“Breakthrough cases” of people fully vaccinated for COVID-19 being infected with the SARS-CoV-2 virus continue to increase throughout the United States. In recent weeks, there have been reports of breakthrough cases “rising” or “accelerating” or “spiking” in numerous states. Even though these breakthrough cases are reportedly “rare,” given that 176 million Americans have been “fully” vaccinated for COVID-19 as of Aug. 3, 2021, which represents 53.6 percent of the U.S. population, there appears to be growing public concern about this phenomenon.1 2 3 4 5 6
Media headlines such as “Don’t Panic, But Breakthrough Cases May Be a Bigger Problem Than You’ve Been Told” and “Breakthrough COVID-19 cases are rising, and experts are trying to figure out exactly what that means” reflect the growing concern about people getting infected with SAR-CoV-2 despite being fully vaccinated.1 5
Part of the concern has to do with a sense that the country is flying blind when it comes to understanding the full breadth of the problem of breakthrough cases, given that the U.S. Centers for Disease Control and Prevention (CDC) has chosen to only track a fraction of these cases. Since May 1, 2021, the agency has only accounted for and reported on breakthrough cases that result in hospitalization or death. In April, the CDC stated:
In the coming weeks, CDC will transition from monitoring all reported vaccine breakthrough cases to focus on identifying and investigating only vaccine breakthrough infections that result in hospitalization or death. This shift will help maximize the quality of the data collected on cases of greatest clinical and public health importance.7
CDC Pressured to Count All Breakthrough Cases
This policy decision has lead to criticism by many public health experts and legislators who are now urging the CDC to “reverse its decision and collect comprehensive data on infections in vaccinated people.”8 In a recent article published by Politico, Adriane Casalotti, chief of public and government affairs at the National Association of County and City Health Officials, was quoted as saying:
Given what we know about Delta now—and more what we don’t know about Delta—having a fuller picture of breakthrough cases no matter what the level of symptoms is important to be able to decide what rules and mitigation strategies you need to put in place in your community.8
In a letter written to CDC director Rochelle Walensky, MD on July 23, U.S. Senator Edward Markey of Massachusetts seemed to suggest that the CDC should reconsider its decision to only track hospitalizations and deaths among breakthrough cases in order to better understand the effectiveness of the COVID vaccines. “Is the effectiveness of COVID-19 vaccines decreasing in light of these breakthrough cases?” Sen Markey wrote. Sen. Markey urged the CDC to “remain vigilant and transparent in its surveillance of breakthrough cases” and noted that public health and medical officials and health care providers must have “robust data and information to guide their decisions on public health measures.”9
The concern over the prevalence of breakthrough cases and the sense that these may not be as rare as the public has been lead to believe is reasonable, but it may soon be eclipsed by a more troubling problem—the growing number of breakthrough cases in the U.S. that lead to hospitalization or death. According to the CDC, as of Sept 7, 2021, there were more than 14,000 patients with COVID-19 vaccine breakthrough infection who were hospitalized or died. Of those patients, 11,440 were hospitalized but were non-fatal cases. The remaining 2,674 cases were deaths.10
Hospitalizations and Deaths Among Vaccinated People Rising
It is unclear how accurate the CDC’s assessment of the breakthrough cases resulting in hospitalization or death is and whether the public has been kept fully informed about how often fully vaccinated individuals are being infected with SAR-CoV-2 and dying despite being vaccinated. What seems to be clear is that these type of cases are on an upward trend in some parts of the country. It was recently reported, for example, that in the Southern Nevada Health District 105 fully vaccinated people have died since Aug. 26. Health officials in Massachusetts confirmed on Aug. 31 more than 3,700 breakthrough cases during the previous week and that 80 of those people were hospitalized and 13 died.11 12
In Virginia, breakthrough cases resulting in death reportedly more than doubled from mid-June through the end of July. In Los Angeles, breakthrough cases represented only five percent of those hospitalized for COVID in April but, by July, that number was up to 13 percent. Last month, Los Angeles Director of Public Health Barbara Ferrer, PhD, MPH confirmed that the number of fully vaccinated Los Angelenos coming down with coronavirus and hospitalized for COVID had been rising for three months.13 14
In West Virginia, Governor Jim Justice announced on Aug. 23 that during the previous eight weeks there had been a 26 percent increase in new breakthrough cases, a 21 percent increase in breakthrough cases needing hospitalization and a 25 percent increase in the number of breakthrough cases resulting in deaths.15
Reports are coming in from around the U.S. that fully vaccinated people are not only becoming infected with the SARS-CoV-2 virus and developing symptoms of COVID-19 but are also, increasingly, being hospitalized with severe symptoms and dying. This development is creating a dilemma for those who argue that, although the COVID vaccines may not prevent coronavirus infection and transmission, at least they protect people from something worse. This may be why there is such a sudden rush to push a booster shot.
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1 Mamula KB. Breakthrough COVID-19 cases are rising, and experts are trying to figure out exactly what that means. Pittsburgh Post-Gazette Aug. 30, 2021.
2 Olson J. Breakthrough COVID-19 cases accelerate in Minnesota. Star Tribune Aug. 30, 2021.
3 Ruskin L. Breakthrough COVID cases are rising in Alaska. Here’s why, and why vaccines are still ‘amazing.’ Alaska Public Media Aug. 30, 2021.
4 Sobey R. Massachusetts coronavirus cases spike 1,796 — the highest daily count in months. Boston Herald Sept. 1, 2021.
5 Wallace-Wells D. Don’t Panic, But Breakthrough COVID-19 Cases May Be a Bigger Problem Than You’ve Been Told. New York Aug. 12, 2021.
6 Our World in Data. COVID-19 Vaccination Statistics: United States.
7 Cáceres M. CDC Intentionally Undercounting COVID-19 “Breakthrough Cases” in Vaccinated Persons. The Vaccine Reaction May 23, 2021.
8 Roubein R, Lim D. CDC under fire for decision to limit tracking of Covid-19 cases in vaccinated people. Politico July 30, 2021.
9 U.S. Senator Edward J. Markey. Letter to Dr. Rochelle P. Walensky. July 22, 2021.
10 Fung K. Over 14K Vaccinated People With Breakthrough COVID Cases Have Been Hospitalized or Died. Newsweek Sept. 13, 2021.
11 Lupiani J. Breakthrough cases account for 105 COVID-19 deaths in Clark County. KTNV Las Vegas Aug. 27, 2021.
12 Staff Reports. Mass. Has 3,704 New Breakthrough Cases, 13 More COVID Deaths Among Vaccinated. NBC 10 Boston Aug. 31, 2021.
13 Daily Veracity Staff. Fully Vaccinated People Represent Over 50% of Cases and Hospitalizations in Several Regions, Weeks After the CDC Stopped Tracking Breakthrough Cases. Daily Veracity July 31, 2021.
14 Tapp T. In Los Angeles, Breakthrough Infections Are Now 30% Of All New Covid Cases Amid Delta Surge. Deadline Aug. 19, 2021.
15 Mistich D. W.Va. Officials Say ‘Breakthrough’ COVID Cases On The Rise. West Virginia Public Broadcasting Aug. 23, 2021.