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Breakthrough Deaths Comprise Increasing Proportion of Those Who Died from COVID-19

Arielle Mitropoulos wrote . . . . . . . . .

A growing proportion of COVID-19 deaths are occurring among the vaccinated, a new ABC News analysis of federal data shows.

In August of 2021, about 18.9% of COVID-19 deaths occurred among the vaccinated. Six months later, in February 2022, that proportional percent of deaths had increased to more than 40%.

Comparatively, in September 2021, just 1.1% of COVID-19 deaths occurred among Americans who had been fully vaccinated and boosted with their first dose. By February 2022, that percentage had increased to about 25%.

Experts said the increase in breakthrough deaths is expected with more Americans reaching full vaccination status.

“These data should not be interpreted as vaccines not working. In fact, these real-world analyses continue to reaffirm the incredible protection these vaccines afford especially when up to date with boosters,” said Dr. John Brownstein, an epidemiologist at Boston Children’s Hospital and an ABC News contributor.

In addition, many vulnerable Americans are more than one year out from their primary vaccinations and have yet to receive booster doses.

To date, more than 220 million Americans have been fully vaccinated, 100 million of whom have received their first COVID-19 booster. However, about 91.5 million eligible Americans — about half of those currently eligible — have yet to receive their first booster shot.

The increase in breakthrough deaths comes as a growing proportion of older Americans enter the hospital for COVID-19 related care.

Last summer, after more vulnerable, older populations had been vaccinated, the share of Americans ages 65 years and older in the hospital had dipped to a pandemic low — with younger populations representing the largest age groups of people in need of care. However, throughout the omicron surge, the average age of those in the hospital with COVID-19 has steadily gotten older again.

More than 90% of seniors have been fully vaccinated, but a third of them have yet to receive their first booster shot. Even with overall high vaccination rates in older populations, in recent months, during the omicron surge, 73% of deaths have been among those 65 and older.

Health experts said vaccines and boosters continue to provide significant protection against severe disease. However, waning immunity re-emphasizes the urgency of boosting older Americans and high-risk Americans with additional doses.

“This trend in increased risk among the elderly further supports the need for community wide immunization. Older populations, especially those with underlying conditions, continue to be at great risk of severe complications, especially as immunity wanes. The best way to protect them is to make sure everyone around them is fully immunized,” Brownstein said.

All Americans over the age of 50, immunocompromised people over the age of 12, and people who received two doses of the Johnson and Johnson vaccine, are currently eligible for a second booster.

Approximately 10.5 million people in the U.S. have received their second booster dose.

“Given the fact that immunity is waning, we’ve got to get people boosted,” Dr. Anthony Fauci told GBH News’s Boston Public Radio on Monday.

In February, unvaccinated adults were 10 times more likely to die of COVID-19 compared to vaccinated individuals and five times more likely to require hospitalization, according to data from the Centers for Disease Control and Prevention.

Compared to fully vaccinated and boosted adults, unvaccinated people were about 20 times more likely to die of COVID-19 and seven times more likely to require hospitalization.


Source : abc News

Breakthrough Infections With SARS-CoV-2 Omicron Despite mRNA Vaccine Booster Dose

Constanze Kuhlmann, Carla Konstanze Mayer, et al. wrote . . . . . . . . .

The most recent SARS-CoV-2 variant of concern to emerge has been named omicron. Its immune evasion potential was predicted by genomic data and has been preliminarily confirmed by observations of an increased incidence of reinfections and breakthrough infections. This has triggered calls to intensify vaccination programmes including provision of vaccine booster doses.

A group of German visitors who had received three doses of SARS-CoV-2 vaccines, including at least two doses of an mRNA vaccine, experienced breakthrough infections with omicron between late November and early December, 2021, while in Cape Town, South Africa. The group consisted of five White women and two White men) with an average age of 27·7 years (range 25–39) and a mean body-mass index of 22·2 kg/m2 (range 17·9–29·4), with no relevant medical history. Four of the individuals were participating in clinical elective training at different hospitals in Cape Town, whereas the others were on vacation. The individuals were members of two unlinked social groups and participated in regular social life in Cape Town, in compliance with applicable COVID-19 protocols. Upon arrival during the first half of November, 2021, each individual tested negative for SARS-CoV-2 by PCR and provided records of complete vaccination, including booster or third, doses administered via intramuscular injection using homologous (n=5) and heterologous (n=2) vaccination courses (appendix p 3).

Six individuals were fully vaccinated with BNT162b2 (Comirnaty, Pfizer–BioNTech, Mainz, Germany), five of whom received a third (booster) dose of BNT162b2 in October or early November, 2021. One individual had received a full dose of CX-024414 (Spikevax, Moderna, Cambridge, MA, USA) in early October, 2021; this was not in line with the European Medicines Agency recommendations at that time, which suggested a half dose to boost healthy individuals.5 The seventh individual received an initial dose of ChAdOx1-S (Vaxzevria, AstraZeneca, Cambridge, UK), followed by a dose of BNT162b2 for completion of primary immunisation, and a booster dose of the same vaccine. Except for the CX-024414 booster, all vaccinations were in accordance with European recommendations.4, 5 The early timepoints of some individuals’ primary and booster vaccinations were due to their occupation in the medical field. Nobody reported a history of SARS-CoV-2 infection.

During a marked increase in incidence of SARS-CoV-2 infections in the Western Cape province, these individuals observed onset of respiratory symptoms between Nov 30 and Dec 2, 2021. SARS-CoV-2 infections were diagnosed by ISO 15189-accredited diagnostic laboratories using molecular assays approved by the national regulator.

The investigation was approved by the Health Research Ethics Committees of Stellenbosch University (C21/12/004_COVID-19) and the University of Cape Town (279/2021) and all participants provided informed consent.

