I hope your week was good. There's so much to talk about. I need to keep this one shorter and more virus-centric than usual, even though I have a pile of things I wanted to mention. (And I deeply appreciated how many of you were into last week's parachuting beaver tangent). But I'm working on some broader pandemic stories, as the situation in the U.S. is deteriorating faster than I expected.
And, anyway, I hope you're outside having fun with people someplace where it's too sunny to read your phone.
At 2 a.m. yesterday I finally got back home, to Brooklyn, after a few weeks visiting people who the pandemic had kept at a distance for too long. It was wonderful, and I still recommend taking advantage of this time if you're able. No one should be acting like we're not in a pandemic, but it's reassuring that vaccinated people remain remarkably well protected from serious illness. I'm still operating without the acute worry for the health of my friends and family that defined the past 18 months. And in a relative way, that feels amazing, despite so much news of "breakthrough infections."
Which I'm watching closely, and is specifically what I wanted to talk about.
I think the term is a bad one. I wish we'd stop throwing it around. It can be extremely misleading. Especially in a situation like this.
Not to get too into semantics, but these words matter a lot. It's like suddenly everyone knows someone who had a "breakthrough case," and people are worried they're not protected. Like something big has changed. The drama and ubiquity of the news gives the feeling that the vaccines are proving much less durable or effective than we hoped.
This is especially dangerous in the context of so many people who've already been misinformed about whether vaccines work at all. For whatever portion of the 100+ million Americans who haven't gotten vaccinated yet but are legitimately on the fence, it might seem like the news of breakthrough cases is reason not to bother.
It's just exactly the opposite.
What's happening right now is a failure of vaccination; not a failure of the vaccines. The more people who refuse to get vaccinated, the more vaccinated people will get infected.
But what we're seeing is pretty much just what you'd expect. No one who knows what they're talking about ever claimed that the vaccines would block the virus from landing on you. You can absolutely test positive. Vaccines do not coat you in non-stick armor. They do not make you invincible. They do not turn you into a walking bug zapper. (I'm working on a device that would, but the GoFundMe got taken down because some "electrical engineers" said my design was "insanely dangerous".)
Vaccines train your body to fight off and withstand an attack. So far, the vaccines have proven to do that very well. No vaccine protects every individual 100 percent in every circumstance. But traditionally a "breakthrough case" is when a vaccinated person gets a disease they've been vaccinated against; not when they simply test positive or have some mild symptoms. COVID deaths are rising in the U.S., but 99.5 percent are among people who haven't gotten vaccinated.
Given that we're in the middle of an historic global pandemic driven by a perfect-storm virus that is growing more contagious by the day, it's not surprising that vaccinated people are showing evidence of being attacked—either in the form of a positive COVID test, and/or some symptoms. It would be surprising if a vaccinated American tested positive for, say, measles tomorrow. Because, where did you get measles? 90 percent of us are vaccinated, so we've driven it almost completely out of the country. Even though it's one of the most contagious viruses imaginable, there have been two cases in the U.S. this year. Yes, vaccinated people can contract measles, but the combined effect of so many vaccinated people means this almost never happens.
Meanwhile SARS-CoV-2 is all around us. In some places it's like a thick cloud of mosquitoes. The virus is getting even better at replicating within us, and it was already extremely adept at clinging to our cells. Yet 100 million cognizant adult Americans have made themselves willing vectors for a variant that takes over their bodies like wildfire, and which these vectors then spew out at tremendous volumes.
The longer that people leave themselves vulnerable, the more likely it is that any given vaccinated person will pick up the virus and test positive.
Some will even get sick. It's not surprising that vaccinated people who inhale SARS-CoV-2 sometimes develop mild cold-like symptoms before their body clears out the virus. When you have a respiratory infection of any sort, the unpleasantness we call symptoms is mostly a result of our immune systems clearing out the invasion. Your body heats up, lines its passages with mucous, preserves energy that it normally would've doled out to keep you awake and lucid and friendly, etc. It's not fun to have to put up with these symptoms, but they also don't mean that your immune system (or the vaccines that trained it) failed or didn't work.
That's not to say that these post-vaccination infections don't matter. Even if people only have a mild headache or gastrointestinal symptoms for a day or two, it's extremely important that we continue testing and keeping track of how this virus is spreading and affecting people. That will inform how we keep people safe. Especially given the variables like new variants and expectation of waning immunity over time. We absolutely need to follow just how effective the vaccines are in any given place/moment, so we know how to advise people to stay safe—who might need a booster, and when, or when it's useful to wear a mask and when it's not. Trends in asymptomatic infections could alert us to any changes in important variables like whether vaccinated people are spreading the virus, or whether a brief infection might still lead to chronic symptoms.
But none of this means the vaccines are failing; none of this is reason not to get vaccinated. It's only more reason to.
The textbook goal of vaccination is to build a sort of wall around a population, sealing out the virus and starving it. The additive effects of imperfect individual immune protection can become, overall, perfect. This is the effect known as herd immunity.
If an outbreak happens despite that—if the virus breaks through that wall—it would be confounding. It would challenge our understanding of vaccines and lead to emergency changes to guidelines.
But that's not what's happening. We haven't yet built up such immunity. The virus isn't so much breaking through a wall as it is stepping over one while half of us are still laying bricks.
Vaccines are a tool. They're one of the best that humans have to save lives. But they're not designed to work in isolation. They're sort of like seatbelts or airbags: You can have both of them and still get hit by another driver, and this wouldn't constitute a failure of seatbelts and airbags. And the more reckless drivers are out on the road, the more likely you'll be injured despite seat belts and air bags. As cases rise, it's like traffic on the highway is picking up. So accidents increase. If people use that as reason to claim that seat belts don't work, they're sending us further into a vicious cycle.
Anyway, this is all the more reason to make sure everyone you know and care about is buckled up. If everyone did that, we'd be fine.
For comparison, is there any data on reinfections of people who already had COVID or who tested positive but were asymptomatic? I'd be curious to see the relative effectiveness of vaccines vs naturally acquired protection vs superhumans who now think t…