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I Got a 'Mild' Breakthrough Case

155 points| dsr12 | 4 years ago |npr.org | reply

505 comments

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[+] hvocode|4 years ago|reply
I’m getting a little tired of articles or chats with people where you get the impression that people think the vaccines will create some sort of covid-proof bubble around them. This is the only explanation I can find for people acting surprised that vaccinated people get sick. The whole point was to prime the immune system so that when exposed, the likelihood of extreme effects would be drastically reduced. That’s it.

(E: I don’t get why people downvote this - all of the benefits of vaccination are precisely due to what I describe. Lower likelihood of individual bad outcomes, which reduces burdens on healthcare, and ideally, reduces community spread by reducing the amount of virus that replicates in an individual and can be passed on. This is why I was one of the first in line when I could get the vaccine. Perhaps daring to critique people with unrealistic vaccine expectations is unacceptable?)

[+] TobTobXX|4 years ago|reply
But all the regulations around us create this covid-proof impression.

Eg. where I live, hospitals consider introducing vaccination requirements for visitors. But that somehow defies logic. The vaccine only reduces symptoms (and might thus save yourself, or others, when extended with the hospital-bed-limit-thought), but it wouldn't stop you from transmitting the disease if you are infected (and vaccinated) but you aren't aware.

So I don't even blame the public, but rather the regulators. They ought to know better.

Edit: I might need to support this claim.

The most trustworthy source I found was this article by the JHU [1] (2021-08-02). While there are many that claim different numbers (ranging from stopping roughly 60% to 0%), for transmission, no one claimed that virus infection is influenced.

[1]: https://publichealth.jhu.edu/2021/new-data-on-covid-19-trans...

[+] javagram|4 years ago|reply
> I’m getting a little tired of articles or chats with people where you get the impression that people think the vaccines will create some sort of covid-proof bubble around them. This is the only explanation I can find for people acting surprised that vaccinated people get sick.

No, it’s because until the Delta variant became the most common variant, the vaccines essentially did create a covid-proof bubble around the recipient. The trials for Comirnaty and the Moderna vaccine both showed >90% effectiveness against PCR positive infections, not just against hospitalization and death.

[+] choeger|4 years ago|reply
To the contrary, I don't think that's plausible. In the whole COVID-19 decision the question of the initial load has not been discussed well enough, IMO.

If you think about the virus passing your various layers of protection it is clearly a numbers game, IMO. A mask, even if imperfect, might reduce your initial viral load below a threshold that allows your immune system to kill all infected cells very quickly so you don't develop strong symptoms. The same goes for distance.

So I don't see any reason to not expect a certain "sterile" immunity after a vaccination. The way I see it, the vaccination should prevent some of the low-load infections completely, regardless of the virus variant.

[+] ianai|4 years ago|reply
Right. It’s like a hardware update for an immune system.
[+] ummonk|4 years ago|reply
“ To sum it up, I'd put my breakthrough case of COVID-19 right up there with my worst bouts of flu.”

Exactly. I see no reason why I’d take strong measures to avoid getting exposed to it (now that I and 90% of adults around me are fully vaccinated) when I never did the same for the flu. Somewhere along the way we seem to have lost sight of what constitutes a normal disease burden.

[+] jlokier|4 years ago|reply
I don't know what policy around flu should be, but I'd like to share my data points about flu, for those who think flu is no big deal.

The last two times I had flu (first age 36, then a few years later), I was unable to work for an entire month each time.

For most of that time I struggled to get out of bed, and couldn't think much. I was too weak and tired, so I slept most of the time or did low energy activities, and relied on other people to bring me food. The first one meant I missed Christmas: My partner went to an all-day get together with our mutual friends, and I stayed home in bed, too ill to go.

My other flu story would be, a good friend and former employer got flu one day when he was visiting his wife and children (he normally worked in another country to them). Few days into it, he lay down on a sofa and died. I don't know the rest of the story, but I miss him. I think my life would be different if he were still around.

These experiences certainly gave me more respect for flu as a killer.

[+] Barrin92|4 years ago|reply
>Somewhere along the way we seem to have lost sight of what constitutes a normal disease burden.

