About Those COVID-19 'Breakthrough Cases' the White House Never Disclosed...

AP Photo/Susan Walsh

In the daily press briefing yesterday, the Texas Democrats who traveled to D.C. and tested positive for COVID-19 came up amid news that one White House staffer and an aide to Nancy Pelosi have also tested positive. Currently, we would consider these positive tests breakthrough cases, as all of these individuals were reportedly vaccinated. It is not clear whether any are suffering more than mild symptoms or that they took a test for any reason other than being in proximity to the nation’s leaders. Those national leaders are also reportedly vaccinated.

During the briefing, press secretary Jen Psaki confirmed that other, previously unreported breakthrough cases have occurred in the White House. She reiterated a commitment to reporting COVID-19 infections among senior leaders—though not every instance.

So, what do we make of this amid reports of sports figures also experiencing breakthrough cases of COVID-19? We also know that Israel is reporting reduced efficacy in the Pfizer mRNA vaccine as the Delta variant circulates in the country. The U.K. is also seeing breakthrough cases. In truth, we won’t hear about the full scope of breakthrough cases in the United States due to a CDC decision at the end of April:

As of May 1, 2021, CDC transitioned from monitoring all reported vaccine breakthrough cases to focus on identifying and investigating only hospitalized or fatal cases due to any cause. This shift will help maximize the quality of the data collected on cases of greatest clinical and public health importance.

Previous data on all vaccine breakthrough cases reported to CDC from January–April 2021 are available.

To be honest, the CDC has probably handled the study of breakthrough cases better than it has the rest of the pandemic. The only data a public health agency should be interested in is on those cases of significant failure. Breakthrough infections that cause severe illness and death are the proper ones to monitor. As Johns Hopkins professor of medicine Marty Makary noted in a recent op-ed:

CDC Director Rochelle Walensky claimed that vaccinating a million adolescent kids would prevent 200 hospitalizations and one death over four months. But the agency’s Covid adolescent hospitalization report, like its death count, doesn’t distinguish on the website whether a child is hospitalized for Covid or with Covid. The subsequent Morbidity and Mortality Weekly Report of that analysis revealed that 45.7% “were hospitalized for reasons that might not have been primarily related” to Covid-19.

Hospitals routinely test patients being admitted for other complaints even if there’s no reason to suspect they have Covid. An asymptomatic child who tests positive after being injured in a bicycle accident would be counted as a “Covid hospitalization.”

However, the CDC is also very detailed in its assessment of breakthrough cases. It reduced the cycle threshold (Ct) for a positive test to 28 rather than the 37-40 used in commercial labs. There is no information to suggest that any tests, other than the analysis of a potential breakthrough case, are subject to the lowered Ct. The Ct is an essential factor in evaluating breakthrough cases.

Related: Here’s the Most Interesting Thing in the CDC Data About Post-Vaccine COVID Breakthrough Infections

The CDC was very detailed in evaluating the cause of hospitalization and death in patients who tested positive for COVID-19. The agency finally acknowledged what doctors like Makary have been pointing out all along. Patients admitted for an illness other than COVID-19 had compulsory testing and were counted in the case and death numbers if they tested positive. The CDC does not consider all people hospitalized or who died post-vaccination that tested positive for COVID-19 as breakthrough cases.

As noted by Children’s Health Defense, reporting on a lawsuit regarding the vaccination of children under 18 in the Alabama Federal District Court:

Using HHS COVID death data, SARS CoV-2 has an overall survivability rate of 99.8% globally, which increases to 99.97% for persons under the age of 70. This is consistent with the seasonal flu, the complaint states.

So, aside from breakthrough cases and deaths in the United States, we deal with bad data sets that are never specific or tracked by age or comorbidity. It took the CDC until March of 2021 to say that obesity is a significant risk factor present in 78% of COVID-19 hospitalizations. The agency still does not report daily new hospitalizations for COVID-19 illness, meaning a patient who shows up with symptoms and subsequently tests positive. Instead, they use a lagging report that includes everyone who tests positive using a compulsory test.

So, what should Americans make of breakthrough cases in populations subject to mandatory testing like the Texas Democrats and professional athletes who are fully vaccinated? Not much, really. We don’t know what Ct the labs use for the tests. If it remains at 37-40, large numbers of tests could be picking up RNA fragments as the result of an effective immune response. There is no reliable data on how many of the positive tests are asymptomatic.

The only measure we should be interested in is the one the CDC is vigorously tracking, investigating, and reporting: How many people who are fully vaccinated end up hospitalized for COVID-19 and die as a result? While the CDC acknowledges their data could be an undercount, 75% of hospitalizations and deaths for breakthrough cases are in those 65 or older. As of July 12, with 159 million Americans fully vaccinated, the breakthrough cases report footnote says:

1,456 (28%) of 5,189 hospitalizations reported as asymptomatic or not related to COVID-19.
272 (26%) of 1,063 fatal cases reported as asymptomatic or not related to COVID-19.

A tiny fraction of fully vaccinated people are becoming severely ill and dying of COVID-19. Americans should insist on the same granular, detailed reporting on the pandemic as a whole. Like it or not, SARS Cov-2 will likely be a fellow traveler with the population going forward. Children rarely become ill, and it seems to act like pneumonia in frail people.

Healthcare workers used to call pneumonia “the old man’s friend” because it was often the final straw for an impaired immune system in elderly patients with other chronic or terminal diagnoses. The sooner the CDC comes to that conclusion, the sooner we can get back to living our lives, stop testing people who are not ill, and focus on the most vulnerable populations. And we can stop discussing mass vaccination as the ones currently available become analogous to the therapeutics we call “flu shots.”