of protection of BNT162b2 and mRNA-1273 COVID-19 vaccines against symptomatic SARS-CoV-2 Omicron infection in Qatar.

and Denmark.

21
  • Hansen CH
  • Schelde AB
  • Moustsen-Helm IR
  • et al.
Vaccine effectiveness against SARS-CoV-2 infection with the Omicron or Delta variants following a two-dose or booster BNT162b2 or mRNA-1273 vaccination series: a Danish cohort study.

Generally speaking, these data suggest that two doses of the mRNA vaccine are likely to provide only limited and short-lived protection against infection caused by the omicron variant and symptomatic COVID-19,

14
  • Thompson MG
  • Natarajan K
  • Irving SA
  • et al.
Effectiveness of a third dose of mRNA vaccines against COVID-19-associated emergency department and urgent care encounters and hospitalizations among adults during periods of delta and omicron variant predominance – VISION Network, 10 States, August 2021-January 2022.

16
  • Danza P
  • Koo TH
  • Haddix M
  • et al.
SARS-CoV-2 infection and hospitalization among adults aged ≥18 years, by vaccination status, before and during SARS-CoV-2 B.1.1.529 (omicron) variant predominance — Los Angeles County, California, November 7, 2021–January 8, 2022.

17
UK Health Security Agency
SARS-CoV-2 variants of concern and variants under investigation in England. Technical Briefing 34: update on hospitalisation and vaccine effectiveness for Omicron VOC-21NOV-01 (B.1.1.529).

18
  • Tseng HF
  • Ackerson BK
  • Luo Y
  • et al.
Effectiveness of mRNA-1273 against SARS-CoV-2 omicron and delta variants.

19
  • Buchan SA
  • Chung H
  • Brown KA
  • et al.
Effectiveness of COVID-19 vaccines against Omicron or Delta infection.

20
  • Chemaitelly H
  • Ayoub HH
  • AlMukdad S
  • et al.
Duration of protection of BNT162b2 and mRNA-1273 COVID-19 vaccines against symptomatic SARS-CoV-2 Omicron infection in Qatar.

21
  • Hansen CH
  • Schelde AB
  • Moustsen-Helm IR
  • et al.
Vaccine effectiveness against SARS-CoV-2 infection with the Omicron or Delta variants following a two-dose or booster BNT162b2 or mRNA-1273 vaccination series: a Danish cohort study.

22
  • Accorsi EK
  • Britton A
  • Fleming-Dutra KE
  • et al.
Association between 3 doses of mRNA COVID-19 vaccine and symptomatic infection caused by the SARS-CoV-2 omicron and delta variants.

23
  • Andrews N
  • Stowe J
  • Kirsebom F
  • et al.
Covid-19 vaccine effectiveness against the omicron (B.1.1.529) variant.

and two doses have reduced effectiveness against hospital admission due to omicron compared to that seen for previous SARS-CoV-2 variants.

13
  • Collie S
  • Champion J
  • Moultrie H
  • Bekker L-G
  • Gray G
Effectiveness of BNT162b2 vaccine against omicron variant in South Africa.

14
  • Thompson MG
  • Natarajan K
  • Irving SA
  • et al.
Effectiveness of a third dose of mRNA vaccines against COVID-19-associated emergency department and urgent care encounters and hospitalizations among adults during periods of delta and omicron variant predominance – VISION Network, 10 States, August 2021-January 2022.

17
UK Health Security Agency
SARS-CoV-2 variants of concern and variants under investigation in England. Technical Briefing 34: update on hospitalisation and vaccine effectiveness for Omicron VOC-21NOV-01 (B.1.1.529).

Additionally, preliminary data suggest that three doses of the mRNA vaccine provide increased but modest protection against SARS-CoV-2 infection

16
  • Danza P
  • Koo TH
  • Haddix M
  • et al.
SARS-CoV-2 infection and hospitalization among adults aged ≥18 years, by vaccination status, before and during SARS-CoV-2 B.1.1.529 (omicron) variant predominance — Los Angeles County, California, November 7, 2021–January 8, 2022.

20
  • Chemaitelly H
  • Ayoub HH
  • AlMukdad S
  • et al.
Duration of protection of BNT162b2 and mRNA-1273 COVID-19 vaccines against symptomatic SARS-CoV-2 Omicron infection in Qatar.

