My entire family is vaccinated, and from what I’m reading (limited though it is) “breakthrough” infections are a bit of a thing these days. Now, in reading about these positive tests, there is often the caveat that it is ‘asymptomatic’ or ‘symptomatic’ but I never seem to hear that the patient is hospitalized, ventilated, or deceased.
If this particular virus is overwhelmingly likely to land me in bed for a couple of days, or pass entirely unnoticed, I’m overwhelmingly likely to think it’s no big deal. Am I totally being stupid about this? From a personal safety standpoint, that is.
I could be concerned about the impact on our unvaccinated population, but it’s hard to drum up a lot of sympathy for people who are deliberately avoiding the one (free & widely available) thing that will protect them.
Don’t forget that, in addition to the large numbers of people avoiding the one thing that will protect them, there is a small number of people who cannot be vaccinated due to allergies, underlying health conditions, or other factors. Plus (at the moment) everyone under twelve, but always newborns. I think some sympathy for these people is warranted.
The one person I know to have had a breakthrough infection was in their late thirties and lost their sense of taste and smell completely for a couple of weeks and still isn’t quite back to normal a couple months on. Now for me at least, that’s a very moderately big deal. Though technically classed as a “mild” symptom, not being able to taste would suck and long COVID is a thing particularly with that symptom. But it definitely wasn’t remotely life-threatening.
But allow me for a moment to be a pedantic jerkass . Saying “just a cold” is one thing, saying “just a flu” is another. I mean I get what you mean, but the common colloquial conflation of the two has always kinda perplexed me . I don’t know if you’ve ever had a bad case of influenza, but it is misery squared and does kill some variable thousands of people in the US most years. It isn’t exactly a trivial thing. I DO NOT want to catch a case of the flu - it sucks hard in the moment and is potentially life-threatening.
I think the issue here is that a lot of people get a stomach bug that makes them puke for a day or three and call it “the flu” or “the stomach flu”. Since it can be pretty mild, they tend to opt out of the flu shot and don’t get too concerned when something is compared to the flu (like covid was at the beginning).
I worry when I see statistics like that. Specifically because I think ‘it only kills the elderly’ is part of what made it as bad as it was last year. So many people ignored or downplayed the virus because they weren’t part of that group.
Everyone’s immune systems are different. No vaccine is 100%, not even the ones we’ve relied on for years. All anyone can tell you are probabilities. The ones I’ve seen are for hospitalization and death, which is very very low when fully vaccinated. Anything above that, I’ve heard conflicting stories about, as you may expect. I don’t think there’s been a formal survey or study on this.
Given anecdotal evidence, I’m inclined to think the probabilities are with most vaccinated people with it being no big deal (given that one argument in favor of mask mandates and such returning is that there seem to be a lot of breakthrough cases that don’t show symptoms, or at least major symptoms). But your mileage may vary widely.
Currently, the data indicates about a 30% breakthrough infection rate (which is consistent with the composite efficacy of the vaccines to the B.1.167.x and B1.1.351 variants) with about 10% of those having severe morbidity (requiring treatment beyond monoclonal antibodies) and a 2% mortality rate, although it should be noted that the vast majority of severe cases have significant comorbidities that likely contribute to deaths. If you are healthy and have good Vitamin D and other nutrient levels, the odds are good that you will not have severe presentation of any of the currently identified circulating variants.
However, the virus continues to mutate, and while the focus has primarily been on the mutations in the S-protein (which forms the ‘spike’ by which the virus attaches to the ACE2 receptor) which makes it more infectious, mutations in the ORF region that produces proteases and RNA-dependent RNA polymerase could potentially alter the replication rate and pathogenesis of the infected cell. In fact most alterations occur in the ORF region because it is the largest part of the viral genome which coding for 29 individual proteins, and could potentially make the virus far more virulent along the lines of SARS-CoV(-1) or MERS-CoV, with estimated mortalities of 9% and 30% respectively. That would be potentially catastrophic, and although such a variant would show up quickly in the data, the foothold a highly infectious, often asymptomatic pathogen with the latency of SARS-CoV-2 could be quite large, especially with the easing of public health measures and international travel.
Another potential issue is the post-acute sequelae, i.e. “long-haul COVID-19” or just “long covid” as people are now casually referring to it. The assumption is that the vaccine protects against this as well, and the data, such as it is, seems to bear this out in general insofar as there are less instances of people who are fully vaccinated reporting symptoms, but the phenomenon is so poorly understood that it isn’t even known if this is just one post-infection inflammatory syndrome, or multiple syndromes with different, potentially interacting causes. Post-acute sequelae has been seen in at least a handful of fully vaccinated people so far albeit not to a point of complete disability but without understanding the causal mechanisms it is hard to say just how much protection vaccines actually provide and what mutations might enhance long haul conditions.
