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A committee of advisers to the Food and Drug Administration voted unanimously to recommend that the agency authorize COVID-19 vaccines from Moderna and Pfizer-BioNTech for children as young as 6 months.

The committee’s recommendations, in a pair of 21-0 votes, pave the way for the FDA to make COVID-19 vaccines available to immunize the last group of people to become eligible for them. The agency is expected to authorize the vaccines soon.

“I feel incredibly relieved,” said Jessica Herring, 33, of Upper Marlboro, Md., who has been waiting to vaccine her 2-year-old son, Glenn. “Young children can finally have some protection beyond isolation and the actions of other people. It allows myself and other parents like me to finally breath a huge sigh of relief.”

On Friday and Saturday, a committee of expert advisers to the Centers for Disease Control and Prevention is scheduled to meet and make recommendations about use of the vaccines. Then, Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, will weigh in with a statement on their use.

If, as expected, she endorses them, the way would then be clear for vaccination of the youngest children to begin as soon as Tuesday.

While the risk of death and serious COVID-19 illness is lower for young children than people in older age groups, several committee members and a top FDA official said that authorization of vaccines that could protect young people from the worst outcomes would be worthwhile.

In remarks as the beginning of the day’s deliberations, Dr. Peter Marks, the FDA’s top vaccine official said that as of May 28 there had been 442 deaths from COVID-19 reported for children under 4 years old. “We are dealing with an issue where I think we have to be careful we don’t become numb to pediatric deaths because of the overwhelming number of older deaths here,” he said. “Every life is important. And a vaccine-preventable death [is one] we would like to do something about.”

The expert committee found that the benefits of the Moderna COVID-19 vaccine given as two shots four weeks apart outweigh its risks for use in infants and children 6 months through 5 years of age.

The advisers also voted in favor of the Pfizer-BioNTech COVID-19 vaccine for infants and children 6 months through 4 years of age. That vaccine is given as three shots. The first two are given three weeks apart. The third dose is given eight weeks after the second shot.

Pfizer revised its vaccination protocol during its clinical trial to include a third dose after two doses didn’t prompt a strong immune response in children ages 2 to under 5-years-old.

Rob Stein contributed to this report.

Copyright 2022 NPR. To see more, visit https://www.npr.org.

Mohammad Palwala went on his first cruise last year. The cyber security engineer from Dallas sailed through Southeast Alaska aboard Royal Caribbean’s Ovation of the Seas.

“And I told my family, ‘It’s like, the best thing ever. You get a full-on vacation on the cruise,’” he said.

There was lots of entertainment on board and amazing experiences in Southeast Alaska communities. And, as far as COVID-19, it felt safe. Everyone had to test negative before boarding, just about everyone was vaccinated, and the ship was only at 30% capacity. That was in September.

Palwala wanted to share the experience with his extended family of 12. He booked another Alaska cruise on the same ship with almost the same itinerary. They sailed in May. This time, the ship was closer to full, with about 4,000 passengers. It wasn’t like before.

“Very understaffed,” he said. “We did not have shows on — we only had like, two shows on the whole of the cruise. Lack of entertainment, lack of entertainment for kids.”

There were long lines to disembark, facilities on board that were shuttered — even eating became disappointing. His whole family is vegetarian, and he was told the kitchen was too short staffed to cook up proper meals for them.

Day after day, “the SAME thing. I mean, yeah, not even a few things, the same things. So whatever we ate in lunch, we ate in dinner,” he said.

His family ate a lot of lentil soup with rice.

Immediately after the cruise, 10 out of 12 people in his party tested positive for COVID. They were far from alone.

Experienced cruisers say staff shortages mean they’re having less fun. But they were also surprised by how widely COVID-19 seemed to spread. They want the public to know that lots of passengers are getting infected, and that on board, they’re left in the dark as the risk level changes.