22
  • Accorsi EK
  • Britton A
  • Fleming-Dutra KE
  • et al.
Association between 3 doses of mRNA COVID-19 vaccine and symptomatic infection caused by the SARS-CoV-2 omicron and delta variants.

23
  • Andrews N
  • Stowe J
  • Kirsebom F
  • et al.
Covid-19 vaccine effectiveness against the omicron (B.1.1.529) variant.

that wanes quickly,

20
  • Chemaitelly H
  • Ayoub HH
  • AlMukdad S
  • et al.
Duration of protection of BNT162b2 and mRNA-1273 COVID-19 vaccines against symptomatic SARS-CoV-2 Omicron infection in Qatar.

as well as increased protection against hospital admission in the first few months.

16
  • Danza P
  • Koo TH
  • Haddix M
  • et al.
SARS-CoV-2 infection and hospitalization among adults aged ≥18 years, by vaccination status, before and during SARS-CoV-2 B.1.1.529 (omicron) variant predominance — Los Angeles County, California, November 7, 2021–January 8, 2022.

20
  • Chemaitelly H
  • Ayoub HH
  • AlMukdad S
  • et al.
Duration of protection of BNT162b2 and mRNA-1273 COVID-19 vaccines against symptomatic SARS-CoV-2 Omicron infection in Qatar.

The effectiveness of a third (booster) dose of an mRNA vaccine against infection with the omicron variant or symptomatic COVID-19 has been estimated to be higher than that achieved after two doses,
14
  • Thompson MG
  • Natarajan K
  • Irving SA
  • et al.
Effectiveness of a third dose of mRNA vaccines against COVID-19-associated emergency department and urgent care encounters and hospitalizations among adults during periods of delta and omicron variant predominance – VISION Network, 10 States, August 2021-January 2022.

17
UK Health Security Agency
SARS-CoV-2 variants of concern and variants under investigation in England. Technical Briefing 34: update on hospitalisation and vaccine effectiveness for Omicron VOC-21NOV-01 (B.1.1.529).

19
  • Buchan SA
  • Chung H
  • Brown KA
  • et al.
Effectiveness of COVID-19 vaccines against Omicron or Delta infection.

24
UK Health Security Agency
Effectiveness of 3 doses of COVID-19 vaccines against symptomatic COVID-19 and hospitalisation in adults aged 65 years and older.

but with waning observed in the first few months.

17
UK Health Security Agency
SARS-CoV-2 variants of concern and variants under investigation in England. Technical Briefing 34: update on hospitalisation and vaccine effectiveness for Omicron VOC-21NOV-01 (B.1.1.529).

24
UK Health Security Agency
Effectiveness of 3 doses of COVID-19 vaccines against symptomatic COVID-19 and hospitalisation in adults aged 65 years and older.

Only two published reports from the CDC

14
  • Thompson MG
  • Natarajan K
  • Irving SA
  • et al.
Effectiveness of a third dose of mRNA vaccines against COVID-19-associated emergency department and urgent care encounters and hospitalizations among adults during periods of delta and omicron variant predominance – VISION Network, 10 States, August 2021-January 2022.

15
  • Ferdinands JM
  • Rao S
  • Dixon BE
  • et al.
Waning 2-dose and 3-dose effectiveness of mRNA vaccines against COVID-19–associated emergency department and urgent care encounters and hospitalizations among adults during periods of delta and omicron variant predominance — VISION Network, 10 States, August 2021–January 2022.

and one non-peer-reviewed report

17
UK Health Security Agency
SARS-CoV-2 variants of concern and variants under investigation in England. Technical Briefing 34: update on hospitalisation and vaccine effectiveness for Omicron VOC-21NOV-01 (B.1.1.529).

have estimated the effectiveness of a third dose against hospital admission due to omicron. All studies reported vaccine effectiveness of roughly 90% soon after receipt of the third dose of an mRNA vaccine; however, none reported vaccine-specific estimates

14
  • Thompson MG
  • Natarajan K
  • Irving SA
  • et al.
Effectiveness of a third dose of mRNA vaccines against COVID-19-associated emergency department and urgent care encounters and hospitalizations among adults during periods of delta and omicron variant predominance – VISION Network, 10 States, August 2021-January 2022.

