Authors: By Ariel Hart Zachary Hansen May 19. 2022 – The Atlanta Journal-Constitution

Doctors say it’s caused by a combination of a variant that can escape the vaccine’s effects and the most vulnerable also being the most vaccinated

As summer once again brings signs of a coming COVID-19 wave, an unusual trend has emerged: The Georgians who are fully vaccinated and boosted are increasingly winding up in the hospital with serious COVID-19 symptoms.

The phenomenon points to two changes in the unpredictable pandemic battleground more than two years in. The circulating omicron variant has become better at evading the vaccine, which was designed on the first version of coronavirus to appear in China. And the people most likely to get boosted are those who were most vulnerable to begin with: the elderly, or patients with pre-existing conditions. Despite the extra vaccine protection, those people remain the most vulnerable.

Even in light of the unexpected hospitalizations of those vaccinated and boosted, doctors say it’s still true that boosted groups are the least likely to die.

“I’ve had several older patients who have been boosted and had the vaccine,” said Dr. William Cleveland, a nephrologist in southwest Atlanta. “They get hospitalized, and they had to have some significant medical attention, but they get discharged. And I know that just because of their frailty, without having had the vaccine they would not have survived.”

The rate of hospitalizations for boosted Georgians fell again this week, but still remains higher than the rate of hospitalizations for those with only the primary vaccine series (2 shots). The fact that boosted patients’ hospitalizations nearly outstripped all others even for one week was an unprecedent moment in the pandemic. In the past, hospitalization rates for unvaccinated groups have drastically outnumbered those who have taken the vaccine — sometimes tenfold.

The trend emerged at the tail-end of the omicron variant outbreak and has accelerated over the past two months, setting off alarm bells for state public health experts already expecting a surge in cases this summer.

Dr. Eva Lee, director of the Center for Operations Research in Medicine and Healthcare at Georgia Tech, agreed that the rate of hospitalizations among boosted people was on track to outpace other populations. However, she said it’s not a sign of vaccines losing all effectiveness — it has to do with who is choosing to get boosted.

“A big part of the people that are boosted are also the ones that are really at high risk already to begin with, right?” Lee said. “But what has remained and hasn’t changed is the following: The people that are at risk remain at risk. That means the people that are immune-compromised and the people that are like the elderly people, and people who have coexisting conditions, their risk is still higher.”

Growing number of breakthroughs

Overall, the number of people hospitalized with COVID remains at or near the lowest rate since the beginning of the pandemic. But state data shows that the most protected and least protected groups are starting to find themselves fighting for their lives in Georgia hospitals at nearly the same levels.

According to Georgia Department of Public Health data, unvaccinated groups were being hospitalized due to COVID at twice the rate of other populations at the beginning of March. By the end of April, there were 1.3 hospitalizations per 100,000 vaccinated and boosted Georgians compared to 1.6 hospitalizations for every 100,000 unvaccinated Georgians.https://datawrapper.dwcdn.net/qtaSR/1/

In addition to at-risk groups being more likely to get every shot available to them, omicron and its subvariants have presented a challenge for the U.S.’s current vaccines. Breakthrough cases of less serious illness are now common, and health experts warn they are a sign of the vaccines’ waning immunity.

“Prior to Omicron we could, with a booster, assume there was well over 90-95% vaccine effectiveness vs severe disease,” Eric Topol, founder and director of the Scripps Research Translational Institute in New York, wrote in a recent column sounding the alarm for a summer surge in COVID-19 infections. “It is clear, however, from multiple reports … that this level of protection has declined to approximately 80%, particularly taking account the more rapid waning than previously seen. That represents a substantial drop-off.”

The growing number of breakthrough cases has prompted national health officials to discuss reformulating the current vaccines to specifically target omicron and its subvariants. The U.S. Food and Drug Administration has a meeting scheduled for June 28 to evaluate vaccine efficiency and composition.

Georgia hasn’t seen any noticeable uptick in COVID-19 deaths, but death reports often lag behind increasing hospitalization rates by several weeks.

While health experts are troubled by the rising hospitalization rates, they emphasize that COVID’s death toll would already be on the rise if the most at-risk Georgians weren’t vaccinated and boosted.

Surprised to still be alive

Raymond Fain knew he couldn’t risk getting COVID-19. Given he has kidney disease, the 58-year-old made sure to not only get fully vaccinated but he took a Pfizer booster shot to boot.

Just two months later, during the onslaught of the omicron variant this winter, he was shocked to be told that in spite of his vaccinations he caught COVID. What followed was a bad sickness and two rounds of hospitalization that totaled nearly a month. But at the end of it, came another surprise: He lived.

“I was sort of shocked that that disease that I caught didn’t overcome me with, the failed kidneys. You know what I’m saying?” Fain said.

Cleveland works with Fain’s doctor, both of whom have pleaded with their kidney patients to get vaccinated. Cleveland is all too familiar with kidney patients who get COVID and don’t make it. He’s heard all the excuses, and he’s ready to counter them.

“I’ve seen so much of that (kidney patients succumbing to COVID) that I do not hesitate to try to explain to my patients that I’ve just seen this too many times to to be comfortable with them saying that they are afraid,” Cleveland said.

The percentage of Georgia residents who’ve been vaccinated is among the lowest in the country — the peach state currently ranks 45th. The state’s booster adoption rate is even worse, with less than half of all fully vaccinated people choosing to get one booster dose.

There’s also a large age disparity among those getting boosted. Nearly 60% of all Georgia seniors, people 65 and older, have gotten a booster dose, but there’s a stark drop-off for younger populations. Only about 15% of 25- to 34-year-old Georgians are boosted.

The low booster adoption rate for younger people, who are less likely to be at a high risk of life-threatening infections, is an explanation for why boosted groups seem to be hospitalized at higher rates, health experts said.https://datawrapper.dwcdn.net/KYHdI/1/

“All such people need to have vaccination and booster coverage but our (Centers for Disease Control and Prevention) has failed to convey their life-saving impact from the get go…” Topol wrote in his column. “That’s why we have 31% of Americans who had had 1 booster shot whereas most peer countries are double that proportion.”

For Fain, he’s surprised he was able to pull through his severe bout with COVID and get back on his feet, but his friends and loved ones haven’t let him forget how close he was to death.

“Everybody’s going to talk to me now, they say, ‘Boy when you started, we thought you was going to get gone. You sounded so bad,’” Fain said. “Yeah, but everything is okay now. I’m strong.”