Setting aside the under-12 set that still doesn’t have an available vaccine and the people who have medical conditions that make vaccination risky or less effective, think less in terms of “sympathy” or respect for these people and more about a responsibility to limit the transmission of the virus. It is true that the willfully unvaccinated who are nonetheless circulating are by far the main cause for massive spread and will foster new variants regardless, but by treating this casually you are also offering tacit if unintentional approval of their choices. Until we have high enough inoculation to prevent epidemic spread and/or readily available therapeutic treatments that can prevent severe morbidity and mortality, there is still a need to limit the spread of the pathogen even if the personal impact to you is not significant.
“The plural of anecdota is not data.”
The problem with how we’ve dealt with this pandemic is we’ve been largely flying on anecdota, poorly sampled and reported infection data, and peoples’ “feelings” about what they think is right or fair. The virus, however, doesn’t give a flying fuck about fairness or liberty or any other principles you may hold dear, and “anecdotal evidence” is at about the same level of usefulness as taking guidance from random Twitter posts. We got into the situation we’ve been in for the year and a half because many people felt like this was “no big deal”, and it is unlikely that the casual approach is the way out of it, either, notwithstanding how much diminishing the impact of the yes-still-very-much-circulating-and-killing-people virus is dismissive to front line and medical workers who have been working tirelessly throughout the pandemic while people flaunted public health orders and requests to do even the simplest things to prevent spread because “it’s just a flu”. I would appeal to people to stop guessing their way through this and look at actual data and informed speculation and analysis by virologists and epidemiologists instead of hucksters, scammers, “public health officials” with no actual background in public health management, and politicians primarily concerned with keeping the voters happy with them for the next election cycle.
If I didn’t have a toddler at home, I’d probably think about it as the OP does - minimal risk, and I’m just not worried about spreading it to other adults. But I think anyone who regularly comes into contact with children under 12 should remain somewhat vigilant until they can get vaccinated. I’m venturing out a bit these days, but still doing things like consolidating grocery store trips, not taking the kid on those, wearing masks when indoors (at stores, etc.) It helps that our immediate vicinity has a very high vaccination rate, too.
I think I was answering the question more along the lines of, what is most likely to physically happen to the OP, rather than the implied question of how he should behave based on those probabilities. The behavior question is, IMO, a completely different and much more fraught topic.
No, that is the breakthrough percentages seen on the ICMR Prune Institute of Virology study that was done in India. There are a few caveats with that; India is using four different vaccines with varied efficacy, and the study did not distinguish either between the vaccines nor patients who were infected just after vaccination vice those who had time to develop full immunogenicity. It did indicate that 86% of those infections were from the ‘Delta’ variants (B.1.167.1 and B.1.167.2) but those are spreading rapidly around the world so for any country that does not have effective public health measures and tight quarantine and test for people entering this is expected to become the dominant variant. The ZOE/King’s College London study should be releasing an updated comprehensive assessment of how the ‘Delta’ variants have spread through the UK in the 01-15 July period shortly with a more rigorous analysis but they are showing upticks even in reasonably well-vaccinated areas. It does indicate that the “two dose” mRNA vaccines are showing better overall efficacy, arguing for a second dose even in those who have had a single dose adenovirus-vector vaccine, and possibly modified booster doses across the vaccinated population.
Fortunately, the vaccines as-is do provide good protection against severe illness and almost complete protection from death (the majority of deaths can be attributed to conditions independent from or at worse exacerbated by COVID-19) but it is very clear that strains of the virus are evolving to evade immune response provoked by the vaccines. That is to be expected; it is, after all, what viruses do, and we live with the constant threat of multiple strains of seasonal Influenza A, any one of which could emerge with a severely virulent mutation that the population would have little naive resistance against. But it seems like the public expectation is a “one-and-done” with vaccination; the reality is that SARS-CoV-2 will be around indefinitely, will need to be surveilled and monitored, and will require periodic revaccination and the development of more effective therapeutics. This is actually kind of a blessing in disguise, such as it is, as it will keep the threat of pathogenic outbreak more on the forefront, because as bad as this pandemic has been, a more virulent viral pathogen or highly antibiotic resistant strain of transmissible bacteria could be worse, and we should be spending far more money and effort on preparing for those.
Well, we can observe what the odds of developing severe disease based upon current data are, and they are certainly favorable for the fully vaccinated. However, we have pretty poor quality data on the incidence and long term implications of post-acute sequelae, and we can only guess at what mutations in a hypothetical future variant may do with respect to current immune response. If the disease were under control and the opportunities for novel variant to develop and spread before detection were low, then we could make a credible evaluation that the odds of getting a severe breakthrough infection from a newly emerged virulent strain are along the lines of any other severe infectious disease one might encounter. But the reality is that SARS-CoV-2 is still killing more people than even a borderline epidemic seasonal flu or other serious pathogen, and is far from being “under control” in most of the developed world not to mention South America, Africa, and Southeast Asia. You can’t walk around worried about every possible hazard, but this one is very much a real and present threat, even for those people who are fully vaccinated.