We obtained swab and serum samples 2–4 days after onset of symptoms. Futher details of how samples were processed are provided in the appendix (p 2). All patients were placed in domestic isolation and used a daily symptom diary to document the course of disease during the observation period of 21 days.

Illness was classified as mild (n=4) or moderate (n=3; shortness of breath) according to National Institutes of Health COVID-19 Treatment Guidelines. Two individuals were asymptomatic by the end of the observation period (day 21). Blood oxygenation levels (SPO2) remained in the normal range (>94%) without exception and none of the patients required hospitalisation. Prevalence of symptoms over time is provided in the appendix (p 4).

All seven individuals were infected with omicron (PANGO lineage B.1.1.529, Nextstrain clade 21K). Viral loads ranged from 4·07 to 8·22 (mean 6·38) log10 viral RNA copies per mL of swab eluate. Anti-spike antibody levels ranged from 15 000 arbitrary units (AU) per mL to more than 40 000 AU/mL, with a mean of approximately 22 000 AU/mL of serum (appendix p 3).

Robust CD4 and CD8 T-cell responses to SARS-CoV-2 spike, nucleocapsid, and membrane proteins were detected in six of the participants tested after a minimum of 2 weeks after onset of symptoms (appendix p 5), at frequencies of 0·011–0·192% for CD4+ and 0·004–0·079% for CD8+ T cells.

These were the first documented breakthrough infections with the omicron variant in fully vaccinated individuals after receipt of booster vaccine doses. Some of these individuals had received heterologous vaccine doses, in line with emerging global practice. Booster doses were administered 21–37 weeks after the second vaccine doses, and breakthrough infections occurred 22–59 days thereafter. At the onset of their breakthrough infections, all individuals had high levels of viral spike protein binding antibodies, similar to levels reported 4 weeks following second vaccine doses6 and as expected after receipt of booster vaccine doses.

Viral RNA loads in omicron variant infections have yet to be reported. It remains unknown whether the viral loads observed in our group are different from those in unvaccinated, or differently vaccinated, individuals. During wild-type SARS-CoV-2 infection, an average viral RNA load of 5·83 log10 viral RNA copies per swab was found in samples taken up to day after onset of symptoms,8 with a maximum of 8·85 log10 viral RNA copies per swab. In this group of individuals, an average of 6·38 log10 viral RNA copies per mL of eluted swab was detected, with the highest viral load (8·22 log10) detected on day 4 after onset of symptoms. This suggests that the individuals were infectious, in keeping with the occurrence of infection clusters sparing none of the members of the two groups.

Specific T-cell responses were detected in all participants tested at least 2 weeks after symptom onset, in the range reported after vaccination, with additional T-cell responses to the viral nucleocapsid and membrane proteins.
The mild to moderate course of illness suggests that full vaccination followed by a booster dose still provides good protection against severe disease caused by omicron. However, we cannot exclude long-term sequelae of COVID-19. Furthermore, our findings are limited to a low number of individuals in relatively young and otherwise healthy individuals (n=7). This case series adds further evidence that, as predicted, omicron is able to evade immunity induced by mRNA vaccines in vivo. South Africa only recently introduced booster vaccinations for individuals immunised with two doses of BNT162b2, so the presence of this group from Germany presented a unique opportunity to study omicron breakthrough infections in individuals with mRNA vaccine boosters.

In-vitro data suggest lower titres of neutralising antibodies against omicron compared to other SARS-CoV-2 lineages following BNT162b2 vaccination but increased titres after a third dose, supporting calls for booster doses while the omicron variant appears to be spreading globally. Our study, however, demonstrates insufficient prevention of symptomatic infection in otherwise healthy individuals who had received three doses of COVID-19 mRNA vaccines.
These findings support the need for updated vaccines to provide better protection against symptomatic infection with omicron13 and emphasise that non-pharmaceutical measures should be maintained. Encouragingly, early data from South Africa suggest maintained if reduced effectiveness of the BNT162b2 vaccine against hospital admission.


Source : Lancet

Chart: Nearly 40 percent of All Illinois COVID Deaths in the Last Month Are Breakthroughs

Source : Wirepoints

Nosocomial Ooutbreak Caused by the SARS-CoV-2 Delta Variant in a Highly Vaccinated Population, Israel, July 2021

Pnina Shitrit, Neta S Zuckerman, Orna Mor, Bat-Sheva Gottesman, Michal Chowers wrote . . . . . . . . .

Israel was one of the first countries to achieve a high level of full vaccination with the Comirnaty (BNT162b2 mRNA, BioNTech-Pfizer, Mainz, Germany/New York, United States (US)) vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). From May through mid-June 2021, with more than 55% of the population fully vaccinated, new cases decreased to less than two cases per million, with no social restrictions, indicative of very high vaccine effectiveness. Since mid-June, a sharp increase in cases has been observed, attributed to the SARS-CoV-2 Delta variant (Phylogenetic Assignment of Named Global Outbreak (Pango) lineage designation B.1.617.2 and AY.* sublineages), which by mid-July constituted more than 95% of sequenced virus isolates in Israel. This variant was assessed to have higher transmissibility than the Alpha variant (B.1.1.7 and Q.* sublineages).

We present an investigation of a coronavirus disease (COVID-19) outbreak that started from one unidentified COVID-19 patient, with extensive, rapid nosocomial spread among vaccinated, including individuals wearing surgical masks.

Setting

Meir Medical Center has 780 beds, most rooms accommodate three to four patients, 1 m apart with separation curtain partitions between beds. Starting in March 2020, patients have been encouraged to wear surgical masks. Although use was inconsistent, it was enforced during patient–staff encounters for both sides. On the dedicated COVID-19 ward, dedicated staff members worked with full personal protective equipment (PPE): N-95 mask, face shield, gown, gloves and hair cover.

