Comparison between vaccinated vs unvaccinated infections in the US. These data
apply to hospitalizations. Eric
See the Data on Breakthrough Covid Hospitalizations and Deaths by State
By The New York TimesAug. 10, 2021
Serious coronavirus infections among vaccinated people have been relatively
rare since the start of the vaccination campaign, a New York Times analysis of
data from 40 states and Washington, D.C., shows. Fully vaccinated people have
made up as few as 0.1 percent of and as many as 5 percent of those hospitalized
with the virus in those states, and as few as 0.2 percent and as many as 6
percent of those who have died.
There is still a lot we do not know about so-called breakthrough infections —
when fully inoculated people contract the virus. And there is some evidence
that these cases are becoming more common as the more transmissible Delta
variant surges. While vaccines have done a remarkable job at protecting a vast
majority of people from serious illness, the data in the Times analysis
generally spanned the period from the start of the vaccination campaign until
mid-June or July, before the Delta variant became predominant in the United
States.
Breakthrough Covid-19 Hospitalizations and Deaths by State
Among fully vaccinated people in each state since vaccination began.
STATE BREAKTHROUGH HOSPITALIZATIONS AS A PCT. OF ALL COVID HOSPITALIZATIONS
BREAKTHROUGH DEATHS AS A PCT. OF ALL COVID DEATHS
Alabama 77 0.3% 21 0.4%
Alaska 17 2.0% 2 3.3%
Arizona 379 0.5% 34 0.3%
Arkansas — 4.7% — 2.6%
California 843 0.4% 88 0.5%
Colorado 312 1.2% 52 3.1%
Delaware 22 0.4% 6 3.5%
Georgia 85 0.1% 21 0.2%
Idaho 37 0.9% 6 1.3%
Illinois 563 0.6% 151 2.2%
Show all
Note: Arkansas did not provide counts of breakthrough hospitalizations or
deaths, and West Virginia did not provide a count of breakthrough
hospitalizations.
Data on less serious breakthrough infections is not widely available, though it
is possible those cases are rising. Data was not available for several states
in which the virus has been surging, including Florida and Missouri.
Until recently, the Centers for Disease Control and Prevention estimated that
fully vaccinated people accounted for less than 3 percent of coronavirus
hospitalizations nationwide and less than 1 percent of virus deaths. But last
week, the agency
noted<https://www.google.com/url?q=https://www.whitehouse.gov/briefing-room/press-briefings/2021/08/05/press-briefing-by-white-house-covid-19-response-team-and-public-health-officials-48/&sa=D&source=editors&ust=1628527736671000&usg=AOvVaw1NLFgT9bAYQY_D6jv-pM1b>
that those figures did not reflect new data involving the Delta variant and
said it was actively working to update them. Only about 50 percent of people in
the United States are fully vaccinated.
Looking at how many hospitalizations and deaths have involved fully vaccinated
people is a common but crude measure of how well the vaccines are working.
As more people get shots, the percentage of hospitalizations and deaths among
fully vaccinated people should rise. This may seem counterintuitive, so it’s
important to understand why.
In a state with a high vaccination rate, a higher percentage of breakthroughs
may simply reflect that fully vaccinated people are a bigger chunk of the
population, or that there are few hospitalizations and deaths overall. Imagine
a state where just two people are hospitalized but both are vaccinated —
breakthroughs would account for 100 percent of the hospitalizations in that
state, even though these cases were very rare.
Assessing breakthrough rates
Some epidemiologists and state health officials instead recommend comparing how
likely a vaccinated person was to be hospitalized or to die, compared with an
unvaccinated person.
To do this, the Times used the number of breakthroughs and the vaccination rate
over time to estimate rates of hospitalizations and deaths for each group in
every state for which data was available.
In those states, people who were not fully vaccinated were hospitalized with
Covid-19 at least five times more often than fully vaccinated people, according
to the analysis, and they died at least eight times more often.
How Rates of New Covid-19 Hospital Admissions and Deaths Compare
Among fully vaccinated people and among people who were not fully vaccinated in
each state since vaccination began.
