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TThe Delta variant was first identified in the United States in April and May was well on its exponential growth curve, doubling every 10 to 12 days, as the basis of Covid infections, now reaching over 96 % prevalence. Ironically, on May 1, the CDC announced it would stop monitoring post-vaccination breakthrough infections unless they result in hospitalizations or death. This decision can be seen as exceptionally misguided and has led a country to go blind in its attempt to cope with its fourth wave of infections – one that quickly led to over 100,000 new cases per day and over 60,000 hospitalizations, both higher. than the first and second waves of US pandemics. It is unfathomable that we do not know how many of them occur in people who have been vaccinated.
Most people who contract Covid infections after being fully vaccinated have mild to moderate symptoms, and are generally thought to avoid hospitalizations. But that sense of confidence in vaccine protection leaned on pre-Delta data when the CDC was monitoring progress. Still reported by the CDC, from the latest data from its website and a constant refrain from public health officials, “99.99% of people fully vaccinated against Covid-19 have not had a breakthrough case resulting in hospitalization or death ”. It couldn’t be further from the truth. During the July outbreaks in Provincetown Delta, the CDC reported that the risk of a full vaccination requiring hospitalization was 1%, not 0.01%, and this may not be a reliable estimate of the incidence of such infections occurring throughout the country.
Without follow-up, we have no idea what proportion of fully vaccinated people get sick, hospitalized, or die. There is no doubt that the frequency of hospitalizations is on the increase, as evidenced by data from some counties which themselves follow the advances and report that 10 to 20% of admissions are to people who have been vaccinated. But we don’t have a denominator.
Why is this so important? On the one hand, the false sense of security conveyed by the CDC’s lack of data in the Delta Wave likely promotes complacency and the lack of protective measures such as masks and distancing. The CDC’s mission is to prevent such a disease, and the first step is to collect the relevant data. It would be very straightforward to know the vaccination status of every American with a breakthrough infection admitted to hospital with Covid-19, along with key demographics such as age, time from vaccination, which vaccine and coexisting medical conditions. The PCR diagnostic test for each patient has an associated cycle cutoff (Ct) value, which is an indicator of viral load and which would be important to monitor. Additionally, the virus sample could undergo genomic sequencing to determine if there was any further evolution of the virus and blood samples to neutralize antibody levels that could be obtained in as many patients as possible. Tracing the contacts of these people would help determine the actual rate of transmission from other vaccines, which is pure conjecture. Such systematic data collection would be the basis for understanding who is at risk for breakthrough infections, determining the current level of vaccine efficacy, and if, when and in whom booster injections should be recommended. It is remarkable that none of this is done for hospital patients, who represent an undetermined fraction of people who become very ill, some requiring infusions of monoclonal antibodies to anticipate their admission.
This is by no means the CDC’s first failure in managing and communicating about the pandemic. But with billions of dollars allocated to the CDC earlier this year for better Covid-19 surveillance, it represents a blatant failure that puts millions of vaccinated Americans at unnecessary risk of groundbreaking infections and leaves us without a navigation system. for the American Delta wave.
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