FARGO — Far less than 1% of people who have been fully vaccinated against COVID-19 in North Dakota and Minnesota have developed infections in spite of the protection, an expected phenomenon called breakthrough infections.
In North Dakota, health officials have identified 354 breakthrough infections among 264,447 fully vaccinated persons, including deaths of six elderly people over the age of 70.
"This is why it is so important for everyone in the community to be vaccinated, so we can protect the most vulnerable," said Molly Howell, immunization director at the North Dakota Department of Health. "The less COVID-19 circulating in the community, then the fewer cases, hospitalizations and deaths there will be."
Minnesota health officials have documented 1,942 breakthrough cases — 1,691 confirmed and 251 suspected — among 1,886,753 fully vaccinated persons, including 21 deaths, the average age for which was 75.
In both states, the numbers translate into a breakthrough infection rate of about 0.1% of those fully vaccinated, which public health officials said demonstrates that the vaccines are highly effective in preventing COVID-19 infections — and even more effective at preventing serious illness or death.
Breakthrough infections, according to the Centers for Disease Control and Prevention, are those that occur at least two weeks after a person has received a complete series of vaccinations, the point at which the person is considered fully vaccinated.
Almost half of North Dakota’s breakthrough infections — 145 — were among those who are 60 years old and over, Howell said. Eighty-three breakthrough infections were asymptomatic, and 36 resulted in hospitalization, according to state figures.
Also, 65 of North Dakota’s breakthrough infections involved people who had previously tested positive, so it wasn’t clear whether it was a new infection or enough of the virus remained for those people to again test positive, Howell said.
In Minnesota, breakthrough infections have resulted in 175 hospitalizations, and details that are available for 71 of those admissions showed an average age of 70.
Public health officials have advised that breakthrough infections are inevitable because the vaccines aren’t 100% effective in preventing infection. The two-dose Pfizer/BioNTech and Moderna vaccines are considered about 95% effective in preventing infections and the single-dose Johnson & Johnson vaccine is considered 67% effective.
“So you would expect, and even in clinical trials, some people went on to develop COVID-19,” Howell said.
The reality of breakthrough infections underscores the importance of everyone to get vaccinated in order to prevent spreading the coronavirus, she said. Vaccinating only those who are the most vulnerable, including the elderly and those with underlying health conditions such as diabetes or heart disease, won’t check the spread of the virus, she added.
Vaccinations that so far have protected 99.9% of North Dakota’s inoculated population likely saved more than 7,000 lives, Howell said. “That’s significant,” she said.
Also, both deaths and hospitalizations of those 65 and over have dropped sharply since vaccinations began, Howell said.
Between August and November of 2020, before vaccinations began, 1,614 North Dakotans age 65 and older were hospitalized for COVID-19, she said. From January through April, after the vaccine became available, the number plunged to 258, or a decrease of 84%.
Similarly, North Dakota recorded 859 COVID-19 deaths for those 65 and older from August through November last year, and 109 deaths in that age group from January through April, a decrease of 87%, Howell said.
Even among the elderly who are more vulnerable, those who have been fully vaccinated are at “extremely low risk” of death from COVID-19, she said.
Dr. Avish Nagpal, the chief infectious disease specialist at Sanford Health in Fargo, said people have an unrealistic expectation that vaccines can prevent all infections.
“Nothing in life is going to be 100%,” he said. “That would be a miracle. We hold vaccines to a different standard.”
Still, vaccines are much more effective than common drugs to prevent strokes and heart attacks, for example, Nagpal said.
The vaccines are even more effective in preventing serious illness or death than they are in preventing infection, he said. Those who don’t get vaccinated and get infected by the coronavirus risk developing long-term symptoms, Nagpal said, including shortness of breath, fatigue and neurological or heart problems.
“Vaccine is way more cost-effective and way more efficacious than the common drugs we take,” he said.
The population of Sanford employees in the Fargo service region provides an illustration of how effective the vaccines are, Nagpal said.
In rounded numbers, almost 80% of Sanford employees have been vaccinated, or 8,000 of 10,000 employees. Among those 8,000 vaccinated employees, 17 breakthrough COVID-19 infections have been documented.
But among the 2,000 unvaccinated employees, 117 have caught COVID-19. In other words, Nagpal said, roughly 90% of infections occurred among the roughly 20% of employees who weren’t vaccinated.
Nagpal and other experts believe it is unlikely that the United States will see another significant infection surge because enough of the population has been vaccinated.
In North Dakota, 43.7% are fully vaccinated and in Minnesota 50.5%, according to state figures.