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What to know about your risk of a serious or fatal COVID infection:

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Houston Fire Department paramedics prepare to transport a woman with COVID-19 to a hospital on September 15, 2021 in Houston, Texas. While the virus is still rampant in the United States, some vaccinated people will continue to be infected. John Moore / Getty Images .

. John Moore / Getty Images

Houston Fire Department paramedics prepare to transport a woman with COVID-19 to a hospital on September 15, 2021 in Houston, Texas. While the virus is still rampant in the United States, some vaccinated people will continue to be infected.

John Moore / Getty Images

When Colin Powell died this week from complications from COVID-19, it came as a shock to many Americans.

While scientists and federal health officials are adamant that vaccines work well to protect against hospitalization and death, it’s bewildering to hear from fully vaccinated people like Powell, or maybe your own. friends and neighbors, getting seriously ill with COVID-19.

So how do vaccines work? How serious is the risk of a serious infection, which could lead you to the hospital?

In Powell’s case, of course, there are several reasons he was more at risk. He was 84 years old and had been treated in recent years for multiple myeloma, a cancer of the blood that forms in plasma cells, which are essential for the immune system. These facts alone would put him at a very high risk for breakthrough disease, says Dr Rachel Bender Ignacio, who leads COVID-19 clinical research at the Fred Hutchinson Cancer Research Center.

“We shouldn’t change our risk estimate on a good or bad outcome that happens to one person,” she said. “Vaccines still hold up extremely well. “

Even with concerns about the possibility of declining protection from the vaccine, scientists say the best data in the United States still tells a clear story: People who are fully vaccinated have a much lower risk of becoming infected or die from COVID-19 than the unvaccinated, according to data representing about 30% of the U.S. population from the Centers for Disease Control and Prevention.

Who becomes seriously ill with COVID after being vaccinated?

Those with serious illnesses tend to be older or have serious underlying health issues, or a combination of these risk factors.

“People of old age or with weakened immune systems always respond less well to vaccines, it’s true, whether it’s a flu shot or any other vaccine,” says Bender Ignacio .

The effect of age on the risk of acute infections is striking. The CDC has released data separating breakthrough infections and deaths by age. Among fully vaccinated people, people aged 80 or older had an almost 13 times higher risk of dying from COVID than people of all ages. However, the unvaccinated 80-year-olds were at much higher risk than the vaccinated.

Research shows that the people who fare the worst tend to be particularly medically fragile. A study of vaccinated patients hospitalized at the Yale New Haven Health System found that the median age was around 80 and that many had underlying problems including cardiovascular disease, lung disease, diabetes and some were taking also immunosuppressive drugs.

Although these findings predate the explosion of the delta variant, Dr. Hyung Chun, who led the study, says their ongoing research shows that these types of patients still account for most of the breakthrough diseases “even with the changing landscape of revolutionary infections “.

Chun says those who are vaccinated generally tend to do better once in the hospital, compared to those who are not vaccinated.

“Even if you were hospitalized [with a breakthrough infection], the trend we’ve seen is that you’re likely to be much less sick in terms of your need for things like supplemental oxygen or mechanical ventilation, or even your risk of death, ”says Chun, associate professor of cardiology at Yale School. of Medicine.

In mid-July, the CDC found that immunocompromised people accounted for 44% of groundbreaking hospitalizations, a figure that supported the decision to recommend a third shot of the vaccine for people who meet criteria for a weakened immune system. A more recent study, conducted by vaccine maker Pfizer, and not yet peer-reviewed, found that study participants who were immunocompromised accounted for about 60% of breakthrough hospitalizations and were three times more likely to have an infection with compared to people who were not immunocompromised. .

The three main clinical trials done by vaccine makers did not include people who are immunocompromised, so researchers are still trying to determine how different medical conditions affect a person’s immune response to the vaccine, says professor Dr. Jonathan Golob. assistant at the University of Michigan in the Division of Infectious Diseases.

