We need to change the narrative on ‘breakthrough’ COVID-19 cases

OPINION: Some fully vaccinated people will nevertheless test positive. Instead of fear-mongering headlines, we need a focus on the lives saved
By Zain Chagla - Published on Jul 08, 2021
As of July 7, 78.7 per cent of Ontario's over 18 had received a first dose of a COVID-19 vaccine. (Lars Hagberg/CP)

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Early in the pandemic, COVID-19 vaccines seemed like a distant hope — many guessed it would take between 12 and 18 months to develop one. Yet, while I write this article, less than 18 months after the initial lockdown, we are discussing the possibility of having nearly all eligible individuals fully vaccinated by the end of the month. Borders and society are slowly reopening, with the expectation this is a one-way course to a return to normal. There is incredible hope and optimism. 

But there are also new fears, as the media covers so-called breakthrough cases — those involving fully vaccinated people who’ve nevertheless tested positive.

As the population nears full vaccination, we will hear about such cases. Even in the pivotal phase III clinical trials of Moderna, Pfizer, J+J, and AstraZeneca, some fully vaccinated individuals contracted COVID-19. 

Those people, however, still faced a significantly decreased risk of hospitalization and death.

When hearing about these cases, it’s important that we interpret them based on an understanding of what vaccines prevent, rather than what they don’t prevent. For the example below, the headline could read, “Local outbreak: One-third of cases in fully vaccinated.” 

graphic showing three vaccinated figures on the left and six unvaccinated figures on the right

The reality, though, is very different when you consider the exposed population and the effects of vaccinations. Below, we see that, in the unvaccinated group, 75 per cent acquired the infection, while in the vaccinated group, only 18 per cent did. In terms of severe disease, hospitalization, and death, the effects are even more profound.

graphic showing 13 black and three red vaccinated figures on the left and two black and six red unvaccinated figures on the right

Breakthrough cases will occur: Not everyone makes a response that is optimal to block infection from establishing. But enough of a response is there to prevent them from getting sick. 

There are individuals whose medical frailty puts them at high risk even with a mild infection, and deaths may occur. These should not be seen as failures, though, as the vaccines have largely changed the landscape of the disease, even in the medically frail. In long-term care in Ontario, the site of the highest rate of COVID-19 deaths locally in the first two waves, there were only seven deaths in fully vaccinated individuals during the third wave.  Judging by the toll taken by prior waves and a more virulent Alpha variant, that vaccination saved the lives of nearly 2,000 individuals in the highest-risk population. At some point, when the entire population is fully vaccinated, the deaths from COVID-19 will occur only in the fully vaccinated. 

In the United States, where 154 million people are now fully immunized, as of June 28, there had been 3,187 hospitalizations for symptomatic COVID-19 and 656 deaths due to COVID-19 in fully vaccinated individuals. While this may seem overwhelming, compare that to 2018-19 influenza season, which saw around 450,000 adult hospitalizations and more than 33,000 adult deaths. Even if fully vaccinated COVID-19 deaths were 20 times higher due to fewer public-health restrictions, year-round spread, and increased breakthrough cases, this would still put fully vaccinated COVID-19 deaths on the same level as influenza deaths.

Vaccines have fundamentally changed the landscape of COVID-19 and made it a disease that will be prevented in most; breakthroughs will result in mild disease. The overwhelming anxiety we’ve faced as a society over the past 18 months may make it difficult to shift our thinking: COVID-19 is no longer an ongoing fatal threat but an illness that will leave most vaccinated people largely unaffected. The media coverage of breakthrough infections needs to reflect this — instead of fear-mongering headlines, we need reporting focused on the lives saved through vaccinations.

Ultimately, vaccines proved to be the answer for hepatitis A, hepatitis B, measles, mumps, rubella, pertussis, tetanus, HPV, pneumococcus, meningococcus, diphtheria, polio, Hemophilus influenza B, rotavirus, varicella, shingles, yellow fever, and rabies. So why wouldn’t they be the answer to COVID-19?

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