“Treating this casually” means assuming that vaccination is the end of the story and that one can simply engage in all pre-pandemic behaviors without risk, e.g. the Tokyo Olympics, Las Vegas, crowded stadium events, et cetera. Personally, being vaccinated means that I’m more willing to meet with small groups of people indoors (if they’re also vaccinated) and I’m more comfortable traveling without being totally self-contained, but I’m not going around unmasked in indoor public spaces or eating inside of restaurants, because even if the vaccinate will protect me against severe infection it may not prevent me from carrying it to others, and frankly I don’t even want a ‘mild’ case of this because I got a relatively light taste of the original wild-type early on and that was utterly miserable and kept me from strenuous physical activity for over a month.
You (obviously) have better access to (and understanding of) REAL numbers than the rest of us - do you have similar numbers for the un-vaccinated?
Yeah, the 30% surprised me, because everything we heard about the first vaccines was 70-80% after the first shot and 90%+ two weeks after the second. However, it doesn’t worry me. When’s the last time you knew someone with the Mumps, and the Mumps part of the MMR vaccine is only about 60% effective. Just the fact that those vaccines are SO universal helps the crappy individual effectiveness translate into herd immunity.
How about thinking of it this way - these people are being lied to by Faux News and others. They are misinformed, and are victims. In a better world, there would be a “get the vaccine” push from ALL areas of the political spectrum, from ALL religious areas. Instead, we have Tucker Carlson "JAQ"ing off and causing distrust. The best argument I’ve been using is "yes, there are some side-effects of the vaccine, but they’re a lot less severe than the KNOWN long-term effects of getting the disease.
Yes, you can get infected. The vaccines seem to be covering the Delta variant, I haven’t read about how the Lambda variant is responding. From what I have read, you can get it, and be symptomatic (or asymptomatic) but hospitalization is unlikely, and death is unlikely. You could still spread it.
For me, even though I feel fairly safe, it would still be a PITA to be exposed. I would have to test, quarantine and test again, using PTO/ short term disability to cover mandated time off.
California is experiencing another spike. Many experts think we are headed into a third wave. This thing is not over. Don’t assume you and yours are completely safe. Masking and distancing are still recommended by WHO. CDC still has their collective heads up their asses.
I have eaten inside restaurants in the last couple of months. But these weren’t cozy, crowded, low-ceiling, intimate, close-quarters places. They were places with high-ceilings (15+ feet), ceiling fans going full blast, air conditioning full-on, only a few occupied tables, and those spaced widely apart. Servers masked. I felt safe in restaurants like that.
I commend people who are still willing to curtail their activities to help protect the unvaccinated but to a point I’m done with that. I have no problems wearing a mask if asked to but life is short and I’ve already lost a year due to COVID; I’m not giving up more because of the anti-vaxxers.
I have a friend who hasn’t gotten the vax yet because “I don’t want people telling me what to do.” If I thought I had any chance of changing his mind I would tell him how immature that is but I’m not sitting home because of people like him. I just don’t go out with him.
All of the data and studies I’ve looked at are public access. Quite frankly, I’m dubious that anyone has “REAL numbers” in terms of reliably vetted data that statistically predicts trends more than a couple of weeks out; the best I’ve found is the aforementioned ZOE study (which uses a voluntary app for tracking infections) and even that has stated limitations. I’ll say that the pattern of outbreaks has not been very uniform; some regions can go months without significant outbreaks and then all of a sudden blossom out, like what happened in the United States in the middle of last year; based upon trends from data, I was anticipating outbreaks throughout the country 3-4 weeks after New York was experiencing massive outbreaks, and yet it took 2-3 months to reach epidemic levels for reasons that still no one can explain beyond waving hands about superspreader events and skewness and kertosis; at best, we can say that it is a small number of infected people are responsible for most transmission, but not who or why.
The infection likelihood of non-inoculated people is difficult to even guess at because it depends so much on environmental and behavioral conditions, but the naive R0 of the wild-type virus was found to be 3.8 to 8.9, so even at the low end it is highly contagious. There is some argument over whether the newer variants are actually as more transmissible as indicated by data, or whether they are actually just producing more symptomatic disease and severe outcomes in younger people. The more I look at data the less convinced I am that we have an answer.
shrug It is the best data we have. Unfortunately, the US (or rather the individual states) is piss-poor at doing any kind of comprehensive sample testing or studying or the vaccinated population, and because vaccination rates are so low in most of the rest of the developed countries (except the UK) it is difficult to get a better estimate. It is worth noting, however, that the BioNTech/Pfizer and Moderna efficacy trials looked at symptomatic disease and did not do comprehensive rtPCR testing of the study populations, so any genuinely asymptomatic or unreported mildly symptomatic infections were unlikely to be reflected.
Given that the US doesn’t have even half of the population fully vaccinated and most nations are even behind that, as well as the personal variability in observed immunogenicity, I suspect the 30% factor is not that far off of reality. What is clear, however, is that the vaccines are highly effective in preventing severe illness in otherwise healthy people, and it looks like boosters are effective at provoking at least a transitory immune response even in many immunocompromised individuals.