Outbreak investigation

Contact investigations were carried out by trained infection control personnel and were initiated after suspected nosocomial acquisition or COVID-19 diagnosis of a staff member confirmed by positive PCR for SARS-CoV-2. All exposed individuals were PCR-tested for SARS-CoV-2. All those testing positive were considered as a COVID-19 case. All data were collected in real time and included all patients and personnel exposed to a case, last negative SARS-CoV-2 test, presence of symptoms, date of symptom onset, any sick family member, and vaccination status and date. All exposed individuals were PCR-tested for SARS-CoV-2. Whenever more than one patient was identified as COVID-19 case, all staff and patients on the ward were screened regardless of a known encounter with the positive case. All exposed patients found negative in the first screening, were cohorted and rescreened 7 days post exposure. All identified cases were either transferred to a dedicated COVID-19 unit or discharged as per clinical status.

The index case was a fully vaccinated haemodialysis patient in their 70s. They were admitted to Ward A in mid-July with fever and cough and placed in a room with three other patients. On admission day, the index case was not tested for SARS-CoV-2, because their symptoms were mistaken for possible bloodstream infection exacerbating congestive heart failure. During their stay, the index case and one roommate were dialysed every other day in the dialysis unit. Four days after admission, the index case was diagnosed with COVID-19 by PCR for SARS-CoV-2 E gene with a quantitative cycle (Cq) value of 13.59; the case was therefore transferred to a COVID-19-dedicated unit of Ward B. On the same day, all three of this case’s roommates on Ward A were screened for SARS-CoV-2 and tested positive and were transferred to the dedicated ward or discharged.

The contact investigation included Ward A, the dialysis unit (contacts of the index case) and Ward C following a 1-day stay of Case 1. This investigation revealed a total of 27 COVID-19 cases by SARS-CoV-2 PCR: 16 patients, including the index case, nine staff and two family members.

The COVID-19 diagnosed cases were transferred on the day of their diagnosis to a COVID-19 unit on Ward B, which operated as a mixed ward because of the small number of COVID-19 patients in our hospital at the time. Half the ward was dedicated to COVID-19 patients, with dedicated staff in full PPE, while half remained a regular ward. The index case was treated on transfer day by a healthcare worker (HCW) who had recovered from COVID-19 a year earlier, and was vaccinated once, as per Israeli guidelines. Three days after transfer day, this HCW attended a room in the regular ward with three patients of whom two developed symptoms compatible with COVID-19 2 days later and tested positive for SARS-CoV-2. Contact investigation on Ward B identified a total of 19 COVID-19 cases by SARS-CoV-2 PCR: 10 staff, including the aforementioned HCW, eight patients, including the three above, and one family member.

The calculated attack rate among all exposed patients and staff was 10.6% (16/151) for staff and 23.7% (23/97) for patients, in a population with 96.2% vaccination rate (238 vaccinated/248 exposed individuals).

Sequencing and analysis

Sequence and patient data were obtained via the Israel National Consortium of SARS-CoV-2 sequencing. FASTQ files underwent processing, mapping to the reference genome (NC_045512.2) and construction of consensus FASTA sequences as previously described. All sequence data were deposited and are available in GISAID. Phylogenetic trees were constructed using NextStrain’s Augur pipeline and visualised with auspice.

We conducted phylogenetic analysis on the whole-genome SARS-CoV-2 sequences that were available for 12 cases in this outbreak, including staff and patients from Wards A, B and C and dialysis departments (Figure). All were infected with the Delta variant and epidemiologically and phylogenetically connected to the same outbreak except for Case 11 from Ward C. Case 11 and three staff members identified on Ward C were not considered as part of this outbreak. The three staff members from Ward C were exposed to both Case 1 and Case 11 and therefore the source of their infection could not be verified.

Whole genome-based phylogenetic tree of SARS-CoV-2 Delta isolates, nosocomial outbreak, Israel, July 2021 (n =12)

Demographic and clinical information

Of the 42 cases diagnosed in this outbreak, 38 were fully vaccinated with two doses of the Comirnaty vaccine, one was recovered with one vaccination and three were unvaccinated. The median age was 55 years (interquartile range (IQR): 36–77.5) and 24 were female. Twenty-three were patients, 16 staff members and three family members. The median time from second vaccine dose to breakthrough infection was 177 days (range 111–194). On the day of diagnosis, only 24 individuals were symptomatic, but in the following days, 36 had become symptomatic. All staff (median age: 33 years; range: 22–48) remained asymptomatic or with mild disease. Among the patients (median age: 77 years; range: 42–93; median time from second vaccine dose to infection: 176 days; range: 143-188), eight became severely ill, six critically ill and five of the critically ill died. The patient population was considerably older than staff and all patients had comorbidities: diabetes mellitus (n = 9), hypertension (n = 16), ischemic heart disease (n = 12), congestive heart failure (n = 7), dementia (n = 5), body mass index > 30 (n = 8), chronic renal failure (n = 11) of whom six were on dialysis. Eight patients were immunocompromised.

The median Cq values on diagnosis days were 19.9 (IQR: 17.8–25.1) and were lower for symptomatic individuals (median: 18.2; IQR: 15.7–21.7) than for asymptomatic individuals (median: 22; IQR: 18–28), but the difference was not statistically significant.

Ethical statement

The clinical data of this work was from an outbreak investigation; thus ethical approval was waived by the Meir Medical Center Ethical committee. The bioinformatics work was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of the Sheba Medical Center institutional review board (7045–20-SMC). Patient consent was waived because the study used remains of clinical samples and the analysis used anonymous clinical data.

Discussion

We have investigated a nosocomial COVID-19 outbreak involving the SARS-CoV-2 Delta variant among a highly vaccinated population. The attack rate among exposed individuals reached 23.3% in patients and 10.3% in staff, with 96.2% vaccination rate among exposed individuals. Moreover, several transmissions probably occurred between two individuals both wearing surgical masks, and in one instance using full PPE, including N-95 mask, face shield, gown and gloves.

