Extra protection: Medical providers work fast to give a third dose of COVID-19 vaccine to vulnerable patients

Aug. 16, 2021
immunocompromised man and his sisters who are happy he will be able to get a third dose of the COVID-19 vaccine.
Dean Cavalier, with his two protective, younger sisters, Danni Brancio, left, and Amberly Cavalier, right. The sisters cared for Cavalier after a Hepatitis A infection destroyed his liver and he needed an emergency liver transplant. A third dose of a COVID-19 vaccine will give Cavalier and other immunosuppressed patients extra protection from COVID-19. Photo by Cyrus McCrimmon, for UCHealth.

Medical providers are working quickly to give third doses of COVID-19 vaccines to immunosuppressed patients now that federal health officials have authorized extra protection for people who have had difficulty producing antibodies to the coronavirus.

The third doses no longer are considered “booster” shots for this particular group of people. Instead, three COVID-19 vaccine doses now will be standard for about 3% of the U.S. population. The new, third doses apply to the following people:

  • Organ transplant recipients.
  • Cancer patients.
  • People who have received stem cell transplants in the previous two years or who are taking medicine to suppress their immune systems.
  • Patients with severe primary immunodeficiency such as DiGeorge syndrome or Wiskott-Aldrich syndrome.
  • People with advanced HIV infection.

Scheduling your third dose

Patients with a weakened immune system may now schedule an appointment for a third dose of either the Pfizer or Moderna vaccines through the UCHealth website. For more information, visit uchealth.org/covidvaccine or log in to My Health Connection and select schedule appointment.

UCHealth leaders are expanding vaccine clinics over the coming weeks to provide third doses to qualifying patients as soon as possible. (Learn more about how to get free COVID-19 vaccines, including third doses for immunocompromised people.)

“I fully support and applaud the decision,” said Dr. Thomas Campbell, who has overseen clinical trials for COVID-19 vaccines at UCHealth University of Colorado Hospital on the Anschutz Medical Campus. “We need to do what we can to protect our immunosuppressed patients.

“Right now, there are surges in cases across the United States, and we know that there are breakthrough cases, meaning people who have been fully vaccinated are getting COVID-19,” Campbell said. “We know that people who are immunosuppressed are disproportionately represented among those who are getting breakthrough cases.”

So far, doctors are not recommending third doses of COVID-19 vaccines for healthy people.

“We know that these vaccines are very safe and effective for healthy people. But, we don’t have a lot of data about third doses in otherwise healthy people,” Campbell said.

liver transplant patient, seeing here with his fishing tackle, will get a third dose of COVID-19 vaccine.
Dean Cavalier, 56, is a liver transplant recipient. He loves fishing and is now able to get back to his favorite activities after recovering from an emergency liver transplant that saved his life. Federal health officials now are recommending that people like Cavalier get a third dose of the COVID-19 vaccine. Photo by Cyrus McCrimmon, for UCHealth.

So, he is urging people without compromised immune systems to wait for new guidance.

Leaders at the Food and Drug Administration (FDA) authorized third doses for some immunocompromised people on Aug. 12, and a committee of experts at the Centers for Disease Control and Prevention (CDC) endorsed the decision on Aug. 13. (View the CDC’s newest information on vaccines for immunocompromised people.)

FDA and CDC experts plan to decide soon whether to authorize booster shots — or third shots about eight months after people received their first two doses of a COVID-19 vaccine — for healthy people if research shows that the effectiveness of the vaccines is waning over time.

Frontline health care workers and older adults could be first in line for those booster shots since many received their initial doses of COVID-19 vaccines back in December and January.

CDC experts outlined the following guidelines for the third dose of COVID-19 vaccines for immunocompromised people:

  • Get the third dose at least 28 days after receiving the second dose of the Pfizer or Moderna vaccine.
  • If possible, try to get a third dose of the same vaccine that you received for the first two doses. So, if you got Moderna for your first two doses, try to get Moderna for your third. The same is true for those who received Pfizer. But, if it’s not possible to get the same type of vaccine for a third dose, health experts said it’s OK to get a different type of vaccine.
  • No doctor’s order is needed for the extra dose.
  • In order to get the third dose, patients can “attest” that they have a qualifying condition.
  • The authorization of a third dose of COVID-19 vaccines for immunocompromised people does not apply to people who received the Johnson & Johnson (J&J) single-dose vaccine. Health authorities said they do not have enough data yet to determine whether immunocompromised people who received the J&J vaccine should get an additional vaccine dose.
  • While early research shows that a third dose of a COVID-19 vaccine may give immunocompromised people some additional protection, they still may be at greater risk of getting COVID-19. Therefore, immunocompromised people should continue to wear masks, avoid crowds, practice social distancing and avoid close contact with people who have not gotten their COVID-19 vaccines.

Among people who are eager to get a third dose is Dean Cavalier, 56.

He’s an organ transplant recipient who also works around people who have COVID-19 since he’s a clinical engineer who fixes medical equipment at University of Colorado Hospital.

56-year-old man sitting on a bench with his fishing tackle will be one of those who get a third dose of COVID-19 vaccine because he had a liver transplant..
Dean Cavalier, 56, had a liver transplant in 2019. Federal health officials now recommend a third dose of COVID-19 vaccines for people like Cavalier. Photo by Cyrus McCrimmon, for UCHealth.

