In this case, Barnstable ain’t a barn, and it ain’t a stable. It’s a County in Massachusetts that has been experiencing a Covid-19 outbreak affecting predominantly fully vaccinated people. This doesn’t mean that the Covid-19 vaccines don’t offer good protection. However, the outbreak has shown why premature relaxation of other Covid-19 precautions such as social distancing and face mask wearing may have let the proverbial horse out of the proverbial barn. And this proverbially has not been a proverbially good thing.
A just-released report in the Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) detailed what has happened to a town in Barnstable County in July. This County helps form the elf boot-shape that comprises Cape Cod and the Eastern part of Massachusetts. After a good start to the month, this town soon got a kick in the you know where. On July 3, everything looked peachy-keen and hunky-dory at least Covid-19-wise. Back then the town had had a 14-day average of zero new Covid-19 cases per 100,000 residents per day, according to the Massachusetts Department of Public Health (MA DPH). Zero was pretty darn good.
However, things soon turned hunky-sucky. From July 3 through 17, the town had a whole lotta events and large public gatherings that brought thousands of tourists from all over the U.S. Apparently, people were behaving as if the Covid-19 coronavirus pandemic were over like The Games of Thrones TV series, ditching face masks and social distancing like they were soiled underwear. Yep, lots of visitors packed themselves into a variety of indoor and outdoor events at bars, restaurants, guest houses, rental homes, and other venues. Unfortunately for everyone there, some of these visitors were shaped like very little spiky massage balls and not very friendly.
Alas, on July 10, the MA DPH began noticing an increase in new Covid-19 cases. By July 17, the 14-day average had jumped to 177 cases per 100,000 residents per day. As of July 26, there were already 469 reported cases spanning the July. And nearly three-quarters (74%) of these cases exhibited Covid-19 symptoms. So much for zero cases.
A majority of those infected (85%) were men. And this wasn’t just an outbreak among much older people. The median age was 40 years, with people ranging from under one year to 76 years of age.
Here’s the punch line though. Nearly three quarters (74%) of the Covid-19 cases were in fully vaccinated persons, with 301 of these 346 cases being men with a median age of 42 years. The cases spanned all three available Covid-19 vaccines with 46% of those suffering breakthrough infections having received the Pfizer-BioNTech vaccine, 38% having received the Moderna vaccine, and 16% having received the Johnson & Johnson/Janssen vaccine.
Benjy Renton showed some of this data in the following tweet:
Now before you say, “see this shows that the Covid-19 vaccine doesn’t help,” take your right hand, use this hand reach to for a pie (any pie will do), grab the pie, and then push the pie firmly into your face. Seeing more fully vaccinated people get infected does not mean that fully vaccinated people are more likely to get infected. That would be like going into a Comic-Con, throwing baklava at everyone and then saying that in general people who are dressed like Superman or Supergirl are more likely to be hit with baklava. Keep in mind that 69% of eligible Massachusetts residents had been fully vaccinated. Chances are you would have more fully vaccinated people in Barnstable County than unvaccinated people. Therefore, it’s not surprising that more of those infected were fully vaccinated.
Of the breakthrough infections, 79% resulted in symptoms, most commonly cough, headache, sore throat, myalgia, and fever. Four of the five people who ended up being hospitalized were fully vaccinated, ranging in age from 20 to 70 years. Two of these folks did already have underlying medical conditions. No one died but naturally being hospitalized ain’t a fun thing.
You can blame Delta for most of the infections too. Not Delta the airline but Delta the variant, the more contagious version of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that’s been sweeping the nation. Genomic sequencing of specimens from 133 patients revelead that the vast majority (90%) had the Delta or Delta-plus variant.
One more interesting fact, the real-time reverse transcription–polymerase chain reaction (RT-PCR) cycle threshold (CT) values for specimens from the 127 breakthrough cases was a median of 22.77. By comparison, the CT values for the unvaccinated cases was 21.54, which is pretty similar. Now, perhaps you are nodding your head and saying, “oh, I see,” without knowing what the heck a CT value is and what this means. You wouldn’t be alone, because CT values aren’t exactly common language. You don’t tend to bring up CT values during a date unless your using it as an abbreviation for “cutie.”
A CT value can give a sense of how much virus an infected person may have. Like most Adam Sandler movies, this measure is not perfect. When you get a specimen from a patient, like a swab from his or her throat, the sample may have a very small amount of virus genetic material in it. That would not be surprising because it ain’t easy shoving that cotton swab into your nose to get to the back of your throat. Plus, viruses are very small, otherwise they would be unbelievably terrifying. Therefore, PCR is needed to “amplify” or essentially multiply the amount of virus genetic material that may be there. PCR use enzymes to make many more copies of this genetic material in the sample. After each cycle of such PCR amplification, you can check to see if detectable amounts of the virus’s genetic material are present. You keep doing this, cycle after cycle, until you find some virus genetic material or reach 37 to 40 cycles. If no viral genetic material, which in the case of SARS-CoV-2 is RNA, is present after these many cycles, you can consider the test to be negative. The CT is the number of cycles needed to finally yield a detectable amount of viral RNA. The less virus there is to start in the specimen, the more cycles of amplification it would take to reveal the genetic material. The lower the CT, the more virus is present. So if specimens from the vaccinated and unvaccinated had similar CT’s then that suggests that they were shedding the same amount of virus and thus were equally infectious.
All of this suggests that fully vaccinated people can still infected by, spread, and get sick from the Delta variant. It doesn’t mean that the Covid-19 vaccine won’t offer you substantial protection. But it is a reminder that the vaccine is like underwear. It offers needed protection but alone is not enough, at least not while the virus is so widespread.
Here Leana Wen, MD, former Baltimore Commissioner of Health and current CNN medical analyst, summarizes some of what this Barnstable County outbreak should be telling us:
In mid-May, many politicians and officials may have, surprise, surprise, given the public the wrong impression, that being fully vaccinated meant that you could just return to doing everything you did prior to the pandemic. But this just wasn’t and isn’t true. The Covid-19 vaccines are good, but they aren’t like full-body concrete condoms. They do not offer 100% protection. Overestimating the protection offered by the vaccine by itself may have led to premature relaxation, too many people dropping other Covid-19 precautions. In turn, this premature relaxation probably fostered the spread of the Delta variant. As a result, more officials including the CDC have now had to backtrack on face mask recommendations. They are now recommending face mask use while indoors in public in places with moderate to high transmission of the virus, which is essentially most of the U.S. They are basically trying to get the horse back into the barn, which as we know is not an easy thing to do, both proverbially and non-proverbially.