15
  • Ferdinands JM
  • Rao S
  • Dixon BE
  • et al.
Waning 2-dose and 3-dose effectiveness of mRNA vaccines against COVID-19–associated emergency department and urgent care encounters and hospitalizations among adults during periods of delta and omicron variant predominance — VISION Network, 10 States, August 2021–January 2022.

17
UK Health Security Agency
SARS-CoV-2 variants of concern and variants under investigation in England. Technical Briefing 34: update on hospitalisation and vaccine effectiveness for Omicron VOC-21NOV-01 (B.1.1.529).

and only one provided long-term follow-up after receipt of a booster dose.

15
  • Ferdinands JM
  • Rao S
  • Dixon BE
  • et al.
Waning 2-dose and 3-dose effectiveness of mRNA vaccines against COVID-19–associated emergency department and urgent care encounters and hospitalizations among adults during periods of delta and omicron variant predominance — VISION Network, 10 States, August 2021–January 2022.

Thus, studies evaluating the effectiveness of BNT162b2 against omicron in other robust health systems across the world, especially for severe outcomes and with sufficient follow-up, are urgently needed to inform public-health decision making about the need for (and timing of) additional boosters, improved COVID-19 vaccines tailored to target the omicron variant, or other effective COVID-19 vaccines. We aimed to evaluate the age-specific effectiveness and durability of two and three doses of BNT162b2 against hospital and emergency department admissions due to the omicron variant in a large integrated health system in the USA.

Methods

 Study design and participants

This test-negative case–control study included members of Kaiser Permanente Southern California (KPSC), a large integrated health-care system in California, USA. KPSC membership includes more than 4·7 million members who are representative of the socioeconomic, racial, and ethnic diversity of the population of southern California.
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Sociodemographic characteristics of members of a large, integrated health care system: comparison with US Census Bureau data.

KPSC electronic health records integrate clinical data across all settings of care, including care delivered to members outside of the KPSC system. The study protocol was reviewed and approved by the KPSC institutional review board, which waived requirement for informed consent (number 12816).

All KPSC patients aged 18 years and older who were admitted to hospital or an emergency department from Dec 1, 2021 (date of the first laboratory-confirmed SARS-CoV-2 infection due to the omicron variant at KPSC), to Feb 6, 2022, with a diagnosis of acute respiratory infection based on ICD-10 codes (appendix pp 1–3) and who underwent a PCR test for SARS-CoV-2 were eligible for inclusion in this study. For inclusion in this study, patients were required to have at least 1 year of health plan membership (allowing a 45-day gap during previous membership to allow for potential delays in renewal) to determine comorbidities and medical history.
Specimens were included in the analysis if they were tested with the ThermoFisher TaqPath COVID-19 Combo Kit (ThermoFisher; Waltham, MA, USA), which can distinguish specimens with S protein target failure among positive specimens. Mutations in the S protein of omicron specimens cause a failure in PCR probes targeting the S gene, while the Orf1ab and nucleocapsid (N) probes retain sensitivity. S gene target failure (SGTF) is rare for the delta variant.
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Early assessment of the clinical severity of the SARS-CoV-2 omicron variant in South Africa: a data linkage study.

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Track Omicron’s spread with molecular data.

An internal validation study of 1477 SARS-CoV-2 isolates that underwent whole genome sequencing resulted in confirmation of the omicron lineage in all SGTF samples (382 [100·0%] of 382) and the delta lineage was confirmed in 1092 (99·7%) of 1095 non-SGTF samples. Thus, samples with SGTF were characterised as omicron and those without as delta. We also included specimens not tested with the ThermoFisher TaqPath kit that were collected during periods when there was a 7-day rolling average with at least 95% predominance of a single variant lineage (ie, delta or omicron). Specifically, specimens collected from Dec 1, 2021, to Dec 9, 2021, were characterised as delta, and those from Dec 20, 2021, through to the end of the study period characterised as omicron (appendix pp 3–4). Specimens not tested on the ThermoFisher TaqPath COVID-19 Combo Kit or outside of our specified delta or omicron time periods were excluded from the analyses.

 Exposures

COVID-19 vaccines were provided at no cost to KPSC members following emergency use authorisation. Vaccinations administered outside of KPSC were captured via the California Immunization Registry, to which providers are required to report all COVID-19 vaccine administrations within 24 h.

