CDC Chooses to Fly Blind on Vaccine Breakthrough Cases

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Reader GM sent this nugget from the CDC:

To be more polite that I ought to be, this action make no sense from a scientific perspective. The CDC could provide updates on serious cases versus mild/asymptomatic cases among the fully and partly vaccinated. Or are we to believe the CDC is less good at data than the Bureau of Labor Statistics, which has no trouble publishing multiple unemployment indices?

And there do appear to be meaningful numbers of fully vaccinated people who are testing positive. When I mentioned this issue this evening, our aide, who also works part time in a local hospital, said an RN in her ward had just tested positive despite having had two shots and being >2 weeks past the second. I have more reports from MDs all over the country but was asked to hold back one more week on publishing anecdata to make sure this troubling trend looked to be sustained.

But as you can see, now thanks to the CDC, MDs will be left only with anecdata. Is that any way to practice public health? As one MD in the oil patch said, “The health department here treats us like enemy combatants, we are assumed to be on the wrong side of everything.”

Reader GM elaborated as to why asymptomatic cases among the vaccinated matter. Remember that this vaccine was never expected to achieve the level of sterilizing immunity, where the immunity conferred by a vaccine is so complete that the pathogen can’t get a foothold in a vaccinated individual. With a respiratory virus1 (or one with the airways as a major vector for infection), it’s pretty much impossible to achieve that level of protection.

But that doesn’t mean that sticking your head in the sand about breakthrough cases makes any sense. In fact, it is fully part of the US prioritizing profit over public health. The pretense of getting back to a semblance of normal, and relaxing Covid precautions, is more important than having a reality-based grip on health outcomes and what they imply.

As GM observed:

The real worries here are the following:

First, that the breakthrough cases are asymptomatic/mild now, but they will not be so mild later in the year, as antibodies wane.

Second and most important, from the perspective of the virus, this is not actually an OK state of affairs. Sure, it gets transmitted at some level, but its evolutionary “goal” is not just to survive, but to make as many copies of itself as possible. And the milder cases tend to have less of the virus (yes, there are completely asymptomatic superspreaders that generate a huge amount of virus in the URT, but in general, if it can get past the URT and cause real damage, that means a lot more copies of the virus, so the evolutionary pressure is there for it to evolve in that direction). So whatever can escape the antibodies generated by the vaccines and lead to more replication will be selected for, and that may well mean a much more contagious and virulent virus just from that. So far immune escape has evolved hand in hand with stronger affinity for the ACE2 receptor, which directly translates into higher contagiousness and also elevated virulence too. The likely mutations to come next identified in vitro (to be noted, in vitro evolution had already correctly identified the ones that characterize the current variants, so it has a good track record so far) also have exactly those characteristics.

But in vitro works has also identified ways for it to get deadlier through a different mechanism – shutting down innate immunity by inhibiting the interferon response is a key strategy that these viruses have evolved in their battle with bats’ immune systems, and there is some evidence that this one is actually not all that good at it compared to, for example, the first SARS virus from 2003. And this might be a major reason why SARS-1 was much more lethal. Could vaccination select for a reversion back to that state, i.e. it goes in the direction of countering the immune system as whole by becoming better at overcoming the innate arm of it when the adaptive arm has been strengthened by vaccines, the evolutionary potential for which does appear to be there? I don’t have an answer, but I sure hope that it does not.

The refusal to stop transmission runs the risk of breeding something much more contagious and deadly. And because it may well happen in stages, there is also the risk of it becoming gradually normalized, just as the current level of deaths was.

Don’t say you weren’t warned. At a bare minimum, I would stockpile masks, particularly the really good ones, now that they are being depicted as out of fashion.


1 Covid is looking more and more like a vascular disease.

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  1. campbeln

    Big Pharma is salivating at the prospect of a yearly (or twice-yearly!) booster, so this is music to their bank accounts.

    I can see between India, the Seychelles, Israel’s plateauing vaccination percentage, vaccination hesitance domestically, new variants and people who are vaccinated acting like everything’s “back to normal” that at some point we’re all going the way of today’s India :(

    In fact, it is fully part of the US prioritizing profit over public health.

    This is the issue in a nutshell, and with this driving the “$500 singing bonus” to get new hires for McDonalds and all the BS propaganda surrounding it… it’s all going to get FAR worse before it starts getting any better. I have the dark feeling COVID will be the US’s Chernobyl.

    1. Lambert Strether

      > Big Pharma is salivating at the prospect of a yearly (or twice-yearly!) booster, so this is music to their bank accounts.

      I’m seeing a subscription model. And if you don’t keep up with your subscription, no jab! Also, why aren’t we setting up price points for effectiveness?

      Adding, like, say, Bronze, Silver, Gold, and Platinum versions of the Pfizer jab? Really, Big Pharma is thinking too small!

      1. mwbworld

        And the higher the level of the plan the less the side effects of the vaccine… ;-)

        1. Jen

          I think it should be the reverse, actually. You want those high-flying subscription customers to know they’re getting their money’s worth and bragging all over social media that they must have gotten the very best vaccine because they feel so awful.

      2. Pelham

        I agree with the sentiment.

        But strictly weighing only the need to dump Covid on the ash heap of history, would a subscription model be such a bad idea? It might persuade huge numbers of people to actually take the shots.

        Even as a lifelong introvert and semi-recluse, I’m growing weary of this business, which includes the endless, infantile harangues on Fox News about the evils of mask wearing. And yet I’m frightened to death by the anecdotes, such as the local one about a young pregnant woman slammed by Covid who had to give birth in a coma and spent 87 days on a respirator before needing a double lung transplant. This s–t has to stop, and it’s OK in my estimation if what it takes is Orwellian health tracking and vaccine companies making a mint for a while. First let’s deal with this rotten killer, throwing absolutely everything at it, then with the deep state and Big Pharma.

      3. PHLDenizen

        Still thinking too small. To reach parity with the current healthcare hellscape, you’d need to sculpt vaccination programs in the likeness of existing neoliberal meanness and sh*t.

        You get recurring revenue via a subscription model, but that’s just the “access” component. There are still copays, co-insurance, out of pocket maximums to tack on. Then there’s network arbitrage. The better your plan, the more vaccination providers are in network. Local drug stores, doctors’ offices that are “certified” to dispense that particular jab. That kind of thing. Bronze might be a single RV in Tulsa. Silver might give you one provider in each state. Gold gets you CVS, YOUR GP, etc. Ideally each vaccine is treated as a healthcare plan unto itself.

