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Carey Alexander Washington, 80, a practicing clinical psychologist, called his daughter in January as soon as he received his first dose of the Pfizer COVID-19 vaccine.

“He was so excited to get it,” said Tanya Washington, 49, an Atlanta resident who works at an investment firm.

Carey received his second blow on February 4. Just over a month later, the South Carolina resident experienced shortness of breath. His internist did not test him for the virus. Carey, after all, was fully vaccinated. Instead, the doctor sent him to a cardiologist, who also did not test for the coronavirus.

On March 25, Carey passed away after nearly two weeks in hospital, his last days in intensive care. COVID-19 had destroyed his lungs.

Carey was among a tiny proportion of people who had been vaccinated against COVID-19 and then contracted the virus. The Centers for Disease Control and Prevention reported that about 0.008% of fully vaccinated people were infected and about 1% of them died. Public health officials have said such cases are expected and relatively few in number.

“No armor is 100% effective,” said Dr. John Swartzberg, infectious disease expert at UC Berkeley.

But the so-called revolutionary infections remain worrying and the reported figures are probably lower than the real cases. They serve as warning stories for fully vaccinated people to get tested if they develop symptoms of the infection and to continue to follow health guidelines.

In Carey Washington’s case, her daughter wondered if he could have survived had he been tested for the coronavirus early, after the onset of his symptoms. Did his vaccine status dissuade his doctors from testing him?

As the pandemic continues, researchers want to know more about these cases, including the role that different strains of the virus can play and whether those infected share traits or behaviors that make them more vulnerable. This information could lead to changes in the vaccine or the way it is given to certain people.

Stacia Wyman, a UC Berkeley scientist who sequenced the virus genome in breakthrough cases, said there should be a centralized place to collect breakthrough genomic sequences so that patterns can be detected and information shared.

The virus will continue to evolve and sequencing detects if the virus is one of the variants already identified or if a new one has emerged.

“This is information we need to fight the pandemic,” said Wyman, a computational biologist at the Innovative Genomics Institute at UC Berkeley. “It’s really quite frustrating that there isn’t a lot of organization around this. I don’t think we have a year to wait to prepare for revolutionary affairs.

As of April 20, the CDC reported 7,157 infections among 87 million Americans who had been fully vaccinated. Almost half of the cases were in people aged 60 and over, and about a third of those infected had no symptoms. Nearly 500 have been hospitalized, two-thirds of them due to COVID-19. Eighty-eight people have died, 13% of them from causes other than COVID-19.

The CDC warned the cases were likely underreported.

In California, the State Department of Public Health has identified 1,379 cases of infection among 10.7 million fully vaccinated residents, which occurs 14 days after the second dose of Pfizer or Moderna or a single dose of Johnson & Johnson . The department said it did not yet have information on the number of vaccinated Californians who have been hospitalized or have died from the disease.

To better understand rupture infections, the researchers said it is important to know whether the vaccines were stored correctly, the underlying conditions and behavior of the “hosts” that were infected, and the nature of the virus that caused them. has infected.

Were people taking certain drugs that reduced the effectiveness of vaccines? Were they vaccinated when they slept little or drank too much? Swartzberg asked. Could these factors interfere with the vaccine? “This is pure speculation,” he said.

He said the amount of exposure to the virus may also play a role, overcoming the immunity one gets from the vaccine.

“The dose makes the poison,” he said. “In many cases of infectious diseases, the more you are exposed to the virus in the same environment, the more likely you are to be infected.”

Dr George Rutherford, an infectious disease expert at UC San Francisco, said it was not surprising that some fully vaccinated people have died from COVID-19. It is well known that vaccines do not offer 100% protection, he said, and frail and elderly people are particularly susceptible.

“Remember we vaccinated the oldest of the oldest in nursing homes first, so if there were breakthrough cases there, there would be mortality,” Rutherford said.

A CDC study published last week found that the Pfizer and Moderna vaccines were 94% effective in preventing adults 65 and older from getting sick enough to require hospitalization. The study looked at patients in 24 hospitals in 14 states from January to March 2021. “Vaccination is an essential tool in reducing severe COVID-19 in high-risk groups,” the study said.

Two other CDC studies of groundbreaking nursing home cases showed vaccines protected residents, even as the virus spread through homes.

At a trained Kentucky nursing home, 18 residents and four staff who had been fully vaccinated were infected during an outbreak caused by an unvaccinated employee. The culprit was a variant that had never been detected in Kentucky, a rare strain that is not on the CDC’s list of variants of concern.

Residents and staff who were vaccinated were 87% less likely to have symptoms of COVID-19 than those who were not vaccinated, according to the study. Three residents died, two of whom were unvaccinated.

In the second study of qualified nursing homes in Chicago, 22 possible rupture infections occurred in people who were fully vaccinated. Two-thirds of those infected were asymptomatic. The rest had mild to moderate symptoms and one person died.

Dr Art Reingold, professor of public health at UC Berkeley, noted that the Biden administration has provided $ 1 billion to expand genome sequencing of the virus, which should make it easier to detect new variants and their role in infections.

“The problem is that some of the variants could eventually develop in a way that the vaccines no longer protect you,” he said. If that happened, booster shots or reformulated vaccines would be needed, he said.

So far, he said, the tiny fraction of breakthrough infections means “people shouldn’t panic.” In fact, he said, the numbers in California look so good that people may be able to get rid of their masks indoors by the summer.

A person is more likely to be struck by lightning than to have a breakthrough infection, Swartzberg said. Dr Carlos del Rio, an infectious disease and vaccine expert at Emory University School of Medicine, said someone was more likely to be hit by a car in a busy intersection than to develop a breakthrough infection to COVID-19.

“It’s really important for the public to put this into perspective,” Swartzberg said. “The chances of you having a breakthrough of any kind are tiny. And the chances that this breakthrough will make you even slightly ill are even slimmer.

But Tanya Washington wants people to remember breakthroughs are possible. She believes her father was infected by an unvaccinated employee in the office suite he shared with other doctors. Her father contracted the California variant of the virus, as did at least one other person in the office.

“He’s been to all of these doctor’s appointments, and no one has ever had COVID,” she said. “He was vaccinated twice. He was in what he thought was his safe office environment.

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