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36% of COVID Infections in Rhode Island Are Now In Vaccinated People

Wednesday, October 13, 2021


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The Rhode Island Department of Health reports a running cumulative total of post-vaccination (“breakthrough”) COVID infections, hospitalizations, and deaths in vaccinated individuals. The most recent report shows that as of October 6, 2021, there have been 7,624 fully vaccinated Rhode Islanders who have developed COVID infections, 362 who have been hospitalized, and 61 deaths.

In these reports, RIDOH also indicates the total number of COVID cases, hospitalizations, and deaths to date. Compared with the totals, the number of breakthroughs seem small – 5% of all cases, 4% of hospitalizations, and 2% of deaths. However, that is only one way of looking at the situation and may be downplaying the importance of breakthrough cases.

A more relevant way to look at the numbers could be post-vaccination cases, hospitalizations, and deaths since the advent of vaccination. Focusing on the time since vaccinations started can provide a better sense of what is happening in the vaccinated vs. unvaccinated.


The Pfizer COVID vaccine became available on December 14, 2020. The first full dosing regimen was completed on January 2, 2021, making the first fully vaccinated individuals as of January 17, 2021.

Looking at breakthrough infections, hospitalizations, and deaths since January 17, 2021, shows a different analysis with breakthrough infections accounting for 12% of total COVID cases over that time, 9% of hospitalizations, and 9% of deaths.


Comparisons With Other States

It is difficult to make comparative assessments of breakthrough infections with other states because the Centers for Disease Control no longer report breakthrough data and do not require states to provide it. Many states still do provide some level of reporting on breakthrough cases, but the data they chose to report, the format, and the frequency of reporting vary widely.

Some approximate comparisons, through September 5, Vermont reported 6% of COVID cases since vaccination started have been in the fully vaccinated, along with 6% of hospitalizations and 8% of deaths.

Through October 1, Maine reported 8% of COVID cases have been in vaccinated individuals.

Through September 15, Massachusetts reported 8% of COVID cases have been in vaccinated individuals along with 5% of hospitalizations and 5% of deaths.

While these are not direct comparisons, qualitatively it appears the breakthrough COVID infection rates, hospitalizations, and deaths in vaccinated individuals may be higher in Rhode Island than some other New England states.


Most Relevant: Trends and Recent Numbers

The most important assessment of breakthrough COVID is to analyze the trends over time and in particular, the most recent cases in vaccinated vs. unvaccinated individuals. This analysis yields a different perspective for Rhode Island.

The graph below plots weekly COVID breakthrough cases in vaccinated individuals since January 17, 2021. Post-vaccination cases stayed under 100 per week until mid-July, and then increased dramatically to around 700 per week in recent weeks:


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A striking figure is the proportion of COVID infections in vaccinated individuals. Last week in Rhode Island 36% of all COVID infections were in vaccinated individuals. The proportion of breakthrough infections generally stayed low, a single-digit percentage until around mid-June, and has been rapidly and significantly increasing since then.


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Rhode Island currently has the third-highest rate of breakthrough COVID hospitalizations in the country.


Why Is This Happening?

Part of the reason for the rise in breakthrough infections in vaccinated individuals is because they now represent a majority of the population. 733,694 Rhode Islanders are now fully vaccinated, 69.3% of the population. The vaccinated are now a bigger pool for the virus to infect.

However, there are three other important causes at work.


1. Partial resistance of the Delta variant to vaccines.

The Delta variant now accounts for essentially 100% of COVID infections Many studies have shown the Delta variant is partially resistant to currently available vaccines, with reduced protection against infection.

Studies by the CDC show vaccine effectiveness dropped from 91% overall to 66% when the Delta variant became predominant.


2. Declining vaccine effectiveness over time.

The increase in breakthrough infections after 5-6 months coincides with the growing number of clinical studies showing waning of protection of the Pfizer vaccine over that same time. Clinical observations from Israel have found the effectiveness of the Pfizer vaccine in preventing infection declines to 41% by 5 to 6 months, and to 16% after 7 months, though effectiveness remains high for preventing severe illness and death.


3. Human behavior.

The New York State Department of Health just released a study in nearly 9 million New Yorkers, evaluating vaccine effectiveness and COVID infections over time. The investigators corroborated the same findings of declining vaccine effectiveness found by others, but also observed that changes in human behavior around masking and other safety measures may be a bigger factor than immunological waning of vaccine effectiveness.

In other words, many vaccinated individuals may be becoming too careless with safety measures such as wearing masks.

The current COVID vaccines work remarkably well, but they are not perfect. They are a very important tool, but only one of several weapons that must be used against the pandemic.

Though booster shots are still being debated by some, the growing clinical evidence shows they significantly reduce the risk of infection, hospitalization, and death. A recent study in the New England Journal of Medicine showed a third vaccine dose reduced the risk of infection 11.3-fold, and reduced the risk of severe illness 19.5-fold. Another study of 2.5 million people in Israel found a 70-84% reduction in the chances of getting infected after receiving a third vaccine dose.

As of October 7, 28,332 booster doses have been given in Rhode Island – meaning only about 4% of fully vaccinated people have received a booster dose so far.

Most people don’t enjoy wearing masks, but a good N95 or comparable filter mask can help protect both you and others from infection. A report in the Journal of The American Medical Association reviewed 11 separate studies and showed a 50%-80% reduction in infection from wearing masks A study by the Massachusetts Institute of Technology and Massachusetts General Hospital looked at data from all 50 states and found that wearing masks significantly reduced new COVID cases, hospitalizations, and deaths.

To date, more than 237 million people around the world have become infected, and 4.8 million have died including over 700,000 in the U.S. That is more than the number of Americans killed in World War I, World War II, the Korean War, and the Vietnam War – combined. The actual numbers are certainly much higher than the reported counts. Unless and until we all take COVID seriously those numbers will continue to climb, including in those who are vaccinated. To change that, we need to use vaccine booster doses, wear masks during times of high infection risk, and think carefully about being indoors unmasked with large numbers of other people.

COVID vaccines alone are not an impenetrable force field that can somehow magically repel virions away from the body. No vaccine works 100% of the time. With a potentially deadly infection like COVID, we cannot place all bets on a single measure – as the 7,624 vaccinated Rhode Islanders who have become infected, 362 who have been hospitalized, and 61 who have died, have found out the hard way.


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