So it’s been two weeks or longer since you’ve gotten your final dose of COVID-19 vaccine. You don’t have to worry anymore about catching the virus now that you’re fully vaccinated, right? Or about spreading the virus to others?
Not so fast.
There have been more than 7,100 cases nationwide — and 273 in Utah as of Wednesday — of what’s known as breakthrough COVID-19 in people who are considered fully vaccinated, meaning they received both doses of the Pfizer or Moderna vaccines, or the single dose of the Johnson & Johnson vaccine, at least 14 days ago.
Health officials stress cases where COVID-19 “breaks through” the protection provided by the vaccines are rare but not unexpected, and show the need for continued vigilance against the deadly coronavirus even after being vaccinated.
That’s because no vaccine is 100% effective in preventing infection. But the vaccines rapidly developed to prompt the immune system to respond to COVID-19 exposure with antibodies were up to 95% effective in stopping the virus in clinical trials.
Still, that leaves a small chance of not only catching COVID-19, but also of spreading the virus.
“I don’t think people should be surprised,” Kelly Oakeson, Utah Public Health Laboratory chief scientist, said. “We’re going to have some cases crop up where people that were fully vaccinated still got sick. That’s expected, right, so right now we’re seeing what we expected to see.”
Utah’s breakthrough numbers
Breakthrough cases are climbing in the state, according to data provided by the Utah Department of Health. Just 18 Utahns tested positive for the virus at least two weeks after their final vaccine dose in February; but there were 101 breakthrough cases in March and 154 so far in April, with 41 new cases reported since April 22.
No one has died from a breakthrough COVID-19 case in Utah, although the virus has killed at least 77 fully vaccinated people in the United States, according to the Centers for Disease Control and Prevention, and hospitalized at least 331. The numbers do not include those who were asymptomatic or whose hospitalization or deaths were not related to the virus.
Nineteen of the 273 Utahns with breakthrough COVID-19 were sick enough to be hospitalized.
The breakthrough infections accounted for 0.07% of the state’s nearly 400,000 COVID-19 cases through that date. The CDC reported 7,157 breakthrough virus cases through April 20, 0.02% of all cases in the United States at that point, showing the strength of the vaccines and the state and national push to get the public vaccinated.
The number of vaccinations is going up, with more than 2 million doses already administered in Utah. More than 900,000 Utahns — about 38% of those 16 and older who are eligible for the shots, and just over 28% of the state’s overall population — are fully vaccinated.
Earlier this month, the statewide mask mandate ended and other restrictions are set to end once Utah reaches 1.63 million first vaccine doses received from the federal government, likely in mid-May. But masks are still required by many private business and public entities, including K-12 schools.
Amy Carter, a public health nurse with the Weber-Morgan Health Department, said the shots aren’t a green light to give up wearing a mask in public when it’s not possible to social distance, wash hands regularly, cover a sneeze or take other steps that slow the spread of the virus.
“I do think it’s easy for people to kind of get this blanket of security and to a point, it’s OK. But it’s not that we want them to be so relaxed yet that they can say, ‘We don’t have to take any precautions,’” Carter said, warning that becoming lax about public health measures after being fully vaccinated could lead to more cases.
“Vaccination is a good answer for us but it’s not our entire answer. So at this point in time, we do still need to be mindful,” she said, calling for “practicing just a little bit of that commonsense method to just making sure we’re doing our best to prevent spreading germs as much as we can.”
“The vaccine is great, you know, it’s going to give you some protection. But it’s not 100% protection. So if you can take the protection you get from the vaccine, add on mask wearing and social distancing, that’s a pretty good recipe,” he said.
What about variants?
So far, the vaccines are effective against the variants of the virus that are prominent in Utah, but that may not always be the case. Sequencing samples from the breakthrough cases at the state lab is a priority, but Oakeson said it’s too soon to say if the variants increase the risk of someone who’s fully vaccinated getting COVID-19.
“I don’t think we have enough data right now, at least for the Utah samples, to really know,” he said. Of the 50 or so samples from breakthrough cases that have been sequenced, Oakeson said only nine infections have come from virus variants — five from the California variant, three from the U.K. variant and one from the New York variant.
While the variant first identified in the United Kingdom may be the best known for forcing lockdowns in Britain and other nations recently, the California variant first surfaced in Utah last fall, he said, and recently was added to the same CDC category as the variants from the U.K., Brazil and South Africa.
