SC is not tracking mild COVID-19 ‘breakthrough cases’ as delta variant surges. Why?
South Carolina is not tracking mild coronavirus infections among fully vaccinated residents, even though new research has suggested that inoculated people can contract and spread the super-contagious delta variant.
The S.C. Department of Health and Environmental Control used to collect data on all of the Palmetto State’s “breakthrough cases,” but in May changed course and started to track only the number of vaccinated people with COVID-19 who had been admitted to a hospital or had died.
DHEC made the switch after the Centers for Disease Control and Prevention announced that it would no longer monitor all breakthrough cases nationwide.
It’s now impossible to say how many South Carolinians have experienced a breakthrough case this summer amid the ongoing surge of delta infections.
That’s not the case elsewhere in the South.
The majority of southern states have not followed the CDC’s lead and are still tracking all breakthrough infections, including cases that resulted in symptoms as mild as a cough or a sore throat, according to an Island Packet survey.
The usefulness of such granular data is the subject of debate among experts.
The CDC has argued that only monitoring rare COVID-19 hospitalizations and deaths among fully vaccinated people helps “maximize the quality of the data collected on cases of greatest clinical and public health importance.”
In other words, the CDC’s logic is that breakthrough cases were always expected to occur this year, because no vaccine is perfect, and it’s now important to pay closer attention to severe infections, which are especially troubling and merit further investigation. (DHEC will continue to follow the CDC’s guidance on breakthrough infections, agency spokesman Ron Aiken wrote in a Tuesday statement.)
But given delta’s devastating march across the country, collecting and releasing more data on breakthrough cases could be helpful in the coming weeks, some experts say, including for fully vaccinated residents who are increasingly concerned about the pandemic’s ever-shifting trajectory, an anecdotal increase in the number of breakthrough cases and recent CDC research that suggests inoculated people can spread delta to other residents if infected with the variant.
Dr. Helmut Albrecht, medical director of the Center for Infectious Diseases Research and Policy at Prisma Health and the University of South Carolina, used to notice one fully vaccinated person testing positive for COVID-19 each week, he said in an interview.
Now, Albrecht sees five or 10 inoculated patients testing positive every day, he said.
“It is more common, but most of them do well,” he said, noting that such cases are typically mild.
Unvaccinated residents, Albrecht stressed, are still faring much worse with delta.
DHEC’s data support his observations.
Dr. Linda Bell, the state’s top epidemiologist, during a Wednesday briefing told reporters that the vaccines from Pfizer-BioNTech, Moderna and Johnson & Johnson remain extremely protective against severe COVID-19 cases.
The state between May 1 and Aug. 4 recorded 213 breakthrough hospitalizations and/or deaths, Bell said. (Thirty-one people died in total.)
From Feb. 22 to April 30, meanwhile, DHEC identified 445 breakthrough cases, including mild infections. There were 54 hospitalizations and 14 deaths during that time period, according to Aiken.
Added together, if the 45 breakthrough deaths in 2021 have all been among state residents, only 0.002% of fully vaccinated South Carolinians have died with COVID-19 after completing inoculation.
DHEC’s focus on these severe cases, however, has made it harder to spot trends in mild breakthrough infections this summer. It also has made it more difficult to understand how delta is spreading through various communities.
Adriane Casalotti, chief of government and public affairs for the National Association of County and City Health Officials, in an interview said that tracking all breakthrough cases could help local health departments across the United States decide what COVID-19 safety measures are worth sustaining or reintroducing as delta spreads, like indoor mask rules or social distancing requirements.
And Dr. William Schaffner, an infectious disease expert and professor of preventive medicine at the Vanderbilt University School of Medicine, in an April interview (before delta became the country’s dominant coronavirus strain) said that monitoring such cases could help government regulators and vaccine makers determine if booster shots are needed to combat a particularly troublesome variant.
“The better data we have, the better (we) can prepare and work through this,” Albrecht said.
What are other states doing?
The Island Packet recently surveyed every state in the U.S. Census Bureau’s southern region to ask if they followed the CDC’s lead in limiting data collection for breakthrough cases.
The newspaper found that several states have opted to gather more information than less.
Spokespeople in Delaware, Maryland, Washington, D.C., Virginia, Kentucky, Tennessee, North Carolina, Alabama, Louisiana, Arkansas and Oklahoma confirmed that their health departments have continued to track all breakthrough infections in their respective jurisdictions, including those among fully vaccinated residents who had not been admitted to a hospital or had died.
Like South Carolina, Texas was the only other state in the South that said it’s not tracking mild breakthrough infections.
Three states did not respond to requests for comment: Georgia, Florida and Mississippi. A spokesperson for West Virginia’s health department provided an unclear answer.
Most of the surveyed spokespeople simply pointed The Island Packet toward publicly available state reports or data on breakthrough cases. They did not explain why their health departments have continued to collect such information.
The CDC did not respond to requests for comment.
‘A complex conversation’
Even the experts who pointed to the possible benefits of collecting data on mild breakthrough infections acknowledged that the issue is nuanced.
“It’s a complex conversation,” Casalotti said.
“While I think health departments would love to focus tons of resources on the data side of things,” government officials are also trying to bolster vaccination rates, host testing events and work with K-12 schools to make sure districts can safely reopen this fall as delta spikes, Casalotti said.
Albrecht agreed.
“I understand that DHEC and CDC, within this surge, probably have bigger fish to fry,” he said.
Health officials are overwhelmed in South Carolina. The state has seen COVID-19 hospitalizations triple in the past three weeks, Bell said Wednesday. More than 1,160 coronavirus patients, as of Monday, were admitted at hospitals statewide. That’s a 474% increase since July 14.
Delta has been pummeling the state, Bell said, thanks to South Carolina’s low vaccination rate. Only 45.3% of residents 12 or older have been fully vaccinated.
“We have to stop transmission now. We must take action now,” the epidemiologist said. “It previously seemed unimaginable, but we could soon be seeing 5,000 or 6,000 cases a day if we do not do more.”
Note: Data in this story are current as of Wednesday afternoon.