Palwala said there was a Facebook group with hundreds of passengers from that same sailing. At first, it was a fun space where people posted what to do in port and shared photos. After the cruise, it turned into an informal COVID tracking site with tips for dealing with Royal Caribbean customer service.

Lorna Bradley from Monterey, California, was on that same cruise, and in that same Facebook group.

“Somebody finally just posted a poll because so many people were reporting COVID,” Bradley said. “So, of the 400 passengers who happened to see the poll, 25% of those, 100 people, came in and said, ‘I’ve got COVID.’ … I would have had no idea if I weren’t in that Facebook group since I didn’t get sick. I would’ve had no idea there was that much COVID on board.”

She later learned through the group that she’d been in close contact with a cabin steward who had gotten COVID. She was never formally notified of it. Even general information about the ship’s COVID status was noticeably absent.

“And it would have been so easy for the captain’s morning announcements to just remind us, you know, ‘Oh, we have 20 passengers on board, you know, currently having COVID symptoms and you know, just a reminder, you might want to wear a mask,’” she said. “I mean, none of that happened at all, which I found surprising.”

Bradley is extra COVID-conscious because she has a medical condition that puts her at higher risk of complications. She also takes care of an elderly parent who’s at even higher risk.

“When there are COVID cases (on) board, on your floor, down the hall, with your cabin steward, passengers need to know so that they can make better choices for themselves,” she said.

Palwala said he wouldn’t have taken his family if he’d known more in advance.

“Definitely not, because of my wife mostly, because she is pregnant. … If I had known, I would have not gone,” he said.

Conditions vary from ship to ship, and from sailing to sailing.

For example, the Carnival Spirit made headlines for a badly managed outbreak when it was coming to Seattle to begin its season in Alaska this year.

Bruce Hogarth had booked the Spirit’s second Alaska sailing this season. He almost canceled his cruise when he heard about the outbreak. He had travel insurance, but it wouldn’t cover a cancellation for fear of COVID. He rolled the dice.

“And for the first four days, it was a wonderful time,” Hogarth said. “We enjoyed it. The service was good. The food was good. It was up to par in my mind. And then I came down with COVID, then three days later my wife came down with COVID.”

He thinks the cruise line could have done more to avoid people getting sick. His isolation went better than passengers’ on the earlier Spirit sailing.

“It was the opposite,” he said. “I had lost my appetite and I wasn’t eating a lot. They would check in and say, ‘Did you want to order anything? You haven’t ordered in awhile.’ So they were very gracious that way.”

Hogarth lives near Victoria, British Columbia, one of the stops on the cruise. He was able to arrange to disembark there and finish his isolation period at home, instead of at a hotel in Seattle. He said a Canadian government official who walked him through his isolation obligations told him 127 customers and 42 crew from the cruise were infected.

Passengers are relying on second hand information like this or Facebook polls because the cruise lines and public health authorities aren’t sharing the information they already have about COVID on cruise ships.

The Centers for Disease Control and Prevention did not respond to questions about its COVID-19 Program for Cruise Ships and data reporting.

The government of Canada addresses the risk with direct language on its cruise ship travel page: “The virus can spread easily between people in close quarters, such as on cruise ships. The chance of being infected with COVID-19 on cruise ships is very high, even if you’re fully vaccinated.”

You got sick with COVID back in January, so you figured you were done with the virus for a while. But then you began feeling a scratchy throat and a runny nose, took a home test just in case — and that second line blazed red once again.

You might well be wondering: How this can happen? Is it possible to get COVID again just a few months or even weeks after recovering from a case?

We asked four specialists to answer frequently asked questions about reinfection.

I thought I was immune – at least for a while — after having COVID. Is that not the case?

If you caught a previous variant — before the arrival of omicron — that meant you had an 84% lower risk of infection, significantly lowering your risk of getting COVID again, especially in the months right after you were sick.

But the omicron variants changed that.

