4 ms·

Who knows? Since the majority of healthy vaccinated individuals who get a breakthrough infection are likely to have mild symptoms or be totally asymptomatic, I'

Who knows? Since the majority of healthy vaccinated individuals who get a breakthrough infection are likely to have mild symptoms or be totally asymptomatic, I'd imagine most breakthroughs are not being detected in most places. In this case, the individual (who was ostensibly healthy as she's in her 40s and working as a pilot) was asymptomatic and her infection was only detected because Taiwan has strict border controls that require quarantine and multiple tests. Also worth noting that Moderna appears to be the most efficacious of the vaccines (probably due to its higher amount of mRNA) and even then, it's possible to catch a breakthrough after a couple of months.

persedes 5y ago
I think what the previous comment alluded to was that your mixing up efficacy with overall duration of protection. But re you're "Who knows", there are studies[0] that tracked the same group of people over a course of time after vaccination. So if you have a 90% efficacy after being fully immunized, you can still get covid. The data in that study indicated that efficacy after 6 months was at 50%. So now you're even more likely to get covid. As a comparison: The influenza / flu vaccine is around 40-60% effective against infection. [0] - https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02183-8/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
- LurkingPenguin 5y ago
  > I think what the previous comment alluded to was that your mixing up efficacy with overall duration of protection. But re you're "Who knows", there are studies[0] that tracked the same group of people over a course of time after vaccination. I'm not mixing anything up. We simply don't know precisely how many breakthroughs there are at any stage after vaccination. It does seem logical that many if not most breakthroughs are not being caught. The case I cited was only caught because the individual was a pilot and residing in a country with strict border that require regular testing. It's not clear from the study you cited what the testing criteria was but it does not look like they were testing all the subjects (members of Kaiser Permanente Southern California) continuously. That's simply would not be feasible. We do know that Pfizer's protection starts to decline after around 2 months, so it seems likely that the case I cited was probably not an extreme outlier and efficacy against infection is probably overestimated even in the first few months. https://www.webmd.com/vaccines/covid-19-vaccine/news/20211008/pfizer-vaccine-protection-may-wane-after-2-months https://www.webmd.com/vaccines/covid-19-vaccine/news/2021100... Of course, breakthrough cases shouldn't be a problem. The problem is that there are unrealistic expectations around sterilizing immunity. > As a comparison: The influenza / flu vaccine is around 40-60% effective against infection. But we're not shutting society down every year for flu, are we?
  - persedes 5y ago
    good point, the study does not do fixed time intervals and tests all participants. Skimming the literature I've seen likelihoods reported of being covid positive and having no symptoms between 13% and 45% (and evidence that says they don't infect vs some that says they do..) > But we're not shutting society down every year for flu, are we? I'm sorry, but have you seen hospitals being overwhelmed by the flu as they are by covid on the same scale? I admit I'm biased here because a friend of mine is an ECMO specialist and he has seen nothing like this before. I don't see the case you describe as unlikely. Unless I'm misinterpreting efficacy, even with everyone vaccinated today, 2+ million people could still get covid in taiwan, assuming the same rate of transmission etc. However if the efficacy was overestimated, maybe due to time and less potential exposures to covid, I don't think we would see a complete restoration in efficacy after a booster was given? Personally I think 70% overall as more likely and at least in my social bubble there are no expectations about a "sterilizing immunity". It mainly boils down to "less likely to die / be hospitalized and better protect those that are vulnerable". But I get that some outlets spread the expectation of absolute immunity, I believed that might happen when I first heard of a 90+ efficacy.. Fauci and Drosten at least have started to manage expectations in that regard, that most vaccinated people will eventually get covid, which should further boost their immunity.
    - LurkingPenguin 5y ago
      > I'm sorry, but have you seen hospitals being overwhelmed by the flu as they are by covid on the same scale? In bad flu years, hospitals were overwhelmed to the point of taking pretty significant measures not dissimilar to what has been done during the pandemic, like cancelling elective surgeries. See https://time.com/5107984/hospitals-handling-burden-flu-patients/ https://time.com/5107984/hospitals-handling-burden-flu-patie... I cited a source in another comment indicating that ICUs at level 1 centers were typically running at 80-90% of capacity even before the pandemic. Obviously, there are no ideal solutions here, but shutting society down every time hospitals near capacity isn't a realistic approach indefinitely.
      - persedes 5y ago

