When Covid-19 sneaks in
Breakthrough Covid-19 cases that occur in fully-vaccinated people can be frustrating for those who get it despite following recommended guidelines.
THEY followed all the guidance and took every precaution, but got Covid-19 anyway.
Christina Van Norman and David Coe had resumed small gatherings – finally – of their fully-vaccinated friends at their home in Montgomery County, Maryland, United States, where coronavirus transmissions were relatively low.
The day after the last event, Van Norman felt rundown.
Two days later, she had a fever and body aches, and a rapid test confirmed that the infection wasn’t a seasonal cold, but Covid-19.
Her husband, Coe, soon tested positive and they alerted their guests.
“We thought we were vaccinated and safe, and that’s the scary part,” Van Norman said.
“I’m not dying, but I’m pretty darn sick and absolutely spreading it to others.”
Ultimately, 14 of 17 vaccinated people tested positive after the gathering.
Such results are becoming more common in Maryland and across the US, as more people emerge from Covid-19 lockdowns and face mask mandates, only to run headlong into the more contagious and fastspreading SARS-COV-2 Delta viral variant.
Cases are again on the rise.
Best line of defence
Still, the overarching message from public health officials is that vaccines are working and are the best line of defense against serious illness.
Official reports of so-called breakthrough cases, i.e. fullyvaccinated people becoming infected, remain low in Maryland and around the US.
While Van Norman continues to have really unpleasant symptoms two weeks after testing positive, neither she nor the others likely infected at the party have been hospitalised.
“The key message is the vaccine works very, very well,” said Dr Georges Benjamin, executive director of the American Public Health Association and a former Maryland state health secretary.
“It is extremely effective in preventing severe illness, hospitalisations and death.”
There were about 3,000 post-vaccination infections recorded in Maryland as of last week, according to data provided by the Maryland Department of Health.
There could be more, however, because until recently the US Centers for Disease Control and Prevention (CDC) didn’t advise vaccinated people who were exposed, but asymptomatic, to be tested.
Officially, the tally of breakthrough cases accounts for just 0.08% of the over 3.6 million residents vaccinated in the US state – fewer than one in every 1,000.
The state couldn’t immediately say how many of those infected had been hospitalised, but officials previously said that most of those hospitalised and all those who have died of Covid-19 had not been fully vaccinated.
Maryland state health officials continue to “strongly encourage” eligible Marylanders – anyone 12 or older – to get a shot.
Children as young as five years old are expected to become eligible by late autumn (in the US).
“Vaccinated Marylanders have taken the most important step they can to keep themselves, their families, friends, community and countless others safe from Covid-19 and the highly contagious Delta variant,” said Charles Gischlar, a spokesman for the Maryland state health department.
Spread still possible
The Maryland numbers mirror those from other US states reporting post-vaccination infections.
The US CDC collects data only on serious breakthrough cases, but a new report from the Kaiser Family Foundation found that infections remain rare in the 25 US states publicly reporting some post-vaccination case data, which does not include Maryland.
The report found the rate of breakthrough cases was well below 1% in each of the US states and the rate of hospitalisations ranged from zero in several states to a high of 0.06%.
Deaths were reported in two states.
This does not mean people aren’t getting sick.
Van Norman said she still has head congestion, and some dizziness and fatigue.
“I’m not on a ventilator,” she said.
“So, it’s better than it could be. But it’s hanging on.”
Dr Benjamin said a real problem is that infected people who have been vaccinated still can become carriers for brief periods of time and pass on the SARS-COV-2 virus, particularly to children or others vulnerable in the household.
There are also a lot of unvaccinated people around the US who could be infected.
For this reason, until more people are vaccinated and the pandemic slows, he said, “the best way to protect them is to have everyone wear a mask.”
An associate professor in the department of microbiology and immunology at the University of Maryland School of Medicine said that earlier estimates about how many people would need to be vaccinated to achieve herd immunity – when a virus slows dramatically because it can no longer find viable hosts – have been pushed higher due to the Delta variant.
But Dr Matthew Frieman added that some communities may be able to contain the virus with lower levels of vaccination coverage if they use other public health interventions such as face-masking, physical-distancing and ventilating spaces.
People in areas with low levels of vaccinations and that are more resistant to using such layered approaches will have higher rates of severe infection and death, he said.
“There’s been pushback from people who don’t want to wear masks and who say, ‘We shouldn’t need to because we’re doing good here’; and my response to that has been, ‘We know the small inconveniences that can protect our kids and our families work, and we want to keep the virus at bay as long as possible’,” he said.
Stay masked-up
It’s unclear how willing the pandemic-weary public will be to return to face-masking, especially those who are vaccinated.
US state and local officials are pondering their masking policies – whether mandates or recommendations – which have changed and diverged over time with circumstances in the community.
Some US states such as Florida and Arkansas, have come out forcefully and legally against masking.
In Maryland, state governor Larry Hogan said he would not reinstate an indoor mask mandate that expired last month.
Some local authorities, along with schools and private businesses, have considered or are considering mandates.
But the mishmash of advice has likely only been confusing for some, while Van Norman considers it disappointing.
According to the guidance she sought from the US CDC, her partygoers didn’t need to wear masks because the level of transmission in their county was not high.
Montgomery is not among the the counties in Maryland now listed as having “substantial” or “high” transmission where masks are recommended indoors for unvaccinated and vaccinated people.
There are sure to be more cases everywhere because there is more virus in the community and more opportunities for spread, said Dr Caitlin Rivers, an epidemiologist and senior scholar at the Center for Health Security in the Johns Hopkins Bloomberg School of Public Health.
“I’m still very confident that I’m protected against severe illness as someone who is vaccinated,” she said, “but I’m reaching for the mask to reduce my risk further.”
Dr Frieman said those cases are sure to rise more as the seasons change.
For children, those who are immunocompromised and others who respond poorly to vaccinations, the impact of the Delta variant and future viral variants could be staggering.
“These cases will go up this winter, there’s no doubt about it, and where do we want to be on the spectrum here?” he said. “I certainly want to be on the low end.” – By Meredith Cohn/the Baltimore Sun/tribune News Service