        Pharma will also lobby Congress with dire warnings about the existential threat Covid presents, requiring the NIH and CDC to foot the bill for R&D. It’s a national defense issue. How do we keep our country safe from Covid terrorists?

        1. tegnost

          somewhere an actuary, or more likely actuaries in the plural, is/are counting the money coming out of their loss column (you know, the part of insurance where you get what you’ve paid for…which includes social security) going into the profit column and seeing covid as a dream come true. The really wealthy weren’t impacted by covid, more amazon/instacart/doordash…more profit fattening their bottom line, no one they know dying, just poors and easily replaceable immigrant labor. And add vax shaming and it’s practically a religious experience….

    2. Cocomaan

      Agreed. The claim from pharma is that these mRNA vaccines are easy to produce and rollout. This allows not only annual shots but constant boosters to chase the snake’s tail for variants that arise.

      The last 20 years was the self perpetuating War on Terror. We have spent almost twenty years in the USA taking our shoes off before flights because of one guy who failed to do anything but blow off his toes.

      The next two decades will be the self perpetuating War in Health.

      1. MrBrokenRecord

        The next two decades will be the self perpetuating War in Health.

        I wish us luck. I was in the military in the early 80’s. Even back then, we had an acronym, NBC, which stood for nuclear, BIOLOGICAL, chemical. So how is it that the country that spends what, $700 billion annually on defense, more than 2x what China and Russia spend put together, didn’t even have an adequate stockpile of PPE for it’s first responders, much less it’s population, in the event of a bio attack or pandemic?

        1. John Wright

          Thanks for mentioning the China and Russia spend as I was unaware that the USA was spending only about 2x their combined budget.

          But combining Russia and Chinese budgets together obscures the relative expenditure.

          Google has that Russia is spending $69.2 billion per year while China is listed at $209.16 billion per

          One can see that Russia should be nervous about China and its anticipated need for Siberian resources.

          Yet the USA has amped up the Russian threat to push back at the barbarian Trump, perhaps pushing Russia and China closer together when they are not natural allies.

          As some have suggested, the Defense budget is not for defense, it is for projection of the USA’s diminishing economic power.

          1. philnc

            The NYPD budget is multiples larger than what most countries spend on national defense. As for the US military, they demonstrated their real worth on September 11 and, amazingly, repeated that again this January 6. Any vendor with that track record would find their subscription cancelled. The police aren’t the only American institution that needs defunding and replacing. As for NBC readiness, other than adding expensive (and profitable for contractors) modifications to hardware like tanks and bunkers, the US military was never really serious about fighting under those conditions. The full NBC kit for an individual soldier circa 1980 is proof of that. A grunt wouldn’t be able to see the enemy once they were buttoned up, let alone shoot back at them (never mind that the civilian population they were supposed to be there to protect would already have been wiped out — but hey, at least no traffic on the Autobahn!).

    3. flora

      yep. Anything to help big Pharma get its FDA approval. Who needs accurate data? / ;)

  2. Raymond Sim

    Oh good grief. I spent my afternoon trying to figure out what percentage of cases our local schools are missing, 8 out of 10 I think.

    We have exceptionally good school testing arrangments here in Davis. Good for the US that is. But in actual fact, it isn’t frequent enough, compliance isn’t high enough, and the quarantine period is too short. It’s not going to stop epidemic spread.

    There’s a lot of effort going into it, and I think goodwill too, but functionally it’s hygiene theater.

    We’re 75% B.1.1.7 now, which has a near 100% household attack rate. The spike will likely be very sudden, and I very much doubt our leaders will react anywhere near quickly enough.

    1. campbeln

      We’re up the road from you in SacTown. If it weren’t for the Zombie apocalypse, we’d have to do coffee!

      If Davis can’t manage this, with their frog underpasses in the “socialist utopia” that is California… then the US really can’t find it’s ass with both hands.

  3. Raymond Sim

    Regarding the normalization of ever worsening casualties, I have a sick feeling that’s what will happen.

    As that happens, how will the countries of East and Southeast Asia deal with the rest of us? We’re an ongoing menace.

    Variants with the L452R mutation appear to pose an extraordinary risk to the populations of those countries, so they might be pressed to act sooner rather than later

  4. Mark

    It is beyond comprehensions why we would choose NOT to collect as much data as you can when we are STILL dealing with a once in a century pandemic. Lets not start treating things like the a pandemic is over because it is not.

    We still have years of rolling waves of infections and deaths. Many countries are still a year or more away from widespread vaccination. But even once a significant part of the world is vaccinated we are still likely looking at half a decade of rolling waves of infection before things stabilise.** (No scientific basis for this claim, just guesstimate/extrapolation.)

    I’m in Australia, we have a different perspective. We don’t have COVID here. A wholesale opening of our border would change that but that isn’t possible until most are vaccinated. Even then there will be a reluctance to open the floodgates to a horrible virus in a hurry. Not that our politicians will address this openly.

    1. campbeln

      Bite yer tongue, mate! Scotty from Marketing is a fine manager!

      Hopefully things like the breakthrough rate from new variants are so clear that even Scotty can’t make that bad of a decision.

  5. Greg

    For my money, I’d say it’s another “noble lie”, as with Fauci and the masks.
    They don’t want to talk about breakthrough cases, because that might reduce the uptake of vaccinations. More treatment of the public as too stupid to handle the real data.

    1. Medbh

      This theory gets my vote. It reinforces two of the anti-vaccination arguments. One, that vaccines “don’t work” and two, that vaccinated people are “shedding” the virus. I’m vaccinated and don’t believe either of these claims, but suspect that’s how the data would be spun.

      1. Romancing The Loan

        Yep, another “you’re too stupid to handle the truth.” I’m sure it will have the opposite of the intended effect and reinforce both of these arguments by making it look like they’re hiding something.

        Between this and the CDC having to be dragged kicking and screaming into acknowledging aerosol transmission a year late (and the appearance being very much that this was because admitting the truth was inconvenient for business interests!) it makes it difficult to argue any of the official messaging should be given greater credibility than your dotty aunt’s favorite Youtube doctor. Which is ironic because the data coming out from other countries seems to confirm that the vaccines really are quite safe and effective, even if not 100%.

        My second shot is tomorrow, and I’m not sure the full-face respirator I bought in February 2020 and wore to constant (but steadily diminishing and now zero) jeers is going to be completely retired just yet.

