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COVID-19 surge: Why we need more data on breakthrough infections

In May, the CDC made a decision to reduce tracking and collecting data on breakthrough infections to only those involving hospitalizations and deaths -- leaving a big gap in understanding the impact of variants as COVID-19 cases surge across the nation once again. Jessica Malaty Rivera, an infectious disease epidemiologist and research fellow at Boston Children’s Hospital, and former science communication lead at the COVID Tracking Project joins.

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  • Michael Hill:

    In May, the Centers for Disease Control and Prevention made a decision to reduce the tracking of breakthrough COVID infections to only those involving hospitalizations and deaths. That leaves public health officials without the full data that can answer questions as the new delta variant spreads.

    I spoke with Jessica Malaty Rivera, an infectious disease epidemiologist and research fellow at Boston Children's Hospital. She's also a former science communications lead at the COVID Tracking Project.

  • Michael Hill:

    Jessica, thanks for joining us. You used to work with the COVID tracking project. When you hear the CDC is no longer tracking all of these breakthrough cases, what do you think of that?

  • Jessica Malaty Rivera:

    To be completely honest, it's heartbreaking. By not tracking breakthrough data with as much granularity as we would hope, we are just basically creating blind spots in our understanding of the true impact of the virus, especially the variants that are circulating so widely in the United States.

  • Michael Hill:

    Why did the CDC, as best you understand this, adopt a policy like this?

  • Jessica Malaty Rivera:

    You know, I don't know. Actually, I've yet to see a really explicit explanation. I've heard rumors of things like lack of resources, lack of funding, lack of staff. But to me, it seems pretty, from an epidemiology standpoint, not defensible.

  • Michael Hill:

    Is there something that should be done such as encouraging people perhaps to self report, If they do, to whom?

  • Jessica Malaty Rivera:

    You know, I'm aware of a few research groups and a few universities that are still tracking that information, and it's better than nothing. But at this point, one of the biggest issues that we saw throughout the pandemic was the lack of data infrastructure and even systems that can collect this data and speak to each other so that we can have a kind of broad understanding of what's happening. If you look back at how states were tasked with collecting COVID-19 data, they all kind of had to fend for themselves. They all had different systems of reporting. They all had different dashboards with different formats. So we're dealing with once again between vaccine data and breakthrough data, very, very disparate systems of data collection and data reporting.

  • Michael Hill:

    What are we missing here? What are we missing out on?

  • Jessica Malaty Rivera:

    We're missing a lot of details. We're missing a lot of opportunities to get ahead of new variants that are emerging. We're getting so many questions from people anecdotally about their experiences with breakthrough infections or breakthrough transmission, which is not actually that surprising. I mean, we knew that the vaccines were not 100% effective. Breakthrough infections were expected. So we could have had a chance, though, to get ahead of that. We could have also had a chance to get ahead of some of the policy shifts that kind of set us back a bit. And I'm thinking specifically back in May when we kind of prematurely encouraged folks who were vaccinated to take their masks off. And I think if we had this kind of data, if we had this kind of detail to what we would expect with regard to transmission, we could have calibrated everybody's expectations a bit better.

  • Michael Hill:

    Explain what your work at the tracking project, the COVID tracking project, did. And does that make you feel even more strongly now that all of these cases at least make an attempt to track them?

  • Jessica Malaty Rivera:

    You know, the COVID tracking project was a really remarkable group of mostly volunteers who collected testing, case hospitalization and death data from 56 states and jurisdictions. And it was done manually. We would collect that data from state dashboards. We would synthesize it, analyze it and report it and share it freely and publicly because we felt very strongly that this data belonged to the people. And we did that kind of in the absence of that detail coming from the CDC, we have since stopped that data collection as of March 7th. And there are many of us who are alum of that network who are aggrieved by this kind of repeat situation that we're in. We started because there was an absence of data and here we are again over a year later with yet another absence of data that is causing us to kind of operate in the dark.

  • Michael Hill:

    Does this leave us then with a lack of understanding of this virus?

  • Jessica Malaty Rivera:

    It really does, because we know that viruses mutate, we know that variants can emerge, and we know that that can especially happen in the context of having a large percentage of the population unvaccinated. We've just hit the 51% mark of people in the United States being fully vaccinated. That presents a vulnerability for us. And we know that variants like Delta emerged in the absence of vaccines in India, and we expect for that to continue to happen. And so in an effort to get ahead of new variants that are emerging in an effort to understand kind of the continued efficacy of these vaccines, we need that data. Now, we do have some data that has proven that these vaccines are still very effective against the Delta variant. But now, as you've seen in the headlines, we're talking about boosters because we want to ensure that we are not allowing people who get vaccinated to have any possible additional risk of having severe outcomes.

  • Michael Hill:

    Why were we dropping mask mandates when we knew that these breakthrough cases were happening?

  • Jessica Malaty Rivera:

    It's a great question, Michael. I wish I had an answer to that that made sense. I think in many ways, some of these public health policies are intended to kind of reward people for a job well done, getting vaccinated, bearing through this really difficult time. But it was premature. I will stand by that forever on that statement, because I do think that we have to recognize that public health mitigation is never one thing. It's never a silver bullet solution. And we've failed to recognize still that we can't even look at vaccines that way, too. It's always additive. It's always layered. So it's vaccines plus masking, plus distancing plus reducing your risk. Plus recognizing that individual choices have community consequences sometimes. So I think we've learned that lesson the hard way and we've had to kind of backtrack on those messages. And you're seeing a lot of policies change on small levels and even possibly national levels to kind of mitigate that premature decision.

  • Michael Hill:

    Jessica Malaty Rivera is an infectious disease epidemiologist and a research fellow at Boston Children's Hospital. Thank you very much.

  • Jessica Malaty Rivera:

    Thanks, Michael.

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