Don’t be Surprised When Vaccinated People Get Covid
I wonder if Charles Dickens knew COVID was coming.
“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of light, it was the season of darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us …”
- A Tale of Two Cities
Let’s start with the good news.
The vaccines are rolling in. One in four Americans ages 18 and older — and nearly 60% of people ages 65 and older — are fully vaccinated, according to CDC data.
We are currently administering a seven-day average of 3 million vaccine doses per day. According to data tracked by Johns Hopkins University, the latest seven-day average of new coronavirus cases in the U.S. is approximately 70,000, well below January’s peak of about 250,000 new cases per day but about the same as in July 2020.
The vaccines are working. We already know that they take death and severe disease off the table — even for the variants. Real-world data continues to show that the vaccines are crushing the curve — slashing death rates and hospitalizations AND reducing the risk of asymptomatic transmission by somewhere from 80 percent to 94 percent in people who are fully immunized.
What else? Last week, the Lancet published an important study showing that reinfection is RARE after having had COVID-19.
All of this points to our ability to lift restrictions soon. When will that happen? For some sanguine thoughts on the subject, I highly recommend this opinion piece written by top epidemiologists, public health experts and clinicians Syra Madad, Monica Gandhi, and Ashish Jha, who believe that
“...the tipping point at which restrictions like masks and social distancing can be lifted by looking at two parameters: 1) severe disease from covid-19 as represented by hospitalizations and 2) vaccination rates. The goal for hospitalizations from covid-19 should be less than 5 cases per 100,000 people, or about 16,000 hospitalizations in the nation, less than half of where we are right now….And as such, the Israeli experience suggests that once we manage to get at least 40 percent of people at least one dose, we can expect substantial and sustained drops in infection rates.”
What’s the bad news du jour?
Case rates continue to go up in various states (like Michigan) where restrictions have been lifted, rendering unvaccinated people vulnerable to COVID-19. It’s no mystery why this is happening: the more contagious variants (and of course the original coronavirus) put unvaccinated people at increased risk of infection when masks, distancing, and ventilation measures aren't in place.
One in four Americans are hesitant to get the vaccine, according to a new poll. This will only slow our ability to reach herd immunity which, as you probably know, is not a hard target but essential nonetheless to protect our most vulnerable citizens from illness.
We’re starting to see news reports of “breakthrough” COVID infections in vaccinated people, and it's causing another wave of anxiety.
Patients and readers commonly ask me: How could someone possibly get sick after vaccination? How can your vaccine optimism and COVID infection possibly co-exist?? Haven’t we had ENOUGH curve-balls and confusion?
Let’s break these questions down.
Breakthrough infections — while important to observe and study — should not be made into lurid headlines. In fact, a vaccinated person getting COVID-19 isn’t new news in the first place.
Some proportion of post-vaccination infections are expected. The vaccines are NOT sterilizing (that is, they are not 100% effective against every single infection). However they are pretty darn close. Recall that real-world data estimates our risk of COVID-19 after vaccination to be 0.05%. That means that out of 1000 vaccinated people, there is a 50/50 chance that one person out of the thousand will get COVID-19. So if you do the math on the number of vaccinated Americans, we can expect a small portion of vaccinated folks to get COVID-19.
Breakthrough infection frequency will vary for different coronavirus variants. It will also vary between demographics, i.e. we will see more infections in people who are the least able to mount a robust immune response to vaccination — like organ transplant patients, patients on chemotherapy or medications to suppress their immune system. (Reminder: MOST PEOPLE mount a robust immune response, and there is zero reason to check for it; just look at the curves in Israel! But if you are immunosuppressed for other reasons, you should talk with your doctor about possibly testing your immunity to SARS-coV-2 by testing your blood for spike antibody and T-cell responses to the vaccine.)
But before you do anything, remember this key point: Breakthrough infections are rare — and when they don’t cause death or severe disease or necessarily cause onward transmission, there is no reason for alarm.
But the headlines will come. They will torment the anxious, traumatize the apprehensive, and put the BASKET back in basketcase.
My advice?
Look at the facts. Re-read this little ditty from the beginning. Watch my Instagram COVID Q & A from yesterday where I rapid-fire answer your excellent COVID-19 FAQs.
Breathe. Get out in nature, take a brisk walk, and practice deep breathing to quiet anxiety. Try a meditation app to help get you started. I regularly recommend Calm, Headspace, and Insight Timer.
Remember your mental health. Here I am yesterday on Fox News Sunday reminding people to address their mental health like they do any other organ system — and to ask for help when it’s hard.
Get vaccinated. Don’t wait. Just get it done. Even if you’ve had COVID. Don’t overthink the side effects before you even have any. Know that it’s fine to take Tylenol or Advil if you do get side effects (unless your doctor says otherwise). The sooner we all take this ticket to normalcy, the better off we ALL are together.
I will see you later this week. Until then, be well.