HOSPITALIZATION RATE PER 100,000 DEATH RATE PER 100,000
STATE FOR VACCINATED PEOPLE FOR UNVACCINATED PEOPLE FOR VACCINATED
PEOPLE FOR UNVACCINATED PEOPLE
Alabama 9 696 75x higher for unvaccinated people 3 124
48x higher for unvaccinated people
Alaska 9 154 17x 1 11 10x
Arizona 27 1,306 47x 2 182 73x
California 9 647 68x 1 58 58x
Colorado 24 567 22x 4 37 8x
Delaware 7 978 148x 2 26 14x
Georgia 5 735 161x 1 99 87x
Idaho 11 288 25x 2 30 16x
Illinois 20 1,001 48x 5 68 11x
Indiana 9 547 57x 4 29 7x
Show all
Note: Table shows rates for the entire reporting period for each state
calculated with the average vaccination rate for the total population over that
period. Rates per 100,000 are rounded. Rates used to calculate comparisons were
unrounded. Data for unvaccinated individuals includes partially vaccinated
people, unvaccinated people, and people with unknown vaccination status.
“In an ideal world, you would be able to calculate the rates based on the
number of people who were actually exposed,” said Kristen Panthagani, a
geneticist at Baylor College of Medicine who runs a blog explaining complicated
scientific concepts, including breakthrough
infections<https://youcanknowthings.com/2021/07/21/some-vaccinated-people-are-getting-covid-what-does-this-mean/>.
“But that number is really hard to figure out.”
More breakthroughs as the outbreak grows
In interviews, epidemiologists said that the United States is likely to see
more breakthroughs, especially in areas where cases are surging. Essentially —
the more that the virus circulates, the more exposures you can expect, and the
more breakthroughs you can expect.
“The more infection rates go up in the background, the more you’re going to see
disease among people who were immunized,” said Dr. Paul McKinney, associate
dean at the University of Louisville’s school of public health in Kentucky.
“People need to be aware that, to the extent that we can keep the incidence
down, the better off everyone’s going to be.”
It does not help that, in recent weeks, new research has shown that vaccinated
people, if they become infected, can carry high levels of the coronavirus.
Although at least 80 percent of people 65 and older are vaccinated in the
United States, surging cases could still present an elevated risk for them. It
is possible, epidemiologists said, that seniors and people with compromised
immune systems could be particularly vulnerable in a surge, even if they were
fully vaccinated, because their bodies might not produce a strong immune
response from the vaccine. The Food and Drug Administration is speeding efforts
to authorize booster
shots<https://www.nytimes.com/2021/08/06/health/covid-booster-shot-immunocompromised.html>
for people with weakened immune systems.
In Mississippi — where only about 35 percent of the population is fully
vaccinated and where infections and hospitalizations have been surging —
vaccinated older people and people with weaker immune systems have been
overrepresented among those hospitalized and dying, according to the state
health department.
“We’re seeing a pretty dramatic spillover effect from the transmission in the
community to our more vulnerable parts of our population,” Thomas Dobbs,
Mississippi’s state health officer, said last week, though he emphasized that a
higher proportion of breakthroughs did not mean the vaccine had become less
effective.
A need for better data
A lack of comprehensive data, paired with growing concern over the Delta
variant, may be helping to drive fears about breakthrough infections.The C.D.C.
does not provide data for breakthrough instances at the state or local level,
nor does it provide the data over time, which makes it difficult to see if
fully vaccinated people may be becoming more vulnerable to the virus in certain
areas.
The agency, along with some states, stopped tracking mild breakthrough cases in
May, focusing instead on breakthrough infections that result in hospitalization
or death. The decision has recently garnered criticism from several lawmakers,
who have argued that having detailed information on the infections is critical
to understanding how the virus is behaving.
Several epidemiologists told The Times that collecting comprehensive data on
mild cases is nearly impossible because those infected may have such mild
symptoms that they do not bother getting tested (or they may have no symptoms
at all).
