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Since Americans began rolling up their sleeves for coronavirus vaccines, health officials have said the chances of those vaccinated becoming infected or suffering serious illness or death are very low. But preliminary data from seven states hints that the arrival of the Delta variant in July may have changed the calculus.

According to figures collected by The New York Times, six of these states accounted for at least one in five newly diagnosed cases, breakthrough infections in vaccinated people, and a higher percentage of overall hospitalizations and deaths than previously observed in all.

However, absolute numbers remain very low and there is little doubt that vaccines remain strongly protective. As federal health officials often say, this remains an “unvaccinated epidemic.”

Still, the increase marks a shift in how vaccinated Americans can assess their risk.

Head of medicine at the University of California, San Francisco, Dr. “When the first vaccine studies came out, it was like nobody was hospitalized, nobody was dying,” said Robert Wachter. “This is absolutely not true.”

The figures are widely accepted by Biden-led officials, and some Americans take advantage of booster shots in the coming months. Federal officials plan to allow additional shootings by mid-September, although it’s unclear who will receive them.

“If the likelihood of a severe infection has increased significantly, and I think the evidence is clear what they have and the level of protection against serious disease is no longer as robust as it used to be, I think the situation for boosters has increased quite quickly,” said Dr. wachter.

Seven states—California, Colorado, Massachusetts, Oregon, Utah, Vermont, and Virginia—were surveyed for holding the most detailed data. It is not certain whether the trends in these states hold across the country.

In any case, scientists have always hoped that as the population of vaccinated people increases, the seriously ill and dead will be more often represented in their tally.

At Brigham & Women’s Hospital in Boston, infectious disease physician and epidemiologist Dr. “We don’t want to dilute the message that the vaccine is tremendously successful and protective any more than we initially hoped,” said Scott Dryden-Peterson.

“The fact that we’re seeing breakthrough cases and breakthrough hospitalizations and deaths doesn’t lessen the fact that this still saves many people’s lives,” he added.

The CDC declined to comment on the states’ numbers. The agency is expected to discuss breakthrough infections, hospitalizations and vaccine efficacy in a news briefing on Wednesday.

Most analyzes of breakthrough infections include numbers collected. until the end of June. Based on the cumulative figures, the CDC and public health experts concluded that breakthrough infections were extremely rare and people who were vaccinated were not likely to become seriously ill.

State data confirms that vaccinated people are much less likely to become seriously ill or die from Covid-19. In California, for example, the 1,615 hospitalizations of people with breakthrough infections as of August 8 represent only 0.007 percent of the nearly 22 million fully vaccinated residents, and breakthrough deaths represent an even smaller percentage.

But in six states, breakthrough infections accounted for between 18 percent and 28 percent of cases recorded in recent weeks. (In Virginia, the outlier was 6.4 percent of cases in vaccinated people.) These numbers are likely to be underestimated, as many infected and fully vaccinated people may not be taking careful precautions or feel ill enough to see a doctor. Scale.

“There’s a lot more viruses circulating, and there’s something uniquely contagious about the variant,” said Natalie Dean, a biostatistician at Emory University in Atlanta.

The Times found that epidemic infections accounted for 12 percent to 24 percent of Covid-related hospitalizations in states. The death toll was small, so the rate among vaccinated people seems to be higher than the CDC’s 0.5 percent estimate, but is too variable to be useful.

If breakthrough infections do become widespread, “it will also show how well these vaccines work and prevent hospitalizations and deaths, which is what we really want our vaccines to do,” says epidemiologist Anne Rimoin. University of California, Los Angeles.

The vast majority of vaccinated people hospitalized for Covid-19 are likely to be older adults or people with weakened immune systems for other reasons. CDC data show that 74 percent Most of the breakthrough cases are among adults aged 65 and over.

Most states do not compile numbers by age, sex, or presence of other conditions. But in Oregon, the median age of death associated with a breakthrough death is 83.

The numbers show that people at higher risk for Covid-19 complications, and anyone living with someone in this group, should “really think seriously about the risks they’re taking now.” State of Oregon epidemiologist and state paramedic.

Dr. “The most important message is, if you get Covid, take it seriously,” Dryden-Petersen said, especially for high-risk groups. “Don’t assume it will be light. And if you’re at high risk, seek treatments like monoclonal antibodies to try to avoid the need for hospitalization.

numbers too underline the urgency to vaccinate all nursing home residents and staff.

Numbers of states come with many caveats. In most states, the number of vaccinated adults is much higher than that of unvaccinated adults, and their numbers are increasing day by day. Therefore, the proportional representation of vaccinated people among cases, hospitalizations and deaths is expected to increase as well.

Breakthrough infections are also likely to be more severe in older adults or those with conditions such as obesity or diabetes. These individuals have the highest vaccination rates but are at the highest risk for weakened or diminished immunity.

Their representation among hospitalized patients can skew the percentages, indicating that vaccinated Americans are generally hospitalized more often than they actually are.

Dr. “Older people are both more likely to be vaccinated and more likely to be hospitalized given a breakthrough,” Dean said.

He and other experts noted that states must collect and report timely and consistent data to the CDC to draw more direct conclusions about breakthrough infections.

Instead, each state slices its own dataset differently in different time zones, and many still do not record mild cases of progress due to a directive from the CDC in May. Dr. “This is a microcosm of the larger challenges we’re having in putting data together,” Dean said.

Dr. Studies are also needed on how often people with breakthrough infections spread the virus to others, including unvaccinated children, and how many of them have persistent symptoms for months after the active infection has resolved, Rimoin said.

Some scientists noted that while vaccines are quite effective, people need to be more careful than they were earlier this summer, including wearing masks in public enclosed spaces. As more vaccinated people adapt, the incidence of cases and hospitalizations may decrease.

Meanwhile, the trend in groundbreaking infections, if it continues around the country, is likely to intensify the debate about boosters.

Most experts still say that boosters for the general population won’t be needed in the near future. But increased hospitalizations among those vaccinated may indicate that supplements are necessary for some high-risk groups.

Data from Israel and several studies suggested that immunity to the virus may be weakened in some groups after the first few months and may need to be supplemented with booster vaccines.

Among vaccinated Americans, 72 percent of those 65 and older already say they want a booster vaccine. one last poll.

An epidemiologist at the Harvard TH Chan School of Public Health, Dr. “When boosters are available, you should go and get a vaccine, except for ethical arguments about the global vaccine supply,” said Michael Mina.

Ideally, Dr. Mina said that doctors will monitor their patients’ antibody levels over time to assess who needs a booster vaccine, similar to what healthcare workers do for measles and rubella vaccines. However, the CDC and the Food and Drug Administration recommend that existing antibody tests not true enough to this end.

Dr. Dryden-Peterson said it’s difficult for Americans to reconcile the idea of ​​boosters with his work in Botswana, where vaccines are mostly unavailable.

“Even one dose helps a lot in terms of preventing death,” he said. “We’ve done a poor job infusing the United States, and that should probably be our focus rather than moving on to boosters.”