In a recent publication by Bernal et al., the effectiveness of full vaccination with the Comirnaty vaccine against the Delta variant was high, although lower than against the Alpha variant (88% vs 93.7%). This was not the experience in Israel, with a rapid increase in cases since June 2021 despite a high vaccination rate.

Although reports of breakthrough infections are increasing [10-12], this communication emphasises several points. It challenges the assumption that high universal vaccination rates will lead to herd immunity and prevent COVID-19 outbreaks. This was probably true for the wild-type SARS-CoV-2 virus, but in the outbreak described here, 96.2% of the exposed population was vaccinated. Infection advanced rapidly (many cases became symptomatic within 2 days of exposure), and viral load was high. Another accepted view is that, when facing a possible mismatch between the SARS-CoV-2 variant and vaccine or waning immunity, the combination of vaccine and face mask should provide the necessary protection. Although some transmission between staff members could have occurred without masks, all transmissions between patients and staff occurred between masked and vaccinated individuals, as experienced in an outbreak from Finland. We cannot rule out that protection measures were not optimally implemented, however, transmissibility in summer 2021 differs from our experiences in the previous 18 months. Whether this can be attributed to the low Cq and high transmissibility of the Delta variant is not clear. Of note, in our cases, in particular case patients, the time from vaccination was considerable. The shortest interval was 142 days (5 months), and many of our case patients advanced to severe disease. Data from Israel imply that the main reason for the increase in COVID-19 cases in summer is indeed waning immunity, and a third vaccine dose, 5 months after the second dose will possibly result in trend reversal.

Conclusion

This nosocomial outbreak exemplifies the high transmissibility of the SARS-CoV-2 Delta variant among twice vaccinated and masked individuals. This suggests some waning of immunity, albeit still providing protection for individuals without comorbidities. However, a third vaccine dose may be needed, particularly in individuals with risk factors for severe COVID-19. Appropriate use of masks, especially in high-risk settings is advised.


Source : Eurosurveillance

‘Post-Vax COVID’ Is a New Disease

Katherine J. Wu wrote . . . . . . . . .

Boghuma Kabisen Titanji was just 8 years old when the hyper-contagious virus swept through her classroom. Days later, she started to feel feverish, and developed a sparse, rosy rash. Three years after being fully dosed with the measles vaccine, one of the most durably effective immunizations in our roster, Titanji fell ill with the very pathogen her shots were designed to prevent.

Her parents rushed her to a pediatrician, worried that her first inoculations had failed to take. But the doctor allayed their fears: “It happens. She’ll be fine.” And she was. Her fever and rash cleared up in just a couple of days; she never sickened anyone else in her family. It was, says Titanji, now an infectious-disease physician and a researcher at Emory University, a textbook case of “modified” measles, a rare post-vaccination illness so mild and unthreatening that it doesn’t even deserve the full measles name.

The measles virus is ultra-infectious, much more so than SARS-CoV-2, and kills many of the uninoculated children it afflicts. But for those who have gotten all their shots, it’s a less formidable foe, which we’ve learned to live with long-term. That’s the direction that many experts hope we’re headed in with SARS-CoV-2 as it becomes endemic, as my colleague Sarah Zhang has written.

We’re not yet at the point where we can officially label post-vaccination COVID-19 cases as “modified”; maybe we never will be. Some immunized people are still getting dangerously sick. But the shots are softening COVID-19’s sharp edges: On average, breakthrough infections seem to be briefer, milder, and less contagious. Among the fully immunized, catching the coronavirus doesn’t mean the same thing it did last year. “It’s a very different kind of infection than in people who are immunologically naive,” Lindsey Baden, an infectious-disease physician and COVID-19 vaccine researcher at Brigham and Women’s Hospital in Boston, told me.

If this virus becomes as inescapable as the culprits behind the colds and flus that trouble us most years, we could all have to grapple with one of these infections, and learn that lesson on a personal level. That’s the social tax of a forever virus: Nearly everyone may eventually know what it is to get COVID-19—but a tamer, more domesticated version of its pre-inoculation self.

Since the start, COVID-19 has been tough to define.

Part of the problem is that COVID-19 is the disease, not the virus. Actual microbes, compared with the problems they cause, are arguably neater conceptual packages. SARS-CoV-2 is a knowable pathogen, a tangle of genetic material swaddled in a protein coat; COVID-19 has fuzzier boundaries, dependent on both the virus and how our bodies react to it. To understand that interaction, researchers had to, unfortunately, wait for a decent number of people to get sick—to observe the virus screwing with us in real time.

Next to other airway-loving viruses, such as the ones that cause the flu and common colds, SARS-CoV-2 can be a bit of an oddball. It lopes almost indiscriminately throughout the body, invading a plethora of tissues; it winds up certain immune responses, while dialing others down, sparking bouts of inflammation that can afflict everything from brain to toe. COVID symptom lists that at first focused on the virus’s ground zero—the respiratory tract—eventually ballooned to include nausea, vomiting, changes in mental status, and chest pain. Infection severity operates on a continuum, and SARS-CoV-2 occupies its spectrum fully. Many people never realize they’re infected; others might have a two-day tickle in their throat, while some weather the disability of long-haul COVID for months; a fraction end up ventilated in the ICU.

The experience of having COVID is now poised to splinter further, along immunological boundaries largely defined by vaccines. Inoculated bodies are less hospitable to SARS-CoV-2, making it harder for the pathogen to infect them; when it still manages to, it seems to be purged much faster, affording it less time to cause symptoms—especially the bad ones—and fewer opportunities to hop into other hosts. “I think about it as defanging the virus,” Natalie Dean, a biostatistician at Emory, told me.

