Thread by @dwallacewells

This report on breakthrough prevalence, by ⁦@apoorva_nyc⁩, largely echoes the story I published a week ago (nymag.com/intelligencer/…) But it contains striking data, notably dark comments, and represents a real shift in establishment CW. A thread (1/x) nytimes.com/2021/08/17/hea…

“Breakthrough infections in vaccinated people accounted for at least one in five newly diagnosed cases in six of these states and higher percentages of total hospitalizations and deaths than had been previously observed in all of them,” @apoorva_nyc writes.

(“The piecemeal data,” I wrote then, suggested breakthroughs “represent a bigger share of spread, particularly in the Delta wave, than has been widely acknowledged—perhaps, overall, somewhere in the range of 5 to 20% of current cases, rather than the 0 to 5% range.”)

“In six of the states, breakthrough infections accounted for 18% to 28% of recorded cases in recent weeks,” @apoorva_nyc writes.

“These numbers are likely to be underestimates, because most fully immunized people who become infected may not be taking careful precautions, or may not feel ill enough to seek a test.”

“Breakthroughs accounted for 12% to 24% of Covid-related hospitalizations in the states, The Times found. The number of deaths was small, so the proportion among vaccinated people is too variable to be useful, although it appears to be higher than the C.D.C. estimate of 0.5%.”

Using the CDC’s own data, I calculated roughly that, between June 25 and July 26, the share of deaths from breakthrough infections was probably just above 5%. nymag.com/intelligencer/…

But @apoorva_nyc’s story is very good at contextualizing these numbers with risk ratios (which are much clearer measures than shares of cases, hospitalizations, or deaths).

“The states’ data do affirm that vaccinated people are far less likely to become severely ill or to die from Covid-19,” she writes.

“In California, for example, the 1,615 hospitalizations of people with breakthrough infections as of Aug. 8 represents just 0.007 percent of nearly 22 million fully immunized residents, and breakthrough deaths an even smaller percentage.”

She is also very clear that, as with the much larger risk facing the unvaccinated, there is a dramatic age skew to the much smaller risk facing the vaccinated.

“A vast majority of vaccinated people who are hospitalized for Covid-19 are likely to be older adults or those who have weakened immune systems for other reasons,” she writes. “C.D.C. data show that 74 percent of breakthrough cases are among adults 65 or older.”

“Most states do not compile the numbers by age, sex or the presence of other conditions. But in Oregon, which does, the median age for a breakthrough-associated death is 83 years.”

But the most striking feature of the story, to me, are the dark-sounding quotes. “Remember when the early vaccine studies came out, it was like nobody gets hospitalized, nobody dies,” said @Bob_Wachter, chairman of the department of medicine at UCSF. “That clearly is not true.”

“If the chances of a breakthrough infection have gone up considerably, and I think the evidence is clear that they have, and the level of protection against severe illness is no longer as robust as it was, I think the case for boosters goes up pretty quickly,” @Bob_Wachter said.

@SDrydenPeterson tried to strike a more optimistic note. “We don’t want to dilute the message that the vaccine is tremendously successful and protective, more so than we ever hoped initially,” he said, adding…

“The fact that we’re seeing breakthrough cases and breakthrough hospitalizations and deaths doesn’t diminish that it still saves many people’s lives.”

“There’s just a lot more virus circulating, and there’s something uniquely infectious about the variant,” said @nataliexdean.

“‘People who are older are both more likely to be vaccinated and more likely to be hospitalized given a breakthrough,’” she added.

“Especially for high-risk groups, ‘the most important message is that if you do get Covid, then take it seriously,’ Dr. Dryden-Petersen said. “Don’t assume that it’s going to be mild.”

“And seek out therapies like monoclonal antibodies if you’re high-risk, to try to prevent the need for hospitalization.’”

“The numbers suggest people who are at higher risk for complications and anyone who lives with someone in that group, ‘really needs to seriously consider the risks that they’re taking now,’ said Dr. Dean Sidelinger, a state epidemiologist and health officer for Oregon.”

“When boosters become available, barring arguments about ethics about global supply of vaccines, you should go and get a vaccine,” advised @michaelmina_lab, who spoke to me at length last week (x/x) nymag.com/intelligencer/…