        1. Mantid

          Hello Romancing, Respirator right on! We’ve been using our older ones from the days when I painted (no Picassos). They are very effective when the fires come. Then, just yesterday, 2 of 5 EMTs exiting a fire truck to help someone, had respirators on. If they think it’s a good idea I’d respect their choice – good call.

          1. Romancing The Loan

            Nice to see someone else is doing it! It cost me all of $40 to walk into crowded stores without worrying so I have no idea why more people don’t have them. Maybe we’d mostly rather die than look weird.

            1. tegnost

              I don’t think respirators filter your exhale, only your inhale, so unless you have a mask under it you’re capable of spreading

              1. Romancing The Loan

                Over is also fine and far less stuffy. The ear loops fit nicely over the two side pieces.

            2. campbeln

              Raises hand.

              The equipment was already on hand since SARS so it was easy to redeploy.

              I’ve had quite the opposite of jeers, myself. The maskers ask where they can get one and the anti-maskers comment how “that one actually works”. I also get express service at the pizza place as they know who I am when I walk in!

              It also keeps me from punching the d*ck noses, so it’s a net benefit all-round!

          1. campbeln

            We have a few 3Ms like this one – They are WELL worth the $13 (just note the size) plus some REAL (non xxxxCN) P95+ filters. Works great for painting, mixing concrete and at the grocery/hardware store. I wear mine anywhere that is enclosed that has a lot of people or is not first thing in the morning.

            Keeps the glasses from fogging, though you do have to yell through it for other to understand you.

          2. Romancing The Loan

            I got a “wide field of view” full face respirator from a brand called Atwood, but anything that takes P95/P100 filter cartridges should work fine. That it covers your whole face prevents transmission via aerosols getting into your eyes and also means you just put it on like a helmet and tighten the two straps in front, meaning it takes all of three seconds to get it on with a nice tight seal. The downside is that it’s hard to make yourself heard and it’s not great for extended or very physical activity because it does get sweaty and stuffy. I have been changing the cartridges after every few hours (totaled up over time) of use in public indoor spaces. If you’re looking for better protection than a regular mask I like it as it’s easier to fit than an N95 and will last longer since it doesn’t eventually go limp from your own breath. Also, as noted upthread, looping a regular mask over the exhale valve is a nice gesture as it means your own respiration is as filtered as anyone else’s.

    2. kareninca

      When I first saw articles on breakthrough cases I decided that that was what I was going to track!!! Then suddenly there were fewer and fewer, and older and older, articles on the topic. It was not something that the MSM “wanted” to report on. This CDC policy should make their chosen “reporting” job much easier.

  6. Stephanie

    Singapore has had quite a number of vaccine breakthrough cases (as a % of new community cases at the moment). In a way Singapore is quite an interesting place to watch – there are very few cases so they do report in excessive detail information on each one, including when exactly they had each dose. It also makes it more glaringly obvious that people who have been fully vaccinated are susceptible to infection. Unlike in the case of the UK, where I live, where such figures aren’t available.

    Friends in Southeast Asia are thinking that this is going to mean border restrictions for a much longer time, since vaccinations may not actually protect against infection and transmission. Singapore was quite interested in vaccine passports but I wonder if they will now change their mind.

    1. GM

      Yes, that bit about having sufficiently few cases to actually put out the details about them is greatly overlooked.

      In the West, we got past that point right from the start, and nobody bothered to do any contact tracing anyway.

      So the population has been deluged with numbers, not with concrete stories about how individual people caught it exactly.

      The consequence of which is that people approach every individual action with “I don’t know anyone who got the virus that way, this is safe”. Well, yes, of course, when we don’t know how anyone got it because we never bothered to examine it, then you will not know anyone who got it in any specific situation. But clearly tens of millions got it somehow…

  7. Mikel

    “So whatever can escape the antibodies generated by the vaccines and lead to more replication will be selected for, and that may well mean a much more contagious and virulent virus just from that…”

    And I remember learning about this kind of thing in science class. So not only do you have lying officials that did everything possible it seems to help the spread of an airborne disease (Fauci and hus “no masks”) early in the pandemic, now they are running a playbook for creating more virulent strains.

    And the narratives. We all are hearing the narratives. It’s none of this info we about the mutations and the rate of infection of the “vaccinated” (yes, it deserves the quotes) . Everyone getting the screentime and the write-ups all sound like pharma salesmen. It’s all about jacking everybody up with an experiment that is only taking some pressure off the health care system…for the moment.
    They are running around saying things like these shots will get the virus under control and it won’t. It just gets degenerating public health care systems under control.

    So not only is there still a pandemic with the potential to be even more deadly, none of the deep seated issues with health care systems have been fixed.

    1. chuck roast

      This is what I’m thinking. The Spanish Flu was with us for several years and must have morphed into different viral strains during that period. If I’m understanding correctly, it eventually settled in as just another flu ‘bad neighbor.’ Our attempts at suppressing Covid and wiping it out may just be making it extremely annoyed and ever more deadly. Time will tell…for some of us anyway.

      1. GM

        Smallpox on the other hand never attenuated.

        And there are very good reasons to think this one will not not only not attenuate, but will get worse.

        Certain viruses are not bad for you because you have not seen them, they are bad for you because of what they do to you.

    2. Procopius

      Mikel, I don’t see where he gets the risk of “more virulent” from. Evolutionary pressure is to select for characteristics that make more copies of the virus. The more virulent the virus, the shorter the life span of its hosts, the fewer copies made. As ghastly as Ebola is, notice that even without a vaccine the outbreaks haven’t lasted long. Sure, evolution in action is random, so “more virulent” may come up, but it’s not as likely as “more contagious” or “less virulent.” I don’t see how the virus gains advantage from killing its host faster, but maybe virologists know better. I recommend meditating on the Sufi parable of the Appointment in Samarra.

      1. Jeotsu

        It is my understanding that there is little evolutionary pressure on mortality compared to transmissibility, as you become infectious in the day 2-7 region, but don’t get critically ill and die until much later. So even if you are carrying a super-lethal form of the virus, you pass it along just as well as non-lethal versions in that first week or so.
        The selection pressure is on binding ACE2 strongly, and on making lots of copies of the virus. Lots of copies, if they make it to the respiratory system, give you transmissibility. Large copy numbers also correlate with increased severity.
        And heavy help us if selection pressure gives it new ways to attack or subvert our immune system.
        Question to Ignacio or others knowledgable on these matters: do any of the four circulating ‘common cold’ coronaviruses have any nasty tricks that could be picked up in a recombination event with CoV2?

