Breakthrough Covid, in Perspective – The New York Times
Revolutionary infections – in which vaccinated people nonetheless contract the Covid-19 virus – are one of those thorny topics that can be difficult to put into perspective.
On the one hand, breakthrough infections obviously occur. They have arrived at New York Yankees and White House officials, as well as at summer rallies in Massachusetts, Oklahoma and elsewhere. My colleague Liam Stack recently fell ill with a breakthrough infection (and I’ll tell you his story below).
On the other hand, the extent of breakthrough infections remains uncertain. Are they a big reason why cases are now on the rise in the United States – and a reason those vaccinated are concerned? Or are breakthrough infections the rare exceptions that receive inordinate attention?
They are two very different scenarios. If breakthrough infections are a significant source of the spread of Covid, it would suggest that those vaccinated should resume some of their previous precautions, such as avoiding crowded places. If Covid spreads rather massively among the unvaccinated, this would suggest that the behavior of the vaccinated does not matter much; the only reliable way to reduce the number of cases would involve more vaccinations.
I will warn you up front that I do not have a definitive answer for you. “There is a lot of uncertainty right now,” as Natalie Dean, biostatistician at Emory University told me. But there is some evidence that can help you think about the situation as scientists collect more data.
What we know
Let’s start with some clear facts:
Among children under 12, who remain ineligible for the vaccine, severe forms of Covid are also extremely rare. Children are at greater risk when driving a car.
In view of all this, the most effective Covid strategy has not changed, experts say: “Shots”, as my colleague Apoorva Mandavilli writes. Or as Dean says, “The biggest problem is that there are a lot of people without protection.”
And there are measures that would almost certainly increase vaccinations: full FDA approval (which has not happened despite public approval of the vaccines by FDA officials); immunization mandates from employers and local governments; and pro-vaccination messages from Republican politicians, professional athletes and other credible people among vaccine skeptics. Each of these steps would almost certainly have a greater effect than the behavioral changes in the vaccinees.
Still, I understand why many vaccinated people wonder if they need to change their behavior. I feel the same. I don’t want to help spread the virus, and I’d rather not contract even a modest version of Covid.
Among other reasons, the risks of “long Covid” remain uncertain. Yes, those risks are sometimes exaggerated: Many viruses, like the flu, cause long-term symptoms, and part of the focus on long-term Covid stems from society’s current obsession with all things Covid. . There is still no rigorous study that compares the long Covid with the “long flu”. But long Covid is probably worse, which calls for caution.
What we don’t know
So what is the frequency of breakthrough infections?
One of the reasons for optimism is the recent trend among the most vaccinated segments of society: the elderly. About 80 percent of Americans over 65 have been fully immunized. This graph looks at the United States since the end of June, when cases started to increase:
This graph takes a look at England – where more than 90% of the elderly are vaccinated – since the end of May, when cases started to increase there:
As you can see, new cases have only increased modestly in people over 65, suggesting that breakthrough infections are rare. “I believe that vaccinated people are not, at the population level, major contributors to the transmission of the disease,” said Dr. David Dowdy, epidemiologist at Johns Hopkins University.
Part of the reason is that vaccinated people are both less likely to be infected and less likely to transmit the virus even if they are infected, scientists say. A person vaccinated without symptoms of Covid seems particularly unlikely to infect anyone else.
“What is clear is that people who are vaccinated and have symptomatic infections can pass it on to others,” said Dr Ashish Jha of Brown University. “What is not at all clear is whether asymptomatic vaccinated people can transmit it. And my best guess is no – or not very often. “
He added: “I am not worried that an asymptomatic vaccinated person will pass it on to me.”
Of course, a vaccinated person can still contract the virus from someone who is showing symptoms or who has not been vaccinated. Liam Stack, a Times reporter who covers religion, was fully vaccinated in April but nonetheless caught the virus in June, probably socializing with friends, whether at a bar or a beach house, he says.
“It wasn’t the sickest I have ever been, but it was very disturbing,” he told me. He was ill for a full week, with flu-like symptoms, including congestion, muscle aches and fatigue. One day he took a three-hour nap around lunchtime, followed by a two-hour nap before dinner.
Liam is feeling better now and as far as he knows none of his friends or family have contracted the virus from him. But he does not recommend the experience. “It was unpleasant,” he says.
Different people who get vaccinated will make different decisions, and that’s okay. I find that the risk of breakthrough infections is low enough that I do not make major changes in my behavior.
I would feel different if I lived in a community with a lower vaccination rate – or if I lived with someone who was vulnerable to Covid due to an immunodeficiency. And the current increase in cases has changed my thinking. I will wear a mask again sometimes when in close contact with strangers, although it has little tangible effect. The main reason for doing so, as Dowdy said, is to contribute to the shared feeling that we have entered a worrying new phase of the pandemic.
It is also important that the country does not react in a way that would do more harm than good – for example, by delaying the full reopening of schools, Dowdy added. For those vaccinated, Covid still represents a very low risk, and the cost of our response must not exceed the benefits.
But when cases increase, as is the case now, our approach to Covid should be different than when they dive.
For more: My colleague Tara Parker-Pope and Slate’s Susan Matthews have both written thoughtful articles with advice on breakthrough infections. And today’s episode of “The Daily” also examines the subject.
The rise of “sincere TV”
How has television changed over the past two decades? James Poniewozik of The Times has a theory: irony, drama, and squeaky comedy have given way to sincerity. The best example, he argues, is the shift from David Brent – the egocentric and vulgar boss of the British series “The Office” – to Ted Lasso, the serious comedy hero now in his second season.
In a time of plague and polarization, suggests James, “sincerity can be a better cultural fit.” Read the rest of the story. – Ian Prasad Philbrick, a morning writer
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