March 25, 2021

Covering COVID-19 is a daily Poynter briefing of story ideas about the coronavirus and other timely topics for journalists, written by senior faculty Al Tompkins. Sign up here to have it delivered to your inbox every weekday morning.

I have seen so many misleading stories about vaccine efficacy that I want to spend a few lines to help you understand what is happening.

Google the words “COVID-19 breakthrough cases” and you will see stories about people who seem to have gotten the virus after they were vaccinated. It is not impossible for this to happen, but it is far more likely that people who test positive for COVID-19 after they were vaccinated were infected before they got the shot and didn’t know it.

95% efficacy does not mean there is a 5% chance that you will get COVID-19. LiveScience explains what it does mean:

One common misunderstanding is that 95% efficacy means that in the Pfizer clinical trial, 5% of vaccinated people got COVID. But that’s not true; the actual percentage of vaccinated people in the Pfizer (and Moderna) trials who got COVID-19 was about a hundred times less than that: 0.04%.

What the 95% actually means is that vaccinated people had a 95% lower risk of getting COVID-19 compared with the control group participants, who weren’t vaccinated. In other words, vaccinated people in the Pfizer clinical trial were 20 times less likely than the control group to get COVID-19.

All three vaccines (Moderna, Pfizer, Johnson & Johnson) were 100% effective at preventing severe disease six weeks after the first dose (for Moderna) or seven weeks after the first dose (for Pfizer and Johnson & Johnson, the latter of which requires only one dose). Zero vaccinated people in any of the trials were hospitalized or died of COVID-19 after the vaccines had fully taken effect.

I have even seen public health officials get this wrong. In Hawaii, for example.

The words “efficacy” and “effectiveness” are not interchangeable. The New York Times explains:

Efficacy and effectiveness are related to each other, but they’re not the same thing. And vaccine experts say it’s crucial not to mix them up. Efficacy is just a measurement made during a clinical trial. “Effectiveness is how well the vaccine works out in the real world,” said Naor Bar-Zeev, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health.

It’s possible that the effectiveness of coronavirus vaccines will match their impressive efficacy in clinical trials. But if previous vaccines are any guide, effectiveness may prove somewhat lower.

The mismatch comes about because the people who join clinical trials are not a perfect reflection of the population at large. Out in the real world, people may have a host of chronic health problems that could interfere with a vaccine’s protection, for example.

All the same, there are rare — very rare — cases that may actually be breakthrough cases in which a person is vaccinated and gets infected. It could be that the person was exposed to the virus soon after the vaccination, as we know it takes a little time for your body to build immunity after getting a vaccine.

The Atlantic’s Katherine J. Wu explains that so-called breakthrough cases, rare as they are, do happen, and they are not unexpected, but are also not a reason to avoid getting the vaccine. The shots dramatically lower your chances of being infected:

When breakthrough cases do arise, it’s not always clear why. The trio of vaccines now circulating in the United States were all designed around the original coronavirus variant, and seem to be a bit less effective against some newer versions of the virus. These troublesome variants have yet to render any of our current vaccines obsolete.

But “the more variants there are, the more concern you have for breakthrough cases,” Saad Omer, a vaccine expert at Yale, told me. The circumstances of exposure to any version of the coronavirus will also make a difference. If vaccinated people are spending time with groups of unvaccinated people in places where the virus is running rampant, that still raises their chance of getting sick. Large doses of the virus can overwhelm the sturdiest of immune defenses, if given the chance.

The human side of the equation matters, too. Immunity is not a monolith, and the degree of defense roused by an infection or a vaccine will differ from person to person, even between identical twins. Some people might have underlying conditions that hamstring their immune system’s response to vaccination; others might simply, by chance, churn out fewer or less potent antibodies and T cells that can nip a coronavirus infection in the bud.

Affordable Health Care Act signup extended

The Biden administration has extended the special Affordable Care Act sign-up period until at least Aug. 15 (it was to expire May 15). People usually have six weeks a year to sign up for what has become known as Obamacare, but now they have six months, and enrollment has been robust.

The extension of the special enrollment is important for people who want to use the new federal subsidies that are part of the latest federal stimulus bill. The subsidies, which make more people eligible for lower-cost health insurance, do not take effect until April 1, so the Biden administration said people need more time to explore the plans and sign up.

The Washington Post summarizes:

The new thresholds allow people earning up to 150 percent of the federal poverty level (about $19,000 for an individual) to purchase a plan with the premiums fully subsidized by the federal government. Furthermore, there’s no longer a cap on subsidies for people earning 400 percent or more of the federal poverty level. These individuals or families would be expected to pay no more than 8.5 percent of their income in monthly premiums.

