‘Be vigilant’: Vaccine breakthrough COVID-19 cases in Alaska are surprising, usually less severe and part of the reality of the pandemic for now

Theresa Christman got vaccinated against COVID-19 in April. The 37-year-old Anchorage resident suffers from autoimmune disorders and knows she’s more vulnerable to severe illness from the virus.

When the headache and scratchy throat came on in late July, Christman figured she’d caught the flu from friends. It couldn’t be COVID.

“Because I’ve been vaccinated and I shouldn’t be worried about it,” she said.

She tested positive in early August. Then she lost her sense of smell and taste. Now, Christman says she’s fully recovered.

And she has no regrets about getting those twin Moderna doses in the spring.

“I know that, especially with everything that’s been going on with my health, if I hadn’t been vaccinated and I had gotten it, I would have been really really sick,” Christman said.

She urged vaccinated people to “still be vigilant” — wear masks in indoor public spaces and be aware of whether people around you are vaccinated — and keep encouraging friends and family to get the shot.

“For those who are not vaccinated, shame on you,” Christman said. “Bill Gates does not care enough about you to microchip you. And it’s FDA approved now, so get on it.”

Nearly a third of July’s reported cases in vaccinated people

Her case isn’t as unusual as it was earlier this year, when COVID-positive tests in vaccinated people were a rarity.

[Among the unvaccinated, delta variant more than doubles risk of hospitalization]

COVID-19 cases have become more common among fully vaccinated persons than they were in the initial months after vaccine roll-out, state health officials say. And that’s complicating the message they’re trying to communicate to unvaccinated people who may not be Bill Gates conspiracy theorists, but just vaccine-wary for other reasons.

Last month, vaccinated people accounted for 30% of the COVID-19 cases reported to the Alaska Section of Epidemiology, according to a new report from the Alaska Department of Health and Social Services.

Still, getting vaccinated remains the best defense against serious illness and death, particularly with the aggressive delta variant that accounts now for most of the state’s cases and surging hospitalizations, health authorities say.

[‘The crisis we have been warning about is here’: Alaska reports 701 new resident COVID-19 cases, the year’s highest daily tally, as hospital counts swell]

“We have always said that the vaccines are not perfect, but they are still our safest and most expeditious way to get the rampant spread of this virus under control,” said the state epidemiologist, Dr. Joe McLaughlin.

McLaughlin points to a July study that shows the number of cases, hospitalizations and deaths prevented by vaccination is orders of magnitude higher than serious adverse outcomes from vaccination. Another study this month demonstrates COVID-19 infection is much more likely to cause a range of serious medical problems than vaccination.

The state’s July report found unvaccinated Alaskans were 7 1/2 times as likely to be hospitalized last month as vaccinated people.

At Providence Alaska Medical Center, 82% of the COVID-positive patients hospitalized one mid-August day were not fully vaccinated.

Messaging tightrope

Nonetheless, the role of breakthrough cases in this stage of the pandemic is proving a tricky message for public health officials.

With more breakthrough cases come more hospitalizations and deaths, albeit at far lower rates than in unvaccinated people.

Both the number and proportion of hospitalizations among fully vaccinated people were higher in July than any previous month, according to the new state report. Of 17 COVID-19 deaths in July that the state documented by Aug. 23, four were in vaccinated people, according to the new state report.

Vaccine skeptics are quick to jump on any indication the shots don’t “work” as advertised.

[An unvaccinated elementary school teacher took off her mask for a read-aloud. Within days, half her class was positive for delta.]

Meanwhile, as some in the health community talk about how rare breakthroughs are, the general public can see evidence of vaccinated people testing positive, in stories from friends and neighbors, or in COVID-cancelled major league baseball games among mostly vaccinated players.

“The messaging has not been as clear and as helpful as it could have been,” Wendy Parmet, director of Northeastern University’s center for health policy and law, told Bloomberg Law. “Health officials, media, and folks who support vaccination perhaps oversold it in ways, so now the breakthrough cases seem inconsistent and undermining.”

