COVID vaccines work well to suppress severe outcomes. But public health communications may be overstating the vaccine effect on transmission and understating the scale and risk of breakthrough infections. dwallacewells and michaelmina_lab discuss
Photo: Mark Felix/Bloomberg via Getty Images The term itself, perhaps, is a problem. “Breakthrough” sounds bad — implying an immune-escape mutation, likely rare, and therefore alarming.
“The message that breakthrough cases are exceedingly rare and that you don’t have to worry about them if you’re vaccinated — that this is only an epidemic of the unvaccinated — that message is falling flat,” Harvard epidemiologist Michael Mina told me in the long interview that follows below. “If this was still Alpha, sure. But with Delta, plenty of people are getting sick. Plenty of transmission is going on.
Unfortunately, more accurate month-to-month data is hard to assemble — because the CDC stopped tracking most breakthrough cases in early May, before the Delta wave had begun, and the states maintaining their own databases often update them irregularly and, in some cases, according to idiosyncratic logic — but over the last week, I’ve tried. And while several states show prevalence rates roughly in line with Kaiser’s ballpark one percent estimate , in others the patterns were divergent.
The vaccine effect is considerably more encouraging when it comes to the risk of severe disease and hospitalization on those 50 percent of the country — and 61 percent of adults — who have gotten the shots. According to Kaiser, the hospitalization rate for vaccinated people is, for most states, at or just below 0.01 percent — meaning one out of every 10,000 vaccinated people has been hospitalized. Over the past year, the hospitalization rate for the country as a whole is about 0.7 percent.
Yes. And that’s exactly right. Breakthrough cases are real. It’s no longer what we were talking about when we talked about the Yankees outbreak. And I think what we’re seeing is that viral loads can get very high with Delta. They could actually get high with some of the other variants too, actually. It’s worth mentioning, We are seeing some new data that shows that clearance of the virus from the body is faster, too —Well, that’s how it’s being interpreted. But at the end of the day, I’d be willing to bet that almost all transmission happens when people are at their peak viral load.
Possibly. But to your point, we haven’t done a very good job at testing the unvaccinated, either. Really the only people who go get tested today at a PCR lab are those who are feeling ill.So I don’t think we’ve done such exhaustive testing at this point in time that we would really be seeing a major difference in the unvaccinated versus the vaccinated populations.
We haven’t seen the data to really show it because it’s extremely difficult to measure. I’d say that there’s a very good chance that vaccines will help prevent an exposure turning into an infection. But amongst those who are getting infected and detected, the viral loads are really high. And we’re clearly seeing transmission happen. We’re seeing outbreaks happen amongst vaccinated groups.
I do think they are serving to protect people from hospitalization. Absolutely. But I also do think that we need to consider this a very dynamic process. For a year, really, I’ve been saying that we need to be very cognizant that the way that we’re measuring these vaccines has been, still to this day, within the first month post vaccination.
And then we’d probably going to see a lot of breakthrough cases in nursing homes. And we’ll probably see these outbreaks in nursing homes turn into hospitalizations and deaths by the end of the year, absent boosters. We know that people start to lose the physical architecture of their immunological memory development system as they age. It’s why we get shingles. It’s why we get all kinds of infectious diseases as we get older. It’s why we get cancer, in large part, because our immune system no longer surveys the way it should.
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