A4 EZ RE THE WASHINGTON POST.MONDAY, APRIL 25 , 2022
BY LINDSEY BEVERA string of recent suicides
among sailors assigned to the
same U.S. aircraft carrier has
sparked concern, prompting
questions about mental health
issues in the military and poten-
tial barriers to seeking treatment.
Navy officials confirmed that at
least four sailors assigned to the
USS George Washington have
died by suicide in the past year —
three of them in the past month.
Retail Services Spec. 3rd Class
Mikail Sharp was found dead
April 9 at an off-base location in
Portsmouth, Va.; Interior Com-
munications Electrician 3rd
Class Natasha Huffman was
found dead April 10 in Hampton,
Va.; and on April 15, Master at
Arms Seaman Recruit Xavier
Hunter Mitchell-Sandor was
found unresponsive on board the
ship in Newport News, Va., and
later died, officials said.
The fourth sailor, who has not
been publicly identified, died by
suicide in 2021, and the cause of a
fifth death that occurred last year
is undetermined, according to
officials.
“Each death is tragic in its own
right,” Pentagon press secretary
John Kirby said during a news
conference this week. “Our
thoughts and prayers continue to
go out to the families and, frankly,
the shipmates because they’re af-
fected, too — they’re part of a
sailors’ family.”
Mental health experts say the
recent spate of suicides is con-
cerning and raises questions
about whether there are underly-
ing issues in the military’s culture
contributing to the problem —
and how to fix them.
Experts say suicide deaths
among service members have
been a persistent problem since
the wars in Afghanistan and Iraq
but have been steadily climbing
during the past several years. A
Department of Defense report
shows that there were 287 sui-
cides in 2017 among active duty
members in all branches of the
military, 326 in 2018, 349 in 2019
and 386 in 2020. The number of
suicides dropped in 2021 to 328,
according to the report.
The coronavirus created
unique stressors and, in fact, mili-
tary suicides spiked during the
pandemic, experts said.
Craig Bryan, a professor of
psychiatry and behavioral health
at Ohio State University, said sui-
cide clusters are often a coinci-
dence. But mental health experts
also see them when there is an
underlying factor affecting an en-
tire group, and “some people who
are perhaps more vulnerable kind
of exceed the thresholds for sui-
cide,” he said.
The third and least-common
scenario is when the suicides are
directly linked to one another,
Bryan said. Lt. Cmdr. Rob Myers,
a public affairs officer with Naval
Air Force Atlantic, said in a state-
ment that the investigation is
ongoing, but “there is no initial
indication to suggest there is a
correlation between these tragic
events.”
Sharp, Huffman, Mitchell-San-
dor and the two sailors who have
not been publicly identified were
assigned to the USS George Wash-
ington. The nuclear-powered,
Nimitz-class aircraft carrier has
been docked since 2017 at New-
port News Shipbuilding in New-
port News, Va., undergoing a ma-
jor overhaul.
But oftentimes, it is not at theheight of crisis — or combat —
when members of the military
start to experience mental health
issues, said M. David Rudd, dis-
tinguished professor of psycholo-
gy and director of the Institute for
Veteran and Military Suicide Pre-
vention at the University of Mem-
phis.
“In the midst of crisis and in
the midst of significant demands,
people feel a real sense of pur-
pose,” he said.
“It’s afterward, it’s in these
periods where there’s less activity,
less to do, less purpose and less
structure, that it creates opportu-
nities for people to reflect and to
feel and to think” about difficul-
ties in other areas of their lives,
Rudd said. In those times, prob-
lems tend to take on more emo-
tional meaning, fueling depres-
sion, anxiety and substance use
“that are always a part of the
problem with suicide,” Rudd ex-
plained.
Mental health experts agree
that one limitation in preventing
military suicides is that suicides
are extremely complex, typically
involving a number of factors,
and there is rarely one explana-
tion or solution. In addition,
there are military policies and
procedures that can make it more
difficult — not less — for those
seeking help.
Rudd said one problem is that
there is an inherent conflict be-
tween stated military values —
courage, duty and selfless service
— and human vulnerabilities. “All
of those things are wonderful and
are appropriate in warrior cul-
ture. But the problem is it doesn’t
leave soldiers, and particularly
young people, much room to be
human when they have emotion-
al problems or they have mentalhealth challenges,” he said.
Rudd said many facing mental
health challenges say they feel a
sense of failure for not meeting
that standard.
