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Parsing the numbers: Why vaccinated residents made up 40% of Erie County's positive Covid-19 tests

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Local data shows vaccinated individuals are not immune from contracting Covid-19 or being hospitalized for it. But they are more protected overall. 

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Breakthrough cases of Covid-19 among those who are fully vaccinated are a bigger issue with the Delta variant in Erie County, but the data paint a nuanced picture.

An Erie County Health Department investigation of positive cases over the past three weeks indicates that four out of every 10 cases involved fully vaccinated residents. In addition, local hospital systems continue to report that between 20% and 40% of patients recently hospitalized with Covid-19 also were fully vaccinated.

The breakdown is similar for Covid-19 related deaths, with 70% of county Covid-19 deaths since early July involving residents who were not fully vaccinated and 30% involving residents who were.

But the data also show that those who are unvaccinated are still much more likely to suffer and die from the virus.

Unlike those with no protection, fully vaccinated patients who are hospitalized with breakthrough Covid-19 cases, or who die from the virus, are far more likely to have serious, underlying health issues. 

"You’re definitely seeing patients older, typically over the age of 65, and those who have significant co-morbid conditions or whose immune systems are impaired in some way," said Dr. Jamie Nadler, critical care physician and medical director of quality and patient safety at Buffalo General Medical Center and Gates Vascular Institute. "The vaccine is going to offer some degree of protection if you’re otherwise healthy."

Dr. Hans Cassagnol, executive vice president and chief physician executive with Catholic Health, said the Delta variant behaves differently than prior versions of the virus. So vaccines that were previously more than 90% effective in preventing any Covid-19 infection or symptoms are only 66% effective in preventing Delta-related infections or symptoms, but still offer far greater protection from serious illness than no vaccine at all.

"We should be going full throttle with getting shots in arms," he said.

Dr. John Sellick, an infectious disease specialist at the University at Buffalo's Jacobs School of Medicine and Biomedical Sciences, said breakthrough cases need to be considered within a much broader population context. Vaccinated residents who get seriously ill from Covid-19 still represent a "very tiny percent" of the vaccinated population. 

"You’re seeing the tiny tip of the iceberg or the mountain," he said. "In Erie County right now, you’ve got well over half a million people over the age of 18 who are either fully vaccinated or partially vaccinated. And they’re not in the hospital."

Vaccination and hospitalization

Roughly a quarter of patients hospitalized with Covid-19 are fully vaccinated, but unvaccinated residents still constitute the majority of all Covid-19 hospitalizations and deaths. Unvaccinated patients also are more likely to be younger. 

Since the start of August, the average percentage of fully vaccinated patients hospitalized with Covid-19 across Erie County Medical Center, Buffalo General Hospital and Millard Fillmore Suburban Hospital has been 25%, according to data collected by The Buffalo News.

The daily and week-to-week total in hospitals has fluctuated more broadly, from as low 19% at Kaleida Health hospitals as of Wednesday to 41% at Catholic Health hospitals as of Thursday.

All hospital system administrators noted that the majority of vaccinated individuals who were hospitalized with Covid-19 had other serious, complicating health factors or compromised immune systems. Catholic Health also pointed out that only 9% of its fully vaccinated patients were being treated in intensive care units, while 36% of unvaccinated patients were in the ICU.

"We have not had a hospitalized, vaccinated person that did not have a significant factor in the medical history that did not put them in the category of being immunocompromised," Cassagnol said.

Hospital capacity impact

The number of people who aren't being hospitalized because they are vaccinated is still more important than the number of vaccinated people who are winding up in hospital beds. Overall hospitalizations due to Covid-19 are not yet taxing hospital capacity limits because more people have vaccine protection, health experts said.

Covid-19 hospitalizations in Erie County have remained fairly level over the past two weeks, even though the number of people testing positive for virus has been growing by at least double-digit percentages every week for the past eight weeks.

Tuesday's Covid-19 update from the county Health Department saw the highest week-over-week increase in Covid-19 case numbers since the spring, with 1,326 residents testing positive over a seven-day period.

"Some people get confused, 'Oh, the vaccines don’t work.' But they work. They work, they work, they work – especially for keeping people out of the hospital," said Dr. Peter Winkelstein, executive director of the University at Buffalo's Institute for Healthcare Informatics. "The vaccine is not a golden shield. It’s not a magic wand. But it’s really good, and it’s a lot better than nothing."

As with hospitalizations, fully vaccinated residents constitute a notable minority of all Covid-19-related deaths. But those who are unvaccinated are dying more frequently and dying younger.

Consider the 50 county residents who died with Covid-19 from July 1 through Sept. 2. While 30% of those deaths involved residents who were fully vaccinated, none of those deaths involved people under the age of 60, according to the Erie County Health Department.

Comparatively, nearly a third of unvaccinated county residents who died with Covid-19 during this period were under the age of 60.

Better public messaging

As the highly contagious nature of the Delta variant results in more breakthrough infections, public health advocates and physicians are working to fine-tune their public message. The public is no longer hearing a "get vaccinated so you won't get Covid-19" message.

They are now hearing, "Get vaccinated, and regardless of your vaccination status, wear your mask and socially distance so you won't spread the virus to others, and you won't get really sick and die."

That message may be a heavier lift to to get across. Health experts acknowledge that the constant adjusting of the public health message can be confusing and frustrating to people trying to sift fact from fiction when it comes to protection against Covid-19.

"It’s confusing for those of us who do this for living; I can't imagine somebody who’s an accountant or whatever trying to sort this out," Sellick said. "The other problem we have is we’re still swimming upstream with the misinformation on social media."

More than 100 people locally are hospitalized with Covid-19 and far more people, even if vaccinated, could be infectious and experiencing mild Covid-19 symptoms or no symptoms at all. So the burden falls to public health leaders to help people understand the need for "layered protection."

The potential for breakthrough infections due to the Delta variant is part of the reason why the U.S. Centers for Disease Control has been recommending that even fully vaccinated individuals continue to wear masks while indoors in areas of "substantial" or "high" transmission, which includes all of New York State. 

The Erie County Health Department reported that the vast majority of vaccinated people who tested positive for the virus in Erie County in recent weeks had some type of symptoms, as did those who were unvaccinated. And far more individuals are likely walking around thinking they have allergies or a cold who are actually spreading Covid-19. 

"The Delta variant is very highly transmissible, as transmissible as the chicken pox was before we had vaccines," said Erie County Health Commissioner Dr. Gale Burstein. "Even fully vaccinated people have to be cautious about infection. So we have to, again, go back to our strong and effective non-pharmaceutical interventions to protect ourselves against infection. So masks."

She and Winkelstein held a video news conference on Friday cautioning people to again socially distance and wear masks as cold weather approaches. Last year, before vaccinations were available, the onset of cool, fall weather led a major spike in cases.

This year, vaccinations should have a dampening effect on positive cases, but without the community taking additional physical precautions, hospital capacity could again become strained, said Winkelstein, who works with a UB team to forecast the impact of Covid-19 cases on hospital admissions.

"What we do today is going to have an enormous impact on the number of people that are likely to be in the hospital down the road," he said. "I'm not suggesting that we have to close all the restaurants and the bars and everything else, but people have to start being really careful."

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