Robin Hauser, a pediatrician in Tampa, Florida, got COVID in February. What sets her apart from the vast majority of the tens of millions of other Americans infected with the virus is this: She became ill seven weeks after her second dose of the Pfizer-BioNTech vaccine.
“I was shocked,” said Hauser. “I thought, ‘What difference does it make? How did that happen? ‘ I now tell everyone, including my colleagues, not to be wary after the vaccine. “
As more Americans are vaccinated every day, a small but growing number are struggling with the troubling experience of getting COVID, despite having had one or even two injections.
In data released Thursday, the Centers for Disease Control and Prevention reported that at least 5,800 people became ill or tested positive for the coronavirus two weeks or more after completing both doses of the Pfizer-BioNTech or Moderna vaccine .
In total, about 78 million Americans are now fully vaccinated.
These so-called breakthrough infections occurred in people of all ages. Slightly more than 40% were people aged 60 or older, and 65% were women. Twenty-nine percent of infected people reported no symptoms, but 7% were hospitalized and just over 1%, 74 people, died, according to the CDC.
Public health officials said breakthrough infections were expected as manufacturers have loudly and often warned that the vaccines are not 100% protective. The Pfizer and Moderna versions have been consistently shown to be over 90% effective, most recently for at least six months. Studies have also shown that they are nearly 100% effective in ensuring that the small proportion of vaccinated patients who contract the virus do not develop severe cases or require hospitalization.
Yet people are usually shocked and confused when they become the rare breakthrough victim. After months of fear and taking precautions to avoid contracting COVID, they felt safe once they got their photos.
Hauser, 52, had stayed home from work to care for her children, ages 21 and 16, who had both contracted the virus. She was convinced she was protected. She also took care of her father, who has cancer.
“It’s a small miracle that I didn’t get it before I realized I was sick too,” Hauser said. In keeping with the virus’s erratic behavior, Hauser’s husband, Brian, who had not yet been vaccinated, also never became infected.
Masha Gessen, a staff writer for The New Yorker, completed the two-part process in mid-February. A month later, Gessen became ill and tested positive after both Gessen’s son and partner, Julia Loktev, endured attacks from COVID. The experience was “troubling, even a little traumatic,” said Gessen. Loktev’s disease occurred six days after her first dose.
“The psychological effect of getting the virus after a year of being very, very careful and vaccinated hit me,” said Gessen, 54, in an interview with KHN. “It took me about three weeks to feel normal again.” Gessen wrote about the experience in The New Yorker this month.
Dr. Kami Kim, director of the department of infectious diseases and international medicine at the University of South Florida in Tampa, said doctors are equally disturbed when these cases arise.
“All of this, while expected, is absolutely confusing and frustrating for people, doctors and patients alike. We all learn along the way and make judgments about what’s best for our patients – and for ourselves, ”said Kim.
Vaccine manufacturers said the number of breakthrough cases reported by the CDC was not surprising.
Moderna’s most recent analysis of data from his vaccine clinical trials shows that 900 people received COVID after being vaccinated, which equates to 90% or more vaccine efficacy, said company spokesman Colleen Hussey.
Pfizer spokesman Jerica Pitts said the company would follow trial participants for two years after their second dose to learn more about the Pfizer vaccine’s protection against COVID.
In their reporting, the CDC defines a breakthrough case strictly as disease or a positive test two weeks or more after full vaccination. But tens of thousands of people who have had a first injection or are short two weeks after their second injection also become infected.
Pfizer and Moderna report data showing up to 80% protection against infection two weeks or so after the first shot. But most experts believe that protection varies widely, from 50% to 80%, depending on the length of time after the injection and the individual variation that exists with each vaccine.
The second shot further boosts immunity, but not for at least a few days, and then builds up in two weeks. And again, this can vary from person to person.
Leslie Fratkin, 60, a freelance photographer in New York City, got her second dose of Pfizer on March 12. So she was surprised when obvious symptoms of COVID showed up on March 24 and she was quite sick at home for three days.
“You can’t print the words I spoke at the time,” she said.
The CDC advises people who receive COVID after a first injection to get the second dose shortly after recovery, with no specified minimum waiting time. That’s a change from the prevailing opinion in December and January, when some state health departments advised people to wait 90 days after a bout of COVID to get a first or second injection, and especially a second injection.
At the basis of this important change is growing evidence from studies and experience indicating that the immunity to infection conferred by the vaccines is stronger and possibly more ‘stable’ over time than the immunity conferred by a COVID infection.
Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota in Minneapolis, said further research and better public health guidance are urgently needed. For example, is there even a second dose needed for people who receive COVID after the first dose, or does the infection itself serve as enough to boost the immune system? And if a second shot is recommended, what is the optimal waiting time before getting it?
“These are important practical questions that should be prioritized,” said Osterholm. “We’re flying a bit blind now.”
Other countries have approached the rollout of the second dose differently.
In the UK, health authorities have delayed it to 12 weeks to expand the vaccine supply and prioritize getting at least one injection into the arms of more people more quickly. In Canada, a government vaccine advisory committee on April 7 recommended that the second doses be delayed for up to four months.
Speaking at two press conferences this month, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and COVID adviser to President Joe Biden, said the number of breakthrough cases in the US so far is no cause for concern and the administration will keep a close eye on cases.
An important line of research is the role of variants or mutated versions of the original coronavirus in these breakthrough cases. Research suggests that current vaccines may be slightly less effective against some new variants.
Martha Sharan, a spokesman for the CDC, said the agency is now urging states to use genetic sequencing to test virus samples from patients with breakthrough cases to identify variants. For example, in Washington State, eight variants were detected in the genetic sequencing of nine outbreak cases reported through April 3.
Today, the Biden administration announced that $ 1.7 billion in spending would be led out of the COVID emergency law to help the CDC, states and other jurisdictions detect and track variants more effectively by scaling up genomic sequencing efforts.
The CDC has also launched a national breakthrough COVID vaccine database that allows state health departments to store and manage data.
“We are lagging behind in sequencing samples,” said Osterholm. “That gives us valuable information.”
JoNel Aleccia, KHN’s senior correspondent, contributed to this story.
Steven Findlay, a reporter for KHN, was given COVID 30 days after his first dose and 24 hours after his second dose.
Kaiser Health News (KHN) is a national health policy news service. It is an editorial independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.