All the Ways That “1 in 5,000 per Day” Breakthrough Infection Stat Is Nonsense

Asking if breakthrough infections are rare misses the point.

9/26/2021 9:56:00 AM

The stat made its way from the New York Times to a presidential speech, but it reflects broad estimations and bad priorities.

Asking if breakthrough infections are rare misses the point.

that less than 25 percent of infections are confirmed through testing. This underreporting problem is likely worse for people who are vaccinated—their symptoms tend to be milder and they are less likely to be tested in a health care setting. Another problem is that health departments struggle to confirm whether an infected person has in fact been vaccinated. If someone has been vaccinated in another state or at a Veterans Affairs facility, they would in most cases be mislabeled as unvaccinated. Finally, the few jurisdictions that Leonhardt reviews do not include states like Florida and Louisiana, which have experienced the highest coronavirus spread in recent weeks.

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AdvertisementWhat is the actual risk that a vaccinated person will experience a breakthrough infection? There is no simple answer. It depends on levels of community spread, whether individuals are exposed at high levels (due to risk levels in their workplaces, schools, and households, for example), and how long the pandemic lasts. We are also still learning about why breakthrough infections occur and whether it involves waning vaccine effectiveness over time. But if we make some realistic assumptions about underdetection, a place that consistently reports a 1-in-5,000 daily breakthrough infection risk could easily translate to 10 percent or more of its vaccinated population becoming infected over three months.

AdvertisementMaybe breakthrough infections aren’t rare, but can they be ignored? It is true that most vaccinated people who become infected will be fine, experiencing. It is also true that large majorities of the people who are hospitalized or die from COVID-19 are not vaccinated.

AdvertisementBut there are three main reasons I think we need to take breakthrough infections seriously. First, vaccinated people can still transmit the virus to people who are unvaccinated, including children who are not yet eligible for the vaccine. Second, there are people whose health conditions put them at high risk of hospitalization and death even if they are vaccinated. This includes people with certain immunocompromised conditions who may not respond as well to vaccines, even with a booster shot. Third, we are still learning about the risks of long COVID among the vaccinated. Even if a small percentage of breakthrough infections lead to persisting symptoms, that adds up to a large number of people when infections are widespread.

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