It’s crucial to be clear with the public about the fact that breakthrough cases exist and why they are occurring, McLaughlin said.

Alaska’s July numbers make sense when you consider that, as more people get vaccinated, the overall proportion of breakthrough cases will also increase, he said. As time goes on, more unvaccinated people are getting COVID-19 and developing natural immunity, so fewer of them are vulnerable and that changes the proportions too.

Another major consideration is the declining immunity researchers are finding in COVID-19 vaccines over time, especially with the entry of the delta variant.

Between January and the end of July, a total of 1,890 vaccine breakthrough COVID-19 cases were documented among Alaska residents, out of a total of nearly 19,300, according to the state report. The numbers have crept up since vaccine was first available, from .1% in January and just under 3% in March when the state made vaccinations available to everyone over 16.

A study involving thousands of health care workers in eight U.S. locations across six states showed the vaccine effectiveness for preventing COVID-19 infection dropped from 85% at four months after being fully vaccinated to 73% at five months after. Before the delta variant was widely circulating, vaccine effectiveness was 91%. After delta arrived, it dropped to 66%.

Breakthrough cases also tend to occur more often in older people, whose immune systems don’t mount as strong a vaccine response as they do in younger people. In Alaska, seniors also got access to vaccines before anyone besides health care workers — eight months ago.

The median age of fully vaccinated Alaskans hospitalized due to COVID-19 was almost 72, 14 years older than the median age for people not fully vaccinated, according to the state report.

A Centers for Disease Control plan calls for a booster dose eight months after people get their second shot of the Pfizer or Moderna vaccine.

‘Equivalent of a lottery winner’

Health officials say vaccinated people can also spread the virus, sometimes without knowing it because they often experience fewer symptoms.

That’s why the Centers for Disease Control in late July began recommending even fully vaccinated people wear masks in public indoor settings in areas with substantial to high community transmission.

At first, the “viral load” in both vaccinated and unvaccinated people infected with the virus appears about the same, McLaughlin said. But that’s only initially. Four or five days into the infection, “the viral load starts to fall off much faster in fully vaccinated people than unvaccinated people.”

A recent study shows lower viral transmission rates among household contacts of breakthrough cases, compared to non-vaccinated people.

Vaccinated people are also more likely to get asymptomatic infections, he said. “Among vaccine breakthrough cases, we expect to see a lower transmission rate ... because viral load drops and because it tends to be a milder course of illness, so they’re frequently not coughing as much, not spewing as much virus into the air.”

Anchorage attorney Moira Smith and her mother didn’t wear masks all the time during a trip in July because they were fully vaccinated and thought they were protected.

They ended up getting COVID-19 after a visit with unvaccinated family members during a trip Outside in July, she told The New York Times. Smith is 46. Her mother is 76 and has lung cancer.

“We were complacent because my risk analysis was that I was 95% protected against getting infected,” Smith said in an interview. “I had not been tracking the news about the delta variant.”

She wore a mask only some of the time. The night before she and her mother traveled, they visited with three relatives including a baby. That same night, the baby spiked a 103-degree fever and tested positive.

“I remember texting with friends, ‘You’d be the equivalent of a lottery winner if you actually got infected being fully vaccinated,’ ” Smith said. “But I got it and mom did.”

Within a few days, she was so sick she didn’t even bother to take her temperature.

“I just woke up feeling terrible,” Smith said. “I was tired. My body was aching, I had a headache, my throat hurt, my nose was running — all the symptoms.”

Her mother got a fever and ended up in the ER. Both tested positive.

Smith and her mother are recovered now, she said Friday. As nasty as getting the virus was, she said, their symptoms would have been far worse had they not been vaccinated.

“We as Americans have a lot of rights. There’s a lot of emphasis on rights in our public discourse right now. I respect people’s rights and will defend them endlessly,” Smith said. “We also have duties. At a minimum, I think it is incumbent on everyone with this variant and with the virus mutating to at least talk to their doctor and get medical advice about whether they should get the vaccine or not.”