“Most of the breakthrough cases will not be diagnosed because they tend to be
mild or more like a cold,” said Dr. Chighaf Bakour, an assistant professor of
epidemiology at the University of South Florida, explaining that the cases that
are diagnosed would be more likely to be moderate to severe because those
people would seek out testing or treatment.
But epidemiologists said that having better data at the local level could help
public health experts identify problems — including more dangerous or
transmissible variants, and also flaws in vaccine storage or manufacturing.
Beyond that, they said it is critical to understand how breakthrough cases
might be affecting different demographic populations — including different age
groups and racial groups, groups that received different vaccines, and groups
that received their vaccines earlier in the year versus later in the year.
That, they said, is important to keeping the virus at bay.
“The data is our access; we have to collect the data,” said Debra Furr-Holden,
a Michigan State epidemiologist and associate dean for public health
integration. “At this point, we are not trying to eradicate Covid. We are now
trying to figure out how to mitigate its impact.”
Methodology
The Times asked all 50 states and Washington, D.C., to provide data on
breakthrough infections, hospitalizations and deaths of fully vaccinated
people, roughly spanning back to the first months of the vaccination campaign
at the end of 2020 and beginning of 2021. Many of the states provided data
through June or July, which may not account for the recent surge in Delta
variant infections. In every state providing information, hospitalizations and
deaths among fully vaccinated people accounted for a small minority of the
totals.
Forty-four states, plus Washington, D.C., shared some breakthrough
hospitalization or death information with The Times, though some provided only
two months or less of records. Those states — Connecticut, Hawaii, Maryland and
Wyoming — were excluded from the analysis. Three additional states — Iowa,
Missouri and Pennsylvania — said they were unable to provide data on
breakthroughs because their own systems did not effectively track them.
Florida, Kansas and New York did not provide any data on breakthrough
hospitalizations or deaths.
The states define breakthrough cases in different ways and provided data for
different periods, so exercise caution when making comparisons. Some count
fully vaccinated people who tested positive for the virus, even if they had no
symptoms, while others do not. Some considered a case a breakthrough only if
the person had been fully vaccinated for 14 days or more. Some states said that
they did not know the hospitalization status of all of their breakthrough
infections or that they only received data from a subset of hospitals. Some
states said their breakthrough data was preliminary and subject to change.
Some hospitalizations and death records lacked vaccine status altogether. Data
for individuals who were not fully vaccinated includes partially vaccinated
people, unvaccinated people, and people with unknown vaccination status.
The Times used data reported by hospitals to the Department of Health and Human
Services for new Covid-19 hospital admissions to calculate total
hospitalizations in each state across the same time period, as well as to
calculate the number of hospitalized people in each state who were not fully
vaccinated. The data can overestimate the amount of people hospitalized if the
same person is admitted to a hospital multiple times, and the data can lag. The
Times counted confirmed and probable virus hospitalizations in adults and
children. For Rhode Island, the Times used total hospitalization data provided
by the state instead of federal data because it was more complete.
The analysis used state data for total Covid-19 deaths when it was possible to
do so. If it was not available, The analysis used death data from The New York
Times coronavirus
database<https://www.nytimes.com/interactive/2021/us/covid-cases.html>.
The rates for fully vaccinated and not fully vaccinated groups were calculated
from the average number of people in each group across all days within the
period for which data was provided. Because only a total number of breakthrough
hospitalizations or deaths for the entire period was available, rates cover
different periods for each state. Rate calculations are based on the entire
fully vaccinated and not fully vaccinated population, not any measure of who
has been exposed to Covid-19.
Sources: State health departments (breakthrough hospitalizations, breakthrough
deaths and some total deaths), U.S. Department of Health and Human Services
(hospitalizations), New York Times database of cases and deaths (some deaths)
By Danielle Ivory, Albert Sun, Amy Schoenfeld Walker, Brandon Dupré, Brillian
Bao, Lauryn Higgins, Laney Pope, Kristine White, Bonnie G. Wong, John Yoon,
Donovan J. Thomas, Benjamin Guggenheim, Cierra S. Queen, Yuriria Avila, Julia
Carmel, Taylor Johnston, Derek M. Norman, Rachel Sherman and Maura Turcotte.
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