The first US Centers for Disease Control and Prevention accounting of breakthrough coronavirus infections among fully vaccinated people shows such infections are very rare, Dr. Kawsar Talaat, an infectious disease physician and assistant professor at Johns Hopkins Bloomberg School of Public Health, told CNN on Thursday. She said it actually underscores the urgency to vaccinate more people against Covid-19.
The likelihood of these “very rare” infections depends on how much virus is circulating within a community, Talaat said. As more people become fully vaccinated, there will be less virus circulating, and less opportunity for anyone to be exposed.
“That’s the whole point of getting to herd immunity,” she said. “Because once we get to a point where enough people in the community are vaccinated, then if somebody develops Covid in that community, the people around them are protected and it’s much harder for that person to spread the virus to somebody else, and therefore the transmission stops.”
About 77 million people in the United States have been fully vaccinated. In data released to CNN on Wednesday, the CDC said 5,800 breakthrough cases have been reported so far, although there is a delay in reporting. Among the reported cases, 396 were hospitalized, 74 died. The CDC also said 29% were asymptomatic.
The CDC said it’s monitoring reported cases “for clustering by patient demographics, geographic location, time since vaccination, vaccine type or lot number, and SARS-CoV-2 lineage,” and so far, no unexpected patterns have been identified.
Talaat said that, overall, the breakthrough infections tend to be much milder than the cases seen among unvaccinated people.
“It’s important to realize how many lives have already been saved by the number of people that we vaccinated so far,” she said. “The more people we vaccinate the more lives that we can save.”
Hypothetically, “you have a population where there’s 20,000 people. Half are vaccinated and half are unvaccinated. In the unvaccinated group, if 1% of those people have Covid – that’s 100 people in the unvaccinated group of 10,000 – then you would have maybe 10 in the vaccinated group,” Talaat said. “But then if at any given time the percent of people infected is .1% in the population, then those numbers go down to 10 and one.”
Some breakthrough infections are expected with these and other vaccines. No vaccine is 100% effective.
In clinical trials of the vaccines, there were a few breakthrough infections among vaccinated people, Dr. Carlos del Rio, executive associate dean at Emory University School of Medicine, wrote in an email on Thursday. Del Rio is an investigator on clinical trials for Moderna and Novovax Covid-19 vaccines.
“There is currently a lot of transmission in many parts of the country. Vaccines will help decrease that,” del Rio said in the email. “Get vaccinated as soon as you can and help control this pandemic.”
Del Rio added that in the meantime, the public needs to continue masking and social distancing to also help drive the numbers down.
France marked a grim milestone Thursday as its Covid-19 death toll exceeded 100,000, according to the French health ministry’s Geodes website.
France has registered 100,077 total deaths, and currently has the eighth highest global death toll, according to data from Johns Hopkins University.
There remains some confusion around new research from the University of Oxford in the United Kingdom that compares the risk of a rare type of blood clot among people who have had Covid-19 with people who received the AstraZeneca, Moderna and Pfizer vaccines, Dr. Anthony Fauci said.
Fauci who is director of the National Institute of Allergy and Infectious Diseases made the comments during a hearing with the House Select Subcommittee on the Coronavirus Crisis Thursday.
“They were trying to find out the difference in the incidence of thromboses, particularly cerebral venous thromboses, following the disease Covid-19 compared to various vaccinations, including influenza as well as the mRNA vaccines of Pfizer as well as Moderna,” Fauci said. “They found that – as you might expect – following the disease, you get a very marked increase in the incidence of this adverse situation of cerebral venous thrombosis.”
However, Fauci added that when the researchers calculated what the incidence of these thromboses may be following Covid-19 vaccination to compare incidents following different types of vaccines, some concerns in the methodology emerged.
“It is impossible, the way this study was designed and conducted to make that determination. So, I believe when this paper, which is in a pre-print server, gets submitted to the classical scientific journals and undergoes peer review that that confusion will be straightened out,” Fauci said.
“It will be clear that you cannot make any statement, the way this is designed, about the adverse events following the vaccination with the mRNA comparing to anything else,” Fauci said.
“There were many, many, I would say, procedural gaps in here regarding the way the study was done. It was a well-meaning attempt to show that Covid-19 disease is followed by this complication, but they led to some suggestions that I think are not called for in the paper.”
Norway is postponing the introduction of the Johnson & Johnson Covid-19 vaccine pending “ongoing investigations,” the Norwegian Institute of Public Health announced on Thursday.
“Use of [Johnson & Johnson’s Covid-19] Janssen vaccine in Norway is postponed until more information is available from the ongoing investigations,” Geir Bukholm, director of infection control at the Institute of Public Health, said on Thursday.
Some background: The US Food and Drug Administration and the Centers for Disease Control and Prevention said Tuesday that they were recommending a pause in the use of the Johnson & Johnson Covid-19 vaccine. The agencies cited the cases of six women between the ages of 18 and 48 who had developed a rare and severe condition called cerebral venous sinus thrombosis (CVST), a brain blood clot, combined with thrombocytopenia, or low platelet counts, after their Johnson & Johnson vaccination.
