U.S. COVID-19 breakthrough infections are 'uncommon,' rising 'considerably,' and 'sort of okay'

The Biden administration is advising eight-month booster shots for Americans vaccinated with the Pfizer and Moderna COVID-19 vaccines because the Delta variant, which now accounts for about 98.8 percent of new U.S. infections, is a lot more contagious and the effectiveness of the vaccines appears to wane with time.

"Fortunately," the COVID-19 vaccines are "still holding at a high level" of protection from hospitalization and death, Surgeon General Vivek Murthy said Wednesday. "But our anticipation is that if the trajectory that we are seeing continues ... we will likely see in the future an increase in breakthrough hospitalizations and breakthrough deaths" without boosters.

Even as the Delta variant surges, "COVID-19 breakthrough cases remain uncommon," The Wall Street Journal reports, citing its own analysis of data from health departments in 44 states and Washington, D.C. In those states, about 0.1 percent of vaccinated residents got COVID between Jan. 1 and early August, the Journal found.

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"This continues to be 'a pandemic of the unvaccinated,'" but "breakthrough infections accounted for 12 percent to 24 percent of COVID-related hospitalizations" in seven states keeping detailed records, The New York Times reports, citing its analysis. Those breakthrough cases are mostly among older or immunocompromised adults — in Oregon, for example, the median age for a breakthrough-associated death is 83, and 74 percent of breakthrough cases nationwide are among people 65 and older, federal data show.

The overall numbers remain small, but it's pretty clear "the chances of a breakthrough infection have gone up considerably," U.C. San Francisco's Dr. Robert Wachter tells the Times. "Remember when the early vaccine studies came out, it was like nobody gets hospitalized, nobody dies," he added. "That clearly is not true."

"Let's be real, here: Breakthrough infections are sort of okay," Larry Corey, a virologist at Seattle's Fred Hutchinson Cancer Research Center, tells the Journal. "You get infected and you have a cold, maybe an achy fever for 24 hours. But you don't end up in the hospital, and you don't end up with that 2.5 percent chance of dying once you are hospitalized."

"All we're really seeing, with vaccine breakthrough cases that come into the hospital, are people who are over 80 or have a compromised immune system," adds Jorge Bernett, an infectious disease specialist with John Muir Health in Walnut Creek, California. "Basically everyone who is on a ventilator is unvaccinated."