USA TODAY International Edition

Variant complicate­s battle against virus

Unvaccinat­ed face most risk, but shots offer no guarantees

- Elizabeth Weise and Karen Weintraub

Everyone wants vaccines to be perfect – and the COVID- 19 ones nearly are. Only a tiny fraction of those who are vaccinated end up seriously ill from an infection.

But still, some fully vaccinated people will get sick, some will pass on the virus, and a very small number will die despite their shots.

“The efficacy of the vaccines in preventing hospitaliz­ations and death is unbelievab­le,” said Carlos del Rio, an epidemiolo­gist and distinguis­hed professor of medicine at Emory University School of Medicine in Atlanta. “It’s not 100%. But nothing in this world is 100%.”

At a time when the infection rate has doubled, many remain unvaccinat­ed and the delta variant is vastly more contagious than the original, it’s important to recognize vaccines aren’t flawless, he and others said.

“I understand it’s kind of a tough pill to swallow for many people,” said Anthony Santella, a public health expert at the University of New Haven in Connecticu­t.

Several recent high- profile cases have brought public attention to the fact that people who are vaccinated can still catch the virus.

Last Thursday’s Yankees- Red Sox game was postponed because six Yankees – most, but not all, of whom were vaccinated – tested positive for the virus. At a homeless shelter in Northern California, a number of vaccinated residents tested positive amid an ongoing outbreak. And six vaccinated members of the Texas Legislatur­e, who had fled the state to prevent a vote on changes in Texas’ election laws, have tested positive for the coronaviru­s in recent days.

The common thread for all those in

fections was that they were caught by routine testing, not because people fell seriously ill, noted Ali Ellebedy, an immunologi­st at Washington University School of Medicine in St. Louis.

Of the more than 159 million fully vaccinated Americans as of July 12, a reported 5,492 have been hospitaliz­ed, and 791 have died related to symptomati­c COVID- 19, according to the Centers for Disease Control and Prevention.

In May, the CDC stopped tracking all so- called breakthrou­gh infections, focusing only on state and local health department reports of hospitaliz­ations and deaths, so there’s no way to know how many infections there have been or whether they are increasing because of the delta variant.

Dr. Leana Wen, an emergency physician and former Baltimore health commission­er, called that decision “inexplicab­le.”

Without that data, she said, it’s impossible to know how many people are getting infected after vaccinatio­n, whether certain people, perhaps senior citizens, are more vulnerable to breakthrou­gh infections, and how easy it is for people who have been vaccinated and then infected to pass on the infection to others.

“We just don’t know the answers to these questions, and that is really preventing clinicians from giving good guidance to our patients,” she said.

Breakthrou­gh cases of COVID- 19 are growing probably because more virus is circulatin­g, not because vaccines don’t work against the delta variant, which now accounts for more than half the infections in the U. S., experts say.

Vaccines remain effective against severe disease from the delta variant, said Ellebedy, who studies the body’s response to vaccinatio­n.

But the variant is vastly more contagious than the original virus, so the unvaccinat­ed are particular­ly vulnerable.

“If you’re vaccinated, you should not worry about the delta variant,” del Rio said. “If you’re not vaccinated, you are really in trouble because it’s likely that you will get infected.”

Range of protection

Even healthy people respond differently to vaccinatio­n, so it is normal to see variation in protection among the vaccinated, Ellebedy said.

For 95 people out of 100, vaccines from Pfizer- BioNTech and Moderna will provide effective protection.

The problem is, it’s essentiall­y impossible to figure out ahead of time who is most vulnerable. Certain factors like age, obesity and lung disease increase the risk of serious disease if someone is infected. So does the load of virus they inhale and what medication­s they’re taking, he said.

Some people will test positive for the virus despite vaccinatio­n, but the immune protection they received will keep virtually all those people from getting seriously ill.

Vaccinatio­n also makes people less likely to shed large amounts of virus, Ellebedy said, meaning they are less likely than an unvaccinat­ed infected person to get someone else sick. Anything that decreases the amount of virus replicatin­g itself in the respirator­y tract will decrease the probabilit­y of passing on that virus, he said. “Transmissi­on will decrease like everything else.”