On Tuesday, Johnson & Johnson unilaterally announced that it was pausing deliveries of its single-dose vaccines to the European Union that had started on Monday. A delivery of 200 million doses to the EU has been scheduled for the second quarter of this year
In a news release on Wednesday, the European Medicines Agency said it “remains of the view that the benefits of the [Johnson & Johnson] vaccine in preventing COVID-19 outweigh the risks of side effects.”
The agency in charge of verifying the safety of vaccines for the EU also said they are still assessing the “very rare cases of unusual blood clots with low platelets” with that vaccine and the “EMA is expediting this evaluation and currently expects to issue a recommendation next week.”
As the pause of administering Johnson & Johnson Covid-19 vaccines in the United States continues, the Centers for Disease Control and Prevention and the Food and Drug Administration will keep the public informed about new developments, CDC Director Dr. Rochelle Walensky said Thursday.
She made the comments to the House Select Subcommittee on the Coronavirus Crisis during a hearing.
“We take all reports of adverse events following Covid-19 vaccinations seriously. As announced earlier this week, CDC and FDA recommended a pause in administering the Johnson & Johnson vaccine while we review data and assess significance around adverse events reported in six people,” Walensky said.
“CDC and FDA are committed to remaining transparent through this process and will provide updates as they are available,” Walensky said. “CDC is working in coordination with national, state, tribal and local governmental and non-governmental partners to build trust in the vaccines, the vaccinator and the vaccination system.”
Researchers at Oxford University have found the risk of a rare type of blood clot is low overall, but higher for people who have been infected with Covid-19 than among people who’ve had the three vaccines authorized in the UK – those made by AstraZeneca, Moderna and Pfizer.
The study, made available in pre-print on Thursday on the Oxford website ahead of publication in a scientific journal, says the risk of cerebral venous thrombosis or CVT – also known as cerebral venous sinus thrombosis or CVST – following Covid-19 infection is around “100 times greater than normal and several times higher than it is post vaccination or following influenza,” across all age groups.
“Covid-19 markedly increases the risk of CVT, adding to the list of blood clotting problems this infection causes,” Paul Harrison, professor of psychiatry and head of the Translational Neurobiology Group at the University of Oxford said.
Oxford University, which developed the AstraZeneca vaccine, said the research is from a separate part of the university and is not connected to the vaccine team. The data used was obtained from external sources, specifically the European Medicines Agency.
When compared to the risk of clots from the three vaccines, the risk from infection is “between 8-10 times higher, and compared to the baseline, approximately 100 times higher for infection,” Oxford said in a news release. According to the research, when compared with the mRNA vaccines – Pfizer and Moderna – the risk of CVT from Covid-19 infection is about 10 times greater. When compared with AstraZeneca, the risk of a CVT from Covid-19 is about eight times greater. The Johnson & Johnson Covid-19 vaccine was not included in the analysis.
Using an electronic health records network of over 500,000 Covid-19 positive cases, 489,871 vaccinated cases and 172,724 cases of influenza, the study found 30% of CVT cases occurred in the under-30 age group, the most at-risk for blood clots.
“Considering the balances between risks and COVID-19 risk is higher than see with the current vaccines, even for those under 30; something that should be taken into account when considering the balances between risks and benefits for vaccination,” Harrison added.
Dr. Maxime Taquet from Oxford’s Translational Neurobiology Group and a co-author of the study cautioned that data is still accruing. Researchers also are still to determine if Covid-19 and vaccines lead to CVT in the same way, she said.
Experts noted that CVT is so rare, there is limited data even from before the pandemic, and the data and data sources around the Covid-19 vaccines are inconsistent and limited.
“Overall the main finding is that these CVT events are very rare – a few in every million people involved – in Covid-19 patients and in people who had one of the vaccines – but they were very much rarer in the people who had a vaccine than in people who had Covid-19,” said Kevin McConway, emeritus professor of applied statistics at the Open University, in a comment to the Science Media Centre in the UK. “The researchers are not claiming that vaccines do not increase the risk at all compared to the risk in people who have not been vaccinated and have also not had Covid-19 – but they say the CVT risk in people who have had Covid-19 is about 100 times the risk in the general population.”
Some background: European and British medicines regulators last week announced a “possible link” between the AstraZeneca vaccine and rare cases of blood clots, with the UK announcing it would offer people under 30 an alternative vaccine. Other countries have followed suit and are either only offering to people above a certain age or are like Denmark and Norway, scrapping the vaccine entirely. While advising the public to look out for the signs of clots, the regulators said the benefits of the shot were still worth the risk. The AstraZeneca vaccine has not been authorized for use in the United States.
Six reports of similar clotting events following vaccination with the single-dose Johnson & Johnson vaccine prompted the US Centers for Disease Control and Prevention and the US Food and Drug Administration to recommend a pause on administering the vaccine to allow for further investigation.