Aside from that internal strug-
gle, Rudd said another problem is
that service members must gen-
erally disclose to superiors that
they are seeking care from a
mental health professional.
“Those are things that, not pur-
posefully, but just inadvertently,
fuel shame and stigma that pre-
vent people from asking for help
at these critical times,” he said.
Rudd said the military needs to
look closely at policies that are in
place that could create potential
barriers.
As for the USS George Wash-
ington, Navy officials said there is
a full medical team aboard the
ship, including a psychologist
and a corpsman who is qualified
as a behavioral health technician.
Sharp, who was found dead
April 9, was the first in the recentspate of suicides.
The 23-year-old, who joined
the Navy nearly two years ago,
had recently gotten married and
was planning to buy a house and
start a family, his mother, Natalie
Jefferson, told NBC News.
Jefferson, who lived with her
son in Norfolk, said she had no
idea he was struggling, calling
him “the life of the party.”
“He never showed his pain,”
she told the network.
A day after Sharp’s death, Huff-
man’s body was found at an off-
base location in Hampton, Navy
officials said. She had joined the
Navy in summer 2018.
In a heart-wrenching Facebook
post, Huffman’s mother, Kathleen
Krull, wrote that her daughter
“always stood up for the under-
dog” and that she was “fiercely
protective of the people she
loved.”
“It still doesn’t in some ways
feel real to me that my baby girl is
gone,” Krull wrote.Less than a year after Mitchell-
Sandor joined the Navy, he was
found unresponsive April 15
aboard the ship and was rushed
to Riverside Regional Medical
Center, where he died, CBS News
reported.
Mitchell-Sandor, 19, had an af-
finity for sports. He had a black
belt in karate and was the quar-
terback of his high school football
team, according to his obituary. It
was during his senior year that he
enlisted and was sent to boot
camp in Great Lakes, Ill., where
he excelled as a leader yeoman
and sharpshooter, his obituary
stated.
He was stationed on the USS
George Washington, “where he
protected the ship until his un-
timely death,” it read.
Jefferson, Sharp’s mother,
urged other military members
who may be struggling to get help
“because the last thing any parent
wants to do is bury their child,”
she said, according to NBC News.Suicides among sailors from same the ship raise mental health concerns
TORU YAMANAKA/AGENCE FRANCE-PRESSE/GETTY IMAGES
The nuclear-powered aircraft carrier USS George Washington leaves the U.S. naval base in Yokosuka,
Japan, on May 18, 2015. At least four sailors assigned to the ship have died by suicide in the past year.tion was waning among people
65 and older, according to data
presented by Ruth Link-Gelles,
part of the CDC’s Epidemiology
Task Force at a federal advisory
committee meeting this month.
The Food and Drug Adminis-
tration’s decision on boosters
came amid skepticism from
some vocal members of the scien-
tific community, who would like
to see more data showing it is
necessary.
“We’re very much on board
with the idea that we simply can’t
be boosting people as frequently
as we are, and I’m the first to
acknowledge that this additional
fourth booster dose that was
authorized was a stopgap meas-
ure,” Peter Marks, director of the
FDA’s Center for Biologics Evalu-
ation and Research, said at a
meeting where experts debated
future boosters.
The debate continued
Wednesday when a CDC advisory
committee held a virtual meeting
at which members discussed
who should get an additional
booster. Breaking with typical
CDC practice, Walensky did not
wait for that advisory committee
to weigh in before issuing guid-
ance supporting the extra boost-
er for people 50 and older. The
committee on Wednesday did not
make any new recommendations
beyond current CDC guidance.
The FDA is also developing
strategies for the rest of the year
and trying to decide under what
circumstances the vaccines
should be modified to deal with
variants. Vaccine companies are
testing alternative formulas and
delivery systems.
The booster debate comes as
many scientists say that what the
world needs are vaccines that
would provide a broader blanket
of immunity to respond to what-
ever the virus evolves into.
“Instead of more boosts of the
same original thing, I think we
need to use a better vaccine,” said
Erica Saphire, president and
CEO of the La Jolla Institute for
Immunology.
Kristian Andersen, an immu-
nologist at Scripps Research, has
contended that people need to be
boosted every six months or so.
“We just need to realize that
immunity, unfortunately, wanes
pretty quickly,” Andersen said.
“We don’t want that to be true.
We want lifelong immunity. We
want measles-type immunity.”
