Tessa Quinn
While the COVID-19 vaccines have proven to be effective in reducing severe outcomes, some fully vaccinated individuals are still ending up in the hospital. This has raised questions and concerns among both the public and medical professionals. Experts like Professor Paul Griffin and Dr. Todd Ellerin have provided insights into the reasons behind this phenomenon. One explanation lies in statistics, as the increasing number of vaccinated individuals naturally leads to a higher likelihood of breakthrough infections within this group. Additionally, the immunity provided by the vaccines wanes over time, especially for those who do not receive booster doses. While hospitalizations among vaccinated individuals have increased, it's important to note that the vast majority of hospitalizations and severe cases still occur in the unvaccinated population, highlighting the continued effectiveness of the vaccines.
| Characteristics | Values |
|---|---|
| Date | December 2021 |
| Location | North-east London |
| Number of patients admitted to ICU with Covid-19 | 124 |
| Percentage of patients not fully vaccinated | 80.6% |
| Third vaccine shot | Best chance of avoiding hospitalisation |
| Vaccination status of patients hospitalised in Massachusetts | 60% fully vaccinated |
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What You'll Learn
- Vaccinated people may make up higher numbers in hospitals because they vastly outnumber unvaccinated people in the general population
- The immunity provided by the vaccine wanes over time
- The risk of hospitalisation aligns with the same factors that put someone at risk of severe COVID-19, such as underlying health conditions
- The likelihood of developing a breakthrough infection increases as the number of vaccinated people increases
- Vaccinated people are still far less likely to end up in the hospital than unvaccinated people
Vaccinated people may make up higher numbers in hospitals because they vastly outnumber unvaccinated people in the general population
It is important to understand that vaccinated individuals may constitute a larger proportion of hospitalised patients, not because they are more susceptible to severe illness, but because they represent a significantly larger portion of the overall population. This concept is known as the "vaccine demographic paradox."
When interpreting hospitalisation data, it is crucial to consider the vaccination status of the general population. If a substantial majority of the population is vaccinated, it is expected that a significant number of hospitalised patients will also be vaccinated. This does not necessarily indicate that the vaccine is ineffective; instead, it reflects the simple mathematical relationship between the two groups.
For example, let's consider a scenario where 80% of a given population is vaccinated. In this case, even if the vaccine were 95% effective at preventing hospitalisation, we could still expect a substantial number of vaccinated individuals to be hospitalised. This is because 5% of 80% is still a sizeable number.
In the context of COVID-19, this phenomenon has been observed in various regions. For instance, in Massachusetts, more than half of hospitalised patients for COVID-19 were fully vaccinated. Similarly, in north-east London, during a specific period, 80.6% of patients admitted to intensive care units with COVID-19 were not fully vaccinated.
To summarise, while it is true that vaccinated individuals may make up a higher number of hospitalised patients, this is often a simple reflection of their overall demographic dominance within the population. The vaccine continues to provide strong protection against severe disease and hospitalisation, and the risk of severe illness and hospitalisation remains significantly lower for vaccinated individuals compared to their unvaccinated counterparts.
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The immunity provided by the vaccine wanes over time
While vaccines are designed to provide immunity to protect us from viruses, the protection offered by vaccines can wane over time. This means that the body's ability to fight off a virus may decrease several months after vaccination.
Vaccines work by stimulating the immune system to produce a protective immune response that mimics a natural infection. This process is known as active immunization. The protection induced by vaccines may involve cell-mediated immunity and antibody responses. Antibody levels induced by vaccination tend to be lower than those produced by natural infection and may decline over time. However, long-lived protection may still be provided, and some vaccines require boosters to provide ongoing or longer durations of protection.
For example, studies have shown that antibody levels for the measles vaccine can wane over decades, but actual measles cases in fully vaccinated people remain rare. Similarly, Dr. Todd Ellerin, chief of infectious diseases at South Shore Health, noted that vaccinated and boosted individuals are still ending up in the hospital with COVID-19. Dr. Fauci attributes this to the fact that immunity wanes over time, and those who were vaccinated but did not receive a booster dose are now at higher risk of hospitalization.
It is important to note that the decrease in immunity over time does not mean that vaccines are ineffective. Vaccines still provide a strong level of protection against severe illness and hospitalization. However, as the protection offered by vaccines wanes, the likelihood of developing a breakthrough infection increases, especially for those who have not received a booster dose.
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The risk of hospitalisation aligns with the same factors that put someone at risk of severe COVID-19, such as underlying health conditions
Vaccines have been proven to significantly reduce the risk of contracting COVID-19, with only 0.2% of those fully vaccinated later testing positive for the virus. Being double-vaccinated also reduces the chances of falling seriously ill or dying from the virus. People who have received two vaccine doses are 31% less likely to experience acute COVID-19 symptoms and 73% less likely to be hospitalised.