Being immunised with three doses of BNT162b2 was defined as receiving a third dose of BNT162b2 at least 21 days after receiving two doses of BNT162b2, with at least 14 days elapsing after the third dose. Individuals who received a third dose less than 21 days after their second dose of BNT162b2, or had a hospital or emergency department admission up to and including 14 days since the third dose, or who received a third dose of a COVID-19 vaccine that was not BNT162b2 were excluded from the analysis. Immunisation with only two doses of BNT162b2 was defined as receiving two doses of BNT162b2, with at least 7 days elapsing after the second dose (and no third dose).
28
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Effectiveness of mRNA BNT162b2 COVID-19 vaccine up to 6 months in a large integrated health system in the USA: a retrospective cohort study.

29
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Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine.

Individuals with partial vaccination were excluded; partial vaccination was defined as receipt of only one dose of BNT162b2, receipt of a third dose less than 21 days after a second dose of BNT162b2, or having a hospital or emergency department admission up to and including 7 days since the second dose or 14 days since the third dose. Individuals were considered unvaccinated if they had never received BNT162b2 or any other COVID-19 vaccine.

 Outcomes

Cases of hospital admission or an emergency department admission without a subsequent hospital admission were defined as those with a diagnosis of acute respiratory infection and a KPSC laboratory-confirmed positive SARS-CoV-2 PCR test from a sample collected within 14 days before the initial admission date through to 3 days after the admission. Controls were defined as those with a KPSC laboratory-confirmed negative SARS-CoV-2 PCR test collected within 14 days before a hospital or emergency department admission for acute respiratory infection to 3 days after the admission, and no laboratory-confirmed positive SARS-CoV-2 PCR tests within 90 days before the initial admission. Patients could contribute more than one event to the study if a subsequent event for the same patient occurred more than 30 days after the previous event.

 Statistical analysis

We described the distribution of demographic and clinical characteristics of the study cohort by outcome status and COVID-19 vaccination status. Characteristics of cases and controls were compared by use of χ2 test for categorical variables and Fisher’s exact text for binary variables. Crude and adjusted vaccine effectiveness estimates following receipt of both two and three doses of BNT162b2 in the hospital and emergency department setting were constructed and compared with odds ratios (ORs) and 95% CIs from logistic regression models. Vaccine effectiveness was calculated as 1–OR multiplied by 100%, with corresponding 95% CIs calculated with the Wald method. Adjusted ORs and 95% CIs were estimated by adjusting for age (18–49, 50–64, and ≥65 years), sex (male and female), race or ethnicity (Hispanic, non-Hispanic White, non-Hispanic Black, non-Hispanic Asian or Pacific Islander, and other or unknown), body-mass index (<18·5 kg/m2, 18·5–24·9 kg/m2, 25·0–29·9 kg/m2, 30·0–34·9 kg/m2, >35·0 kg/m2, and unknown), Charlson Comorbidity Index (0, 1, 2, 3, and ≥4), receipt of influenza vaccine in the year before admission (ever vs never), receipt of pneumococcal vaccine in the 5 years before admission (ever vs never), and documentation of previous SARS-CoV-2 infection (ever vs never) in multivariable logistic regression models. Analyses were done separately for hospital and emergency department admissions. Analyses were further stratified by variant (delta vs omicron) and by age group (18–64 years vs ≥65 years). We also assessed vaccine effectiveness by time since vaccination (months since completion of a two-dose [only] or three-dose series).

All analyses were done with SAS Enterprise Guide statistical software (version 7.1). This study is registered with ClinicalTrials.gov (NCT04848584).

 Role of the funding source

This study was sponsored by Pfizer. The study design was developed by KPSC but approved by Pfizer. KPSC alone collected and analysed the data. KPSC and Pfizer participated in the interpretation of data and the writing of the report.

