15 states are keeping COVID-19 breakthrough cases under wraps

State health departments across the country are taking various approaches to how they keep records on COVID-19 breakthrough cases, with 15 states deciding not to publish any data on the rare incidents.

An analysis by The Hill found that 35 states have disclosed some data on fully vaccinated people who later contracted COVID-19. The information ranged from a one-time percentage of residents who experienced a breakthrough infection to weekly detailed overviews broken down by demographics such as age, sex and race.

Figures on breakthrough cases are not available on the health department websites, social media or other publicly accessible sites for the other 15 states: Florida, Iowa, Kansas, Kentucky, Minnesota, Missouri, Nevada, New Hampshire, New York, North Dakota, Ohio, Pennsylvania, South Dakota, Texas and Wisconsin.

The Hill reached out to the health departments of all 15 states for comment. A handful of states, including New York, Texas and Wisconsin, provided the numbers upon request.

Alicia Shoults, a spokesperson for the Ohio Department of Health, told The Hill that the agency plans to publish a dashboard with breakthrough hospitalizations and deaths Friday. 

Of the states already reporting data, Utah topped the list, with 0.36 percent or 5,265 breakthrough cases in its 1,462,313 fully vaccinated residents from Jan. 16 until this week. In that period, the state reported approximately 115,000 coronavirus cases.

The Centers for Disease Control and Prevention (CDC) stopped monitoring nonsevere breakthrough cases in May.

Some states have followed the CDC in publicly reporting breakthrough hospitalizations and deaths but not the total number of cases.

Tennessee’s Department of Health references the CDC’s policy in its critical indicator reports, where breakthrough cases with severe outcomes are regularly included. As of July 29, the state had reported 31 breakthrough deaths and 218 breakthrough hospitalizations.

Like many other states, Tennessee does not specify when it started collecting COVID-19 breakthrough data.

Illinois, too, only reports breakthrough infections that result in hospitalization or death. Its department of public health said the approach will “maximize the quality of the data collected on cases of greatest clinical and public health importance.”

On Wednesday, Illinois reported 714 breakthrough hospitalizations and 180 deaths, representing 2.58 percent of COVID-19 deaths since data collection began in January.

The state is one of a handful that feature breakthrough case data on their COVID-19 dashboards, joining Virginia, Maryland, Idaho, Indiana, Utah and the District of Columbia. Either through those dashboards or separate report summaries, 18 states publish data on breakthrough infections regularly. Although most updates are weekly, Idaho’s are the most frequent, revised every weekday, while Oregon publishes breakthrough numbers monthly.

The CDC announced in May it would only investigate and publish COVID-19 breakthrough cases that result in hospitalization or death. The change was intended to “help maximize the quality of the data collected on cases of greatest clinical and public health importance,” the agency said.

Nationally, an exceedingly low number of fully vaccinated people have contracted the virus. Out of the 101 million people vaccinated from January through April, the CDC reported 10,262 breakthrough infections in 46 U.S. states and territories. The agency’s latest update, on July 26, identified 6,239 hospitalizations and 1,263 deaths, about a quarter of which were asymptomatic or not related to COVID-19.

Across the board, the rate of breakthrough cases among those fully vaccinated was less than 0.5 percent for the 29 states that disclosed their full tallies, backing up the message from public health officials that COVID-19 vaccines are very effective at slowing infection.

One in three COVID-19 cases nationwide last week occurred in Florida and Texas, Jeff Zients, the White House’s COVID-19 response coordinator, said at a White House briefing Tuesday. He emphasized that places with higher vaccination rates generally have lower COVID-19 case counts, including breakthrough infections. 

“While vaccinated people can spread the virus if they get a breakthrough infection, the odds of them getting sick in the first place are far lower than those who are unvaccinated,” Zients said.

He added that the seven states with the lowest vaccination rates accounted for more than 17 percent of cases, despite representing only 8 percent of Americans. All of those states have put out reports on breakthrough infections.

But even when states do not release figures, some counties have tracked the cases themselves.

In Shawnee County, where Kansas’s capital is located, despite the weekly cases quadrupling in the past month, the local health department has documented only 91 breakthrough cases, just 0.1 percent of its 77,500 fully vaccinated residents.

