COVID-19 breakthrough cases remain uncommon amid highly contagious delta variant

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The delta variant of the COVID-19 virus appears to be breaking through the protection vaccines provide at a higher rate than previous strains, a Wall Street Journal analysis found, though infections among the fully inoculated remain a tiny fraction of overall cases, and symptoms tend to be milder.

U.S. states counted at least 193,204 so-called breakthrough cases among vaccinated people between Jan. 1 and early August, according to data that health departments in 44 states and Washington, D.C., provided to the Journal. The figure represents 0.1% of the more than 136 million fully vaccinated people in those states and the capital.

The total number of breakthrough cases is likely higher, public-health experts said, because fully vaccinated people with asymptomatic infections likely aren’t getting tested for COVID-19. Additionally, several states said the data were unavailable, while others track only breakthrough cases that result in hospitalizations or death.

The United States has counted about 193,204 so called “breakthrough cases” since January 1st and early August (AP Photo/Frank Augstein, Pool)

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Of the 44 health departments that responded to the Journal’s requests, 28 of them also broke down the number of cases they had tracked since the start of July, when the delta variant emerged as the dominant strain of the virus.

At least 11 states, including California and Mississippi, counted more than half of their reported breakthrough cases between July 1 and early August, suggesting that the rise of delta was causing more breakthroughs than earlier strains. In at least six states, including Maryland and Minnesota, more than a third of breakthrough cases were reported during that period.

Health departments said that breakthrough cases represented a tiny fraction of COVID-19 infections and resulted in very few hospitalizations or deaths.

Health officials say the milder cases are evidence that the vaccines are working well, though they add some people have misinterpreted the higher rate of breakthroughs with the Delta variant as proof that they are ineffective.

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"Let’s be real, here: Breakthrough infections are sort of OK," said Larry Corey, a virologist at the Fred Hutchinson Cancer Research Center in Seattle. "You get infected and you have a cold, maybe an achy fever for 24 hours. But you don’t end up in the hospital, and you don’t end up with that 2.5% chance of dying once you are hospitalized."

The Centers for Disease Control and Prevention stopped tracking most breakthrough cases at the end of April, choosing instead to tally those leading to hospitalization or death. The agency is now tracking breakthrough cases in small cohorts of health care workers that yield more representative data, CDC Director Rochelle Walensky said in an interview this month.

Walid Gellad, a drug-policy researcher and physician at the University of Pittsburgh School of Medicine, said the CDC shouldn’t have stopped tracking all breakthrough cases because it made it tougher to know whether asymptomatic transmission is fueling the pandemic.

Since Jan. 1, there have been 16,578,509 cases of COVID-19 in the U.S., according to Johns Hopkins University. The seven-day moving average of new daily COVID-19 cases rose to 130,710 on Monday, its highest level since February and up from 13,118 at the end of June, the Johns Hopkins data showed, as the highly contagious strain has spread, largely among the unvaccinated.

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"Part of it is simple math: We can and should expect that as the overall number of cases goes up, the number of breakthroughs is going to go up," said David Dowdy, an infectious diseases physician at Johns Hopkins. He said behavior is changing, too: "We are all interacting with one another more closely than we were a few months ago."

A U.K. study of people who tested positive for COVID-19, published in July in the New England Journal of Medicine, found that the vaccine from Pfizer Inc. and BioNTech SE was 94% effective at preventing symptomatic COVID-19 from the previously dominant alpha variant, compared with 88% against the delta variant. The study found no reduction in the vaccine’s ability to protect against serious illness and hospitalization in infections from the delta variant.

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Doctors who see COVID-19 patients in states with high levels of breakthroughs said vaccinated patients who become infected typically experience mild symptoms that don’t result in hospitalization and recover within a week or two.

"All we’re really seeing, with vaccine breakthrough cases that come into the hospital, are people who are over 80 or have a compromised immune system," said Jorge Bernett, an infectious disease specialist with John Muir Health in Walnut Creek, California, "Basically everyone who is on a ventilator is unvaccinated."

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