        1. GM

          do any of the four circulating ‘common cold’ coronaviruses have any nasty tricks that could be picked up in a recombination event with CoV2?

          They don’t seem to, which is why they are common cold viruses, while SARS-type coronavirus cause SARS. The accessory proteins are quite different.

          What recombination can do, however, is just directly wipe out the vaccines — ACE2 is also used by NL63, one of those four common cold viruses.

          The right recombination event will replace the portion of the S protein of SARS-CoV-2 that vaccines target with that of NL63 while keeping all the nasty bits there, and all of a sudden we have an entirely new pandemic — it’s not going to be boosters, but altogether new vaccines. The pancoronavirus vaccines won’t work either, as they will be targeting the subset of Betacoronaviruses that SARS-CoV-2 belongs too, while NL63 is an Alphacoronavirus.

      2. Yves Smith Post author

        No, you have this wrong. First, you aren’t even using “virulence” correctly. It does not mean higher death rate from having gotten infected. It can mean simply more transmissability at the same case fatality rate, as has been claimed for some of the Covid variants.

        Second, there have been pathogens, notably polio, where there mechanism for inflicting damage had nothing to to with transmission. Paralysis was almost an accidental by-product and therefore independent of transmission/infection.

        Third, there is plenty of research debunking the myth that viruses have a propensity to become less dangerous over time. They can but it is not a given. See this discussion of viral evolution, for instance, which gives a neutral explanation of the main mechanisms:

  8. Stephen the tech critic

    How to speak PMCian English:

    “[…] CDC is transitioning to reporting only patients with COVID-19 vaccine breakthrough infection that were hospitalized or died to help _maximize the quality of the data_ collected on cases of greatest clinical and public health importance.”

    translated to Trumpglish reads:

    “Don’t forget, we have more cases than anybody in the world. But why? Because we do more testing. […] When you test, you have a case. When you test, you find something is wrong with people. If we didn’t do any testing, we would have very few cases. They [the media] don’t want to write that.”

    The herd immunity policy is the same as before, the PR just changed to a different target demographic. (That’s what voting is for, right? /s) They’re betting the whole farm and the neighbors’ too on this plan. Maybe they’ll get lucky and immunity will persist over time and as new variants from the rest of the world make their way here, but it seems to me that the odds of things spinning out of control again are quite high. What happens if more children start getting sicker?

    Something else I’m concerned about which relates to this CDC policy is that a lot of people who have taken the vaccine may assume they are completely protected from COVID and may decline testing despite symptoms. Walensky already proclaimed that “vaccinated people don’t transmit the virus”, and a lot of people may take that statement literally. This could already be significantly biasing the post-trial / “real world” efficacy data we have. With this new policy, the CDC is basically preemptively pulling the plug on generating any data that would contradict the “vaccines provide complete protection” narrative, and so this decision could make underreporting even worse.

    Lastly, let me point out that if the CDC and other public authorities were more candid about the real risks posed by COVID vs. what’s actually known about the vaccines, I think more people would actually line up to get them. A lot of people believe they are already immune, or that they are young and not at risk. Add to that the incessant narrative of vaccines “making everything normal again”, and *people are probably greatly underestimating the risk of COVID*, which I expect would make them more likely to say “no” to the vaccine.

    1. Katiebird

      My immediate and extended family is all vaccinated (I think) and several of them are planning cross country trips to visit. Some flying, some driving.

      This really scares me. It just seems that with this novel Virus still an international-global-pandemic, it’s too early to start traveling. Isn’t that what spread things so quickly in the first place?

    2. GM

      Policy has not changed, that is exactly 100% correct.

      The media may have been all over this under Trump, for fudging the data, and rightfully so. I say “may” because the media did play a big role in concealing the truth last year even though it did run a number of such stories, so there is no knowing when the political expedience of attacking the enemy will outweigh the class interest and corporate management mandates to placate the population.

      But this will get buried now, just as the deaths trackers disappeared on January 21st.

    3. megrim

      I’m also worried to see positivity rates inching up while testing numbers are taking a nosedive. I’ve just got a bad feeling about all of this.

      1. Yves Smith Post author

        One of my pet peeves is the potential limited comparability of positivity rates across states given marked differences in “access” to tests.

        I haven’t updated this, but as of about 2 weeks ago, Alabama has a positivity rate just <4x that of New York....but New York is testing a >7x higher % of its population than AL. So how much of this is due to only/largely symptomatic people getting tested in AL (because just about no free testing centers and thus only people in the med biz getting tested regularly ex symptom) v a much much higher proportion of people in NYC being tested being non-symptomatic? As the the assumption on the positivity rates is that the tests in various states are sampling their populations comparably, when they clearly are not.

  9. The Rev Kev

    I have been trying to think of a good reason why the CDC thinks that it is a good idea to limit the amount of information being collected in face of a constantly-evolving, novel virus. One that makes medical sense and that would help build up a database of information on this virus. Hmmm. Nope. I’ve got nothing. With computers you have the principal of Garbage In, Garbage Out but this is more akin to Incomplete Garbage In, Total BS Out. Future medical historians are going to curse both the Republicans and Democrats for leaving behind records that will be an incomplete, total mess.

    1. Lambert Strether

      > Future medical historians are going to curse both the Republicans and Democrats for leaving behind records that will be an incomplete, total mess.

      The eternal question: Stupid or evil?

          1. JBird4049

            Anyways, keeping good records costs both money and competent work, and who wants to have that?

            1. flora

              but… but… that would require hiring sector competent people to do the work … gasp!!! Think of the potential stock market value loss costs!!! / heh

    2. Cocomaan

      Why would the Ds and Rs care? They’re beholden to billionaires for whom the covid pandemic has been an absolute money maker.

      What needs to change? Nothing at all. Just keep the money train rolling to the next station.

  10. NVL

    Speaking of ‘ancedata’ here is an ‘ancedatum’ : Yesterday I met a double vaccinated
    person who had tested positive. OF course I started thinking that perhaps there was
    a lot lot more of this… but how much more? Thanks CDC.

      1. chuck roast

        A high profile person. In the near future everybody know or know of somebody(s) who got the post-Vax Covid. The CDC will by then have a new spokesman…Sgt. Schultz.

  11. A.

    In my semi-failed state of a country the Ministry of Health had an infamous proclamation saying “not every COVID case is a patient” to defend shoddy daily reporting. This seems to be the American analogue, backed by vaccine technology.