Late in 2019, Cavalier was fixing some stretchers for the ER when one of his coworkers looked at him and said, “You’re turning yellow.”

Cavalier’s team brought him straight to the ER where he learned that he had a severe case of Hepatitis A that was destroying his liver.  He feels extraordinarily lucky that when his emergency hit, he was steps away from pros who could help him.

“The equipment I work on at the hospital is the equipment I needed,” Cavalier said.

Most people get Hepatitis A from contaminated food or exposure to the virus while traveling in areas with poor sanitation. There’s a vaccine that can prevent Hepatitis A, but Cavalier had never known about it.

He became so sick so fast that Cavalier’s doctors told him that he was dying.

“I had a week or less to live. That’s how quickly it progressed,” he said.

He needed a liver transplant fast.

“I was either going to get a gift of an organ or give my heart to someone else,” Cavalier said.

He received a donated liver just in time and went through transplant surgery on Dec. 7. Altogether, Cavalier spent three months in the hospital. He was discharged just as the pandemic was beginning to spread COVID-19 throughout Colorado and the world.

Cavalier is a divorced father of two and has two protective younger sisters who cared for him throughout his medical ordeal. His sisters — Danni Brancio and Amberly Cavalier — brought their big brother healing Saint Raphael medals and prayed with him around the clock in the hospital. Danni then brought Dean to her home where he spent months recovering and regaining his strength.

man, who will get the third dose of COVID-19 vaccine, with his two sister.
Dean Cavalier with his two protective younger sisters, Danni Brancio, right, and Amberly Cavalier, left, who cared for him throughout his medical ordeal, and who are happy for him to get a third dose of the COVID-19 vaccine. Photo by Cyrus McCrimmon, for UCHealth.

Because of the pandemic, Cavalier couldn’t go in for physical therapy right away, so he enlisted friends from the hospital to give him rehabilitation exercises. With plenty of help from his sisters, he fought to get well so he could get back to work as soon as possible.

He’s also enjoying hobbies again, like fishing and listening to live music with friends who play in bands.

Cavalier got his first two doses of COVID-19 vaccine as soon as he qualified. Now, he’s looking forward to getting a third dose since he had to take anti-rejection drugs after his transplant and thus, is among immunosuppressed people who are at high risk for getting a breakthrough case of the illness.

Cavalier has been working at University of Colorado Hospital for 21 years, so he’s well accustomed to working with people who are struggling with health challenges.

He repairs equipment throughout the hospital, even in units where COVID-19 patients are receiving care.

“I feel safe, but the third dose will give me, everybody else and my sisters peace of mind,” Cavalier said.

“We’re glad he’s getting more protection. He’ll give other people hope and hopefully he’ll be able to get out and travel,” said Cavalier’s youngest sister, Danni.

Along with fishing and enjoying live music, Cavalier loves going to Rockies Games. These days, 20 months after his transplant, he’s feeling much better.

Man, who will get a third dose of COVID-19 vaccine because he had a transplant, now enjoying fishing.
Dean Cavalier is back doing what he enjoys after his 2019 liver transplant, and now is happy to get a third dose of the COVID-19 vaccine to keep him even safer from the coronavirus. Photo by Cyrus McCrimmon, for UCHealth.

His transplant doctor, James “Jay” Burton, is thrilled that immunocompromised patients like Cavalier now will have access to additional doses of COVID-19 vaccines.

“Patients who have solid-organ transplants, such as liver, heart, kidney and lung transplants, have reduced responses to the vaccine,” said Burton, who is the Medical Director of Liver Transplantation at University of Colorado Hospital and also a professor of medicine and gastroenterology at the University of Colorado School of Medicine.

“While normal people have about a 95% chance of being protected from the original strain of COVID-19, people with suppressed immune systems might have only a 50/50 chance of being protected from COVID-19 infection,” Burton said.

Many transplant patients have been reaching out to learn how they can stay safe, Burton said.

“There’s been a lot of anxiety,” Burton said.

He’s thrilled people with compromised immune systems now will be able to get additional vaccine doses. Still, he urges them to continue to be cautious and vigilant.

“Make sure you’re practicing social distancing and continuing to wear masks,” Burton said. “The delta variant is widespread. If you’re a transplant patient, it could kill you.”

Severe cases of Hepatitis A, like the one that attacked Cavalier’s liver, are rare, Burton said.

“He just had some really bad luck,” Burton said.

Thankfully, the liver transplant saved Cavalier’s life. Now, Burton is hoping that a third dose of COVID-19 vaccine will give patients like Cavalier more reassurance that they can stay safe as the pandemic continues.

“He’s currently doing very, very well. His liver is working fine,” Burton said. “I love seeing him around the hospital. He’s a super-nice guy. Everyone knows him and loves him.”

About the author

Katie Kerwin McCrimmon is a proud Coloradan. She attended Colorado College thanks to a merit scholarship from the Boettcher Foundation and worked as a park ranger in Rocky Mountain National Park during summers in college.

Katie is a dedicated storyteller who loves getting to know UCHealth patients and providers and sharing their inspiring stories.

Katie spent years working as an award-winning journalist at the Rocky Mountain News and at an online health policy news site before joining UCHealth in 2017.

Katie and her husband, Cyrus — a Pulitzer Prize-winning photographer — have three adult children and love spending time in the Colorado mountains and traveling around the world.