The data reported from these states indicate that breakthrough cases, hospitalizations, and deaths are extremely rare events among those who are fully vaccinated against COVID-19 (see Figure 1). The rate of breakthrough cases reported among those fully vaccinated is well below 1% in all reporting states, ranging from 0.01% in Connecticut to 0.29% in Alaska.

   The hospitalization rate among fully vaccinated people with COVID-19 ranged from effectively zero (0.00%) in California, Delaware, D.C., Indiana, New Jersey, New Mexico, Vermont, and Virginia to 0.06% in Arkansas. (Note: Hospitalization may or may not have been due to COVID-19.)
  The rates of death among fully vaccinated people with COVID-19 were even lower, effectively zero (0.00%) in all but two reporting states, Arkansas and Michigan where they were 0.01%. (Note: Deaths may or may not have been due to COVID-19.)


   Almost all (more than 9 in 10) COVID-19 cases, hospitalizations, and deaths have occurred among people who are unvaccinated or not yet fully vaccinated, in those states reporting breakthrough data (see Figure 2).
       The reported share of COVID-19 cases among those not fully vaccinated ranged from 94.1% in Arizona to 99.85% Connecticut.
       The share of hospitalizations among those with COVID-19 who are not fully vaccinated ranged from in 95.02% in Alaska to 99.93% in New Jersey. (Note: Hospitalization may or may not have been due to COVID-19.)
       The share of deaths among people with COVID-19 who are not fully vaccinated ranged from to 96.91% in Montana to 99.91% in New Jersey. (Note: Deaths may or may not have been due to COVID-19.)

Implications

While information on breakthrough events is still limited and incomplete, this analysis of available state-level data indicates that COVID-19 breakthrough cases, and especially hospitalizations and deaths, among those who are fully vaccinated are rare occurrences in the United States. Moreover, this data indicate the vast majority of reported COVID-19 cases, hospitalizations, and deaths in U.S. are among those who are unvaccinated or not fully vaccinated. These findings echo the abundance of data demonstrating the effectiveness of currently authorized COVID-19 vaccines. Moving forward, particularly as the more transmissible Delta variant is now the dominant strain of COVID-19 circulating in the U.S., more robust state-level data will help to monitor ongoing vaccine effectiveness and inform discussions about booster vaccinations.

Vaccine doubters’ strange fixation with Israel

From the start of the worldwide coronavirus vaccination campaign, the anti-vaccine movement and vaccine skeptics picked an unfortunate case study: Israel. The country shot to the lead of the pack with an aggressive vaccination campaign, but its results weren’t as instantaneous as these critics suggested they should have been. Cases in Israel kept rising for a little while! So they pitched Israel as evidence that maybe the vaccines didn’t really work that well.

But then the vaccination effort actually took hold. Israel dropped from a high of around 10,000 new daily cases in January to a seven-day average of as low as 10 last month. It began logging some days with zero deaths in April, and has recorded about 100 confirmed deaths in the last three months. If there is one country that reinforced the efficacy of the vaccines, it became Israel. And if there was one country that epitomized the sloppiness of the anti-vaccine movement, it, too, was Israel.

But old habits apparently die hard. A vaccine skeptic community that often focuses on unverified data, innuendo and false and misleading comparisons is suddenly pointing to Israel again. The reason: The country is suddenly seeing an uptick in cases, and most of them are among vaccinated people.

Over the last week, charts have abounded on social media bearing out this latter fact. A prominent vaccine skeptic who appears often on Fox News went so far as to claim Israel’s data showed something amounting to a “complete vaccine failure on every level.” . . .

The reality, as it often is with such claims, is quite different from how it’s being pitched.

While cases are indeed rising significantly in Israel because of the more vaccine-resistant delta variant, that’s from a very low baseline. The country remains at a fraction of its former case numbers. The seven-day average is at about 800 new daily cases, or less than one-tenth of the January peak.

It’s true that most new cases are coming from the vaccinated community, but that’s in large part because of how relatively big that community is in Israel. The latest numbers show that 85 percent of Israeli adults are vaccinated, meaning there are more than five times as many of them as unvaccinated people.

Epidemiologist Katelyn Jetelina last week explained this misleading use of data, which is known as a base rate fallacy — or base rate bias in epidemiology:

   The more vaccinated a population, the more we’ll hear of the vaccinated getting infected. For example, say there’s a community that’s 100% vaccinated. If there’s transmission, we know breakthrough cases will happen. So, by definition, 100% of outbreak cases will be among the vaccinated. It will just be 100% out of a smaller number.
   Cue Israel. They are one of the global leaders in vaccinations; 85% of Israeli adults are vaccinated. So, say we have the following scenario:
   ...
   With an infection rate among the vaccinated of 2% and infection rate of 13% among the unvaccinated, this would give us an efficacy rate of 85%.