    GM says “The refusal to stop transmission runs the risk of breeding something much more contagious and deadly.”, but it’s not clear to me that, in the presence of vaccines that have been shown to dramatically reduce transmission as well as infection severity, there is such a refusal. In the absence of hard lockdown, which sadly no part of the world will feel they have to consider before long, vaccinations will still help render the problem tractable. In particular, decaying case counts will make contact tracing possible. I’m not saying the political will is there, but they will have the option.

    As for variants of the virus evolving to escape the vaccine-induced antibodies: That can happen whether you vaccinate or not. There is no “running the risk” because it is continuously ongoing, the virus is breeding right now. Evolution being a mindless process, what we call “selection” is the application of survivorship bias on a mass scale. Vaccination does not elevate this risk, the presence of a highly vaccinated population does not make the virus more likely to evolve towards vaccine escape, and the fewer the bodies, the fewer the incubation centers.

    1. Susan the other

      “Evolution is a mindless process.” Evolution is doing a pretty steady job of creating thoughtful progress. But not really thoughtful. More like chemical-mechanical. Inventing new proteins to fit new niches and utilize strange molecules in their mysterious energy exchange. We might all be big mindless dolts, but our bodies are pretty smart. If that weren’t true it would be idiotic for a “Center for Disease Control” to collect data on any disease. But in view of the fact that these protein-making patterns are encoded and directly inherited by the immune system does make it seem logical to observe how an acutely ill person survives. Even a mindless one.

    2. Yves Smith Post author

      Again you don’t have this right. Vaccination does exert evolutionary pressure. From GM:

      The vaccine is not going to make the virus mutate, that is an inherent property of the replication process, and immune escape was going to be evolving even without the vaccines, from the selective pressure of convalescence.

      But it does change the fitness landscape which means that it can cross certain valleys in it and reach peaks that were inaccessible previously, i.e. so far the virus has had open paths to evolve both immune escape and better binding to the receptor with the same mutations; in the future it may have to choose immune escape, but that can open other paths of evolution that would compensate for that, such as the better interferon inhibition I mentioned previously, and that would make it deadlier. There is an enormous space of possibilities and these things are extremely nonlinear and unpredictable, and we do not want to be exploring it.

      Also, these viruses are highly recombinogenic, even though they are not flu with its segmented genome that can be and regularly is mixed and matched during coninfection. But NL63, one of the common cold coronaviruses, uses the same ACE2 receptor, so how long before you get a recombination effect between the two that results in the all the nasty bits from SARS-CoV-2 combined with S protein of NL63 (against which the vaccines will have absolutely zero effect), i.e. it will keep its tissue tropism plus the proteins that make it deadly, but then we will have two pandemics, not one? I can in fact put together that sequence even right now. BTW, NL63 itself arose exactly that way.

      The misunderstanding here seems to be due to failing to understand that while vaccines reduce transmission, they do not do that by sufficiently much and we will not vaccinate sufficiently many people to eliminate the virus. And nobody has set that as a goal either. So if the choices for ending this are:

      1. Elimination, which could have and should have been done without vaccines, purely through NPIs (watch how Laos and Vietnam are going to do it now when they are having their most serious outbreaks since the beginning of the pandemic) a year ago, but can be made easier now with vaccines thanks to the transmission reduction that they do confer.

      2. We vaccinate everyone who wants to and that’s that.

      Option 2 will lead to immune escape and could very well lead to breeding a much nastier virus (so far that is precisely what has been happening over the last 16 months) while Option 1 will not.

      I was not comparing vaccination and letting the virus spread as one option and no vaccination and letting the virus spread as another.

      1. A.

        My point was not that vaccination did not exert evolutionary pressure but that evolutionary pressure did not necessarily lend itself to inevitability as GM seems to be emphasizing, on his original tip and now in his response. I simply don’t agree with his language. As for the spread:

        “The misunderstanding here seems to be due to failing to understand that while vaccines reduce transmission, they do not do that by sufficiently much and we will not vaccinate sufficiently many people to eliminate the virus.”

        This does seem to be the crux of our disagreement. I suspect we’ll wait and find out.

        Also, while I suspect you rather enjoyed starting your response with the “Again,” (please take this as a playful jab rather than anything else) I would like to clarify (and this is something you would see if you have access to my comment history given my advocacy for lockdowns in particular) that GM and I are fundamentally in agreement: Vaccinations do not guarantee eliminating the virus, but they will help nations get there. If they want to. This is Israel right now.

        I don’t know what NPIs mean, but Vietnam has been intelligently using local, hard lockdowns and extensive multi-level (almost overcompensating) contract tracing from the beginning, and I suspect they will be doing so again.

  12. Geoff Sheridan

    The Zoe Symptom Study App in the UK has been collecting data on this. They started collect daily symptom data from several million UK volunteers, which has enabled them to track increasing and decreasing prevalence ahead of official test statistics. They have an arrangement with the NHS in the UK to perform PCR testing on people who use the app to check correlation. It also enabled them to identify new symptoms associated with positive infections (e.g. loss of smell). They have data on symptoms and infections for partially and fully vaccinated people with dates from vaccination. You can go to their site, or see YouTube briefings from the lead doctor Tim Spector for full data, but from memory the chance of developing symptomatic* COVID in the next 7 days in the UK at the moment is 1 in 50k for unvaccinated, and drops to 1 in 200k two weeks after being fully vaccinated. Cases are also said to be milder in the vaccinated but they are awaiting more data on that. *no figures are available for asymptomatic cases from this study

  13. King

    I find the new use of the phrase ‘vaccine breakthrough’ to be rather confusing, breakthroughs usually being a positive in science. i.e. mRNA vaccines were a breakthrough. Did we run out of words? am I just being grumpy? Darn virus has spawned a whole new lexicon and I just want my precovid world back.

    1. CanChemist

      Breakthrough isn’t always a positive in science and isn’t a new word :). For example, if you have a Brita water filter at home, if you let it get old and clogged so that stuff starts getting through the filter that shouldn’t, that’s called the “breakthrough” point of the filter.

      From that perspective, the colloquial use and the scientific use have a similar root, of something literally breaking through something.

    2. kees_popinga

      You are not being grumpy. We’re talking about vaccine failure here (right?) so of course let’s avoid/confuse/prettify the issue by calling it a breakthrough. I’m adding it to my list of garbage English words and phrases along with jab, lockdown and herd immunity.