However, it is still possible to contract COVID-19 after being vaccinated, and a small percentage of vaccinated individuals may still experience long COVID. Certain factors increase the risk of hospitalisation from COVID-19, even for those who are fully vaccinated. These factors include underlying health conditions, such as high blood pressure, chronic kidney disease, heart attack, heart failure, and type 2 diabetes. A study of more than 900 fully vaccinated and boosted adults in Los Angeles found that individuals with high blood pressure were 2.5 times more likely to require hospitalisation during a surge of the Omicron variant.
Older age is also a risk factor for severe COVID-19 outcomes, including hospitalisation. A study of over 7 million adults in the UK who received an autumn 2022 booster dose found that older adults (≥80 years) had a significantly higher risk of COVID-19 hospitalisation compared to younger adults (18-49 years). Additionally, individuals with a higher number of comorbidities are at an increased risk of hospitalisation, even after receiving a booster dose.
Other factors that may contribute to the risk of hospitalisation include being male, having a lower body mass index (BMI), belonging to a larger household, and residing in a more socially deprived area. While vaccination, including booster doses, remains an effective measure to prevent severe COVID-19 outcomes, it is important to recognise that certain individuals, especially those with underlying health conditions, may still be at elevated risk.
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The likelihood of developing a breakthrough infection increases as the number of vaccinated people increases
No vaccine is 100% protective against COVID-19. However, vaccinated people are much less likely to get infected, spread the disease, and have severe outcomes compared to unvaccinated individuals. Vaccines are highly effective at preventing severe illness and death. As the number of vaccinated people increases, new cases are more likely to occur in people who have been vaccinated. This is because, with most of the population being fully vaccinated, it is inevitable that some vaccinated people will be hospitalized.
In the US, as of September 30, 2021, 56% of the population, 67% of adults, and 83% of the elderly were fully vaccinated against COVID-19. Unvaccinated individuals made up 44% of the population but the vast majority (85%) of hospitalizations with COVID-19. In June through September 2021, the majority (69%) of breakthrough COVID-19 hospitalizations were of people ages 65 or older. Only 10% of breakthrough COVID-19 hospitalizations were of people under age 50.
Older adults may be disproportionately represented in breakthrough hospitalizations because they are more at risk of severe illness from COVID-19. In the UK, as of July 25, 2021, 75.7% of the Welsh population over the age of 18 had received two doses of a vaccine. As the vaccinated population increases, new cases are more likely to occur in vaccinated people. However, it is important to note that people who have received two doses of the vaccine and are hospitalized tend to have a milder infection and a shorter hospital stay.
While people who are fully vaccinated against COVID-19 have a significantly reduced risk of severe illness, some hospitalizations and deaths have been reported among fully vaccinated people with breakthrough COVID-19 infections. The CDC now recommends that older adults and those with certain comorbidities receive a third dose or booster shot. Overall, age is highly correlated with breakthrough hospitalizations.
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Vaccinated people are still far less likely to end up in the hospital than unvaccinated people
While it is true that some fully vaccinated individuals are ending up in the hospital, it is important to remember that vaccinated people are still far less likely to require hospitalization compared to their unvaccinated counterparts.
For example, in December 2021, 80.6% of COVID-19 patients admitted to intensive care units in north-east London were not fully vaccinated. This suggests that being vaccinated provides a significant level of protection against severe illness that requires intensive care.
It is also worth noting that the effectiveness of the COVID-19 vaccine can wane over time, and a third shot or booster can provide additional protection against hospitalization. As one health official in South Australia advises, "a third shot is your best shot at not catching COVID, spreading COVID, or ending up in hospital."
While breakthrough infections can occur in vaccinated individuals, the vaccines are still highly effective at preventing severe illness and hospitalization. In the state of Massachusetts, for instance, while more than half of hospitalized COVID-19 patients were fully vaccinated, this is likely due to the high vaccination rate in the state, as Dr. Todd Ellerin, chief of infectious diseases at South Shore Health, explains: "Imagine 100 percent of people in Massachusetts were vaccinated. Any hospitalized patient with COVID would be vaccinated, but Massachusetts has over 80% of us fully vaccinated, [among] those eligible [for the vaccine]."
Therefore, while vaccinated individuals may still end up in the hospital, they are far less likely to do so compared to unvaccinated people, and vaccination remains the best way to protect against severe COVID-19 illness and hospitalization.
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Frequently asked questions
Dr. Todd Ellerin, chief of infectious diseases at South Shore Health, explains that vaccinated people may make up higher numbers in hospital beds because they also vastly outnumber unvaccinated people in the general population. Dr. Fauci adds that post-vaccination immunity wanes over time, and the likelihood of developing a breakthrough infection increases as more people become immunized.
No, the risk of hospitalization is still lower for vaccinated people. In January, unvaccinated people made up half of the ICU numbers in the Northern Territory, despite only representing 8% of the population. Similarly, in Queensland, unvaccinated people made up 30% of total deaths, while only constituting 8% of the population.
Jenne, an expert in Manitoba, explains that there is no unifying reason, but certain underlying health conditions can increase the risk. These include immune deficiencies, solid organ transplants, receiving medication that suppresses immunity, cancer therapy, and advanced age.
