Rate of vaccinated in hospitals rises
Doctors cite exposure to those without shots as one reason
The percentage of patients hospitalized in San Antonio with COVID-19 who were fully vaccinated has increased in the past month, even as the total number of infected people in the hospital has declined.
Doctors say they’re not surprised by the uptick in the share of breakthrough infections among those hospitalized and point to several reasons for it.
Some of it is driven by fully vaccinated patients’ exposure to people who didn’t get the shots as the more contagious delta variant spread through the community. Some patients with underlying medical conditions or who are older don’t respond as well to the COVID vaccines.
And some vaccinated patients tested positive for the virus after being admitted to hospitals for different reasons, possibly because they got enough protection from the vaccines to show no symptoms of COVID-19.
It’s not a sign that the vaccines are failing, said Dr. Rita Espinoza, chief of epidemiology for the San Antonio Metropolitan Health District.
“We know no vaccine is 100 percent effective,” she said. “It does not mean that the vaccine’s not working. It just means that there’s no way for us to prevent every single case.”
Patients who have had their shots will likely experience less severe symptoms and recover faster if they are sickened by the virus. They are also less likely to be admitted to intensive care units and far less likely to die.
“People that are fully vaccinated that do end up in the hospital with a breakthrough infection overall do much better than people that are unvaccinated,” said Dr. Jason Bowling, University Health’s director of hospital epi
demiology.
“If you look at the numbers, overwhelmingly, people that are hospitalized and are dying are unvaccinated,” said Bowling, who is also an associate professor of infectious diseases at UT Health San Antonio. “The risk of being unvaccinated is much higher than being vaccinated.”
In mid-august, fully vaccinated patients represented about 11 to 12 percent of all COVID-19 patients in San Antonio hospitals. That was at a time when around 1,400 patients with the disease were in local hospitals each day.
Then that percentage began to rise. In the past two weeks, it has hovered around 15 percent. Meanwhile, COVID-19 admissions at local hospitals declined, dropping to 1,121 as of Friday.
There have been days when the percentage of fully vaccinated hospital patients with breakthrough infections inched even higher — reaching 18 percent Aug. 30 and 17 percent Tuesday.
At University Hospital — where all patients admitted for any reason must get a coronavirus test — the number has held steady at around 10 percent for the past month, Bowling said.
“Some of those numbers are going to reflect people that are fully vaccinated and have a positive test but aren’t admitted for COVID symptoms,” he said.
The Centers for Disease Control and Prevention reports that breakthrough COVID-19 infections “are expected” in some fully vaccinated patients. Some will contract asymptomatic infections and could unknowingly pass the virus to others.
Some fully vaccinated people will still get sick, be hospitalized or die from COVID-19, the federal agency notes on its website.
While data suggests the vaccines protect recipients against most coronavirus variants circulating in the United States, variants will also cause some breakthrough cases in people who got their shots, the CDC’S website states.
“The risk of infection, hospitalization and death are all much lower in vaccinated compared to unvaccinated people,” the CDC noted.
The CDC has tallied more than 14,000 hospitalizations or deaths from COVID-19 of vaccinated patients with breakthrough infections.
Among them, 2,675 deaths were reported, 87 percent of them people 65 or older. Of the 11,440 patients who were hospitalized but survived, 70 percent were 65 or older.
Nearly one-fifth of those who died — 493 people — were asymptomatic or died from something besides COVID-19, the CDC said, while 22 percent of those who were hospitalized but survived breakthrough infections — 2,491 patients — showed no symptoms of COVID-19 or were admitted for unrelated medical issues.
In Bexar County, 2,271 fully vaccinated people contracted breakthrough coronavirus infections between Jan. 1 and July 31, according to Metro Health’s most recent epidemiology report. That accounted for 2 percent of all cases.
During that seven-month period — almost all of it before the arrival of the delta variant — 64 people who were fully vaccinated accounted for 2 percent of all patients hospitalized in Bexar County with the virus, Metro Health’s report shows. Eleven Bexar County residents who were fully vaccinated have died after contracting COVID-19 as of July 31, Metro Health reported.
But the majority of people hospitalized have not been vaccinated at all, Espinoza said.
“That helps continue to have the virus circulating in our community, which then puts other individuals at risk,” she said.
At Baptist Health System in San Antonio, the fully vaccinated patients hospitalized with breakthrough infections account for 10 to 12 percent of all COVID-19 admissions, said Dr. Lynnette Watkins, chief medical officer for the hospital system. Those vaccinated normally don’t require intensive care, she said.
“Those who are vaccinated have had exposure to those who have not been vaccinated and often are in immunocompromised categories and have other (medical) conditions ... such as diabetes, obesity,” Watkins said. Or, she added, “they’re organ transplant recipients. They may have connective tissue disease and may be on immunosuppressants, such as methotrexate or steroids. They may be of advanced age.”
Methodist Healthcare also has seen a few more breakthrough cases requiring admissions to its hospitals, but those are “relatively few” compared with the number of COVID-19 patients who aren’t vaccinated, said Dr. Paul Hancock, chief medical officer.
Unvaccinated patients have longer ICU stays than fully vaccinated patients, while “the average length of time on a ventilator for an unvaccinated patient is three times longer than for a vaccinated patient,” Hancock said.
“The vaccine is not perfect at preventing infection, but it is our experience that the immune response from the vaccine clearly provides a significant level of protection and diminishes the risk of hospitalization and death.”
People should take additional protective measures even if they got their shots, Espinoza said, such as wearing face masks, avoiding large gatherings, socially distancing, getting tested and staying home if they don’t feel well.
“The vaccine is going to be one of the tools in the toolbox to help us get out of the situation,” she said. “But it’s not the only tool.”