It’s the million dollar question: Why did I get so ill with Covid even though I’ve had both jabs?
Jo Macfarlane has been writing about the virus for 18 months – and last week she herself was floored by it. So why do experts say her case isn’t as worrying as it sounds?
IT BEGAN, oddly enough, with a painful shoulder – a deep muscular ache right in the spot where I’d been vaccinated. That might have been easy to dismiss. But then came agonising muscle pains in my legs that kept me awake, intense bouts of shivering and a yo-yoing fever.
A lateral flow test, followed by a PCR – both positive – confirmed what I feared.
After 18 months of writing about coronavirus for this newspaper, I had finally got it myself.
To an extent, it was perhaps inevitable. My husband was the first of our household to fall. He had been struggling for a few days with cold-like symptoms since we returned from a holiday on the Dorset coast. When he suddenly realised his sense of smell had vanished, the penny dropped. By then of course, it was too late for me – or our two children – to take evasive action.
Within a couple of days I was floored by my own symptoms, which were significantly worse than his. A pounding headache, fatigue so severe I could barely walk. I shook violently when I tried to stand, and was groggy and fuzzy-headed. What little appetite I had was diminished further by the fact I couldn’t taste or smell anything.
This was undoubtedly Covid: at this stage in the pandemic, we all know the rollercoaster roster of symptoms.
Except, at this stage in the pandemic, after one of the most successful vaccine rollouts in history, the question is whether I should have had any symptoms at all.
Like more than three-quarters of the UK population over the age of 16, I am fully vaccinated against the virus.
As a fit and healthy 42-year-old, with no known underlying health problems, my first dose of the Pfizer BioNTech jab was delivered in May; the second nearly seven weeks later, at the end of June.
MY HUSBAND received both doses of his OxfordAstraZeneca jab around the same time. For us, as for many others, it was a cause for celebration and relief. The vaccines were mooted, rightly, as our route out of the chaos and frustration of repeated lockdowns and separation from our friends and family.
As I’ve reported many times, study after study has overwhelmingly found that both vaccines provide resolute protection against contracting the virus – even against the Delta variant, the dominant strain in the UK.
The Pfizer vaccine is up to 82 per cent protective against symptomatic infection; the AZ version less so, but still 67 per cent effective.
And there is no doubt that the jabs have weakened the link between infection and hospitalisations or deaths. Despite about 38,000 Covid cases a day in the UK, the number of people being taken to hospital is a fraction of the peak in January. When we had the same number of positive cases then, we recorded 1,200 deaths a day – today, it’s 100.
Many might have sensibly assumed that, with two doses of the vaccine, they were immune to the virus when restrictions were lifted at the end of July.
But since then, reports of socalled ‘breakthrough infections’ like mine appear to be widespread.
Everyone seems to know someone who has been double-jabbed and caught Covid anyway. And many describe those people as being surprisingly unwell, albeit not in hospital – just like me.
Nearly 5,000 of those attending the recent Boardmasters festival in Cornwall are thought to have come home with the virus, despite many being vaccinated and testing negative in order to attend.
Consequently, social media is awash with tales of the infection being ‘seeded’ in families and older relatives.
One wrote on Twitter: ‘I know several young people who became positive shortly after & have now given Covid to their whole families.’
So what’s going on? Does it mean the vaccines aren’t working as well as they should?
And is it a cause for concern?
I say this with an eye on Israel, which has seen a rise in infections and hospitalisations despite the fact that it, like us, has high levels of its population vaccinated. Are cases such as mine a warning shot that we could go the same way?
We put these questions to some leading experts on the vaccine and immune systems – and their answers were, in the main, reassuring. First, the vaccine is not 100 per cent effective – no vaccine is. Or rather, it’s very effective in certain ways and not so much in others. As microbiologist Paul Hunter, Professor in Medicine at the University of East Anglia, told The Mail on Sunday’s Medical Minefield podcast: ‘It’s worth thinking of Covid as two types of illness. ‘The infection you’ve described [I told him about my own illness] is essentially an infection of the nose and throat – we call them mucosal infections. These can still be bad, but they’re not lifethreatening and won’t put you in hospital. And the vaccine isn’t that good against these. ‘The jab still reduces the risk of getting them by 50 per cent or more, but that means there are still going to be a lot of people suffering symptoms like yours.’ Those infections sometimes develop into something more serious, however – a viral pneumonia that can spread further than the lungs. This can trigger a cascade of other damaging effects on the body, such as blood clots and acute respiratory distress syndrome.
‘The vaccine is a lot better at preventing this severe disease, which usually requires hospitalisation,’ Prof Hunter said. ‘Still not 100 per cent, but maybe 85 to 90 per cent protection.’
The other issue is that the Delta variant has chipped away at some of the protection the vaccine offers.
It still works, according to Danny Altmann, Professor of Immunology at Imperial College London, but less well – meaning that we’ll see yet more infections in those who have been double-jabbed.
‘We have amazing vaccines, which give most of us really good immunity,’ Prof Altmann says. ‘But [Delta] does punch holes in that immunity, even sometimes in fit and healthy people who had a good immune response to the vaccine.’
I suppose my question is, did the vaccine simply not work for me?