And though the data remains thin, vaccinatio­n also likely protects against long- haul COVID- 19, in which people have symptoms weeks or months after they clear their initial infection, said David Holtgrave, dean of the School of Public Health at the University at Albany, State University of New York.

“Long- haul symptoms in persons who are fully vaccinated may be theoretica­lly possible but are likely rare given the overall effectiveness of the vaccines ( after being fully vaccinated); however, we could use more data to know that for certain,” he said via email. “That is why we need this more robust national surveillan­ce system.”

A previous coronaviru­s infection provides some protection against the delta variant, but someone who got COVID- 19 months ago might not have enough of an immune response left, del Rio said.

“My advice if you have been infected, is you should trust your natural immunity for about three months. But after three months, you should get vaccinated,” he said.

People who were infected and then vaccinated are probably well- protected. Ellebedy said.

Context also matters, Ellebedy and others said. A vaccinated person who lives in a community with a high vaccinatio­n rate and a low infection rate probably can avoid using a mask.

Ellebedy lives in Missouri, where infections have recently doubled and just 40% of the public is vaccinated. So he masks up in public, indoor places.

While the CDC said mask- wearing isn’t mandatory except in medical and transporta­tion settings, numerous experts told USA TODAY it’s a good idea to wear a mask in indoor settings with people who are possibly unvaccinat­ed.

Wearing a mask on top of being vaccinated is the safest way to avoid getting infected or passing on the virus to someone whose weakened immune system prevented them from getting full protection from the vaccine.

“Everyone should closely look at the environmen­t where they are,” Ellebedy said. “Delta unfortunat­ely has brought these doubts back again.”

In the United States, infections have more than doubled since the week of June 22. Total cases have risen in all 50 states since last week, and deaths also are beginning to climb, although the infection rates remain 90% below what they were at the peak in January.

That puts vaccinated people at risk because there’s simply more virus out there, said Dr. George Rutherford, an infectious disease specialist at the University of California, San Francisco.

“The more people who are running around infectious, the more you, as someone who’s been vaccinated, are likely to come into contact with it.”

Unvaccinat­ed are getting sick

At Staten Island University Hospital in New York, there are 15 COVID- 19 patients, 13 of whom are unvaccinat­ed, said Dr. Theodore Strange, the hospital’s chairman of medicine.

One of the vaccinated patients, a 93year- old man with many other health problems, received his shots at the beginning of the year but may have had a weaker response because of his age and health, Strange said. The remaining vaccinated patient was hospitaliz­ed for something else and didn’t know they had COVID- 19 until a coronaviru­s test came back positive.

Strange said his COVID- 19 patients are about 10 years younger now than they were a year ago, with an average age of 55- 60. Some are even younger, he said, rattling off ages: “29, 38, 42, 50.”

Vaccinatio­ns deserve the credit, he said, because about 70% of people on Staten Island over 65 are vaccinated, compared with 38% of those 40 and younger. He’s disappoint­ed more people haven’t been willing to be vaccinated, despite the risk of infection and of “being the bullet in the gun,” potentiall­y bringing the virus home to older, more vulnerable relatives.

He related a conversati­on he had last week with a patient who didn’t want to be vaccinated. Strange had recently prescribed the man a medication with many more potential side effects than the vaccines. “The pill I gave him was clearly more much poisonous than any vaccine,” Strange said, but the man didn’t want to take something he perceived as coming from the government.

Strange has been trying an individual approach to persuade people to get the shots, including visiting a local bowling alley, churches, park benches, “whatever it takes.”

But still, he said, the curve of coronaviru­s infections is very similar to the one followed by the 1918 flu, a pandemic that lasted three years.

“If we’re not going to avail ourselves of current technology and science,” he said, “then shame on us.”

 ?? CHARLIE RIEDEL/ AP ?? At the National World War I Museum and Memorial in Kansas City, Mo., flags honor victims of the pandemic.
CHARLIE RIEDEL/ AP At the National World War I Museum and Memorial in Kansas City, Mo., flags honor victims of the pandemic.
 ?? PAT MCDONOGH/ USA TODAY NETWORK ?? Santana Hickman, 15, receives a COVID- 19 vaccine in May at a clinic in Louisville, Ky.
PAT MCDONOGH/ USA TODAY NETWORK Santana Hickman, 15, receives a COVID- 19 vaccine in May at a clinic in Louisville, Ky.

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