Results

Between Dec 1, 2021, and Feb 6, 2022, there were 16 063 hospital admissions and 19 699 emergency department admissions across the KPSC health-care system with a documented SARS-CoV-2 PCR test. 3716 (23%) of 16 063 hospital admissions and 9367 (48%) of 19 699 emergency department admissions were for acute respiratory infection (figure 1). Of these, the final study population consisted of 11 123 encounters where patients were either SARS-CoV-2 negative, tested via the ThermoFisher TaqPath COVID-19 Combo Kit (and thus SGTF could be determined), or were assigned a variant lineage based on the time when the infection occurred (ie, when ≥95% of all infections were due to the delta or omicron variant). Among the final study population, 7361 (66%) of 11 123 patients with hospital encounters had a positive SARS-CoV-2 test, with 4523 (61%) of 7361 identified as omicron, and 2838 (39%) of 7361 identified as delta. Overall, 5165 (46%) of 11 123 patients were unvaccinated, 3981 (36%) of 11 123 were vaccinated with two doses only, and 1977 (18%) of 11 123 were vaccinated with three doses. The median age of the study population was 51 years (IQR 35–69). Compared to those who tested positive for SARS-CoV-2, those who tested negative tended to be older and White and more likely to have comorbidities and evidence of previous SARS-CoV-2 infection (table 1). Compared to patients who received three doses, unvaccinated patients were younger, more likely to be Black or Hispanic, less likely to have comorbidities, and less likely to have previously received influenza or pneumococcal vaccination (table 2).

Figure 1Flowchart for study population

Table 1Characteristics of cases and test-negative controls among patients diagnosed with acute respiratory infection from Dec 1, 2021, to Feb 6, 2022

Table 2Characteristics by vaccination status among patients with a diagnosis of acute respiratory infection from Dec 1, 2021, to Feb 6, 2022

Among the study population, 3275 (29%) of 11 123 patients were admitted to the hospital and 7848 (71%) of 11 123 were admitted to the emergency department (without a subsequent hospital admission). Of those admitted to the hospital with a positive SARS-CoV-2 test, 647 (33%) of 1949 were infected with the delta variant and 1302 (67%) of 1949 were infected with the omicron variant (figure 1). Of those admitted to the emergency department only, 2191 (40%) of 5412 were infected with the delta variant and 3221 (60%) of 5412 were infected with the omicron variant.
In adjusted vaccine effectiveness analyses, three doses of BNT162b2 restored immunity against hospital admission and emergency department admission (without a subsequent hospital admission) due to the delta variant to the level seen 3 months after the second dose, which waned 6 months after receipt of only two doses (figure 2; appendix p 5). Vaccine effectiveness against hospital admission due to the delta variant after two doses remained relatively consistent, at 84% (95% CI 74–90) less than 6 months after two doses and 73% (63–80) at least 6 months after two doses. The effectiveness of three doses against hospital admission due to the delta variant appeared to fall from 89% (95% CI 83–93) less than 3 months after three doses to 71% (40–86) from 3 months onwards, although the confidence intervals overlapped and were wide around the latter estimate. Against emergency department admission due to the delta variant, the effectiveness of two doses of BNT162b2 declined from 78% (95% CI 69–85) less than 3 months after the second dose to 57% (45–66) from 9 months onwards. Vaccine effectiveness against emergency department admission due to the delta variant was 84% (95% CI 80–87) less than 3 months after the third dose. Overall vaccine effectiveness after a third dose was 87% (95% CI 81–92) against hospital admission due to the delta variant and 83% (79–86) against emergency department admission due to the delta variant (appendix p 5).

Figure 2Adjusted vaccine effectiveness of mRNA COVID-19 vaccine BNT162b2 (Pfizer–BioNTech) against hospital and emergency department admission among individuals diagnosed with acute respiratory infection by variant of concern, from Dec 1, 2021, to Feb 6, 2022

Show full caption

Estimates adjusted for age, sex, race or ethnicity, body-mass index, Charlson comorbidity index, previous SARS-CoV-2 infection, previous influenza vaccination, and previous pneumococcal vaccination.

Immunity conferred by two or three doses of BNT162b2 was lower for the omicron variant than for the delta variant (figure 2; appendix p 5). The effectiveness of two doses against hospital admission due to the omicron variant was 68% (95% CI 48–80) at less than 3 months following a second dose and 41% (21–55) at 9 months onwards. The effectiveness of three doses against hospital admission due to the omicron variant was 85% (95% CI 80–89) at less than 3 months following the third dose but fell to 55% (28–71) from 3 months onwards, although the confidence intervals were wide for this latter estimate. Protection against emergency department admission due to the omicron variant also appeared to wane after two doses, falling from 64% (95% CI 51–73) at less than 3 months after the second dose to 51% (43–59) at 6–9 months after the second dose and 31% (16–43) at 9 months onwards. The effectiveness of three doses against emergency department admission due to the omicron variant also waned, declining from 77% (95% CI 72–81) at less than 3 months following a third dose to 53% (36–66) at 3 months onwards (appendix p 5).
Overall, stratification of vaccine effectiveness by age group showed similar trends as with all ages, but revealed slightly higher vaccine effectiveness estimates among individuals aged 65 years and older versus those aged 18–64 years (appendix pp 6–8).

