I am disappointed in the CDC. There have been a lot of missteps by this public health organization. One of the worst was the message that the virus was primarily spread through big droplets that would travel no more than six feet. The experts at the CDC were slow to appreciate how aerosolized coronavirus particles could easily spread around a room. My latest CDC frustration is the lack of testing to determine how many vaccinated people are catching the Delta variant. We need to know how well vaccines prevent breakthrough infections!
A Prison “Experiment” Reveals How Well Vaccines Prevent Breakthrough Infections:
As far as we can tell, this was not a planned experiment. Nevertheless, the data are quite revealing. The study was published in the Morbidity and Mortality Weekly Report (MMWR), September 21, 2021.
Diseases spread easily in prisons for obvious reasons. A lot of people are confined in small spaces. Ventilation may be less than ideal. That’s why “Incarcerated populations have experienced disproportionately higher rates of COVID-19–related illness and death compared with the general U.S. population…”
Here’s how the authors of the MMWR report describe the beginning of this “experiment”:
“On July 12, 2021, 18 persons incarcerated in a federal prison in Texas reported COVID-19–like symptoms to BOP [Bureau of Prisons] health services staff members. All 18 received positive SARS-CoV-2 test results using the Abbott BinaxNOW COVID-19 Ag Card (rapid antigen) test; 11 were fully vaccinated. Three of these persons had reported to the on-site clinic on July 8 with symptoms including coryza [inflamed nasal passages], cough, headache, myalgia [muscle pain], or rhinorrhea [runny nose] but did not receive SARS-CoV-2 testing at that time. The 18 persons with positive test results lived in two interconnected units (unit A and unit B) that operated as a single cohort and housed 233 persons in 2- to 10-person cells without doors.”
Of the 233 prisoners in this part of the facility, 79% of them (185 individuals) were fully vaccinated. That is actually quite impressive. Keep in mind that in the general US population, only 55.6% of the population has been fully vaccinated. In Texas, 50.5% of the state’s population has been vaccinated.
Did Vaccinations Prevent Breakthrough Infections?
During July and August three fourths of the prisoners in this Texas facility caught COVID.
The Unvaccinated Prisoners:
Of the 42 unvaccinated prisoners in units A and B, 39 caught COVID-19. That’s 93 percent.
The Vaccinated Prisoners:
On the other hand, 129 out of 185 fully vaccinated people in units A and B came down with the virus. That’s 70 percent.
Of the 172 individuals who were infected, four needed to be hospitalized. Three of these were unvaccinated, including the one who died.
Answering the Question: Did Vaccinations Prevent Breakthrough Infections?
In a word: No!
If 70% of the fully vaccinated prisoners still caught COVID-19, it is clear that there is significant vulnerability.
“During a COVID-19 outbreak involving the Delta variant in a highly vaccinated incarcerated population, transmission rates were high, even among vaccinated persons. Although attack rates, hospitalizations, and deaths were higher among unvaccinated than among vaccinated persons, duration of positive serial test results was similar for both groups. Infectious virus was cultured from vaccinated and unvaccinated infected persons.
“Even with high vaccination rates, maintaining multicomponent prevention strategies (e.g., testing and masking for all persons and prompt medical isolation and quarantine for incarcerated persons) remains critical to limiting SARS-CoV-2 transmission in congregate settings where physical distancing is challenging.”
What Does This Mean for You?
Prisons are unique environments. A lot of people are housed together under challenging conditions. That is quite different from the way most people live. On the other hand, it does tell us that full vaccination does not protect people like a cloak of invincibility. Remember, the vaccine did not prevent breakthrough infections in 70% of the fully vaccinated prisoners.
The CDC is not tracking breakthrough infections unless they result in hospitalization. We wish the CDC would actually collect data from the community to determine how many fully vaccinated people are catching COVID. Such information would be helpful in guiding behavior.
Until we have more clarity, it would seem to us that early testing, isolation of infected individuals and masking are important additions to vaccination. We would like to see home tests distributed at no or low cost to every American household so that people could monitor their own situation on a regular basis and take action accordingly.
The CDC and Booster Approval:
There is still an awful lot we do not understand about this virus. Will the booster protect us from catching the Delta variant or some future mutated version of SARS-CoV-2? That seems to be the implied promise. Until we have data, however, we won’t know for sure.
On Thursday, September 23, 2021, an advisory panel of experts for the CDC recommended booster shots of the Pfizer/BioNTech vaccine. Who is eligible? Anyone who is 65 or older. Anyone who is at high risk of serious illness from COVID. That includes those between 50 and 64 who have underlying health conditions that make them more vulnerable to the coronavirus. People between 18 and 49 who have pre-existing conditions should talk to their doctors.
These recommendations were given the green light last night by Dr. Rochelle Walensky, head of the CDC. She added eligibility for people working in high-risk jobs. That means anyone 18-64 who is at risk because of “occupational or institutional setting” can get a third shot. Within a few days, fully vaccinated people should be able to start getting Pfizer booster shots.
What About Israel? Did the Booster Prevent Breakthrough Infections?
Israel is about two months ahead of the US. The country started administering a third Pfizer/BioNTech shot in July to older Israeli citizens. Within two weeks, infections were down about tenfold, according to Dr. Francis Collins, head of the NIH. He is in a position to see the data. Dr. Collins also said on September 23, 2021, that the booster reduced severe illness if people catch COVID.
I would like to see the data myself.
“The non-booster group included approximately 5.2 million person-days of risk, with 4439 confirmed infections and 294 cases of severe illness.The booster group included 10.6 million person-days of risk with 934 confirmed infections and 29 cases of severe illness.
“The investigators reported the confirmed infection rate was lower in the booster group than in the nonbooster group by a factor of 11.3.”
The Johns Hopkins Tracking System:
We rely upon the Johns Hopkins “Daily confirmed new cases (7-day moving average)” to see what’s happening around the world. Israel is indeed seeing its COVID cases trending down. But other countries are too, and they did not have access to boosters. Those countries include Iran, Malaysia, Brazil, Thailand, Mexico, Vietnam and France. The US is also starting to see cases drop and our booster program is only just getting underway.
Will the 3rd Pfizer shot send COVID cases crashing down or are they already dropping for some unforeseen reason? There are so many questions and so few good answers.
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