        1. SE

          “We are please to announce that in preparation for providing you with our cherry-picked–and therefore much higher quality!–data on May 14th, we are going to make low-quality, very, very mess data that pesky, unhelpful people have been sending us through May 7th, a secret. Thank you for your help and understanding in our very important mission to improve data quality.”

    3. BlakeFelix

      Well, it’s positive for the virus… One small step for Coronavirus COVID-19, one giant leap backwards for mankind…

    4. .Tom

      Think of breaking through a barrier. E.g. flimsy TP can lead to breakthrough, which is not good.

  14. Moon

    Let’s consider a different approach … the creation of an independent credible new reporting database – separate from vested interests that collects more information than CDC. What would it take to do this and who would the collaborators be to make this possible at high standards of data security and integrity?
    And … let’s avoid the reactionary idea that “it can’t be done”.

    1. GF

      It would take the exact amount of money Bill Gates has hidden away from his wife’s divorce lawyers.

  15. CanChemist

    Today in Canada, our equivalent of Fauci (Dr. Tam) was explicit:

    CTV: Tam warns that full vaccination does not equal full protection from COVID-19

    “Canada’s chief public health officer reminded Canadians on Saturday that even those who are fully vaccinated remain susceptible to COVID-19. …’But it’s not absolute. There’s reduction in your risk of transmission, but it doesn’t necessarily eliminate your risk of transmission’.” More discussion in the article.

    A few more points,
    -Breakthrough is to be expected because we know efficacy isn’t 100%, particularly so for newer variants. Provincial modelers here have estimated 60% in their models. I agree that it makes no sense for CDC not to track this. I have also seen in Ontario an unwillingness to discuss these implications publicly – I would agree with Greg’s guess above.

    -We knew it was likely to go endemic early on, and it has. We will likely need boosters 1-2x year to account for variants as well as waning immunity. We already do this on influenza vaccination and I don’t see how this will be any different. I’ve seen estimates that it will take 5-10 years to reach an equilibrium in the population, so I think in the near to medium term, yes, there will be a lot of booster shots.

    1. eg

      I don’t know why the purpose and efficacy of the vaccines are so poorly understood — they reduce the worst health outcomes, but they don’t prevent either contraction nor transmission. Hopefully they at least reduce the latter, but I have no basis for making any claim either way.

    2. JTMcPhee

      How smart is virus evolution? Would a technical strategy of developing a vaccine that teaches the immune system to attack a variety of parts of the virion be more sensible? Can this virus evolve around a vaccine based on killed or inactivated virus?

      What ever happened to smallpox? And not to measles, , or polio,

      1. Jeff W

        “Would a technical strategy of developing a vaccine that teaches the immune system to attack a variety of parts of the virion be more sensible?”

        Scientists at the Walter Reed Army Institute of Research are conducting Phase 1 clinical trials of a vaccine (a “spike ferritin nanoparticle” [SpFN] vaccine) that they hope will work “against any and all variants of the current coronavirus, and even the SARS-1 virus,” one instance of a universal vaccine against coronavirus.

        1. JTMcPhee

          What Pharma corporation will get the nod to monetize this public-funded research?

    3. IM Doc

      We already do this on influenza vaccination and I don’t see how this will be any different.

      This approach may absolutely be required in the future – I agree.

      I would completely disagree with the idea that we already “do” this with the flu shots. I have been fighting for years for people to get flu shots. 30 years of trying every way imaginable to get older people to do it. My EHR at this very moment in time – is telling me that only 18% of my 1327 Medicare patients have been vaccinated for the flu shot in either 2019 or 2020. It is undoubtedly a bit higher, because we do not capture all of them from outside pharmacies – but even that is no longer much of an excuse – the computers do talk to one another much better than they did just 5 years ago.

      At best that number is 33%. I would be confident to state that yearly or every 6 month COVID vaccines would be about the same if not much lower. You will be dealing with a much younger population.

  16. PS

    And there do appear to be meaningful numbers of fully vaccinated people who are testing positive.

    So what are the meaningful numbers?

    1. TroyIA

      Here’s what breakthrough infections reveal about COVID-19 vaccines

      Of the more than 95 million people in the United States who were fully vaccinated, only 9,245 — or 0.01 percent — have been infected with the coronavirus as of April 26, according to the CDC. Just over a quarter of those people never had symptoms; 132 people, or 1 percent of the breakthrough infections, died. Twenty of those deaths were in asymptomatic people or probably not related to COVID-19.

      1. Yves Smith Post author

        Given that asymptomatic people are not being tested, this number is clearly low. Tests aren’t free in many parts of the US. My theoretically free test each time has required me to get a state agency to beat up my insurer to pay for the test. So you have a tax on your time on top of the tax on your time of getting tested.

        The cases of breakthrough infections I have heard of are among medical workers in settings where they are tested regularly and people getting tested for the purpose of international travel.

        Put it another way: the number of breakthrough cases I have heard about in my microscopically small circle of local contacts in Alabama is wildly disproportionate to the reported number.

        1. Stephen the tech critic

          The number reported two posts up as well as the numbers you are likely seeing may be entirely correct. There is a deeper problem here.

          The problem is that the numbers don’t mean what readers are led to believe that they mean. These reports which are widespread as of late do not provide essential qualifications to the data to allow lay readers to properly interpret it. Whether the “experts” pushing these reports to press are being “stupid or evil” applies here again. The short explanation is that the percentage on its own is pretty useless without a lot of additional info. Let me try to explain as concisely as I can.

          The number as calculated will depend substantially on (1) the duration for which each person in the sample has been vaccinated up to the point at which data collection ended; and (2) the “exogenous” risk to each person of contracting COVID-19 for various intervals during that period. The relative risk from day-to-day is strongly correlated to how many people in the “environment” are carrying the virus. I put quotes around these two terms because they bundle in a whole lot of complicated and difficult to model stuff, but it should be possible to understand them intuitively at least.

          So basically the reason the numbers look so low is because they were obtained after a relatively short collection period, because most people achieved “fully vaccinated + plus two weeks” status late in said period, and also because during the period, overall cases (e.g. exogenous risk) were declining substantially from their seasonal highs.