Discussion

In the first few months after receiving a booster dose of BNT162b2, it confers high protection (around 80–90%) against hospital and emergency department admission caused by the delta and omicron variants. Against the omicron variant, however, this protection is likely to wane significantly over time—even after a third dose. Specifically, in the present study, 3–5 months after receiving a booster dose of BNT162b2, effectiveness against hospital admission due to the omicron variant fell to 55% (95% CI 28–71), and effectiveness against emergency department admission due to the omicron variant (without subsequent hospital admission) fell to 53% (36–66), although confidence intervals were wide around the point estimate for hospital and emergency department admissions.

Our estimates of the effectiveness of three doses against hospital admission due to the omicron variant less than 3 months after the third dose (85% [95% CI 80–89]) were generally similar to those seen for hospital admission due to the delta variant (89% [83–93]) in the first 3 months following the third dose. Our vaccine effectiveness estimates against hospital admission due to the omicron variant less than 3 months after a third dose were also similar to those reported by the CDC (which reported effectiveness of around 90% for both mRNA vaccines)
14
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and the UK Heath Security Agency (which reported effectiveness of approximately 85–90% for all vaccines used in the UK combined).

17
UK Health Security Agency
SARS-CoV-2 variants of concern and variants under investigation in England. Technical Briefing 34: update on hospitalisation and vaccine effectiveness for Omicron VOC-21NOV-01 (B.1.1.529).

Our study, to the best of our knowledge, is one of the first to report long-term follow-up outcomes after receipt of a booster dose, stratified by age. Similar to a recent CDC report showing waning effectiveness of mRNA COVID-19 vaccines after a third dose,

15
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Waning 2-dose and 3-dose effectiveness of mRNA vaccines against COVID-19–associated emergency department and urgent care encounters and hospitalizations among adults during periods of delta and omicron variant predominance — VISION Network, 10 States, August 2021–January 2022.

we also detected early signs of waning against severe outcomes caused by the omicron variant from 3 months onwards after the receipt of a booster dose. More long-term follow-up data are needed, however, to fully understand the true magnitude of this decline.

Although waning was observed, effectiveness of two and three doses against hospital admission was generally higher than that seen for the less severe endpoint of emergency department admission across all timepoints. Previous reports have indicated that T-cell immunity might have a role in the prevention of severe SARS-CoV-2 infection,
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and laboratory results have suggested that T-cell epitopes have remained mostly unaltered for the omicron variant.

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Preserved T cell reactivity to the SARS-CoV-2 Omicron variant indicates continued protection in vaccinated individuals.

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Divergent SARS-CoV-2 omicron-reactive T and B cell responses in COVID-19 vaccine recipients.

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Vaccines elicit highly cross-reactive cellular immunity to the SARS-CoV-2 omicron variant.

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SARS-CoV-2 vaccination induces immunological T cell memory able to cross-recognize variants from alpha to omicron.

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T cell responses to SARS-CoV-2 spike cross-recognize Omicron.

The relationship between cell-mediated immunity and protection against severe infection, however, needs more research. It is also likely that trained innate immunity has an important role in durable protection, particularly against severe infection. Unrelated live attenuated vaccines and adjuvanted vaccines can provide sustained protection against heterologous infections and severe outcomes, including COVID-19, possibly through induction of trained innate immunity, which mRNA vaccines also induce.

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Our results showed waning effectiveness of two doses against emergency department admission for both the delta and omicron variants, consistent with previous evidence of waning effectiveness of BNT162b2 against the delta variant over time
28
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Effectiveness of mRNA BNT162b2 COVID-19 vaccine up to 6 months in a large integrated health system in the USA: a retrospective cohort study.

and with preliminary studies showing waning effectiveness against the omicron variant and symptomatic SARS-CoV-2 infection.

17
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SARS-CoV-2 variants of concern and variants under investigation in England. Technical Briefing 34: update on hospitalisation and vaccine effectiveness for Omicron VOC-21NOV-01 (B.1.1.529).