He said that is wishful think-
ing at the moment.
“Our default assumption
should be that we need to broad-
en immunity. If we don’t, the
virus will bypass immunity even
more than it has already with
omicron. ... But we’re not plan-
ning for that,” Andersen said.
“Our entire response to this has
been based on equal measure
hope and wishful thinking, and
that continues to this day.”Katie Shepherd and Lena H. Sun
contributed to this report.Wuhan strain of the coronavirus,
which has since evolved into an
array of slippery variants.
This confusion about the goal
of vaccination — and thus when
shots should be considered to be
failing — even extends to the
experts as they debate the long-
term booster strategy for the
public.
“At what point will we say the
vaccine isn’t working well
enough?” asked H. Cody Meiss-
ner, a pediatric infectious-diseas-
es specialist at Tufts Medical
Center in Boston at a recent
federal advisory committee
meeting.
“What is enough? What is our
expectation?” CDC official
Amanda Cohn asked. “Given that
our effectiveness against hospi-
talization in immunocompetent
individuals is over 80 percent —
and that’s in older adults and
persons with chronic medical
conditions — I think we may
have to accept that level of pro-
tection and then use other alter-
native ways to protect individu-
als with therapeutics and other
measures.”
Vaccine expert Paul A. Offit at
Children’s Hospital of Philadel-
phia argues that it was a mistake
to call mild and asymptomatic
infections “breakthroughs.” The
immunity mustered by current
vaccines is not expected to pro-
tect against all infections.
“The term ‘breakthrough,’
which implies failure, created
unrealistic expectations and led
to the adoption of a zero-toler-
ance strategy for this virus,” Offit
wrote in a recent perspective
piece in the New England Jour-
nal of Medicine.
The decision about when,
whether and who to boost has
also been complicated by imper-
fect data. A widely quoted CDC
study showed that protection
against severe illness from three
shots waned over four months,
from 91 percent to 78 percent.
What was lost in the messag-
ing was that those who had been
vaccinated for more than four
months in that study were pri-
marily people with poorly func-
tioning immune systems, who
typically respond less well to
vaccination. When the data was
instead limited to people with
functioning immune systems,
there was little evidence that
protection against hospitaliza-which are more transmissible
yet. As it mutates, the virus has
become more evasive of the hu-
man immune system.
The result is that an individu-
al’s risk analysis — is it safe, on
this day, with this level of com-
munity transmission of this lat-
est omicron subvariant on the
prowl, to dine indoors at a res-
taurant? — is thoroughly con-
taminated with guesswork, wish-
ful thinking and/or fear.
There is no simple test of an
individual’s protection. There
isn’t a line in the sand — what
experts call a “correlate of immu-
nity” — that means someone is
immune or not immune, or is or
isn’t likely to end up in a hospital
bed.
Antibodies may have become
the public face of the immune
system, to the detriment of pub-
lic understanding. Antibodies
naturally drop after most vacci-
nations, but protection against
the worst outcomes clearly per-
sists longer, because of the multi-
faceted way immunity works.
T cells provide a layer of
immune defense and stick
around in the body for at least six
months, with only modest ero-
sion. Memory B cells persist and
kick into action to churn out
virus-fighting antibodies
through what is called a “recall
response.”
Neutralizing antibodies wane
naturally — the body doesn’t
want to arm itself endlessly with
battalions of defenders against a
hypothetical invader — and in
the case of covid, they wane more
quickly than some disease ex-
perts had hoped two years ago.
The boosters authorized to
date are identical to the first
vaccines. Those shots were de-
signed to deal with the originalonly a modest and brief increase
in protection, peaking at four
weeks after the booster dose and
dropping back to the baseline
after eight weeks.
“[T]hese findings suggest that
protection against confirmed in-
fection wanes quickly,” the re-
searchers concluded.
“I was shocked,” said Robert
M. Wachter, chair of the depart-
ment of medicine at the Univer-
sity of California at San Francis-
co. He said he thought the addi-
tional protection against infec-
tion from the fourth shot would
mirror that of the third rather
than be so brief.
If the fourth shot offers a
relatively brief window of higher
protection, he said, timing that
booster according to plans — a
wedding, a family reunion, visit-
ing an elderly relative, a vacation
— seems reasonable. But it’s not
an easy calculation, he said, be-
cause there are so many factors
in the equation.
“There’s no perfect plan.