The most important numbers to consider, though, are not the overall case rates, but rather the serious cases. And those, too, remain extremely low — even lower than the case rates, relatively speaking.

Israel is averaging about 120 weekly hospital admissions, which is down from a peak of nearly 2,000 in January. So while cases are less than one-tenth of what they were then, hospitalizations are about one-sixteenth. And admissions to the intensive care unit are about one-twentieth, according to data collected by the University of Oxford . . .

All told, Israeli government data show the Pfizer vaccine is indeed significantly less effective at preventing coronavirus cases of the delta variant (64 percent) than it was for previous variants (95 percent). It’s also significantly less effective at preventing symptomatic cases (64 percent vs. 97 percent). But it performs much more similarly when it comes to preventing serious cases and hospitalization (93 percent vs. 97.5 percent).

In other words, the delta variant means the virus will probably continue to spread, even among vaccinated people and even in a strongly vaccinated country such as Israel, because the vaccines don’t protect from transmission or symptomatic cases nearly as well. But that doesn’t mean the vaccines don’t work, especially when it comes to preventing the worst of the disease.

And beyond that, just because a variant emerges that renders the vaccines less effective doesn’t mean those vaccines weren’t effective in the first place; it means this is a fast-changing pandemic that will require nimble scientists. Israel is as good an example of vaccine efficacy as just about anywhere in the world.

The data will continue to shift there, as it will elsewhere, and conclusions about the efficacy of the vaccine will be adjusted accordingly. But if you’re getting your vaccine information from someone who holds up Israel as an example of the failures of the vaccine, based upon this cherry-picked data, you might want to start looking elsewhere for it.

Effectiveness after one dose of vaccine (BNT162b2 or ChAdOx1 nCoV-19) was notably lower among persons with the delta variant (30.7%; 95% confidence interval [CI], 25.2 to 35.7) than among those with the alpha variant (48.7%; 95% CI, 45.5 to 51.7); the results were similar for both vaccines. With the BNT162b2 vaccine, the effectiveness of two doses was 93.7% (95% CI, 91.6 to 95.3) among persons with the alpha variant and 88.0% (95% CI, 85.3 to 90.1) among those with the delta variant. With the ChAdOx1 nCoV-19 vaccine, the effectiveness of two doses was 74.5% (95% CI, 68.4 to 79.4) among persons with the alpha variant and 67.0% (95% CI, 61.3 to 71.8) among those with the delta variant.
Conclusions

Only modest differences in vaccine effectiveness were noted with the delta variant as compared with the alpha variant after the receipt of two vaccine doses. Absolute differences in vaccine effectiveness were more marked after the receipt of the first dose. This finding would support efforts to maximize vaccine uptake with two doses among vulnerable populations. (Funded by Public Health England.)

“In Iceland, 85.3% of people over 16 years old are now fully vaccinated against COVID-19 and 4.9% are partially vaccinated. It should therefore not come as a surprise that among new domestic cases, most are vaccinated . . .

‘Goldilocks virus’: Delta vanquishes all variant rivals as scientists race to understand its tricks


The variant battle in the United States is over. Delta won.

Since late last year, the country has been overrun by a succession of coronavirus variants, each with its own suite of mutations conferring slightly different viral traits. For much of this year, the alpha variant — officially known as B.1.1.7 and first seen in the United Kingdom — looked like the clear winner, accounting for the majority of cases by April. In second place was iota, B.1.526, first seen in New York City. A few others made the rogue’s gallery of variants: gamma, beta, epsilon.

Then came delta — B.1.617.2. It had spread rapidly in India, but in the United States, it sat there for months, doing little as the alpha advanced. As recently as May 8, delta caused only about 1 percent of new infections nationally.

Today, it has nearly wiped out all of its rivals. The coronavirus pandemic in America has become a delta pandemic. By the end of July, it accounted for 93.4 percent of new infections, according to the Centers for Disease Control and Prevention.

The speed with which it dominated the pandemic has left scientists nervous about what the virus will do next. The variant battles of 2021 are part of a longer war, one that is far from over.

Delta is sending thousands of people into hospitals every day and has knocked the Biden administration back on its heels. In a few short weeks, the delta variant changed the calculations for what it will take to end the pandemic.

Epidemiologists had hoped getting 70 or 80 percent of the population vaccinated, in combination with immunity from natural infections, would bring the virus under control. But a more contagious virus means the vaccination target has to be much higher, perhaps in the range of 90 percent.

Globally, that could take years. In the United States, the target may be impossible to reach anytime soon given the hardened vaccine resistance in a sizable fraction of the country, the fact that children under 12 remain ineligible and the persistent circulation of disinformation about vaccines and the pandemic.

With so many people unvaccinated, in the United States and around the world, the virus has abundant opportunity not only to spread and sicken large numbers of people, but to mutate further . . . .

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