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Vaccine effectiveness against SARS-CoV-2 infection with the Omicron or Delta variants following a two-dose or booster BNT162b2 or mRNA-1273 vaccination series: a Danish cohort study.

After a third dose, effectiveness against emergency department admission increased to 84% (95% CI 80–87) for the delta variant and 77% (72–81) for the omicron variant. Waning of immunity against emergency department admission after three doses was moderate for the delta variant but was more pronounced for the omicron variant, falling to 53% (36–66) at 3 months or more after the third dose. This finding is consistent with early reports from the UK Health Security Agency suggesting that even after three doses, vaccine effectiveness against symptomatic SARS-CoV-2 infection due to the omicron variant wanes rapidly.

17
UK Health Security Agency
SARS-CoV-2 variants of concern and variants under investigation in England. Technical Briefing 34: update on hospitalisation and vaccine effectiveness for Omicron VOC-21NOV-01 (B.1.1.529).

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Age-stratified analyses showed that effectiveness was generally higher in adults aged 65 years and older. However, this finding might reflect enhanced risk-mitigating behaviours, especially among vaccinated people in this age group, or the potential dilution of vaccine effectiveness among adults younger than 65 years.

There are two important implications of our findings. First, booster doses significantly improve protection against the omicron variant. Our data suggest that, in the first few months after their receipt, booster doses of BNT162b2 provide high levels of protection (around 80–90%) against hospital and emergency department admission due to the omicron variant—a level of protection not seen with only two doses. Thus, although booster doses were initially introduced to counteract waning immunity against infection during a period when the delta variant was predominant,
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Effectiveness of mRNA BNT162b2 COVID-19 vaccine up to 6 months in a large integrated health system in the USA: a retrospective cohort study.

in the omicron era three doses appear to be necessary to achieve high levels of protection against severe COVID-19 outcomes. These findings are consistent with laboratory data reporting that neutralising antibody concentrations not only improved after a third dose (compared to after two doses) but also that the breadth of coverage against variants of concern seemed to increase.

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Second, although the initial effectiveness of a booster dose of BNT162b2 against the omicron variant was high, this protection waned after 3 months—even against a severe outcome such as hospital admission. Although more data are needed about the precise magnitude of this effect, this finding suggests that additional doses of current, adapted, or novel COVID-19 vaccines, which are currently in development, might be necessary in the future. Thus far, studies have shown that heterologous boosting with adenoviral vector vaccines does not improve the cellular response or the breadth of protection after priming with mRNA;
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however, continual evaluation of booster strategies will be needed in the future. Preliminary data from Israel have shown improved protection against SARS-CoV-2 infection with the omicron variant and severe COVID-19 in individuals who received a fourth dose of BNT162b2 compared to those who had received only three doses at least 4 months ago.

41
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However, data describing the durability of additional booster doses (beyond the third dose) are needed.

Our study is not without limitations. As this was an observational study, there might be residual confounding driven by differences in the likelihood of exposure to SARS-CoV-2 between vaccinated and unvaccinated individuals. Although we controlled for key sociodemographic and clinical characteristics, we were not able to capture data on occupation or behaviours, and sample size limitations precluded inclusion of all potentially confounding variables in adjusted analyses. Moreover, although vaccinated individuals might be more likely to seek care or testing for SARS-CoV-2 (thus biasing vaccine effectiveness results downwards), the test-negative design of the study, particularly in the hospital setting where there is universal testing, helps mitigate against this bias caused by differences in health-care-seeking behaviour—including the propensity to test.
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Furthermore, although we attempted to control for previous SARS-CoV-2 infection, we were not able to assess previous infections among those who do not seek testing at KPSC. If undocumented previous infection was more likely in unvaccinated individuals, for example, this could contribute to underestimation of vaccine effectiveness, which might be more likely in the omicron era. In addition to using a time window where the omicron variant accounted for at least 95% of all new incident cases, we identified omicron cases based on SARS-CoV-2 samples with SGTF on the Thermo Fisher TaqPath assay. This approach could have led to misclassification of some samples. Misclassification, however, occurred in less than 1% of samples tested on ThermoFisher in our small validation study that compared PCR results to those from whole-genome sequencing. It is possible that some emergency department or hospital admissions were “with COVID-19” rather than “for COVID-19.” This could lead to spurious findings of waning against severe outcomes if in fact vaccine breakthroughs were only incidental infections among patients admitted to hospital for something other than COVID-19. This could explain why we found higher effectiveness estimates in adults aged 65 years and older (who are likely to be admitted to hospital for and have more severe COVID-19) compared to those aged 18–64 years who might be more likely to have incidental positivity for the omicron variant. By restricting our analysis to patients with a diagnosis of an acute respiratory infection, we attempted to mitigate this potential bias. However, it remains possible (especially in the emergency department setting) that milder COVID-19 or incidental SARS-CoV-2 infection was included in our analysis, which is likely to bias vaccine effectiveness estimates downwards, especially for the omicron variant given its milder clinical presentation and higher levels of antibody escape. Moreover, it is possible that hospital admission practices changed during our study period. For example, if larger numbers of less severe patients were admitted during the omicron wave, as was reported by the CDC,