“Vaccines are always great, including Delta for just about everyone except people with very, very weak immune systems,” he says. This list includes patients who have had an organ transplant, have active cancer, or another serious autoimmune disease that requires a lot of medication to treat. “All of these people, I would say, still need to be careful and the best thing to protect them is to get everyone around them vaccinated,” he says.

How common is it to have severe to breakthrough illness?

It is currently difficult to answer that in the United States To date, 7,178 people have died from COVID-19 after being vaccinated and about 85% were 65 years and older, according to the CDC, but these numbers are believed to be a “Snapshot” and are an undercount, an agency spokesperson told NPR. During the same period, about 190 million people were fully immunized in the United States.

As more Americans get vaccinated, the crude number of serious infections will inevitably increase as the virus spreads, but those numbers can be misleading.

“Hospitalizations due to a breakthrough infection are higher than just a few months ago, but this should be seen in light of the fact that more people are fully vaccinated,” Chun said. “You work with a larger denominator of patients.”

Conclusion: the risks of hospitalization are much higher for unvaccinated people. According to recent data from the CDC, the risk of being hospitalized in the United States for COVID-19 is 12 times higher if you are not vaccinated. These rates may vary from week to week, the agency notes. And they vary by age group. Unvaccinated adults aged 18 to 49 were 14 times more likely to be hospitalized, while those over 65 were 9 times more likely.

Some of the most compelling data also comes directly from what hospitals see in their communities.

A study of COVID-19 patients hospitalized in Beaumont Health Michigan’s largest hospital system found a “dramatic” difference in hospital visits between the vaccinated and the unvaccinated, says Dr Amit Bahl, an emergency physician who is the author of the study.

“If you were fully immunized, you had a 96% reduction in your chances of being hospitalized or going to the emergency room,” he says. “A bad outcome for a fully vaccinated patient was extremely rare.”

Some states that track peak hospitalizations are seeing a similar pattern.

For example, data from New York shows that 0.06% of the vaccinated population ended up in hospital for COVID-19. Minnesota has a similar rate.

However, it is still difficult to quantify how often a breakthrough infection results in a person being hospitalized because the United States does not closely monitor this data nationally, says Angela Rasmussen, a virologist at the University of Saskatchewan.

“I don’t think we’re there yet,” she said. “We don’t really know the denominator of the number of breakthrough infections overall.”

Has the risk of getting very sick increased and is that why the government is starting to roll out boosters?

The push for booster shots reflects concern that some groups of Americans, namely those who are older, now appear to be slightly less protected from a severe case of COVID-19 than they were in the spring, and is concerned that the risk of infections has increased because of the delta variant. Data vary by vaccine. The single-dose Johnson & Johnson vaccine appears to be the least effective against hospitalization.

But scientists are still trying to unravel exactly what is behind this increased risk.

Older Americans were already more susceptible to the virus. They were also among the first groups to get vaccinated. “So we not only have a higher risk population, but now longer since they received the vaccine,” says Bender Ignacio. “And that’s exactly why boosters have been recommended for these populations.”

The arrival of the delta variant and an increase in cases among the unvaccinated has brought many more people into contact with the virus, including people who may be particularly vulnerable, says Rasmussen.

“Unfortunately, even though we have a lot more people getting vaccinated, it’s still not enough and we still have a lot of viruses,” she says. “When those two conditions are met, you’re just going to have more revolutionary cases.”

Ultimately, protection from hospitalization while it may decline for some groups does not appear to have translated into a major spike in critically ill vaccinated patients, although the country has faced a huge increase in cases. .

“Everyone I’ve seen this week who is critically ill from COVID is unvaccinated,” said Golob from the University of Michigan Health System.

Sources

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2/ https://www.npr.org/sections/health-shots/2021/10/20/1047727415/what-to-know-about-the-risk-of-serious-or-fatal-breakthrough-covid-infections

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