Vaccinated and infected: Officials call breakthrough coronavirus cases rare

May 6—Fred Sandberg is fully vaccinated. His younger brother, Rolf Sandberg, is not. Both contracted the coronavirus last month, but their experiences differed greatly.

Fred, 58, described his symptoms as mild. He had a dry cough that persists three weeks later and felt too tired to work or move around for about three days, but now considers himself 93 percent recovered.

Rolf, an otherwise healthy 55-year-old triathlete and marathon runner, suffered through more than a week of just about every symptom associated with the virus except lung problems: congestion, headaches, a kink in his neck like he'd slept on it wrong, loss of taste and smell, sore eyes, a slight fever, achy muscles and joints, and an extreme fatigue he emphasizes above all else. He also recalls the mental fight against depression and a sense of impending doom.

"I had aches and pains like I had never had in my entire life. My whole body was just racked with exhaustion and pain," the younger brother said. "For someone like me, you know you're in trouble when you're wondering if you can make it to the bathroom, which is 20 steps away, or if you should just pee in the bed and clean it later. It was that bad."

Both attribute the difference in severity to Fred getting the vaccine, but the importance they derive from it is polar opposite.

"I've had worse cases of the flu, so I tell everyone get the shot," Fred says.

"Good for him," his brother, who does not intend to be vaccinated, counters. "One would deduce that, OK, maybe the vaccine helped you, but then there's the other side of, he still got COVID."

Made with Flourish

A vaccinated person testing positive for coronavirus isn't unexpected, health officials say, but it is relatively uncommon.

None of the vaccines claim more than 95 percent efficacy, a number which itself only means that a vaccinated person's chance of getting the virus is 95 percent lower than that of an unvaccinated person. It doesn't mean a person can't or won't be infected.

As of April 26, the U.S. Centers for Disease Control and Prevention reported more than 95 million Americans are fully vaccinated, yet 9,245 of them also got coronavirus. They're considered breakthrough cases, meaning they tested positive more than 14 days after completing their vaccination series.

"Like with other vaccines, symptomatic vaccine breakthrough cases will occur, even though the vaccines are working as expected," the CDC's website says.

Lucas and Wood counties are no exception.

Of the 144,000 Lucas County residents considered fully vaccinated, 81 later tested positive for coronavirus and were sent to the state for final review. At least 29 of them have since come back as confirmed breakthroughs, said Eric Zgodzinski, the county health commissioner.

In Wood County, eight of the 52,000 fully vaccinated residents are believed to be breakthrough cases, Health Commissioner Ben Robison said.

The numbers likely represent an undercount, as some of those infected may be asymptomatic or not get tested. It's also important to note that the CDC is shifting the definition of breakthrough cases to include only those that result in hospitalization or death, presumably to capture only the cases where the vaccine did not work as expected by preventing severe illness.

Under that definition, it's unlikely that Fred Sandberg will ultimately be considered a breakthrough case. He tested positive 17 days after receiving his final dose of Pfizer, but never required hospitalization.

Few breakthrough cases do.

Of the 9,245 breakthrough cases currently reported by the CDC, 835 of them resulted in hospitalization, though a footnote adds 241 of those hospitalizations were reported as asymptomatic or not related to the virus.

At least 132 of the breakthroughs resulted in death, though again the CDC added a caveat that about 20 of those deaths were reported as asymptomatic or not related to the virus.

Those odds are good, health officials say. It means the vaccine is working.

"What we're seeing is it's working really well," Mr. Robison said. "The number of people being reinfected from COVID without a vaccine is higher."

While officials have estimated that a person's natural immunity after infection is expected to last at least 90 days, it's unknown the strength or duration of protection that extends beyond that. People have fallen ill with coronavirus, recovered, and then tested positive again.

Official reinfection-rate data hasn't been reported, and because neither the CDC nor the Ohio Department of Health has officially defined what constitutes a reinfection, health departments have no way of providing numbers for its frequency.

Mr. Zgodzinski says he's heard anywhere from fewer than 50 reinfections to more than 500 in Lucas County.

Mr. Robison says that dating back to April, 2020, contact tracers have encountered possible reinfections at least once a week.

"People think natural immunity means they have no chance of getting COVID again or their chance is about as good as if they had the vaccine and the data just does not bear that out," Mr. Robison said.

The best available indication of a person's potential to contract coronavirus twice seems to come from a recently released peer-reviewed study of 4 million people in Denmark in 2020. It found that a person's overall protection against repeat infection was 78.8 percent.

That's below the up to 95 percent protection offered by the vaccine, but as more people get vaccinated, the window for infection to slip through actually gets even smaller, Mr. Robison said.

He explains it like this:

If person A is fully vaccinated, their chance of contracting coronavirus when exposed is about 1 in 10, if using a general 90 percent efficacy rate. If person A then comes in contact with person B, who is also fully vaccinated, the odds of person B getting the virus is now 10 percent of person A's 10 percent.

In other words, the chance of one vaccinated person passing the virus on to another vaccinated person is about 1 percent.

"So there's really a three-fold benefit for being vaccinated," Mr. Robison said. "One, if exposed, you don't develop disease. Two, you may develop disease but it's not as severe. And three — the population benefit — if you're vaccinated you can help prevent the spread of the disease in the community."

And officials do credit the vaccine for reducing community spread.

"If you notice what's happening now, we're seeing a decrease in cases, even though [our incident rate is] still high, and I think that's attributed to vaccine," Mr. Zgodzinski said.

On Dec. 15, 2020 — when cases were still surging and the first vaccines were administered to health-care workers at Mercy Health — Lucas County was reporting 21,605 infections and 475 deaths.

Ten weeks later, by March 29, when vaccines became available to everyone age 16 and older, another 15,930 cases and 318 deaths had been added.

Fast forward another five weeks and more than 50,000 vaccinations, the spread appears to be slowing. The county on Wednesday reported 41,756 cases, an addition of 4,221 since March 29, and 831 deaths, an addition of 38.

"The vaccine is doing what it's supposed to and that is protecting the individual and the community," Mr. Zgodzinski said.

None of the arguments are likely to win over Rolf Sandberg, who stands firm in his decision not to be vaccinated.

He understands he may be infected again, but he's never been one to seek a vaccine for any reason and when it comes to Pfizer, Moderna, and Johnson & Johnson, he's even more skeptical based on how new they are and how pushy he says messaging has been trying to convince Americans to get it.

For now, he's willing to roll the dice.

"I'm not a conspiracy theorist. It's not a political thing for me. I just don't trust it," Rolf said. "But just because I don't believe in the vaccine doesn't mean it's not helping people."

First Published May 5, 2021, 11:46am