Prof Altmann says one of the biggest studies on infections in vaccinated people, in Israel, found those who were on average older, and had their vaccine doses spread further apart, were more likely to suffer a breakthrough infection. Other studies, however, have shown increasing the time between jabs offers better protection.
And what about antibody response? I’ve never been tested, and there’s no consensus on what an adequate, protective level of antibodies would be anyway. And it seems that while low levels might indicate someone is more vulnerable, this isn’t always the case.
‘We’ve looked at examples of people who’ve had severe Covid after vaccination – they were people who had a great immune response to the vaccine, with high levels of antibodies,’ says Prof Altmann. ‘So in some ways, all bets are off.’
In other words, no one really knows why some people develop symptoms from Covid despite vaccination, and others do not.
From this week, about 8,000 people testing positive are being recruited to take antibody tests – shortly after their positive test result, and again 28 days later.
The results will work out whether there is a level of antibodies that is protective against the virus. And officials at the UK Health Security
Agency, which is running the study,
could use it to determine who may be most in need of a booster jab.
Recent studies have suggested that protection from the vaccine starts to wane within a matter of weeks. But the Government’s experts – the Joint Committee on Vaccination and Immunisation (JCVI) – have so far ruled out giving a third shot to everyone. Instead, interim recommendations include giving another jab only to the most vulnerable.
Israel currently has one of the highest infection rates in the world because of the spread of Delta – but swiftly brought its R rate down thanks to a booster programme among the over-60s. Those who had a third dose of Pfizer got four times the protection against infection compared with those who had only two.
But British experts are still doubtful whether the same will happen here, due to vast differences in the type of jab (Israel used Pfizer exclusively) and the intervals between doses, which was only four weeks in Israel.
Several studies have suggested that leaving eight weeks between doses appears to be a ‘sweet spot’ for maximum protection – supporting the Government’s decision to change the interval from 12 to eight weeks this spring.
Some suggest this means the effect of boosters is likely to be less dramatic here.
Prof Hunter says: ‘We still don’t know whether the booster vaccine programme will help reduce the spread of Covid in the UK. But for those who have other conditions, who are seriously ill – being treated for cancer, who’ve had organ transplants – absolutely they need a booster. I would add to that people over 80, who are still at risk from Covid.’
And regardless, as Prof Altmann says, those who do end up with symptoms may have ended up far worse off without the vaccine. In fact, he says, he would ‘bet his house’ that I would have had to go to hospital if I hadn’t been double-jabbed.
It’s an unnerving prospect for someone who considers themselves otherwise healthy. Yet this is precisely why the vaccine has been so necessary. I’ve heard people scoff during this pandemic. They’re fit and healthy and don’t need a vaccine, or they don’t need it because they’ve already had Covid.
What may make a difference to symptoms, too, is the ‘infectious dose’ – the amount of the virus people are exposed to, which goes on to establish an infection.
It’s similar to what happens with chicken pox. The first child in a household to be affected by it may have only a mild case. But their siblings, exposed to the virus for longer and at close quarters, will tend to have a worse illness.
In my case, my husband’s illness was mild. But, however he picked it up, my exposure to the virus was likely to be far more concentrated, which may partly explain why I was more badly affected.
And as Prof Altmann explains, the more virus there is, the more chance it has to overcome any antibodies from the vaccine. ‘Even if you’re double-vaccinated, the rules still apply,’ he says.
In other words, fully vaccinated people can still get the virus and pass it on.
This was the main message from another study released last week from Oxford University.
It found that some of those who’d had two jabs carried as much virus around as those who were unvaccinated. And yet, new protocol introduced by the Government earlier this month meant doublejabbed people no longer have to self-isolate if they come into contact with someone who tests positive for Covid.
Another case in point: being vaccinated didn’t stop us passing on Covid to our two children, a source of much guilt.
We had been in self-isolation as a family for eight days when my eight-year-old daughter’s temperature spiked and her five-year-old brother developed a snotty nose. Their main symptom, admittedly, is boredom. But it proves that vaccination was no barrier to onward transmission.
According to Prof Hunter, I had a ‘mild’ illness, and this is typical of a breakthrough infection. At the time I might have felt like death warmed up, but in the grand scheme of things, he’s right. No major harm done.
The worst was over in a few days. While my senses of taste and smell aren’t back yet, at least I suffered no breathing problems.
The good news for everyone is that we will, hopefully, build up a natural resistance to Covid over time, until its effects are little more than a common cold.
There is further good news for anyone doubly vaccinated who does become infected with Covid.
‘The quality of the immunity and the strength of the protection that gives is quite a lot better than either vaccine or natural infection alone,’ says Prof Hunter.
‘So you can be comfortable that you’ve actually got some pretty strong protection going on now.’
After everything, that’s enormously reassuring. But without the vaccine, who knows what the outcome might have been?
BEING hard of hearing can trigger depression, according to a British study.
A third of Britons over 65 suffer some form of hearing loss, which has long been linked to cognitive decline and dementia.
But now, an analysis of more than 74,000 Britons aged 50 to 89 shows the problem may be a significant factor in the development of mood disorders too.
The University of Manchester researchers found a strong correlation between the increase in hearing loss and the onset of depressive symptoms.
Dialechti Tsimpida, a psychologist and co-author of the paper, said routine hearing tests at the GP surgery may ‘prevent or delay the onset of depression’.
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