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Just because you’re vaccinated doesn’t mean you can’t get COVID-19

Shots still protect against severe illness, death

Bountiful resident Blaine Gardner, who is immunocompromised, gets a third COVID-19 vaccination in Bountiful.
Bountiful resident Blaine Gardner, who is immunocompromised, gets a third COVID-19 vaccination at the South Davis Senior Activity Center in Bountiful on Wednesday, Aug. 25, 2021.
Laura Seitz, Deseret News

Yes, COVID-19 vaccines still significantly decrease your risk of hospitalization or death from the virus even with the highly contagious delta variant continuing to surge through Utah and the rest of the country.

But, no, getting the shots doesn’t mean you can’t catch the coronavirus.

As of Wednesday, there have been 13,836 breakthrough cases of COVID-19 — including 735 requiring a hospital stay and 80 resulting in death — in Utahns who are fully vaccinated, meaning it’s been two weeks or more since their final dose, the Utah Department of Health reported.

Along with tracking those numbers, the state health department recently started posting the odds of getting COVID-19 for those Utahns who have chosen not to be vaccinated, even though the shots have been widely available at no charge to anyone 12 and older since spring.

Not vaccinated? The odds are shifting since the delta variant showed up this summer, increasing the number of breakthrough cases, but you’re at 4.4 times greater risk of testing positive for the virus without the shots, and once you’ve got COVID-19, your risk of hospitalization is 5.1 times higher, and your risk of dying is 4.8 times higher.

“The evidence is pretty clear that the vaccines aren’t quite as effective against delta,” said Han Kim, a professor of public health at Westminster College in Salt Lake City, when it comes to getting infected with the virus. “But it’s still highly effective against disease, hospitalization and death.”

The better-than-anticipated ability of the vaccines to prevent any sign of COVID-19 in clinical trials may have unrealistic expectations based on a “misconception or overconfidence,” he said. Like most vaccines, the COVID-19 shots protect against symptomatic as well as severe disease that can lead to death but don’t stop infections.

“To be honest, we were kind of spoiled. When the data for the Moderna and Pfizer-BioNTech vaccines came out, we were kind of blown away. We did not expect 95% efficacy. We were thinking if it’s 70%, it’s going to be awesome,” Kim said. “That was the standard that was set.”

But the delta variant that originated in India and is now the dominant strain of COVID-19 in Utah and the rest of the United States is much more transmissible, even to those who have gotten the two doses of the Moderna or Pfizer vaccines, or the single-dose Johnson & Johnson shot.

The difference for those who are vaccinated, Kim said, is that the viral load appears to drop off “really, really quickly,” before sniffles or other symptoms can develop into something more threatening that’s spread to others.

“It takes a little bit, but it kicks in before your disease gets serious,” he said.

Dr. Tamara Sheffield, medical director of preventive medicine for Intermountain Healthcare, also said expectations were too high for the vaccines rolled out late last year, first to front-line health care workers and long-term care facility residents and staffs.

Initially, she said, the real-world effectiveness of the vaccines meant those who’d gotten the shots had “about a 10 times lower chance of getting ill with COVID,” even though some saw it as a 100% chance they’d avoid the virus altogether.

Even then, Sheffield said, it was “just a matter of time if you have a 90% effective vaccine, that 10% of people are still going to become ill.”

Now that the chance of infection is higher with the delta variant, Sheffield said, “people are saying, ‘Well, if people are getting ill, why should we vaccinate?’ It is No. 1, you’re so much less likely to be one of the ones that becomes ill. No. 2, you’re less likely to be passing disease, and No. 3, you’ll have fewer symptoms and it will last less time.”

Kim said vaccinated or not, everyone is likely to experience COVID-19.

“Most epidemiologists think all of us will be exposed at some point. That’s where we are with COVID. All of us are going to get it at some point,” he said. But the immunity that comes from vaccinations is what it’s going to take to tame what continues to be a pandemic after some 18 months into something more like a seasonal flu.”

“At this point, most epidemiologists, I think that’s all we can hope for. I think getting down to zero cases and eradication, I don’t know if that was ever possible. But it’s definitely not anymore,” Kim said, although what still can happen is enough people getting vaccinated to slow the spread.

“That’s where the real power of vaccination is,” Kim said, in protecting a larger population, not just individuals. Until then, he said masks and other precautions continue to be needed even by the fully vaccinated to help stop transmission, particularly among children under 12 who are not yet approved for the shots.

“It’s hard,” Kim said, “because we live in such an individualistic culture, especially in the Intermountain West. We think of our actions as just affecting us and not how it can affect those around us. With infectious diseases, of course it affects those around us.”

Sheffield pointed out that wearing masks in public settings, holding events outdoors and social distancing are not only important at a time when COVID-19 hospitalizations and deaths continue to climb, but helped keep Utah cases of flu and respiratory syncytial or RSV, at bay last winter, when such precautions were mandatory.

Already, Utah hospitals are running out of intensive care unit beds because they’re dealing with so many largely unvaccinated COVID-19 patients. Last week, Intermountain Healthcare, the region’s largest health care provider, announced urgent but not life-threatening surgeries are being postponed in many of its hospitals.

“There is a peace of mind that comes with knowing that you have done what you can to protect yourself and those around you that you care about. So I think hopefully people will feel that. And then I hope there’d be some feeling of responsibility,” Sheffield said, adding, “We are all paying for people who are not getting immunized.”