On the flip side, Southern Nevada Health District’s weekly updates indicate that breakthrough hospitalizations in Clark County have steadily trended upward, from 30 in June to 178 in mid-July.

Many major cities have provided their own status reports as well.

New York City’s health department said July 14 that its breakthrough statistics show the vaccination campaign has proved successful. Just 1.1 percent of all 500,302 COVID-19 cases were in those who were fully vaccinated.

A total of 94 fully vaccinated New Yorkers died from the virus between January and mid-June, compared with 8,069 deaths, and 98.4 percent of hospitalizations were among the unvaccinated.

The Houston Health Department posted a graphic on Facebook that said 0.092 percent of fully vaccinated Houstonians developed breakthrough cases positive for COVID-19 as of July 23. It confirmed six breakthrough deaths, each in patients who were severely immunocompromised or had preexisting conditions.

After the Boston Herald used a Freedom of Information Act request to report there had been 3,907 infections and 71 deaths in fully vaccinated Massachusetts residents, Sen. Edward Markey (D-Mass.) urged the CDC to monitor all of these cases. Previously, the Department of Public Health had disclosed data on breakthrough cases only once, in a memo on the state website.

“As of May 24, 2021, there had been 3,343 instances of COVID-19 infection in over 2.9 million fully vaccinated individuals (a rate of 0.11%),” wrote Catherine M. Brown, the state epidemiologist, and the department’s medical director, Larry Madoff.

In a July 22 letter to CDC Director Rochelle Walensky, Markey asked why the agency announced “that it would no longer require states to report information to the CDC on breakthrough cases that do not require hospitalization,” and asked which states are still collecting data on such cases.

At a briefing the next day, White House press secretary Jen Psaki said the CDC actively tracks breakthrough cases through cohort studies, which involve “tens of thousands of people across the country” working in health care and long-term care facilities. 

“CDC also collects what they call ‘passive surveillance,’ which is where hospitals provide CDC with data when they identify someone who is hospitalized but has been vaccinated,” Psaki said.

Due to inconsistent tracking and underreported asymptomatic breakthroughs, health experts caution that the breakthrough data publicly available is likely incomplete.

Still, Céline Gounder, a professor at NYU’s Grossman School of Medicine and a member of the Biden-Harris Transition COVID-19 Advisory Board, said studying breakthrough data helps us understand who is not responding as well to vaccines, which settings present a higher risk for infection, and what characteristics make certain variants more immune-evading.

She also said the new CDC guidelines, which recommend that even fully vaccinated Americans wear masks in areas with high transmission of the virus, are “partly a reaction to breakthrough infections.”

“The concern is that these people with breakthrough infections could be transmitting onward, could be contributing to community transmission,” Gounder told The Hill. “It’s not that that individual is going to get sick and die … it’s that we’re worried what that infection could mean for others around them.”

Groups with weaker immune responses to the vaccine — organ transplant recipients, people receiving immunosuppressive therapy for cancer, or those over the age of 80 — are at a higher risk of developing a severe or deadly breakthrough case.

For the states that provided detailed demographic data, the median age of people who died from a breakthrough infection was 79 for Indiana, 81 for Ohio and 82.5 for Washington.

Robert Wachter, chairman of the Department of Medicine at the University of San Francisco, thinks some of the concern about contracting a breakthrough infection is valid and supports the CDC’s mask recommendations.

“Is it something that should cause you to worry that you’re going to die? No, but concerned enough,” he said. “I think that for vaccinated people to go back to mask-wearing indoors is a completely rational response to the information as it’s played out over the last few weeks.”

Nahid Bhadelia, professor at Boston University’s Center for Emerging Infectious Diseases, said the CDC should test and track all symptomatic breakthrough cases, whether they lead to hospitalization or not.

But she also said the delta variant may have “changed the equation,” pointing to a new study in China that shows people infected with delta had about 1,000 times more virus in their bodies compared to the original strain.

“With the delta variant, you may get continued protection for severe disease, hospitalizations, and deaths, but you may get potentially more breakthroughs and more symptomatic breakthroughs,” she said. “The vaccines are still doing what they’re supposed to do.”