persedes 5y ago

I think what the previous comment alluded to was that your mixing up efficacy with overall duration of protection. But re you're "Who knows", there are studies[0] that tracked the same group of people over a course of time after vaccination. So if you have a 90% efficacy after being fully immunized, you can still get covid. The data in that study indicated that efficacy after 6 months was at 50%. So now you're even more likely to get covid. As a comparison: The influenza / flu vaccine is around 40-60% effective against infection. [0] - https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02183-8/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

LurkingPenguin 5y ago
> I think what the previous comment alluded to was that your mixing up efficacy with overall duration of protection. But re you're "Who knows", there are studies[0] that tracked the same group of people over a course of time after vaccination. I'm not mixing anything up. We simply don't know precisely how many breakthroughs there are at any stage after vaccination. It does seem logical that many if not most breakthroughs are not being caught. The case I cited was only caught because the individual was a pilot and residing in a country with strict border that require regular testing. It's not clear from the study you cited what the testing criteria was but it does not look like they were testing all the subjects (members of Kaiser Permanente Southern California) continuously. That's simply would not be feasible. We do know that Pfizer's protection starts to decline after around 2 months, so it seems likely that the case I cited was probably not an extreme outlier and efficacy against infection is probably overestimated even in the first few months. https://www.webmd.com/vaccines/covid-19-vaccine/news/20211008/pfizer-vaccine-protection-may-wane-after-2-months https://www.webmd.com/vaccines/covid-19-vaccine/news/2021100... Of course, breakthrough cases shouldn't be a problem. The problem is that there are unrealistic expectations around sterilizing immunity. > As a comparison: The influenza / flu vaccine is around 40-60% effective against infection. But we're not shutting society down every year for flu, are we?
- persedes 5y ago
  good point, the study does not do fixed time intervals and tests all participants. Skimming the literature I've seen likelihoods reported of being covid positive and having no symptoms between 13% and 45% (and evidence that says they don't infect vs some that says they do..) > But we're not shutting society down every year for flu, are we? I'm sorry, but have you seen hospitals being overwhelmed by the flu as they are by covid on the same scale? I admit I'm biased here because a friend of mine is an ECMO specialist and he has seen nothing like this before. I don't see the case you describe as unlikely. Unless I'm misinterpreting efficacy, even with everyone vaccinated today, 2+ million people could still get covid in taiwan, assuming the same rate of transmission etc. However if the efficacy was overestimated, maybe due to time and less potential exposures to covid, I don't think we would see a complete restoration in efficacy after a booster was given? Personally I think 70% overall as more likely and at least in my social bubble there are no expectations about a "sterilizing immunity". It mainly boils down to "less likely to die / be hospitalized and better protect those that are vulnerable". But I get that some outlets spread the expectation of absolute immunity, I believed that might happen when I first heard of a 90+ efficacy.. Fauci and Drosten at least have started to manage expectations in that regard, that most vaccinated people will eventually get covid, which should further boost their immunity.
  - LurkingPenguin 5y ago
    > I'm sorry, but have you seen hospitals being overwhelmed by the flu as they are by covid on the same scale? In bad flu years, hospitals were overwhelmed to the point of taking pretty significant measures not dissimilar to what has been done during the pandemic, like cancelling elective surgeries. See https://time.com/5107984/hospitals-handling-burden-flu-patients/ https://time.com/5107984/hospitals-handling-burden-flu-patie... I cited a source in another comment indicating that ICUs at level 1 centers were typically running at 80-90% of capacity even before the pandemic. Obviously, there are no ideal solutions here, but shutting society down every time hospitals near capacity isn't a realistic approach indefinitely.
    - persedes 5y ago