A study published in March found the risk of reinfection “increased substantially” with the emergence of omicron in November, says Juliet Pulliam, lead author of the study and director of the South African Centre for Epidemiological Modelling and Analysis.

There are several omicron variants now circulating around the world, and they are very transmissible and very good at overcoming immunity, whether it’s from vaccination, prior infection or both.

These omicron variants don’t just evade protection you might have gained from a non-omicron version of SARS-CoV-2; you can catch the newer variants of omicron even if you had the original omicron variant before.

And any protection from infection wanes over time, so if it’s been a few months since your last COVID shot or since you recovered from a case, you’re more likely to be susceptible to reinfection.

But there’s some slightly good news: For now, the newest omicron variants don’t seem better at overcoming immunity than the original omicron.

The most recent resurgence in South Africa is now being driven by omicron sub-lineages BA.4 and BA.5. With these variants, “the risk of reinfection seems to be about the same as it was for BA.1 — so higher than for previous [non-omicron] variants but not any higher than the initially circulating omicron sub-lineage,” Pulliam tells NPR in an email.

How soon could I get reinfected?

That’s something experts are still trying to figure out. But 60% of reinfections from non-omicron variants between March 2020 and March 2021 in Denmark occurred less than two months after the first infection, researchers found in a preprint study, which has not been peer-reviewed or published.

That means you may have a shorter time of maximum protection than you thought after an infection.

Keep in mind: The Danish researchers only looked at 15 confirmed reinfections among 593 suspected cases. The number is low for a few reasons: for one thing, reinfections weren’t as common then.

Because the newer variants are much better at overcoming prior immunity, our specialists say that if you recovered from a case of COVID fairly recently and then begin showing COVID-like symptoms, you should get tested to see if you have it again.

Is a reinfection more likely to be mild or could it be severe?

Research from South Africa suggests that prior infection does protect against severe outcomes, including hospitalization and death.

With reinfection, hospitalization and death “does seem to happen occasionally but both natural infection and vaccination seem to provide good protection against severe outcomes in most individuals,” Pulliam says.

Another study from Qatar found that previous infection was about 87% protective against severe or fatal COVID-19.

But keep in mind that certain conditions — such as having had an organ transplant, ongoing cancer treatments or heart or lung disease — make you more vulnerable to bad outcomes, even if you’ve encountered the virus before through vaccination or infection.

“In immunocompromised patients,” the intensity of illness “depends on the patient and it depends on how impaired their immune system is,” says Jacob Lemieux, an infectious disease doctor at Massachusetts General Hospital. “We can’t precisely say what the effect would be.”

But the intensity of your illness also depends on how long it’s been since your last vaccination or previous bout with COVID, since such protection wanes over time — so staying current on your vaccine schedule is a good idea.

I took Paxlovid, and a few days later I tested positive again. Is this a reinfection?

According to Robert Wachter, a professor and chair of the department of medicine at University of California, San Francisco, this is probably not an example of reinfection but something different, known as “rebound,” when some patients begin experiencing symptoms and test positive again 2 to 8 days after taking the medication.

That’s what happened to Wachter’s wife. After taking Paxlovid, her symptoms improved markedly and she started testing negative on rapid tests. But four days later, she developed new symptoms – for the first round, she had a sore throat, fatigue, and a headache, and when it came back, it felt like a really bad cold with congestion – and she tested positive again.

The potential for rebound made him rethink the use of Paxlovid among younger people who aren’t as at risk of severe outcomes, he says. But if he were to get sick, because of his own potential risk factors, he’d still take Paxlovid.

That’s because in the clinical trials, Paxlovid lowered the rate of hospitalization by 89% among high-risk people, so those who have factors putting them at risk, like being immunosuppressed or over the age of 65, see a major benefit from taking the antiviral. That protection is true for both vaccinated and unvaccinated people who are at high risk, according to a new study.