Having relatives in the healthcare sector and hearing stories during bad flu waves (2020 was not the first year in recent memory where people needed to be treated in makeshift tents[1]) we do indeed have lost sight of the disease burden, but probably not in the way you imagine.

I was lucky to spent the first few months of the covid-19 pandemic in Japan, and I can tell you I did not see overrun hospitals at any point because people by and large take hygiene and avoiding the spread of infectious disease seriously.

[1]https://time.com/5107984/hospitals-handling-burden-flu-patie...

[+] ceejayoz|4 years ago|reply
Perhaps we were too lackadaisical about flu.

I've certainly enjoyed not getting the usual bouts of cold and flu my kids would bring home from school every winter.

I hope at least one lesson we take from COVID is "people should be able to take sick days rather than coming to work/school sick".

[+] zumu|4 years ago|reply
> Exactly. I see no reason why I’d take strong measures to avoid getting exposed to it (now that I and 90% of adults around me are fully vaccinated) when I never did the same for the flu.

It should really go without saying COVID-19 is much more transmissible than any recent version of the Flu. Comparisons of symptoms and severity in healthy adults has never been the sticking issue.

I'm disheartened to see people on HN of all places thinking solely as an individuals and not about the management of health care resources at a population level. Health care resources are finite and viruses like COVID can still spread exponentially even with current vaccination rates.

From the beginning, the goal has been to lower transmission, lower cases, and therefore lower the burden on the _world_ health care system to a tenable degree. Yes, there may be _more_ effective measures we can take at this point, such as ramping up vaccination, but at the end of the day, if you don't transmit the disease to others or end up in the hospital yourself, you are helping the cause.

tldr; Whether or not it poses a risk to _you_ is besides the point, in so far as the risk of overburdening the health care system remains.

[+] jrochkind1|4 years ago|reply
You are conflating two things. This guy's illness was about the same as worst bout of flu -- that doesn't mean that's necessarily typical, but let's say it is.

Currently, in most of the USA, your chances of getting covid are probably a LOT higher than that of getting the flu. Way more people are getting covid than getting a bad case of the flu.

So it's not quite the same.

If the chances of getting the flu were always this high, including the chances of really severe disease or death for some (say, those with organ transplants)... we probably would have been doing something different.

But I agree with you we shoudln't have to, don't need to, and can't sustainably simply shut down life forever.

I find the experts advice reassuring. IF you are vaccinated:

> Even with delta, the goal is not to go back to a lockdown mindset, though, says Malani. "My hope is that people who are fully vaccinated should really feel like this risk is manageable."

> "Feel good about spending time with your friends, or having a small dinner party, but make sure everyone is vaccinated," she says.

For now I am wearing a mask at the store (not that big a deal), and avoiding large public unmasked gatherings. In part because I want to try to help get community transmission rates a lot lower so we can then do more.

But I agree I'm not gonna do it forever.

[+] ASinclair|4 years ago|reply
> Somewhere along the way we seem to have lost sight of what constitutes a normal disease burden.

Alternatively this pandemic may have permanently shifted what we consider to be a normal disease burden. Maybe we shouldn't accept tens of thousands of Flu deaths every year if there are some relatively simple changes we can make to reduce them.

[+] nkozyra|4 years ago|reply
> Exactly. I see no reason why I’d take strong measures to avoid getting exposed to it (now that I and 90% of adults around me are fully vaccinated) when I never did the same for the flu.

Because it's up to 10x more deadly than influenza, particularly for vulnerable populations.

https://www.hopkinsmedicine.org/health/conditions-and-diseas...

[+] derbOac|4 years ago|reply
Most seasonal upper respiratory illnesses don't routinely cause loss of smell or taste, which should be a clue to something more nefarious potentially going on. If I were the author I'd worry about subtle frontal brain injury.

For me, boosters and nasal vaccines can't come fast enough (nor can the ability to administer them to younger children).

At some point I think this virus will become like the flu in terms of public health implications, but I don't think it's quite there yet.

[+] justin66|4 years ago|reply
> Exactly.

Not quite. The worst bouts of flu are the ones that kill people. Some of the influenza A strains are no joke.

[+] nemo44x|4 years ago|reply

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[+] senectus1|4 years ago|reply
in what country are yoy that 90% of the adults are fully vaccinated?