46
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Trends in disease severity and health care utilization during the early omicron variant period compared with previous SARS-CoV-2 high transmission periods – United States, December 2020-January 2022.

this could also bias vaccine effectiveness estimates for the omicron variant downwards. Finally, given the study period, effectiveness estimates 3 months or more after the booster dose are likely to represent findings for individuals who first received booster doses, and additional follow-up will be needed to understand the effectiveness of booster doses over time in the general population and at different stages of the pandemic. Due to limitations in sample size, we were unable to assess long-term durability of the third dose or to provide vaccine effectiveness estimates specific to age groups or high-risk groups. Furthermore, due to the rapid influx of at-home antigen tests and increasing variation in clinic-based testing practices, we were not able to assess vaccine effectiveness against symptomatic or asymptomatic SARS-CoV-2 infection not requiring hospital or emergency department admission.

In conclusion, BNT162b2 provided 85% protection against hospital admission due to the omicron variant in the first 3 months after receipt of a third dose but less protection thereafter. Three doses of BNT162b2 were also effective at preventing emergency department admission due to the omicron variant (albeit slightly less effective than at preventing hospital admission); however, protection also waned for this milder form of infection. These findings reiterate the need to continue the development of additional strategies to ensure long-term protection against severe SARS-CoV-2 infection caused by the omicron variant or future variants that stem from this variant of concern. In the future, additional doses of current, adapted, or novel COVID-19 vaccines might be needed to maintain high protection against severe infection and sufficient vaccine pressure on future waves of SARS-CoV-2 infection.

SYT, JMS, LJ, and JMM conceived this study. JMS, VH, and FX analysed the data, and SYT, VH, JMS, and FX had access to the raw data and verified the data. SYT, JMS, JMM, BKA, SRV, and LP wrote the first draft of the protocol. SYT and JMM wrote the first draft of the manuscript. All authors contributed to the study design, drafting the protocol, and edited the manuscript for important intellectual content. All authors gave final approval of the version to be published and had final responsibility for the decision to submit for publication.

Declaration of interests

SRV, LJ, LP, and JMM are employees of and hold stock or stock options, or both, in Pfizer. SYT, JMS, VH, FX, and BKA received research support from Pfizer during the conduct of this study that was paid directly to KPSC. BKA received research support for work unrelated to this study, provided by Pfizer, Moderna, Dynavax, Seqirus, GlaxoSmithKline, and Genentech. JMS received research support from ALK-Abelló, Dynavax, and Novavax for work unrelated to this study. SYT received research support from Genentech for work unrelated to this study.

Acknowledgments

We thank Timothy Frankland, Harpreet S Takhar, Oluwaseye A Ogun, Donald McCarthy, Errol Lopez, Joann M Zamparo, Kaije Pan, and Sharon Gray for assistance with management and data support on this study. We thank Michael Aragones, Soon Kyu Choi, Lee Childs, Julie Stern, Joy Gelfond, Kourtney Kottman, Ana Acevedo, Jonathan Arguello, Samantha Quinones, Samantha Baluyot, and Elmer Ayala for their technical and laboratory support processing SARS-CoV-2 specimens. We thank Deborah Malden for graphic assistance. We acknowledge Uğur Şahin and Özlem Türeci from BioNTech, the holder of the emergency use authorisation for BNT162b2 in Israel; BNT162b2 is produced with BioNTech proprietary mRNA technology and was developed by BioNTech and Pfizer.

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