Rising reports of ‘breakthrough infections’ fuel vaccine skeptics, scramble reopening plans

Disney’s “Aladdin” shut down on Broadway just two nights into its long-awaited reopening, Harvard Business School moved its MBA classes online, and a State Department spokesman kicked off this week by saying he had to quarantine for 10 days.

The common thread? Infections in people who have been vaccinated, which are being reported with increasing frequency and are complicating efforts to reopen society and promote the shots.

Disease trackers in New York, Los Angeles and elsewhere say vaccinated people have much better protection against COVID-19 than unvaccinated people and even greater protection against the worst outcomes.

But the vaccines’ ability to prevent infection waned during the delta surge over the summer. The trend reveals itself in a steady trickle of reports of symptoms or positive tests in vaccinated people. It also is bedeviling efforts to convince vaccine holdouts.

“You all can still get COVID, right?” Washington Wizards star Bradley Beal, who is unvaccinated, recently told a room of vaccinated reporters pressing him on his holdout status.

Public health experts say breakthrough infections will be reported with great frequency as a bigger share of the population is vaccinated and society reopens after months of closures and COVID-19 restrictions.

They also said the vaccines are designed to avoid the worst outcomes from COVID-19, such as hospitalization and death, so people should accept that COVID-19 will become akin to seasonal flu or a bad cold.

“The incidence is going to increase as people get back to their activities and have more exposure in the face of a more contagious variant. That’s not surprising. However, if you look at who is constituting the bulk of infections, it’s still the unvaccinated,” said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. “The fact that breakthrough infections are mostly mild is something that should not alarm people. This was one of the major factors for vaccination. We’re trying to turn this into a more common respiratory infection that does not have the ability to crush hospitals.”

Federal trackers are focused on hospitalization and death, so the fullest statistics on breakthrough cases come from counties and states. Pockets of the country are reporting thousands of breakthrough cases per week but say the odds greatly favor the vaccinated.

Officials in King County, Washington, said about a third of its 17,500 cases in the past 30 days were in vaccinated people.

Eight in 10 eligible people are fully vaccinated in the county. Its relative risk metric, comparing COVID-19 incidence between vaccinated and unvaccinated people of the same age, found unvaccinated people were eight times more likely to get infected than the vaccinated, 41 times more likely to be hospitalized and 57 times more likely to die from COVID-19.

Massachusetts has consistently reported about 3,700 to 4,500 cases in vaccinated residents per week since mid-August, but only 0.8% of fully vaccinated people in the state have been infected with the virus, 0.03% have been hospitalized and 0.006% have died from COVID-19.

New Jersey Gov. Phil Murphy said Monday that breakthrough infections have accounted for 5.4% of the 485,388 positive tests in his state since mid-January, when the first residents became fully vaccinated.

“Yes, we’ve seen an increase in positive tests among the fully vaccinated as the delta variant has marched across the state, but they remain a distinct minority of cases and there is nothing in the data that suggests a failing among the vaccines,” said Mr. Murphy, a Democrat.

Data shows that the delta wave this summer has put an apparent dent in the vaccines’ armor against all infection, fueling talk of booster shots to shore up protection against the virus.

New York state reported that in early May, vaccinated residents had a 91.9% lower chance of getting COVID-19 than unvaccinated people. Health officials said effectiveness declined in mid-July — about the time delta variant took hold — to 77.2% in early September. The decline froze around that point.

The Yale New Haven Health System in Connecticut found that among 969 people who tested positive for infection during a 14-week period from March through July, 54 were fully vaccinated. Fourteen had critical cases and required supplementary oxygen support, four of them were admitted to the intensive care unit and three died.

“These cases are extremely rare, but they are becoming more frequent as variants emerge and more time passes since patients are vaccinated,” said Hyung Chun, an associate professor of medicine at Yale and the senior author of the study, which was published Sept. 7 in Lancet Infectious Diseases.

The patients tended to be older, with a median age of 80.5, and some had conditions such as heart disease or diabetes.

Doctors in Louisiana and the Sun Belt frequently told cable news outlets that vaccinated patients hospitalized during the summer tended to be older and struggled to mount effective immune responses. Those signals fueled the Food and Drug Administration’s decision to approve booster shots for seniors and younger people with underlying conditions.