“That’s real,” Wachter says. “How meaningful that is for you really depends utterly on your rate of hospitalization and how much risk you have for a bad case that would make you very sick and potentially put you in the hospital or potentially kill you.”

Do vaccines help prevent reinfection?

Getting vaccinated can help prevent infection and reinfection, so it’s a good idea to get the shots even if you’ve had COVID before and thought you were protected.

“For those who are vaccinated and those who have been infected, they are much better protected,” says Peter Palese, a professor and chair of the department of microbiology at the Icahn School of Medicine at Mount Sinai.

Especially if you had a serious case before, getting up-to-date on your COVID shots now means you will likely have a less-severe case if you’re reinfected, Palese says.

“Vaccination vaccination vaccination. Because yes, it will not protect you against the emergence of mild disease, but they will protect you from having a ventilator, being the ICU” or dying, he says.

But the immunity offered by vaccines, especially against infection, begins to wane after a few months, so getting a booster (or a second booster if you’re eligible) is a very good idea.

If you were hospitalized before with COVID and then received two mRNA vaccines, that blend of protection was 35% effective in preventing subsequent hospitalizations during the first omicron wave. If you got a booster, that number rose to 68% effective against hospitalization.

And no vaccine is perfect, so continuing to take precautions – wearing a mask, getting tested if you have symptoms or are exposed to COVID, improving ventilation, and more – is still recommended, especially during surges like the one the U.S. is currently seeing.

Can getting COVID multiple times have long-term effects?

Long-term damage from repeat reinfections, like organ damage, is “the big question, and I haven’t seen any data yet that can address it,” Pulliam says.

And experts believe each COVID case could lead to long COVID, even if you were fine last time.

One in five adults experience continuing health issues after acute cases of COVID, including “persistent symptoms or organ dysfunction,” according to a study published by the U.S. Centers for Disease Control and Prevention.

“There does seem to be a risk of long COVID or symptoms after resolution of the acute infection in a subset of people, and we don’t really know how common that is yet or how long it lasts,” says Lemieux.

How am I supposed to cope with the emerging – and changing – information about reinfection risks?

“It’s a really frustrating situation, because I think everyone wants to be done with this virus, but we’re just not. And we live in an era where we just want complete information at our fingertips, but we don’t have it,” Lemieux says.

That means we need to stay alert to the ways each new variant is changing, and how we respond to it – especially in the age of reinfection.

The same precautions used to prevent infection – masks, distancing, vaccinations, and more – work just as well for avoiding reinfection.

Another other point to keep in mind is that reinfections aren’t that unusual for coronaviruses. “I don’t think it’s surprising the reinfection happens, because that’s a feature of coronavirus biology,” says Lemieux. “It’s actually surprising, if anything, that it didn’t happen more often with the initial variants.”

Melody Schreiber (@m_scribe) is a journalist and the editor of What We Didn’t Expect: Personal Stories About Premature Birth.

Copyright 2022 NPR. To see more, visit https://www.npr.org.

A new report from the federal Centers for Disease Control and Prevention provides the most comprehensive look so far at the disproportionate toll COVID-19 is taking on Alaska Native and American Indian people living in Alaska.

Overall, Alaska Native and American Indian people have made up just about a fifth of the state’s population but nearly a third of all deaths, the report found.

Between the start of the pandemic in March 2020 and last December, Indigenous Alaskans were hospitalized with the virus and died from it at rates three times that of white residents, according to the report released Thursday.

The report is based on data shared with the CDC by the Alaska Department of Health and Social Services between March 2020 and December 2021.

Many Indigenous Alaskans face multiple barriers to health equity and access, including historical trauma and structural racism and remote or rural living that makes it harder and more expensive to access care.

The findings from the latest report showed that the virus’s mortality rate was about three times as high for Alaska Native and American Indian people living in the state (297 deaths per 100,000) when compared to white Alaskans (104 per 100,000) once adjusted for age.