A recent study from the United Kingdom illustrates this well. Researchers surveyed nearly 4.5 million people through a cellphone app, asking whether they’d tested positive for the virus, and if they were experiencing any of about two dozen symptoms. Roughly 1 million of them had received at least one vaccine dose. Among the fully immunized, nearly all the symptoms—including fever, nausea, and brain fog—were rarer. Many of the cases were totally asymptomatic. Even rates of long COVID, which can sprout from initially silent infections, seemed to be substantially slashed by shots.

These qualitative shifts aren’t easy to capture, especially with the studies coming out now that measure vaccine effectiveness in the real world. Most of them gravitate toward metrics at two opposite ends of the SARS-CoV-2 spectrum—how well the vaccines protect against all infections, or against severe disease, hospitalizations, and death—with less precision around the murky hinterlands of mid-level symptoms that exist in between. (The most serious outcomes are, to be fair, what vaccines are intended to prevent, and what inoculated immune systems are best at staving off, making that metric a pretty good one to concentrate on.)

Focusing on the extremes, though, blurs the texture in the middle. In studies of effectiveness against severe disease, anything too “mild” to be considered a serious illness—warranting hospitalization, for instance—ends up collapsed into a single category. At the other end of the spectrum, counting all infections equates every positive test to a case of concern, regardless of how gentle the viral encounter was. All of this makes it very difficult to characterize what post-vaccine COVID actually is—and to know whether immune responses are diluting the disease’s sting. “Just looking at the rate … loses that point,” Holly Janes, a biostatistician at the Fred Hutchinson Cancer Research Center in Seattle, told me. The experience of infection can be “considerably different for someone who was vaccinated.”

This isn’t an easy dilemma to solve. During the vaccine makers’ clinical trials, researchers were able to study participants closely enough to examine how well the shots were blocking any symptomatic cases of COVID-19. (Studying only the severest disease, which are relatively rare events, wouldn’t have been feasible without making the trials even larger, or stretching them out longer.) “Real-world studies are like the wild, wild West,” Dean told me. Researchers often have to wrestle evidence out of electronic medical records, which aren’t logged consistently, or they have to depend on people to seek out tests and accurately remember their symptoms. They might monitor only the worst infections, because they’re more likely to prompt people to seek clinical care and are easier to document and study. Milder cases, meanwhile, are squishier, more subjective; not everyone will interpret an ache or a pain in the same way, or follow up on it with a professional. The studies that have tackled the task of measuring real-world vaccine effectiveness against all symptomatic disease may not always count the same COVID-19 symptoms, experts told me, potentially inflating or deflating numbers. Thorniest of all may be the data investigating long COVID, which still lacks a universal case definition, after vaccination, Lekshmi Santhosh, a critical-care physician at UC San Francisco, told me. “Most studies aren’t even looking,” she said.

Important variations exist, even at SARS-CoV-2’s extremes. Some hospitalized patients might be admitted for just a couple of days, while others need weeks of critical care or die. Early evidence hints that vaccines are batting away the worst blows here as well, another nuance lost when hospitalizations are lumped together. Positive test results, too, can be misleading. Tests, which hunt for precise pieces of the pathogen, can’t distinguish between viruses that are intact, or that have been blown to smithereens by a protective immune response; SARS-CoV-2 carnage, especially in a person who’s immunized and asymptomatic, doesn’t guarantee disease or transmission. “It doesn’t mean the same thing to test positive if you’re vaccinated,” Julie Downs, a health-communications expert at Carnegie Mellon University, told me.

Still, some infections among immunized people will pose a low-but-not-nonexistent transmission risk, especially to the vulnerable among us, and we can’t yet afford to tune the milder cases out. A much larger fraction of the global population will need protection before COVID-19 can truly be considered mellower than before. But the fates of the inoculated and the uninoculated are clearly already forking, a potential preview of what’s to come, Baden, the Boston physician, told me. “If I were a betting man, I’d say, years from now, this will be another common cold.” Titanji, of Emory, has already confronted the likelihood that her childhood bout of modified measles might foreshadow her experience with the coronavirus. When she sees patients in her clinic in Georgia, she tells them, “We’re all very likely going to have COVID, including myself. But it is okay. I have a vaccine that will prevent me from landing in the hospital.”

COVID-19’s march toward diminution won’t be linear or uniform. Immune cells forget; viruses shape-shift; our vaccines will need touch-ups or boosts. Behavioral slipups—vaccine refusals, spotty masking during outbreaks—will create cracks for the pathogen to wriggle through. But on a population level, our future could look quite good. Most people will end up getting COVID-19 in their lifetime. In most cases, it won’t be so bad. Eventually, silent or mild infections will feel less catastrophic, because many of us will have confidence that they are unlikely to progress. Outbreaks might be smaller and slower-spreading, and breakthroughs will no longer be headline-making news. Positive test results, in the absence of symptoms, could generally be shrugged off, and infection will no longer feel quite so synonymous with disease. Our bodies will come to see the virus as familiar—not necessarily a welcome guest, but not quite the intruder it was before.

Data alone won’t define our experience here; our understanding of post-vaccination infection will need to come firsthand, too. For me, the pandemic anxiety that dominated much of 2020 is slow to fade, and the idea of getting COVID-19 still feels far worse than getting the flu, even if the symptoms were identical. “It takes time to get over that,” Downs told me.

A small number of post-vaccination infections are now trickling into my social circles, and it’s actually been sort of comforting to hear some of the stories. A few days ago, I talked with Jayne Spector, who just became mother-in-law to one of my best friends. Spector tested positive for the coronavirus a couple of weeks ago—shortly after attending her grandmother’s funeral, where she’d hugged and kissed dozens of family members. Among them was her daughter, who was, at the time Spector received her test result, about to have her wedding, just 11 days later.