          The percentage we really want is the *risk ratio* for vaccinated vs. unvaccinated people, which should be relatively stable over time (ignoring fading immunity and variants, which are longer time scale things). The percentages quoted in these reports have little to do with that risk ratio. I did attempt to estimate the risk ratio using a simple model that incorporated daily vaccination and new cases trends. I did this for Illinois, back when the first bogus “breakthrough” percentages were first being reported. I spent quite a long time on it before I realized that the Illinois time series data for vaccinations I had summed to a substantially lower total than the totals I saw reported elsewhere. I had to throw in the towel knowing my data sources were of questionable integrity, particularly because the outcome of the calculation is quite sensitive to their reliability.

          Hopefully my above explanation helps clarify why these published reports are misleading and why the data, even if correct, should be interpreted with great care, which is to say should be largely ignored.

          1. Jason

            Thank you for this post. I’m surprised no one responded to it. This paragraph stuck out to me:

            The number as calculated will depend substantially on (1) the duration for which each person in the sample has been vaccinated up to the point at which data collection ended; and (2) the “exogenous” risk to each person of contracting COVID-19 for various intervals during that period. The relative risk from day-to-day is strongly correlated to how many people in the “environment” are carrying the virus. I put quotes around these two terms because they bundle in a whole lot of complicated and difficult to model stuff, but it should be possible to understand them intuitively at least.

            We’re dealing with length of time of vaccination, which is really the easiest variable to fully account for. But then we need to know how effective the vaccine is for that person given that person’s own physical and genetic makeup, a variable that seems impossible to ever fully arrive at. Two people who’ve been vaccinated for two weeks may have very different levels of protection, given aforementioned variables. Said another way, vaccine effectiveness over a set period will vary widely from individual to individual.

            Then we have the next variable, another doozy, this one in determining exposure levels for each individual over set time periods! Good luck, outside of strict quarantine. Once people return to an even extremely limited routine of going out and about a bit, this becomes impossible. Someone may have gone out to a bunch of busy or somewhat busy places but never been exposed, while another person may have only gone to a couple places with hardly a soul, yet been infected by one of those “hardly a souls.” Imagine trying to determine this for a multitude of people, let alone two. It’s impossible.

            There’s an infinite number of variables. Those damn variables that make life interesting. Attempting to tame them leads to Lies, Damn Lies, and Statistics.

      2. Cuibono

        “only 9,245 — or 0.01 percent — have been infected with the coronavirus as of April 26,”

        this is not defensible. They could have said: “to date we have only collected reports of 9245 people who were fully vaccinated and tested positive”.

        I hope the difference in those two statements is obvious to all

        1. Yves Smith Post author

          Agreed. We’ll have to rely on UK data, from the regular Imperial College large-scale tests. But the UK used mainly AstraZenaca, so not clear how germane the breakthrough data will be.

          1. Terry Flynn

            Indeed. However, here is just an anecdote from someone recruited to the Imperial study. My antibody test was tampered with by someone in Royal Mail. No recorded delivery and it had been opened and I knew, before doing the pinprick test, that whilst it hadn’t been “tried”, it was probably useless as it had been opened and examined (and obviously in a rainy environment, which considerably narrowed down the list of suspects).

            I duly got an inconclusive result. Ringing the Imperial team got me a totally unhelpful, bordering on rude request for a replacement kit – I’d uploaded pictures of it (which is part of the study protocols for results checking). Another example of crapification of studies that wouldn’t have happened in my day (I sound like the grumpy old grandpa now).

            What has really frustrated me is that they missed a chance to ascertain if covid-19 was the culprit for the weird virus that went through Dad’s workplace in Feb 2019. Since I’ve had the Astra-Zeneca first dose, with 2nd this week, all chance of investigating this has been lost.

  17. GM

    We already do this on influenza vaccination and I don’t see how this will be any different. I’ve seen estimates that it will take 5-10 years to reach an equilibrium in the population, so I think in the near to medium term, yes, there will be a lot of booster shots.

    I do — the bulk of the population does not bother with flu shots because flu is mostly harmless.

    This is nothing of the sort, and it will only get worse with subsequent reinfections, not better.

    So now we have replaced something optional that one can ignore with something without which normal societal functioning will not be possible, that, even if we manage to do it logistically, adds another layer of fragility and vulnerability to the system.

    And, of course, a lot of people will die in the future even with vaccines.

    1. Katiebird

      The plan? Would annual COVID shots continue to be free? Would they be available at public clinics? Or does everyone have to visit a doctor for their shot? LOTS of people avoid doctor visits — is fear of COVID enough to overcome that.

      Also, what is the cost if they decide to start charging?

      Just a few questions…. And I wish we had Medicare 4 All by the way.

    2. CanChemist

      I’d disagree with the idea that the flu is harmless, the death rate is lower than covid but still problematic, but yes there is a public perception that it’s not a big deal.

      I agree with the rest of your points – I can’t speak to the political/social implementation but you’ve clearly defined the problem. On the science side, we will absolutely need booster shots, and that’s not a conspiracy by big Pharma.

  18. Susan the other

    IIRC, in early 2020 Thailand had figured out the interferon connection and was giving patients interferon and some other HIV drug – referred to as a “cocktail” – which was saving all of them. The success of the Thai doctors was not followed here in this country. It was barely mentioned. Instead we shoved malfunctioning respirators down the throats of people whose alveoli were clogged with a cement of red blood cell detritus and let them slowly suffocate in isolation. I’d really like to hear the discussion on all that. Especially in view of the fact that the CDC is now looking at just such critical patients to see how they are surviving virus variants. Or not surviving. Who can trust these guys?

  19. enoughisenough

    IMO we need to keep mask mandates until Medicare for All is passed, if anyone really cared about public health.

    Which clearly they don’t.

  20. Terence Dodge

    “1 Covid is looking more and more like a vascular disease.”

    Can anyone point me ( us ) at this reference please.


    1. grayslady

      See Medcram video number 63 on YouTube. As far back as April, 2020, Dr. Seheult posited that Covid is an arterial disease that uses the respiratory system to invade the body.

    2. R

      Vascular is a slight misnomer.

      Covid-19 is an endothelial disease, i.e. a disease of the lining / boundary tissues of internal organs. The vascular endothelium happens to be one of the largest attack surfaces and conveniently accessed, for a respiratory disease, across the pulmonary endothelium. Sars-cov-2 exhibits ACE2 tropism, it binds (and attacks) tissues expressing ACE2, and many of these are endothelia. The renal damage is because kidneys contain a lot of vascular endothelial tissue.

      This has been clear from the first months of 2020, when ACE2 tissue expression studies and post mortem data were available.