Also, "Think of the children". those that can't get vaccinated but are now dying from the delta strain?

[+] CarelessExpert|4 years ago|reply
> now that I and 90% of adults around me are fully vaccinated

I'm curious, where did that 90% figure come from?

Around here, of the eligible population, about 1 of every 3 has no shot at all, one 1 out of 4 with just a single shot. If you look at the full population, including minors and other ineligible groups, the numbers are even worse.

That means if I go to the grocery store, I'm absolutely gonna be in proximity to someone unvaccinated at some point along the way.

[+] SavantIdiot|4 years ago|reply
> have lost sight of what constitutes a normal disease burden.

I don't think so. This is only "mild flu" for vaccinated people. We still have kept sight that people who can't be vaxed can die, and people who ignorantly chose not to vax are killing people because they clog the ICUs and prevent people from getting non-covid life-saving care.

So we haven't lost sight, people just choose not to see. You just can't teach some people to be unselfish and considerate.

[+] whb07|4 years ago|reply
Here’s an interesting calculator from Oxford using Britain’s data from COVID:

https://www.qcovid.org/Calculation

My wife is a nurse and doesn’t follow up the data and she was in disbelief that her “risk” of serious/death was around 0.00005% or somewhere near that.

[+] ColinWright|4 years ago|reply
[+] blub|4 years ago|reply
Thanks. NPR used to have a pop-up asking if one wants to be tracked or go to the text-only version. Now they only offer getting tracked or some convoluted guide on “other options”.
[+] SavantIdiot|4 years ago|reply
So did I a few weeks ago. I was vaxxed in April. And then caught it in early August. Three days of sweating and chills, a week of coughing and loopy-head. Positive PCR test. 3 weeks later and I still have a chest-cough I can't shake.

Of course, if I didn't have the vaccine, I probably would be in an overflowing hospital close to death.

[+] qeternity|4 years ago|reply
Very similar to you. Had double Pfizer. Felt like crap on a Sunday, felt worse on Monday so skipped work and took a lateral flow test which came back negative. Same symptoms but for maybe 5 days. Lost my sense of taste on day 3 which was also the day I tested positive (I didn't take a test on day 2). I stopped testing positive a few days later, but taste was lost for maybe a week.

I had a cough for maybe 10 days, which has just subsided. I can't tell if I have brain fog, as my cough was really preventing me from sleeping well.

One interesting observation: I was pretty ravenous the entire time. I had a fever and was sweating like a pregnant nun in church, but I never lost my appetite. If anything, it turbocharged.

[+] ralusek|4 years ago|reply
Assuming that you're between 18-49 years old, the CDC puts the infection fatality rate for that age group at 0.15%. So, unvaccinated, you would have a 99.85% chance of not dying. Being vaccinated, of course, further improves your odds.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena...

The younger you are within that bracket, your odds improve even more. If you have no comorbidities, even better.

Basically, I wouldn't be worrying about death as any given young individual, but at a population scale, COVID is quite deadly. I'm personally much more worried about the other reported effects and lasting tissue damage.

[+] everybodyknows|4 years ago|reply
Which vaccine? Collecting anecdata …
[+] aazaa|4 years ago|reply
> In my case, it was worse than expected, but, in the parlance of public health, it was "mild," meaning I didn't end up in the hospital or require oxygen.

> ...

> It was a miserable five days. My legs and arms ached, my fever crept up to 103 and every few hours of sleep would leave my sheets drenched in sweat. I'd drop into bed exhausted after a quick trip down to the kitchen. To sum it up, I'd put my breakthrough case of COVID-19 right up there with my worst bouts of flu. Even after my fever cleared up, I spent the next few weeks feeling low.

"Mild" can mean different things to different people. I doubt this description of "mild" fits most people's concept of the word, as it sounds like a severe case of the flu. The fact that these infections are happening against a backdrop of normalization efforts should give anyone who thinks we're out of the woods pause.

As the rate of infection increases, so does the risk to the vaccinated. It's another demonstration, once again, of how our public health system (and the CDC in particular) has failed us:

> ... "quantifying that [chance of symptomatic case in an unvaccinated person] in the U.S. is very challenging" because our "data is so shoddy."