“I was really worried I had infected my soon-to-be-married daughter,” Spector told me. And had Spector not been vaccinated, “I think it would have been a disaster.” But Spector was vaccinated. So were almost all the family members she mingled with at the funeral—her daughter included—and not a single one of her contacts has tested positive. (They also kept a lot of the interactions outdoors, and wore masks inside.) Spector isolated at home, where she dealt with what she compares to a nasty but relatively fast-resolving cold—a paltry echo, she suspects, of the sickness she would have had, if not for her shots. “The fact that I’m vaccinated means that it’s tolerable,” she told me. “I took the precautions; I stayed away from others. Now I’m going back to my life.” Her daughter’s wedding was this past Saturday. All 18 people in attendance were fully vaccinated, and tested negative before the ceremony. Spector was one of them.


Source : The Atlantic

More Than 100 Ontario Youth Sent to Hospital for Vaccine-related Heart Problems

Anthony Furey wrote . . . . . . . . .

A report quietly released last week by Public Health Ontario (PHO) tallies the number of people in the province who have presented to hospital with heart inflammation following mRNA vaccination, and it skews heavily towards young people.

As of Aug. 7, there were 106 incidents of myocarditis/pericarditis in Ontarians under the age of 25. That’s slightly more than half of the total of all such incidents.

Broken down further, 31 of these cases were in 12- to 17-year-olds and 75 were in 18- to 24-year-olds. The vast majority — 80% — were in males.

The report explains that PHO issued a directive in June for public health units to increase their surveillance of this side effect following reports from the United States and Israel of similar concerns unfolding in those countries.

“The reporting rate of myocarditis/pericarditis was higher following the second dose of mRNA vaccine than after the first, particularly for those receiving the Moderna vaccine as the second dose of the series (regardless of the product for the first dose),” the report explains.

PHO adds that the reporting rate for heart inflammation in those 18-24 was seven times higher with Moderna than with Pfizer. (The only vaccine currently used for 12- to 17-year-olds in Ontario is Pfizer.)

While PHO initially worked with reports of 314 such incidents, upon further investigation they narrowed that number down to just over 200.

There have in total been 202 emergency room visits across all age groups for such issues following vaccination, with 146 leading to hospitalization. Three of these have led to ICU admission.

When it comes to older age brackets, there were 54 persons aged 25-39 included in the tally and 44 persons aged 40 and over.

When broken down by the number of overall people who have received the vaccines, the reporting rate for this side effect is 7.4 per million for Pfizer and 20 per million for Moderna.

The highlights section of the PHO report conclude with a note that “COVID-19 vaccines continue to be recommended and are highly effective at preventing symptomatic infection and severe outcomes from COVID-19 disease, which is also associated with a risk of myocarditis.”


Source : Toronto Sun

Study: Fully Vaccinated People with “Breakthrough” COVID Delta Infections Carry as Much Virus as the Unvaccinated

Tucker Reals wrote . . . . . . . . .

A study by University of Oxford scientists has found that people who contract the Delta variant of COVID-19 after being fully vaccinated carry a similar amount of the coronavirus as those who catch the disease and have not been inoculated. The researchers stressed that vaccination still offers good protection against catching the disease in the first place, and protects against getting seriously ill with it.

The survey of real-world U.K. data indicates, however, that vaccinated people with “breakthrough” infections could still pose a significant infection risk to those who have not been vaccinated.

“With Delta, infections occurring following two vaccinations had similar peak viral burden to those in unvaccinated individuals,” the study, which has not yet been peer reviewed, concludes. Viral “burden” or viral load refers to how much coronavirus-infected people carry and thus “shed,” or release into the environment around them, where it can potentially infect others.

The survey compared U.K. government data on more than 380,000 people who tested positive for the coronavirus between December and May of this year, when the first-discovered Alpha variant accounted for most of the cases in Britain, with figures for more than 350,000 people infected over the following four months, when Delta was dominant.

Oxford’s lead researcher, Dr. Sarah Walker, told The Telegraph that the study shows two doses of the Pfizer/BioNTech, Moderna or AstraZeneca vaccines “are still protective. You are still less likely to get infected – but if you do, you will have similar levels of virus as someone who hasn’t been vaccinated at all.”

The data used for the study do not show how likely it is that a fully vaccinated person with the Delta variant can pass on the infection to another individual, compared to an unvaccinated individual with the virus. But the high viral loads found in the study are a strong indicator that the risks of transmission from both vaccinated and unvaccinated people with the Delta variant could be similar.

Biden to tie vaccines for nursing home staff to funding
The findings could have implications for policy makers who’ve banked for months on hopes that by vaccinating a large proportion of any given population, they will also protect people who cannot or will not get inoculated themselves by reducing transmissions overall.

“The fact that they [fully vaccinated people] can have high levels of virus suggests that people who aren’t yet vaccinated may not be as protected from the Delta variant as we hoped,” Walker told the British newspaper. “It comes back to this concept of herd immunity, and the hope that the unvaccinated could be protected if we could vaccinate enough people. But I suspect the higher levels of the virus in vaccinated people are consistent with the fact that unvaccinated people are still going to be at high risk.”

The message from Walker and her team at Oxford was clear: Vaccination remains the best way to protect against infection, and certainly against serious illness or hospitalization with COVID-19, including the Delta variant.

None of the coronavirus vaccines approved for use in the U.S. or U.K. thus far eliminate the risk of infection, but they all reduce that risk by between about 70% and 90% — and they’ve proven much more potent at preventing hospitalizations and deaths.

“There are lots of reasons why the vaccines may be very good at reducing the consequences of having the virus,” Walker told The Telegraph. “You may well still have a milder infection and might not end up getting hospitalized.”

She said that while the results of the ongoing vaccine effectiveness study were important, “they aren’t everything, and it is really important to remember the vaccines are super-effective at preventing hospitalizations.”


Source : CBS

I Went to a Party with 14 Other Vaccinated People; 11 of Us Got COVID

Allan Massie wrote . . . . . . . . .

