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Recent data from the Epic Health Research Network has found that breakthrough Covid-19 infections, while uncommon, are significantly more likely to affect elderly and immunocompromised individuals.
Radio Advisory episode: The unanswered vaccine questions you should be tracking
The demographics of breakthrough infections
The Wall Street Journal analyzed data from Epic Health, which includes records for 19.5 million people who have been fully vaccinated against Covid-19.
The Journal found that, so far, about 1.2% of fully vaccinated people have experienced a breakthrough infection.
The data also showed that people ages 65 and older were significantly more likely to be hospitalized with a breakthrough infection than younger people. Also, about 80% of deaths from breakthrough infections occurred among those 65 and older.
Separately, the Journal reviewed aggregated state data and found that among more than 21 million fully vaccinated people, there have been over 1.89 million breakthrough cases; 72,000 hospitalizations; and 20,000 deaths this year.
The Journal found that people with diabetes, chronic lung disease, kidney disease, and compromised immune systems were the most at risk of severe outcomes from breakthrough cases.
For example, data from South Carolina showed that 79% of people hospitalized with a breakthrough infection had at least one underlying health condition, as did 88% of those in the ICU with a breakthrough infection.
According to Andrew Goodwin, section chief of critical care at the Medical University of South Carolina (MUSC), almost all of the fully vaccinated Covid-19 patients in MUSC's ICU have weakened immune systems from other health conditions.
2021 Covid-19 deaths surpass 2020's toll
Meanwhile, the number of Covid-19 deaths in the United States in 2021 surpassed the death toll of 2020, according to federal data and data from Johns Hopkins University. The Journal notes, however, that deaths may have been undercounted in 2020, when the disease was new and testing was scarce.
As of November 20, the total number of Covid-19 deaths in 2021 in the United States hit 770,800 according to Hopkins' data, more than twice the 385,343 deaths reported in 2020, according to CDC data.
Epidemiologists argue that low vaccination rates and fatigue with Covid-19 precautionary measures such as masking led the highly contagious delta variant to rapidly spread in 2021, especially among unvaccinated individuals, the Journal reports.
"Heading into this year, we knew what we needed to do, but it was a failure of getting it done," said Abraar Karan, an infectious diseases doctor at Stanford University.
CDC data shows that Vermont, the most vaccinated state, with 72% of its population vaccinated, has had the lowest Covid-19 death rate per 100,000 people since the start of the pandemic. Mississippi, which has a 47% vaccination rate, has had the highest.
Covid-19 deaths occur primarily among older people, CDC data shows, but younger people are representing a growing number of deaths as they disproportionately remain unvaccinated, the Journal reports. Last year, 81% of Covid-19 deaths occurred among those ages 65 and up, compared to 69% so far this year.
Covid-19 deaths among younger people are rarer. However, 20,563 people under the age of 45 have died from Covid-19 so far this year, more than double the number of deaths in that age group from Covid-19 last year.
"There are plenty of what we call the young invincibles who just didn't get around to getting a vaccine," said Olveen Carrasquillo, chief of the internal medicine division at the University of Miami's Miller School of Medicine, "and a lot of meetings with family where they say, 'Oh, he's so stubborn, we told him to get vaccinated, but he wouldn't.'" (Kamp/Evans, Wall Street Journal, 11/21; Kamp et al., Wall Street Journal, 11/20)
5 key considerations for the expanded booster shot rollout
By Pamela Divack, consultant
FDA's expanded authorization for booster doses of Pfizer and BioNtech and Moderna's Covid-19 vaccine significantly increases the number of Americans eligible for a booster shot. While some states—especially those concerned about waning immunity (like Colorado, California, and Vermont)—have already expanded booster shot eligibility to all adults who want one, this authorization is an important milestone in our pandemic response.
As a next step, CDC must officially recommend the shots before they could be widely administered. However, there are five things all health care leaders must keep in mind today:
1. Ensure a swift booster rollout, but don't forget about getting unvaccinated adults and kids their first shots.
Despite the positive booster news and authorizations, our best tool to fight the virus is still getting as many people vaccinated as possible. However, recent CDC data has shown that more fully vaccinated people are getting their booster shots of Covid-19 vaccines than unvaccinated people getting their first shots. Efforts to roll out boosters should not detract from trying to improve vaccine uptake overall.
2. Proactive and consistent communication is (still) critical for vaccine uptake—including boosters.
People may have questions about why it's important to boost immunity and whether there are potential side effects, as well as hesitance to take off work or dedicate time to getting the additional shot. Additionally, reaching originally hesitant and hard-to-reach populations and convincing them to take a booster may be a challenge—especially with effective Covid-19 treatments on the horizon, which may discourage some people from getting vaccinated. Successful booster rollout will require proactive outreach efforts from all parts of the health care industry.
3. National data collection will be essential to understanding boosters' impact on immunity.
The United States has relied mainly on data from other countries—primarily Israel and the UK—for its Covid-19 booster strategy and understanding of vaccine effectiveness over time. However, FDA advisors and regulators are not always convinced by international data, citing that it does not apply to the United States which has different population characteristics, definitions of breakthrough cases, and health care system infrastructure. With boosters rolling out more broadly—and mixing and matching becoming more prevalent—national data collection will be essential to informing future questions and decisions such as: whether we will need yearly boosters, which vaccine regimens are most effective in certain subpopulations (e.g., high-risk, immunocompromised), optimal timing of vaccination, effectiveness against different variants, and more.
4. True success in booster rollout revolves around strong equity efforts.
We've said this before and will say it again: equity must be embedded into every aspect of the battle against Covid-19. Providers, pharmacies, and clinics must not lose sight of lessons learned during the initial phase of rollout—such as offering boosters at convenient hours, so people don't need to take off work or bringing the shots directly into the community.
5. It may be time for regulators and health care leaders to consider the definition of 'fully vaccinated'.
The widespread availability of boosters raises a myriad of questions including: Does the term "fully vaccinated" now also include receiving an eligible booster shot? Will individuals who have had a diagnosed Covid-19 infection also be required under mandates to receive the booster? These are just some of the many questions that should be expected in the coming weeks and months. However, some countries and states are already thinking ahead. Prime Minister Boris Johnson recently announced that the U.K. will adjust the definition to include booster shots; New Mexico is actively discussing changing the definition of fully vaccinated.
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