The adjusted hospitalization rate was similarly high: 742 hospitalizations per 100,000 Indigenous Alaskans compared with 273 hospitalizations per 100,000 white Alaskans — representing a nearly three-fold risk for Alaska Native people.

The findings echo previous Alaska studies — including those conducted by the state health department and tribal health organizations — which found clear, race-based disparities affecting who gets COVID-19, who is hospitalized for it and who dies.

Nationwide, COVID-19 has affected Black, Indigenous, Hispanic and other people of color the most, data has shown.

On its website, the CDC cites “long-standing systemic health and social inequities” as a major contributing factor to why people from racial and ethnic minority groups are at an increased risk overall of getting sick and dying from COVID-19.

Discrimination, lack of health care access and poverty are all “inequities in social determinants of health that put racial and ethnic minority groups at increased risk,” according to the CDC.

But despite these inequities, predominantly Alaska Native communities have long had some of the highest COVID-19 vaccination rates in Alaska and in the U.S., to the credit of tribal health organizations and health aides who have deep roots in the communities they serve.

The recent CDC report recommends that public health professionals “continue to work with tribal health organizations in Alaska to provide culturally competent and regionally required health interventions,” and that existing health care initiatives should “respect the knowledge and wisdom of these communities as experts on their own needs.”

This story was originally published by the Anchorage Daily News and is republished here with permission.

State health commissioner Adam Crum will rescind Alaska’s public health emergency order for COVID-19 on July 1.

During a press conference Monday, Crum said the department has been working to make sure any COVID-specific tools and systems Alaskans still need are now permanent or sustainable.

“What’s changing for the average Alaskan is nothing. Most folks actually probably don’t even understand that we still have this in place,” he said.

The state Legislature granted the public health commissioner the authority to declare an emergency order in 2021. Crum’s emergency order would have expired with any federal emergency order unless he rescinded it earlier. The federal public health emergency runs through July 15 but is anticipated to be extended through this fall.

July 1 is also the date federal reimbursement will change. FEMA previously reimbursed COVID spending at 100%; after July 1 it will fund 90% with a 10% state match.

The end of the order also means the end of extra SNAP benefits for the more than 56,000 households in the state that receive them. That extra benefit could be anywhere from $95 to more than a thousand depending on the size of the family. Those benefits will continue through August of this year.

Public health director Heidi Hedberg said public health will continue to offer COVID-19 services.

“We are going to continue to pick up the phone, we are going to continue to be there to answer questions, we’re going to continue to make sure that there is access to testing materials and vaccine and therapeutics,” Hedberg said.

The state’s health department will also monitor and track COVID-19 cases and report them on a weekly basis.

COVID-19 public health resources

• Find COVID-19 guidance for your community
• Find a COVID-19 vaccine near you
• COVID-19 treatment options in Alaska
• Alaska vaccine hotline: 907-646-3322

This story has been updated.

The White House laid out the federal government’s plans to make the first COVID-19 vaccines available for very young children.

COVID-19 vaccinations for kids younger than 5 could start right after the Juneteenth holiday.

In a White House briefing on Thursday, Dr. Ashish Jha, the White House’s COVID-19 response coordinator, said if the Food and Drug Administration authorizes vaccines for the youngest kids soon after a June 15 advisory meeting, shipments of the first 10 million doses could start arriving at doctors’ offices as soon as the following weekend.

Advisers to the Centers for Disease Control and Prevention would also have to weigh in. Ultimately, the CDC’s director, Dr. Rochelle Walensky, would have to give the go-ahead before vaccination could start.

“We expect that vaccination will begin in earnest as early as June 21 and really roll on throughout that week,” Jha said.

Jha said that every parent who wants to vaccinate their baby (6 months and older), toddler or other child younger than 5 could likely do so within weeks after the shots become available.

This timeline is consistent with past FDA and CDC decision-making on COVID-19 vaccines.

Copyright 2022 NPR. To see more, visit https://www.npr.org.