I was sitting on an examination table at an urgent care clinic in Timonium, giving my history to a physician’s assistant. An hour later, she would call me to confirm that I was positive for COVID-19.

Given the way that I felt, it was what I expected. But it wasn’t supposed to happen: I’ve been fully vaccinated for months.

Five days earlier, I had gone to a house party in Montgomery County. There were 15 adults there, all of us fully vaccinated. The next day, our host started to feel sick. The day after that, she tested positive for COVID-19. She let all of us know right away. I wasn’t too worried. It was bad luck for my friend, but surely she wasn’t that contagious. Surely all of us were immune. I’d been sitting across the room from her. I figured I’d stay home and isolate from my family for a few days, and that would be that. And even that seemed like overkill.

The official Centers for Disease Control and Prevention guideline stated that, since I was fully vaccinated, I didn’t need to do anything different unless I started developing symptoms. I’m an epidemiologist at a major medical research university, which has a dedicated COVID exposure hotline for staff. I called it, and workers said I didn’t need to do anything.

Then, I started to hear that a few other people who had been at the party were getting sick. Then a few more. At this point, 11 of the 15 have tested positive for COVID.

Fortunately, none of us seems to be seriously ill. When fully vaccinated people experience so-called “breakthrough” infection, they tend not to progress to serious disease requiring hospitalization, and I expect that will be the case for us. But I can tell you that even a “mild” case of COVID-19 is pretty miserable. I’ve had fever, chills and muscle aches, and I’ve been weak enough that I can barely get out of bed. I don’t wish this on anybody.

Several Baltimore restaurants shut down after vaccinated staff members test positive for COVID »
Our research group at work has shown that the COVID vaccine isn’t always fully effective in transplant recipients. I’m proud of the work we’ve done. But once I got the vaccine, I figured the COVID battle was over for me. Out of an abundance of caution I took an antibody test shortly after my second vaccine dose. It was off the charts.

As much as I hate me and my fully-vaccinated friends being sick, I’ve been thinking about what our little outbreak among means for the rest of us. Here’s what I’ve concluded:

State and local health departments, and the CDC, need to do a better job collecting and reporting data on breakthrough infections. The CDC announced in May that it was only going to collect data on breakthrough infections that led to hospitalization or death, which are fortunately rare. But that means that outbreaks like ours will fly under the radar. Any of us could infect others, apparently including other vaccinated people. It’s not clear if our group got sick because of a particularly virulent variant, because the vaccine is wearing off or for some other reason. Without good data, we’ll never know.

Fully vaccinated people exposed to COVID need to isolate at home and get tested. I thought I might be overreacting by leaving work in the middle of the day and immediately moving to our basement at home. Now I’m glad I did.

Governments and businesses should consider bringing back masking requirements, even for vaccinated people. We’re still at risk of getting sick, and we’re still at risk of infecting others. The CDC recently recommended masks for vaccinated people in areas with over 50 new infections per 100,000 people per week. In the seven days before my exposure, Montgomery County had 19.4 new infections per 100,000 people.

Pharmaceutical companies, research institutions and governments should prioritize research into booster vaccines. At one point it seemed like two mRNA doses or a single Janssen dose might be the answer. But apparently, whether because of variants or fading immunity, being “fully vaccinated” doesn’t necessarily mean you’re immune.

COVID-19 vaccines do an enormous amount of good. I expect a milder course of disease since I’m vaccinated. But COVID-19 isn’t over, even for the vaccinated. As the pandemic continues to evolve, we need to evolve with it.


Source : Baltimore Sun

U.S. Provincetown COVID Outbreak Shows 74% Cases Are Among Fully Vaccinated

Ernie Mundell and Robin Foster wrote . . . . . . . . .

The Cape Cod resort town of Provincetown draws big crowds every summer. In July, those largely vaccinated crowds — packed into bars, restaurants and private homes — were the genesis of an outbreak of the Delta variant that could be a sobering model for the nation.

New data on the outbreak, released Friday, shows there were a known total of 469 COVID-19 cases “associated with multiple summer events” among Provincetown revelers. Three-quarters (74%) of those cases occurred among people who’d gotten their COVID vaccinations an average of almost three months before.

In 89% of those cases, the highly contagious Delta variant was implicated, concluded a team led by Dr. Catherine Brown of the Massachusetts Department of Public Health.

There was some good news, however: While many of the 346 cases among vaccinated individuals might have made them feel miserable for a time — coughs, headache, sore throat, aches and fever being the major symptoms — there were only four cases (1.2%) in this group that required hospital care.

In all four of those hospitalized cases, patients had underlying medical conditions that upped their odds for severe COVID-19, the researchers found.

A fifth case requiring hospitalization occurred in an unvaccinated patient, Brown’s team noted, and that case also involved an underlying medical condition.

There were no deaths linked to the outbreak.

The researchers noted that it’s not surprising that three-quarters of cases in the Provincetown outbreak occurred among the vaccinated, because a full 69% of the town’s vaccine-eligible residents have gotten their shots — a number that’s much higher than the national average.

Equal viral loads

However, given the increased transmissibility of the Delta variant, Brown’s team believe their findings “suggest that even jurisdictions with substantial or high COVID-19 transmission might consider expanding prevention strategies.”

Those strategies should include “masking in indoor settings regardless of vaccination status, given the potential risk of infection during attendance at large public gatherings,” they said.

The Provincetown findings also confirm that, unlike its predecessor, the Delta variant appears to produce high viral loads in people’s systems, upping transmission risks.

“Specimens from 127 vaccinated persons with breakthrough cases were similar to those from 84 persons who were unvaccinated,” the research team noted.

That finding helped drive the CDC’s decision this week to reverse course on its masking advisory. The agency now recommends that even the vaccinated once again don masks in many indoor settings, to lessen the odds they might transmit SARS-CoV-2 to others.

It also adds new energy to federal, state and local efforts to get more Americans vaccinated.