The Centers for Medicare and Medicaid Services estimates the extra subsidies mean each person will pay an average of $50 less for premiums. The agency also said 1 in 4 enrollees will be able to upgrade to a more generous plan while paying the same or less in premiums.

(Kaiser Family Foundation)

My friend Larry Levitt, executive vice president for Health Policy at the Kaiser Family Foundation, will be hosting a briefing for journalists today at noon Eastern to explain what the new stimulus bill offers for people who need health insurance. It is a free briefing that I promise will generate story ideas for you. Larry has taught with me at Poynter workshops to explain the Affordable Care Act and he really knows his stuff.

Half of states prioritize people experiencing homelessness for vaccines

A vaccination site set up in the parking lot of the Los Angeles Mission administered by Los Angeles Department of Health’s Housing for Health division for selected individuals, including homeless seniors, on Feb. 10, 2021. (AP Photo/Jae C. Hong)

People who experience homelessness are at a higher risk for COVID-19. This is partly because they are more likely to have other health issues and partly because they face a range of challenges when it comes to socially distancing, sanitation and hygiene.

But half of all states do not give people experiencing homelessness any priority for getting vaccinated. And make no mistake about it, homelessness increased in 2020. Some estimates say it increased by more than 2%, which would be a big jump in one year. Kaiser Health says that 54% of people experiencing homelessness are in four states — California, New York, Florida and Texas — and more than a quarter (28%) are in California alone.

You might think that people who do not live in crowded shelters might not be at a higher COVID-19 risk. But the Centers for Disease Control and Prevention says it is not necessarily true. Kaiser summarizes:

As of January 2020, approximately 226,000 people (or 39% of the total homeless population) were unsheltered, meaning these individuals sleep outside and in other locations not meant for human habitation. According to the CDC, while outdoor settings may allow people to increase physical distance between themselves and others, sleeping outdoors often does not provide protection from the environment, adequate access to hygiene and sanitation facilities, or connection to services and health care.

Although people in congregate settings face increased risk of contracting COVID-19, only 25 states explicitly prioritize residents in homeless in shelters for COVID-19 vaccine allocation.

(Kaiser Family Foundation)

Journalists, this story is worth your attention. As vaccines become more plentiful, find out how your public health agencies plan to hit the streets to offer vaccines to vulnerable populations who might not be able to get to centralized clinics.

Kaiser points out:

For example, in Enid, OK, Gainesville, FL, Berkeley, CA, Louisville, KY, Honolulu, HI and Sacramento, CA mobile teams with staff from health departments, fire rescue and other public health groups are going to shelters, places where people who are homeless get food and areas where unsheltered homeless individuals live to administer vaccines. In DC, the Department of Human Services is partnering with the entity that is the main provider of medical care to the homeless to administer vaccines in homeless shelters. These efforts recognize people who are experiencing homelessness are not able to sign up with a computer for a vaccine appointment and then get to that appointment.

Hundreds of migrant children in shelters test positive

There is a new complication for clearing the huge number of children from migrant shelters near the border. Axios reports that there are at least 300 children currently in the system, at shelters, who have tested positive for COVID-19. In the last year, at least 2,900 children who arrived unaccompanied in the U.S. have tested positive for the virus.

Axios reports:

About 7.4% of tests given to unaccompanied minors in the past year turned out positive, according to HHS’s stats.

But the positivity rate has been higher — about 10% — at the Carrizo Springs shelter in Texas, opened last month as the first overflow shelter to be used by the Biden administration.

Hopeful news: Black and Latinx Americans are increasingly getting vaccinated

NPR reports:

In late 2020, national surveys found that Black and Hispanic respondents were less likely than white respondents to say they planned to get a vaccine. Surveys done in the past month suggest that gap has diminished or disappeared.

Latinx communities appear to be embracing not only COVID-19 vaccines, but seasonal flu shots, says Dolores Albarracín, a professor of psychology at the University of Illinois at Urbana-Champaign.

Data from the 2019 flu season found a vaccination rate of 38% among Hispanic Americans, compared with 53% among white Americans, she says. In the current flu season, she says, “Hispanics are actually vaccinating at a higher rate than are whites.”

Hispanic Americans are still a bit less likely than white Americans to say they have received, or plan to get, a COVID-19 vaccination. But that’s partly because Hispanic Americans as a group are younger than white Americans, Albarracín says, and younger people are generally less interested in getting a COVID-19 vaccine.

We’ll be back tomorrow with a new edition of Covering COVID-19. Are you subscribed? Sign up here to get it delivered right to your inbox.

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Al Tompkins is one of America's most requested broadcast journalism and multimedia teachers and coaches. After nearly 30 years working as a reporter, photojournalist, producer,…
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