All four are considered variants of concern, a threat because they are more contagious and cause more severe disease, and all four have now turned up in Utah. The New York variant, however, is categorized only as being of interest by the CDC.
“Viruses are going to keep doing what they do and that’s mutating, That’s how they got here. That’s how they’re going to keep keeping around is by mutating. It’s almost like an arms race between the virus and your immune system,” he said. “We’ve just got to keep doing all these right things to keep it at bay.”
Utah breakthrough cases
Utahns 65 and older with breakthrough COVID-19 account for 34.1% of the cases, with 78 cases among those 65 to 84, and 15 cases among those who are older. Among those 15-24 years old, there were 25 cases in the state; 25-44, 77 cases; and 45-64, 78 cases.
More women than men have contracted the coronavirus after being fully vaccinated in Utah as well as the rest of the country, and less than half of the nation’s breakthrough cases, 46%, have been in people 60 and older, the CDC reported.
The Salt Lake County Health Department, the state’s largest local health agency, has the most breakthrough cases, 96, followed by the Utah County Health Department with 58, the Davis County Health Department with 41 and the Weber-Morgan Health Department that serves both those counties, with 32.
Six of the state’s 13 local health departments reported fewer than five breakthrough COVID-19 cases — San Juan County, Southeast Utah, Summit County, Tooele County, TriCounty and Wasatch County, while Bear River and Central Utah each had six, and Southwest Utah had 20.
Around a third of the Utah breakthrough cases were asymptomatic, meaning someone caught the virus after being vaccinated but showed no symptoms and so could have unknowingly spread the virus. Such cases are discovered through routine testing of health care workers and others, as well as contact tracing.
Breakthrough cases can be a surprise
Even though Utahns may understand that it’s possible to get COVID-19 after being fully vaccinated, the diagnosis can still be unexpected.
“Some are surprised. They’re just kind of like, ‘Oh, shucks, I’m in that group that got it,’” said Wendy Garcia, the Davis County Health Department’s family health and disease control division director.
Yet they still see the value in having been vaccinated, Garcia said.
“For the most part, I think people understand that this is a great tool and it’s going to help not only them and their families but the community as a whole. So I’m not seeing a great deal of people extremely agitated that they got it. I think they feel unfortunate but they also are grateful that the vaccine has been made available to them,” she said.
Garcia and Sarah Willardson, manager of Davis County Health Department’s communicable disease and epidemiology bureau, said the department is doing contact tracing for breakthrough cases and making sure there are testing samples for the state to sequence for variants.
Willardson said the breakthrough cases are usually milder and largely come from the same sources as COVID-19 in those who aren’t vaccinated — family members or strangers encountered while traveling. But she acknowledged that people who are fully vaccinated may also be going to places they would have previously avoided.
“It definitely is a possibility that as people get vaccinated, they feel a little braver,” Willardson said.
Both Davis County officials stressed the need for the public to have confidence in the virus vaccines as the state continues to push to reach what’s known as herd immunity, when enough people have either had COVID-19 or are fully vaccinated against the virus to significantly slow the spread.
“We want people to feel good that they’re doing the right thing and that this is going to benefit them,” Garcia said, adding “we need to make sure we are not targeting COVID because this can happen with any vaccine, any vaccine that’s out there. It’s just part of the process. ... Nothing is 100% effective. But it’s soooo good.”
Dr. Kristin Dascomb, medical director of infection prevention and employee health for the region’s largest health care provider, Intermountain Healthcare, said the number of breakthrough COVID-19 cases are “extremely minimal,” compared to the number of people at risk of contracting the virus because they are not vaccinated.
“These vaccines that we currently have are, despite a few cases, still staggeringly effective. What do we know about these cases? That they had contact with a patient who had COVID and unfortunately, developed illness,” Dascomb said, that could be related to underlying health issues, age or even being exposed to a large amount of the virus.
She said focusing attention on breakthrough COVID-19 cases could discourage some Utahns from being vaccinated.
“There’s a number out there who say then, ‘Why should I bother?’” Dascomb said. “That’s where I wanted to be clear, that this is still a remarkable and effective vaccine, all of them, and that we should be very proud of the work the state has done in that sense. But we’re not done yet.”