FDA advisers said they didn’t have enough data to recommend boosters for the general population but might revisit the issue.

The decision to approve third doses of the Pfizer vaccine — boosters for Moderna and Johnson & Johnson shots are being vetted — soothed vaccinated people’s worries about waning protection but hardened the views of skeptics, who say the vaccines aren’t as good as promised.

Nearly 8 in 10 vaccinated people viewed the booster program positively, saying it “shows that scientists are continuing to find ways to make vaccines more effective,” the Kaiser Family Foundation found in a recent poll. More than 7 in 10 unvaccinated people said the booster program is a sign “that the vaccines are not working as well as promised.”

Vaccinated people who report breakthrough infections over social media tend to fit a pattern. They say COVID-19 symptoms are unpleasant but think their bouts might have been worse without the vaccine.

“I’m feeling under the weather but am grateful for the protection from severe illness offered by safe and effective vaccines,” tweeted Ned Price, a State Department spokesman who decided this week to self-isolate after experiencing symptoms.

Chris Rock, who was vaccinated but got infected in mid-September, also suggested his illness might have been worse: “Hey guys I just found out I have COVID, trust me you don’t want this. Get vaccinated.”

Scientists said growing numbers of cases among the vaccinated might reflect an increase in vaccinations that are designed to stave off severe illness.

“If you go to the extreme, if 100% of people in the community are vaccinated, all the infections will be breakthrough infections,” said William Schaffner, an infectious diseases expert at Vanderbilt University.

Most of the illnesses are surmountable, but some get serious.

“There are some people who, although they are vaccinated, will get serious infections. From the beginning, we said the vaccines are 95% effective. That’s not 100%,” Dr. Schaffner said.

Officials in Lancaster County, Pennsylvania, are reporting more breakthrough infections. Of the COVID-19 patients at Lancaster General Health, 23% are vaccinated, though bad outcomes are rare.

“It’s typical for what’s going on around the country, but if you look at the number of people in the ICU, that percentage is much lower. If you look at the number of vaccinated people who actually die from COVID, that number is extremely small, and that gives you the benefit of the vaccine,” Dr. Joseph Kontra, chief of infectious diseases at Penn Medicine Lancaster General Health, told ABC 27-WHTM News.

The Centers for Disease Control and Prevention tracks reports of breakthrough infections only if they result in hospitalization or death.

The agency said it had received 19,136 reports of vaccinated people who were hospitalized or died with COVID-19. Those included 4,493 deaths out of the 184 million who were fully vaccinated.

The House Energy and Commerce Committee has chastised the CDC for deciding on May 1 to limit the scope of the information it tracks. Lawmakers said the decision gives the nation little guidance as it tries to understand how the virus affects the vaccinated.

“We are still in the midst of a global pandemic, and national, state, local, and tribal leaders as well as vaccine developers are having to make decisions about how best to protect Americans against COVID-19,” they wrote Tuesday in a letter to CDC Director Rochelle Walensky requesting a briefing on agency efforts. “In addition, the threat that COVID-19 poses to our nation continues to evolve. For example, the situation we were facing in April is very different than the situation we are currently facing due to the delta variant. Providing decision-makers with better, more complete data and information on breakthrough infections will be essential as they continue to respond to this evolving pandemic.”

Reports of cases and possible transmission make institutions antsy. More than 40% of the American population remains unvaccinated. That includes young children, who aren’t eligible for the shot.

Infections canceled a midweek Broadway performance of Disney’s “Aladdin” just one night after it reopened after 18 months, a high-profile sign of how increasing cases among the vaccinated are bedeviling efforts to move beyond the pandemic.

Producers of “Aladdin” on Broadway told audience members its “rigorous” testing protocols detected cases within the repertory company at the New Amsterdam Theatre.

“Because the wellness and safety of our guests, casts and crew are our top priority, tonight’s performance, Wednesday, September 29th, is canceled,” the producers tweeted.

Harvard Business School shifted to remote class through Oct. 3 after an unusually high number of cases were reported, despite high vaccination rates. School officials said transmission appeared to be occurring in off-campus gatherings and not at the school, but the decision to break up in-person learning for a period reflected wariness of high case counts.

“Eventually,” Dr. Adalja said, “the risk tolerance of cases is going to be modulated and a case will not have the same implications in the future as it does currently.”