This commentary is by August Burns of Middlesex, who has had a three-decade career in women’s health and rights. She has had a clinical practice in Vermont with Planned Parenthood and the Women’s Health Center and a private practice in Waterbury. She was a clinical consultant for U.S. AID, special adviser on cervical cancer for the World Health Organization, and executive director of Ground for Health.
As with many people, the pandemic has made me a data nerd. In the beginning, I watched with alarm and fascination as the number of cases just kept growing, and I listened as friends and family tried to make sense out of the numbers for guidance on how both to stay safe and to still live their lives fully.
We all donned masks and stayed indoors, eschewing the simple pleasures of social contact for the health of all.
But then in 2021, a scientific breakthrough happened, and the vaccine rollout began. We were assured that the vaccines would be effective at preventing severe illness and death, and they have been. But the measure of the vaccines’ effectiveness and the remaining very small risk to the fully vaccinated have often been obscured.
The reporting on Covid that we do see and hear daily in Vermont is expressed in graphs, with startling peaks underscoring ever-rising numbers of cases. Always cases — cases by age, by state, region and nationally.
But what do these case counts mean for the vaccinated? What do they mean by the term “vaccinated”; is that one, two or three doses? What is our individual risk? When can we go back to a normal life? Will we catch Covid and die?
So I rolled up my proverbial sleeves and tried to tackle these thorny questions. Here is what I learned:
According to the CDC, the weekly chance of dying from Covid for boosted individuals is about one in a million. By comparison, the chance that an average American will die in a car crash this week is significantly higher — about 2.4 per million. Or from influenza and or pneumonia, about 3 per million.
In fact, with a booster shot, Covid resembles other respiratory illnesses that have been around for years. To be sure, it can still be dangerous, but that is mostly for the elderly and immunocompromised, much as the flu can be.
But what about all of those “breakthrough cases” we’ve been hearing about, seemingly on the same order of magnitude among vaccinated people as among the unvaccinated? The reason: The number of vaccinated people in Vermont is enormous — so much higher than the number of unvaccinated.
Think of it this way. If you have two jars, one with 1,000 green jelly beans and 2 red jelly beans, and a second jar with 10 green and 2 red, the number of red jelly beans in each jar is the same, but the chance of drawing a red is vastly different: 2/1,000 (0.2%) versus 2/10 (20%).
Similarly, according to the Vermont Department of Health, of the 474,000 Vermonters who have received at least two vaccines (defined as fully vaccinated but not boosted), only 6.3% have had a breakthrough case. And of these, a very small few have been hospitalized (0.4%) or have died (0.027%).
And there are two other factors that further accentuate this risk differential between vaccinated and unvaccinated people.
One is that the overwhelming majority of hospitalizations and deaths among the vaccinated are in the above-80-year-old category, which reflects the naturally diminishing immunity of the aging body and therefore diminishes the effectiveness of all vaccines in this population.
Second, if we focus on vaccinated people who have also received a booster shot, the risk of serious illness or death to that group is even smaller: According to the CDC, for non-immunocompromised individuals with a booster, the effectiveness rate jumps from 82% to a whopping 97%. And for immunocompromised individuals, it increases from 69% to 88%.
For this reason, public health messaging should use the terms “vaccinated but not boosted” and “boosted,” rather than the less clear terms, “vaccinated” or “fully vaccinated” (does vaccinated mean at least one, is fully vaccinated two, and boosted three?).
Defining these terms would help people understand the critical importance of the booster and may lead to greater uptake.
Knowing the true and comparative risk of serious health consequences for vaccinated and boosted individuals will help people make better-informed decisions about what they can and cannot do safely. We have the information we need now, so it’s time to trumpet it loudly.
For my part, I think it’s time we get vaccinated, boosted and safely back to our lives. Speaking of the 2.4 in a million risk of dying in a car crash, I always wear a seat belt and drive carefully, but frankly, I don’t spend too much time worrying about dying in a car crash. I know it’s possible, but if I take simple precautions, it is highly, highly unlikely.
For now, I think I’ll go and join my triple-vaccinated friends for a game of mahjong and raise a toast to the vaccine makers.