      What is more complex is how it damages the tissues / organs / systems, beyond lysing cells to release virus. The effect of ACE2 binding appears to be dysregulation of the renin-angiotenin system, governing blood pressure, viscosity, clotting and seemingly a lot of blood chemistry, haemoglobin function, redox pathways etc. By the time we are finished with Covid, we are going to know a lot more about ACE2!

      1. GM

        Autoimmunity is also a major mechanism of pathogenesis, though that can take longer to manifest itself. It appears to cause quite a disastrous dysregulation of the immune system.

      2. Jason

        By the time we are finished with Covid, we are going to know a lot more about ACE2!

        Krystyn, I’m still enjoying my zinc everyday. Thinking of you and hope you’re well.

  21. Mark Sanders

    Just a thought I had — to me, there seems to be no difference between an unvaccinated young person and a vaccinated older person. In each case, hospitalization and death are (supposedly) minimal, yet each group can get and transfer the virus. If so, would there be anything wrong with in-person classes as long as the teachers and staff are vaccinated?

    1. BlakeFelix

      Well, spreading COVID-19 around the community, and (supposedly) minimal is a questionable bar. If they were quarantined from at risk people and the risks really were minimal it would be OK IMO, but neither of those things are even approximately true. At low enough virus incident rates like in New Zealand and with good contact tracing it would be OK enough IMO.

  22. Mme Generalist

    I’m not sure there’s anything nefarious here. It looks like the CDC is interested in collecting only data that help to evaluate the efficacy of the vaccines. Since the claim is that the vaccines reduce serious illness/hospitalizations and deaths, those are the numbers they want to look at. Asymptomatic and minor cases would just be noise in the data. I’m not even sure why they’re being called “breakthrough” cases. That seems meaningless when the vaccines were never intended to confer sterilizing immunity.

    That there may be other very good reasons to amass as much data as possible given that this is a novel virus and a global pandemic seems likely, especially given that even minor cases have been associated with some serious tissue damage. But I’m going with the “stupid” rather than “evil” argument in this instance. Cold comfort, that.

    1. Raymond Sim

      It appears the CDC may be obfuscating by omission. No bureaucracy should ever get the benefit of the doubt on this sort of thing. Otherwise you risk allowing them to turn into an untrustworthy sort of outfit like, for example, the CDC!

    2. Yves Smith Post author

      No, no, no.

      Asymptomatic cases can still transmit the disease:

      Choosing to be ignorant about mild/asymptomatic cases post vaccination means choosing to be ignorant about how often and when they infect others. Have you missed that there have been outbreak clusters, including deaths, among nursing homes with high vaccination rates? This was reported in BC and in 20 nursing homes in Texas.

      On top of that, with the mRNA vaccines, protection against infection is strongest in the first two months and likely decays after that. Keeping tabs on the asymptomatic cases would give a MUCH better profile of the decay path and better guidance on when to vaccinate again. From GM via e-mail (note his 90% for 2 years example at the end is very optimistic and well beyond what the vaccine-makers are touting):

      The math does not look good — the unmitigated-spread R_0 in February 2020 was much closer to 6.0 than to the usually cited 2.0. But the current variants have undergone adaptation and are much more contagious. Let’s say we have R_0 = 6. And let’s say we reach 70% vaccination (it’s hard to see how we will get higher), and that transmission is cut by 80% (this, however, is simplistic — it is quite likely that transmission is cut by 80% in the first couple months after vaccination, but then the first thing that will wear off is protection from infection, with protection from severe disease going away last). That’s 56% effective vaccination. But the herd immunity threshold for R_0=6 is 85%, a lot higher, i.e. it will continue to spread. It might in fact continue to spread even with 100% vaccination with a full return to 2019 in terms of lack of social distancing.

      So we should absolutely never have gone down the path of “solving” this crisis with vaccines and not doing anything to stop transmission. The vaccines should have been used as one of the tools to eliminate the virus, but in combination with NPIs.

      If evolution featured in the thinking of our overlords, they would not have settled on this as the “solution” to the problem. But either it does not, or they just don’t care.

      P.S. Some more sobering simple math. Let’s say the vaccine is 90% protective against severe disease over a period of two years. Then one can expect to have on average three serious COVID episodes by the time he is 60 even if he is always up-to-date with his biannual vaccinations (and there is no knowing how much more virulent to young people it will have become in the future with all the serial passaging). We now see what round #1 of mass reinfections looks like in India. So that is the “solution” being offered right now. However, it will probably not happen as one giant apocalyptic wave so it can be pushed to the background as a non-problem…

  23. Gregory Etchason

    If there has ever been a time for “BIG BROTHER” is now. Public Health authoritarianism is the only long term solution. Civil Liberties’ and “states rights” in the face of a deadly contagious disease simply can’t be off limits.
    “The government ain’t gonna tell me what to do”
    And then again maybe they will.

    1. Yves Smith Post author

      Please stop being a hysteric, even if just for effect. Did you miss that data and test results is already in the hand of the medical industrial complex? And that public health is a state matter per the Constitution (as part of policing powers)?

      1. Gregory Etchason

        Yves I suggest you review the Emergency Powers Act and The Public Health Service Act.
        The President can trigger sweeping Executive authority with these two Fed Laws.
        China and South Korea have demonstrated Public Health authoritarianism is very effective in dealing with the COVID-19 Pandemic. “Hysterical” I think not.?

  24. Noone from Nowheresville

    Homelessnes, COVID, HIV, overdoses… potent mix. Something to be aware of and track as we move forward.

    Hennepin County is battling a new HIV outbreak
    David Chanen

    Hennepin County is the midst of a new HIV outbreak fueled by the COVID-19 pandemic and the continuing synthetic opioid crisis.

    The most recent county statistics show 54 people have tested positive for HIV in the past two years. In a typical year, the county averages less than three people who contract the virus.

    The population impacted most by the outbreak is homeless people living in encampments who inject opioids or spread HIV through sexual transmission, county officials say. Ramsey and St. Louis counties have also recorded sizable HIV outbreaks of nearly 15 cases each.

    St. Louis County had an HIV outbreak declared in February, but the state had been working with local health providers for months before the notice. The county was also informed about an increase in syphilis cases.

    Hennepin and Ramsey counties had an outbreak of 16 HIV cases in December 2018, but the total spiked to 68 last month. As more cases were reported, the state discovered a population pattern of homeless people in encampments who inject drugs.

    “When we shared the HIV outbreak information with people who work in the field, they are surprised,” said Christine Jones, manager for the state Health Department’s HIV section. “They think it’s one of those things that was under control.”

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