Barnstable County: Breakthrough Cases and Vaccinations

Over a year into the COVID-19 pandemic and several months into the spread of the Delta variant of the virus, public health conversations seemingly shifted focus. While 2020 conversations centered primarily on social distancing, masking, and isolation protocols, the rollout of several effective vaccines redirected conversations towards vaccination rates.

However, the CDC’s recent adjustment to their guidance on mask-wearing recommended that even fully vaccinated people should wear masks in high-risk settings. This change reintroduced earlier pandemic mitigation measures into public consciousness and sparked confusion over the efficacy of vaccinations – a potentially detrimental stumbling block to efforts to end the COVID-19 pandemic, especially given hesitancy around vaccines in many areas of the country. Luckily, the CDC clarified many of these concerns by publishing its research into a July COVID-19 outbreak in Barnstable County, Massachusetts.

Barnstable County experienced a significant outbreak of the Delta variant of COVID-19 among vaccinated individuals this summer. Despite high vaccination rates in Massachusetts (69%) compared to the national average, 74% of the cases reported in the outbreak were vaccinated against COVID-19. While most of the vaccinated cases were symptomatic, very few reported severe symptoms, even fewer were hospitalized, and none died.

As Carolyn Y. Johnson, Yasmeen Abutaleb, and Joel Achenbach of The Washington Post note in their article covering the outbreak, the statistics fairly startle and concern many people, especially those already wary of receiving a COVID-19 vaccine. What is the purpose of getting a vaccine if it does not prevent infection? Johnson, Abutaleb, and Achenbach reiterate that the COVID-19 vaccine does not generally aim to prevent infection, but to prevent the severityof the infection. Such an assertion is reflected in this case where comparatively few infected individuals experienced serious illness.

However, the CDC emphasizes in its report that the sample size of this case is extremely limited. While it may reflect overall patterns, this case can’t be used on its own to draw conclusions about the efficacy of the vaccine. Additionally, the CDC quells some concern surrounding the sheer percentage of infections that occurred in vaccinated individuals by pointing out that the fact that the outbreak occurred in an area with a high vaccination rate may have a significant effect on the percentages we see. If the majority of a population is vaccinated, it stands to reason that the majority of infections would occur in vaccinated individuals, if only because fewer unvaccinated people exist in that area.

Despite the possibility of contracting the virus even after vaccination, the substantially lower risk associated with infection after vaccination indicates that vaccination efforts are largely helpful in keeping people safe on an individual level. On a communal level, vaccinations can help slow the spread of COVID-19 thereby producing fewer opportunities for mutation, as reported by the Universtiy of Maryland Medical System.

However, the Barnstable County outbreak indicates the distinct possibility that vaccinated individuals can still spread the virus with a significant viral load. Therefore, although vaccines are almost definitely effective at moderating personal illness, the level to which they help prevent mutations is yet to be seen. While we can be reasonably sure that they have some positive effect on slowing mutations, we will need more research before knowing this for sure.

In a similar vein, this case has also raised questions about herd immunity. Earlier in the pandemic, Dr. Fauci indicated that herd immunity would likely require a vaccination rate of between 60 and 70 percent. But, in the months following vaccine rollouts, Dr. Fauci also emphasized that the true percentage for herd immunity is relatively unknowable and could be much higher.  Additionally, Donald G. McNeil Jr. of the New York Times also reported that the rate of vaccination to achieve herd immunity rises with a disease’s transmissibility.

The relationship between herd immunity and transmissibility is essential in the case of Barnstable County as a vast majority of the positive cases consisted of the Delta variant. The CDC reported on August 6^th that the Delta variant in particular is significantly more transmissible than other forms of COVID-19. Correspondingly higher rates of inoculation to the virus will be necessary as the Delta variant continues to spread. In the Barnstable County outbreak, many vaccinated individuals with the Delta variant exhibited fairly substantial viral loads, meaning that they are likely spreading the virus to other vaccinated individuals once infected.

Concern for federal inmates as public efforts to stop the pandemic expand to include both widespread vaccination and social distancing and masking efforts should remain a top priority. As we reported last summer, prison conditions are almost never conducive to social distancing, heightened hygiene, or healthcare management. Subsequently, they often constitute virtual petri dishes for disease and have proven extremely dangerous during the COVID-19 pandemic.

As such, federal inmates should take note of both vaccination, masking, and distancing guidelines to the best of their ability despite unideal circumstances. The Barnstable County case shows us that both mitigation protocols and vaccination efforts are necessary to keep ourselves and each other safe and that, though new tools exist with the advent of fairly effective COVID-19 vaccines, we are still in the midst of the pandemic and should act accordingly.

If you or a loved one is in federal prison, our office urges you to consider the following:

1. Get vaccinated. The BOP has been vaccinating individuals and boasts over 200k vaccines administered. Vaccination provides individual protection against all existing strains and variants of the virus so far as well as community protection to the people around you. Further, the BOP keeps records of those who refuse vaccination. Although vaccination is not required, government opposition to compassionate release motions can cite vaccination refusal to argue that if your current situation is not dangerous enough to warrant vaccination, it cannot be dangerous enough to justify release.
2. Ask for CARES Act relief. While the BOP has applied the CARES Act wildly inconsistently and we don’t currently know their policy on granting CARES Act relief, we strongly encourage you to continue to seek it, especially if you have preexisting risk factors.
3. Continue to engage in safety measures. The rise of the breakthrough cases in vaccinated individuals is largely anticipated. By most standards the vaccines are between 60-95 percent effective against the delta variant. But those numbers can increase when the user takes special precautions. Specifically, wearing face masks and engaging in social distancing as much as possibly within the prisons can help reduce your chances of contracting COVID-19, spreading COVID-19, or contributing to infection outbreaks that serve as breeding grounds for new mutations and variants.