Some time ago, the CDC stopped counting/sequencing "mild" breakthrough cases, so we're flying blind mostly. Maybe it's delta the reporter caught. Maybe something else. Who knows?

https://www.newsweek.com/why-did-cdc-stop-counting-mild-asym...

What's clear is that COVID-19 isn't going away any time soon. What's also clear is that it shares the tendency that all RNA viruses have to mutate at an extremely rapid rate. It has shown that it can change much faster than we can adapt.

[+] spookthesunset|4 years ago|reply
> What's clear is that COVID-19 isn't going away any time soon.

This isn’t new information. It was obvious all the way back in March of 2020 that covid was here forever.

Life must go on. We cannot live with this myopic fixation on exactly one specific form of illnesses. These “experts” have already asked enough out if people. We’ve been asked to put our lives on hold for more than 1.7 years now.

Dragging any of this on after the first vaccines came out was unethical as hell. Vaccines were it. There is nothing else we can do besides attempt to build some myopic hellscape where our entire existence is centered around stopping the spread of covid.

[+] rkk3|4 years ago|reply
> I doubt this description of "mild" fits most people's concept of the word

Hence the ' around mild in the title. But honestly sure they were sick but they did not seriously fear for their lives or require medical attention. Obviously being asymptomatic would have been more mild but in general this seems like a win.

People need to accept some level unpleasantness and risk in their lives.

[+] tomohawk|4 years ago|reply
This is what post pandemic looks like.

Covid is endemic, and just like you probably don't know anyone who has never had the flu or the cold, it will be the same with this.

Get your vax! It'll likely keep you out of the hospital when you do get it.

Mask up all you want. Avoid crowds. Shun and shame people. You're still going to get it, just like everyone else.

[+] birdyrooster|4 years ago|reply
Sherman should have continued marching through the south for several years completely displacing all of the traitors who have become the Republican Party today. Then we could have public health.
[+] y7|4 years ago|reply
> Recent research from the U.K. suggests that vaccinated people are about 50% less likely to develop long COVID than those who are unvaccinated.

To me that doesn't sound like that great of a risk reduction.

[+] mdp2021|4 years ago|reply
Have you factored in the reduced chance of symptomatic disease? That comes before long COVID.

With (two months after) vs without = ~0.2 vs 0.05×0.5×0.2 = ~20% vs ~0.5%

(Explanation: chance of symptomatic disease 2 months after reported as 5% vs "control"; chance of long COVID after symptomatic infection reported as 2.3% as bare minimum, 13% to other research and 40% to a large interpretation.)

Edit: to the three British studies of 2.3%, 13% and 40%, after this thread I can add 25% from a post from user tfehring, including link to article: «something like a quarter of people with symptomatic COVID seem to have some kind of cognitive symptom (mainly “brain fog” and/or short-term memory loss) 8 months later». I will update the tentative value for the chance of long COVID, but the ratio, half of one twentieth, does not change.

[+] bryanlarsen|4 years ago|reply
That's on top of the reduced risk of catching it in the first place. Estimates of that vary widely, let's use 1/6. So 1/12 risk of long COVID.
[+] Wowfunhappy|4 years ago|reply
People get sick. It happens. I am well-aware that by resuming my pre-pandemic lifestyle, and only wearing a mask in the spaces where they're mandatory, I am increasing my risk of getting ill.

But I'm not going to change my behavior, because I'd rather be sick for a week than sit at home 24/7 for the next year, or wear a mask every time I step outside, and constantly monitor my physical distance from other people. My life is passing me by right now, and I want to enjoy it while I can.

[+] andrewclunn|4 years ago|reply
The recognition that the medical establishment is still unsure of many things regarding a still developing situation is a good first step. The next is to realize that the misinterpretations of their knowledge and understanding are the direct result of misrepresentation of events and facts by media outlets.
[+] ttul|4 years ago|reply

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[+] ColinWright|4 years ago|reply
While what you say is true, I'm surprised that you think it is the most relevant and useful thing to say given the content. I've read the article and it has lots of useful things to say.

It may have been written because they themselves caught the virus, but the article is not just their story.