“As the Delta variant has come along, we’ve had to relearn a whole lot of new things to understand how well the vaccines do and don’t work as the virus evolves,” says Roger Shapiro, an MD, MPH, and associate professor of immunology and infectious diseases at the Harvard T.H. Chan School of Public Health. “The more people who are not vaccinated, the more chance the virus has to evolve and to put itself against vaccinated people’s immune systems and outsmart that.”
Breakthrough cases have been rare, and hospitalization and death as a result even more so. Recent data collected by the New York Times in 40 states and Washington, D.C., is instructive. Arkansas had the highest hospitalization rate among fully vaccinated people at 4.7%, according to the Times’ data; but in many states, including California, New Jersey, and Indiana, hospitalization rates were below 1% for fully vaccinated people. Data is changing by the day as more people get COVID-19, so it’s hard to make permanent inferences from current hospitalization rates.
It’s important to note that the percentage of breakthrough cases will also climb as more people get the vaccine. “One thing you have to think about when you consider what’s happening with vaccinated people and cases is that more and more people in the population are now vaccinated,” Shapiro points out. “There are going to be a higher percentage of cases among the vaccinated because there are many more vaccinated.”
Johns Hopkins Bloomberg School of Public Health associate professor Gigi Gronvall, Ph.D., an immunologist, likes to explain breakthrough infections in the broader context of how vaccines work. Viruses create copies of themselves once they infect a body. It takes time for the immune system to determine how to fight the virus. “The vaccine speeds that process up,” Gronvall says. “It gets all of the cells that are ready to respond. As soon as it detects that there is a virus there, the virus starts making a gazillion copies of itself, your immune system says ‘not today,’ and goes to work.”
But not all immune systems are created equally. Some might take longer to work even with the vaccine, or simply not be as strong as others. Still, the key takeaway is that these vaccines really work. There are multiple ways of evaluating their efficacy: whether they stop someone from contracting the virus in the first place, protect someone from moderate disease, or protect them from severe effects and death.
“These vaccines are so extraordinarily good at keeping people out of the hospital and [from] dying,” Shapiro says. “That’s what they’re intended to do — to save people’s lives.” Fully vaccinated people are about 25 times less likely to go to the hospital or die if they contract COVID-19, according to Shapiro.
Our most dangerous encounter with the virus comes down to our first contact with it, he says. A vaccine introduces to our bodies a small piece of the virus that cannot be replicated or cause harm. That primes the immune system for a second and less harmful contact. It’s the novel part of the novel coronavirus that makes it so potent. “The more times you see it, the better your response is going to be,” Shapiro says, “and the more your immune system is going to take care of it.”
Experts say my experience is far from unusual. Runny nose is a more common symptom of breakthrough COVID-19 cases in fully vaccinated people, Shapiro says; others are entirely asymptomatic.
For those concerned that they may have a breakthrough case, testing is always a good bet. Gronvall notes that local pharmacies have relatively inexpensive at-home rapid COVID-19 tests.
Ultimately, Shapiro sees a future in which COVID-19 is simply a part of everyday life, like remnants of the Spanish flu from the 1918 pandemic still circulate in today’s flus. “COVID will continue to circulate, but COVID is in the process of becoming like the flu,” Shapiro says. “We don’t want to get it and we live with it when it happens. But we’re not there yet.”
Getting more people vaccinated has the potential to change how fast we get there, not just because it will introduce people to the virus in a safe way, but it will lessen the possibility of further variants that may truly challenge the available vaccines.
“That’s the concern going forward — that we will have variants that could start to outsmart the vaccine,” Shapiro says. “The really good news right now is that the vaccines work very well against virtually all the variants that we’ve encountered.”
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