However, one leading infectious disease expert stressed that the one thing the Provincetown report should not do is lessen the average American’s faith in the power of vaccines to protect against what’s most important: Severe illness.

“The new data should not alarm anyone, but reinforce that vaccinations are the solution to the pandemic,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security in Baltimore.

A return to masking indoors

“That severe breakthrough infections were rare is testament to the vaccines, which limit the harm an infection can do in a fully vaccinated person,” he said. “It’s also important to remember the breakthroughs that occurred in this situation are likely not completely applicable to the everyday life of the vaccinated, as the intensity and nature of exposure was in the context of a large public gathering.”

Another expert said the implications of the findings are clear.

“At this time, even fully vaccinated people need to consider large gatherings as a potential place to contract the virus,” said Dr. Teresa Murray Amato, chair of emergency medicine at Long Island Jewish Forest Hills, in Queens, N.Y. “This also means that for Americans that are not yet vaccinated,” they should strongly consider doing so.

Adding to the Provincetown findings, a new internal federal government document also finds the Delta variant can cause more severe illness than earlier coronavirus variants, especially among the unvaccinated, and spreads as easily as chickenpox.

In laying out the evidence that this variant looks like the most dangerous one yet, the document urges health officials to “acknowledge the war has changed,” the Washington Post reported.

The document mirrors the data in the Provincetown study, finding that vaccinated people infected with Delta have viral loads similar to those who are unvaccinated and infected with the variant, the Post reported.

CDC scientists were so alarmed that the agency changed masking guidance for vaccinated people earlier this week, even before making the new data public, the newspaper said.

CDC Director Dr. Rochelle Walensky said in a statement on Friday that the Provincetown investigation “is one of many CDC has been involved in across the country and data from those investigations will be rapidly shared with the public when available.”

The Provincetown study was published in the CDC journal Morbidity and Mortality Weekly Report.


Source: HealthDay

The Reason COVID-19 Cases Are Rising Among the Double Vaccinated

Jamie Hartmann-Boyce wrote . . . . . . . . .

Sir Patrick Vallance, the UK’s chief scientific adviser, has announced that around 40% of people being admitted to hospital with COVID in the UK have been vaccinated. And according to the latest Public Health England data, around 15% of those being hospitalised have had two doses of a coronavirus vaccine. At first glance, this rings very serious alarm bells, but it shouldn’t. The vaccines are still working very well.

There are several factors at play that explain why such a high proportion of cases are in the fully vaccinated.

COVID vaccines are extremely effective, but none 100% so. This itself isn’t surprising – flu vaccines aren’t 100% effective either. Yet in the US alone flu vaccines are estimated to prevent millions of cases of illness, tens of thousands of hospitalisations and thousands of deaths every year. The COVID vaccines are doing the same in the UK right now – all one has to do is compare the curves from the winter wave with those from this summer.

As cases are rising, hospitalisations and deaths are rising too, but not at anywhere near the same level as they were in the winter. In the second half of December 2020 – a time when UK case rates were similar to what they are now – about 3,800 people were being admitted to hospital with COVID each day. The average now is around 700. So though that’s still higher than we wish it was, it’s a lot lower than it was the last time we had this many infections.

COVID is also growing among the vaccinated because the number of people in the UK who have had both doses is continuing to rise. At the time of writing, 88% of UK adults have had a first dose and 69% a second. As more and more of the population is vaccinated, the relative proportion of those with COVID who have had both jabs will rise.

If you imagine a hypothetical scenario in which 100% of the population is double vaccinated, then 100% of people with COVID, and in hospital with COVID, will also have had both jabs. As with deaths, this doesn’t mean the vaccine isn’t working. It just means the vaccine rollout is going very well.

We also need to remember that the vaccine rollout in the UK has systematically targeted people at the highest risk from COVID. Older people and people with health conditions that make them more vulnerable were the first to get vaccinated. Once vaccinated, these people (including me) are at much lower risk from COVID than they would have been otherwise – but they are still at risk.

That means that when we compare people with both vaccinations being hospitalised to those who haven’t had both doses, we aren’t comparing like with like. People with both vaccinations are more likely to have been at greater risk from COVID in the first place. This makes them both more likely to be hospitalised and more likely to have already received both of their vaccine doses.

Is COVID different in the vaccinated?

The latest data from Public Health England suggests that against the delta variant, which is now dominant in UK, two doses of any of the vaccines available in Britain are estimated to offer 79% protection against symptomatic COVID and 96% protection against hospitalisation.

We don’t have clear estimates yet from Public Health England on the level of protection against death caused by the delta variant – fortunately, this is partly driven by the fact deaths have been relatively low during this third wave in the UK.

But for the alpha variant, Public Health England data estimates the Pfizer vaccine to be between 95% and 99% effective at preventing death from COVID-19, with the AstraZeneca vaccine estimated to be between 75% and 99% effective. The evidence we have so far doesn’t suggest that the delta variant substantially changes this picture.

There’s lots we still need to learn about how people with both vaccine doses respond to getting infected with the virus. The UK’s COVID Symptom Study is looking at this. One of the key questions that remain is who is at most risk. Emerging data – released in a preprint, so yet to be reviewed by other scientists – suggests people who are overweight or obese, poorer people, and people with health conditions causing frailty seem to be more likely to get infected after having both jabs.

The preprint also suggests that age itself doesn’t seem to affect chances of developing COVID after being vaccinated, nor does having a long-term condition such as asthma, diabetes or heart disease – but we need more data on this to be sure of these findings.

Generally, the COVID Symptom Study has found that people report the same COVID symptoms whether or not they’ve been vaccinated, but that people who’ve been vaccinated have fewer symptoms over a shorter period of time, suggesting less serious illness. The most commonly reported symptoms in people who had had both doses were headache, runny nose, sneezing, sore throat and loss of smell.


Source : The Conversation