You’re weighing risks, benefits,
uncertainties, your own personal
circumstance,” Wachter said. “I
do this for a living, and I get a
headache when I try to think this
through.”
Risk analysis is not the strong
suit of most people. Guidance
from the CDC about the risk of
infection has not always been
clarifying. The risk on any given
day depends a great deal on the
current level of community
transmission, but that data may
not be easily found or interpret-
ed and could be out of date.
And the virus itself is not a
fixed entity. The omicron variant
is more transmissible than earli-
er forms of the virus, and there is
now a growing roster of omicron
subvariants, including BA.2,save lives and better protect
people, more than 90 million
eligible people in the United
States haven’t rolled up their
sleeves for their first booster.
Booster uptake has been higher
among White people than in
communities of color.
Medical advisers to the federal
government have debated the
necessity and ethics of a fourth
shot given that there are higher
public health priorities, includ-
ing reaching unvaccinated com-
munities and ensuring wider
global access to vaccines. But in
their late March authorization,
federal agencies said people 50
and older could get an additional
booster it they are at least four
months past their previous shot.
Strikingly, the agencies did not
clearly recommend that booster
for everyone who is eligible, and
federal officials’ advice varies.
Rochelle Walensky, director of
the Centers for Disease Control
and Prevention, said people 65
and older and those 50 and older
with underlying medical condi-
tions are most likely to benefit.
Ashish Jha, White House covid-
19 response coordinator, told
“Fox News Sunday” the data were
“pretty compelling” for people
older than 60 to get a second
booster. Anthony S. Fauci, direc-
tor of the National Institute of
Allergy and Infectious Diseases,
said on MSNBC that people older
than 50 should get a fourth shot.
Data from Israel, which of-
fered fourth shots to people 60
and older during the omicron
surge, show that the additional
shot increases protection against
severe illness and death com-
pared with a third shot. But
against infections — most of
which are officially deemed
“mild” — a fourth shot providedMost Americans aren’t trying
to time their next booster for an
overseas vacation, and many
people in low-wage jobs and
crowded multigenerational
households are far more exposed
than the Weissingers are. But
their uncertainty about a fourth
shot reflects the widespread con-
fusion about boosters — who
exactly should get them, and
when, and why — that has
dogged the government’s vacci-
nation campaign.
Even highly informed consum-
ers of pandemic news may strug-
gle to sift through the latest
government guidance and new-
est scientific studies. And even at
this stage in the crisis, they may
be unclear on what additional
boosters can and can’t do.
Public health officials who au-
thorized a second booster shot
last month for people 50 and
older and for immunocompro-
mised people 12 and older have
insisted it’s a stopgap, aimed
primarily at keeping the most
vulnerable people out of the
hospital or the cemetery. A sec-
ond booster appears to add to
protection against severe illness
in people 60 and older but offers
only a modest, temporary shield
against infection.
The booster issue reveals some
tension between public health
priorities and individual inter-
ests. The disease experts worry
about epidemic waves that can
overwhelm the health-care sys-
tem. To a doctor, a vaccine has
worked fine if it keeps a person
out of the hospital, with just a
mild to moderate case — which
can mean anything from a few
sniffles to a miserable week in
bed utterly flattened by the virus.
Many people, though, don’t want
that bad week — with the atten-
dant risk of long covid — and will
do anything to keep it off their
calendar.
“I think the expectations
[from] the first performance of
the vaccines is that it is possible
to be completely protected
against infection, or any small
cough even,” Hanneke Schuite-
maker, head of viral vaccine
development and translational
medicine at Janssen, a division of
Johnson & Johnson, said at a
recent forum held by the New
York Academy of Sciences.
The reality is that a person
who is up to date on vaccination
is very unlikely to wind up in the
hospital, although the virus may
still be able to break through the
initial line of immune defense
and generate sickness.
“You may have sort of a com-
mon cold, but your immune
system will deal with it and
prevent severe disease,” Schuite-
maker said.
Even as many people rush to
get a fourth shot, many others
still haven’t received their third,
second or first. Despite clear
evidence that a third shot can
BOOSTER FROM A
In boosters, tension between public health and individuals
EMILY ELCONIN/REUTERS
An immunocompromised 50-year-old gets a second booster shot April 8 in Waterford, Mich.“There’s no perfectplan. You’re weighingrisks, benefits,uncertainties, your ownpersonal circumstance.”
Robert M. Wachter, chair of the
department of medicine at the
University of California
at San Francisco