Six women between the ages of 18 and 48 had developed a cerebral venous sinus thrombosis, a clot in the area of the brain that collects and drains oxygen-depleted blood. Blood thinners, the typical treatment for clots, should not be used in such cases. The six reported cases were among more than 6.8 million doses of the Johnson & Johnson vaccine administered in the United States.
The EU, which is heavily relying on the J&J vaccine to bolster its lagging vaccination rollout, has also paused use of the shot. The European Medicines Agency is expected to announce a decision on administering the Johnson & Johnson vaccine next week.
The WHO on Thursday said “for now the risk of suffering blood clots, is much higher for someone with COVID-19 than for someone who has taken the AstraZeneca vaccine.” WHO Regional Director for Europe Hans Kluge reiterated its recommendation of the AstraZeneca vaccine for all eligible adults, calling it “effective in reducing COVID-19 hospitalization and preventing deaths.”
Norway will stop using the Oxford-AstraZeneca Covid-19 vaccine as part of its vaccination program because of the risk of side effects in the younger population, the Norwegian Institute of Public Health announced on Thursday.
The institute said there is now a “greater risk associated with the AstraZeneca vaccine than with the Covid-19 disease in Norway,” in a statement on its website.
“Since there are few who die of Covid-19 in Norway, the risk of dying by being vaccinated with the AstraZeneca vaccine would be greater than the risk to die from the disease, particularly among young people,” Geir Bukholm, Director of infection control at the Institute of Public Health, said, according to the statement.
The Institute explains that Norway “has come a long way” in vaccinating its elderly population and the continued use of the vaccine would now be mostly relevant for those age 65 and younger.
“There is now significantly more knowledge about the connection between the AstraZeneca vaccine and the rare and serious incidents of low platelets, blood clots and bleeding, than when Norway chose to put further use of the AstraZeneca vaccine on pause in March,” Bukholm also said. “Based on this knowledge, we have arrived at a recommendation that the AstraZeneca vaccine be removed from the coronavirus vaccination program in Norway.”
In the statement, Bukholm went on to point out that this “has not been an easy recommendation” with a direct impact on the vaccination rollout and infection control measures.
Remember: The European Medicines Agency (EMA) said on April 7 that a particular combination of unusual blood clots with low blood platelet counts should be listed as a side effect of the Oxford-AstraZeneca vaccine, but stopped short of recommending its use be limited. The benefits of the shot outweigh the risks and Covid-19 is a “very serious disease,” it added.
Médecins Sans Frontières (MSF) called on Brazilian authorities to urgently acknowledge the severity of the Covid-19 pandemic and put in place a central Covid-19 response and coordination system.
“More than 12 months into Brazil’s Covid-19 emergency, there is still no effective, centralized and coordinated public health response to the outbreak,” the agency said in a news release Thursday.
“The lack of political will to adequately respond to the pandemic is killing Brazilians in their thousands. Médecins Sans Frontières (MSF) is urgently calling on Brazilian authorities to acknowledge the severity of the crisis and to put in place a central COVID-19 response and coordination system to prevent further avoidable deaths.”
Brazilians accounted for 11% of global infections and 26.2% of global deaths last week, according to the release, adding on April 8, more than 4,000 deaths and more than 86,000 new cases were reported in a 24 hour period. MSF say that these “staggering figures” are evidence of failure of authorities to manage the crisis and protect Brazilians.
“More than a year into this Covid pandemic, the failed response in Brazil has caused a humanitarian catastrophe,” said Dr. Christos Christou, international president of MSF during a news briefing, also on Thursday.
Christou said that even with new record of deaths and infections each week and overflowing hospitals, there is still no coordinated, centralized response.
Health workers are exhausted, he said, and have been left alone to pick up the pieces of a failed government response and improvise solutions. He added that medical facilities are running low on essential medical supplies, and material needed to save lives.
“I have to be very clear on this, the Brazilian authorities negligence is costing lives,” he said. “Public health messages have become associated with political messages, and as a doctor I cannot accept it.”
He also said that science and evidence based medicine have been undermined, which is not just a problem of fake news and disinformation, but also a seeming lack of political will to control the pandemic.
India is currently experiencing its second wave of the pandemic as the number of Covid-19 cases in the country surpassed 14 million on Thursday. More than 200,000 new cases of coronavirus were reported — the highest single-day rise in cases since the start of the pandemic, according to a CNN tally of figures from the Indian Ministry of Health.
The health ministry also reported 1,038 new deaths from the virus, bring the death toll to 173,123.
India’s previous peak was in September when cases rose by more than 97,000.
Several regions have imposed strict curfews. India’s capital, Delhi, imposed a weekend curfew along with a night curfew that will remain in place until April 30.
This comes despite the world’s second most populous country — with nearly 1.4 billion people — rolling out a massive vaccination campaign. More than 114 million doses have been administered. The health ministry also announced it will fast-track emergency use authorization for vaccines approved in other countries to expand the vaccine availability.