What Tennessee's latest data on COVID-19 breakthrough infections means

Sep 20 - The percentage of serious and fatal COVID-19 infections among vaccinated Tennessee people is growing, but experts caution against using data on "breakthrough infections" - which occur when fully vaccinated people become infected with the coronavirus - to reach general conclusions about the vaccine to draw efficacy.
Unvaccinated Tennessees continue to be responsible for the majority of COVID-19 hospital admissions and deaths in the state.
But the proportion of patients fully vaccinated has tripled, according to the Tennessee Department of Health's latest COVID-19 Critical Indicators report:
- The vaccinated accounted for 13% of all COVID-19 cases in Tennessee in August, compared to 4% in May.
- Of those hospitalized with COVID-19, 14% were vaccinated in August, compared with 5% in May.
- Those vaccinated accounted for 17% of COVID-19 deaths in August, up from 3% in May.
Dr. Jason Andrews, associate professor of medicine in the Department of Infectious Diseases at Stanford University School of Medicine, said although vaccine protection against symptomatic COVID-19 infections has declined since the first vaccine study data was published, there are many other factors related to this is leading to an increase in breakthrough cases, and the vaccines' ability to protect against hospitalizations and death remains strong.
New coronavirus variants and the decline in immunity over time are likely to contribute to decreased effectiveness of the COVID-19 vaccine, he said. However, breakthrough infections are more likely even during periods of high community prevalence, which has increased significantly since the beginning of July due to the summer surge.
Unlike large-scale studies, breakthrough case reports do not control factors such as age and disease, and older adults and people with underlying diseases are the groups with the highest vaccination rates. The same groups have a higher risk of severe COVID-19 illness and death, regardless of vaccination status.
“So if we just look at the [COVID-19] deaths and hospital admissions and look at the proportion of people vaccinated, you may see a higher proportion than you would expect deaths to come from those who are [older] or have illnesses "said Andrews.
Vaccines are also usually less effective in adults and people with weakened immune systems.
"It is likely that we are seeing greater decreases in immunity in the elderly and people with compromised immune systems," he said.
“Vaccines aren't perfect - that's the reality. Very few things in life are perfect, ”said Andrews. "We do things because they reduce our risk, even if they are not perfect, and we know full well that vaccines reduce our chances of hospitalization and death by at least 90%."
The Tennessee Department of Health also notes that COVID-19 hospital admissions are more closely screened in vaccinated individuals than unvaccinated individuals, so unvaccinated individuals are likely to have low levels of hospital admissions.
Real-time breakthrough case data is not available, and breakthrough case summary data for Tennessee is only available through August as cases take weeks to properly investigate.
The department links their vaccination registry to their test data to calculate the number of general breakthrough cases that should be considered a minority as not all COVID-19 positive people want a test.
Andrews said the Pfizer and Moderna mRNA vaccines set the bar extremely high when initial data showed the vaccines were about 95% effective at preventing symptomatic infection, while vaccines against respiratory viruses such as influenza had historically been effective aimed for about 60 to 70%.
Now the scientific community is trying to determine how the effectiveness of the COVID-19 vaccine is performing to determine who needs booster vaccinations and when.
"These are the debates that are going on right now," said Andrews. "Given that we have been able to achieve such high levels of effectiveness, we continue to strive because our whole goal as a medical and public health community is to reduce disease, including transmission, as much as possible."
While breakthrough cases are a cause for concern, the biggest concern is that large sections of the population will remain unvaccinated.
A total of 296 breakthrough deaths and 769 hospital admissions were reported during the pandemic, and more than 6.4 million Tenneseers were fully vaccinated, according to the Department of Health.
Contact Elizabeth Fite at efite@timesfreepress.com or follow her on Twitter @ecfite.

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