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Provincetown Breakthrough Cluster - c200gran - 07-21-2021

Curious as to what you all make of the news that there have been three dozen or so breakthrough cases traced to Provincetown since July 4:
Boston urges Provincetown visitors to get tested for COVID-19, self-isolate
https://www.wcvb.com/article/boston-urges-provincetown-visitors-to-get-tested-for-covid-19-self-isolate/37081934#


Unfortunately, I have more than a passing interest as my wife and I tested positive after visiting P-town July 7-9 (we both had the J&J vaccine). Thankfully, we both suffered only mild flu-like symptoms (so the vaccine did help) and are on the mend. So far, no one we know we've been in contact with has gotten sick but we're still in the incubation period and we know how easily this spreads so we won't rest easy until the end of the month.

Any thoughts on what a breakthrough cluster portends? Might it be sign of a new variant that the vaccines are not as effective against?


RE: Provincetown Breakthrough Cluster - M_T - 07-21-2021

Welcome... It is unfortunate that you got sick, and I'm glad it has been mild. I hope others around you either don't get it or won't have bad cases.

I actually was just looking at a similar article. (I've never been to Provincetown) It indicates that Provincetown is a town of 3000 people, but with visitors, it would swell to 60K in the summer. I was thinking that an outbreak of the residents wasn't too surprising with that many people packing it in, and the 3K serving them (restaurants, shops, etc).

The article I saw indicated the outbreak was 39 residents of the town, 50 others from the state and 43 others from out of state. So something like 2/3 were visitors. Note that the visitors got tested there, so presumably developed symptoms after they arrived and tested before (it isn't clear where/when they were exposed). The allegation that "the vast majority were vaccinated" is unsubstantiated with numbers so far.

I saw something very odd. The CDC page on vaccinations by county in Mass. indicate 3 counties have less than 10% of the residents vaccinated. Barnstable (~220K, incl. Provincetown): 5.6%, Duke: 3.7%, Nantucket: 1.5%. The other counties are 50-72%. My expectation is this is a data collection error.

At 5.6%, Provincetown would only have about 168 vaccinated.

Vaccinations, nor a prior infection, do not give immunity, only resistance. As you may have seen in another thread that I posted yesterday, with enough exposure, a vaccinated person is LIKELY to get COVID.

And, of course, If vaccine effectiveness were 50%, then if 2/3 of the population is vaccinated and 1/3 is not, then one should expect about an equal number (but at 50% rate) of infections among those vaccinated as among those not vaccinated. Those numbers aren't too far away from the situation in the US versus COVID Delta. And, at 90% vaccinated, the vast majority of infections will be among those that were vaccinated.

Obviously, it would be speculation now to hypothesize a new variant that exploded on the scene in Provincetown. It is possible. My first guess is that this is just statistics of many exposures to many people resulting in many infections, but that wouldn't explain it if those with vaccines were infected more readily than those without.

There have been recent conflicting articles about the effectiveness of J&J against getting COVID delta versus getting a severe case of COVID delta. You have to read the details to see what they actually are measuring. J&J was less effective (69%) against getting an infection the original COVID than the mRNA vaccines. Its clinical trial couched its effectiveness (85%) against getting a severe case.

Fauci was saying (in January/February) that everyone should get whatever vaccine they could. That's true. The J&J vaccine improved your chances of having no more than a mild case. You stayed out of the hospital. But, in terms of getting sick at all, the mRNA vaccines seem to have a better effectiveness against the original COVID. (I can't say for certain that it is the same for the Delta variant. They data is still coming in.)



If you don't mind, I have a few questions.
1. Relative to your 2 or 3 days in Provincetown, when did you or your wife's symptoms first show up? The roughly 10 cases that I personally know that got COVID (not Delta) got symptoms about 2 days after a known exposure.
2. Are you fairly certain you weren't exposed/infected before your trip? (For instance, if you took public transport to Provincetown, or attended a large event a day or so before going, then your exposure may be earlier.)
3. Did you get your test in Provincetown, or after you got home?
4. Was your J&J shot more than 28 days before your visit to Provincetown?
5. Has your community's contact tracing team contacted you and connected your infection to Provincetown? Has Provincetown's tracing team or the CDC contacted you? (I'm curious how thorough the health departments are at tracing these inter-community spread.)
5. Am I correct in presuming you haven't had COVID before?


RE: Provincetown Breakthrough Cluster - M_T - 07-21-2021

In another thread, I've posted a quick summary of a recent study comparing the various vaccines in their projected effectiveness against the variants.

One of the news reports interpreted these results to suggest approximately 33% effectiveness of the J&J vaccine against the Delta variant.  

If I am interpreting the CDC data correctly, 
about 0.26M doses of J&J,
about 2.25M sets of Pfizer vaccinations,
about 1.87M sets of Moderna vaccinations,
 were sent to Massachusetts,
with about 4.95M getting at least one dose.  (People could get doses from other sources than the doses delivered to the state (such as those delivered to the military, etc.)

Ah, better data for Provincetown.
The MA municipality (zip code, actually) data indicates 1976 fully vaccinated in zip code 02657 (Provincetown) with another 198 partially vaccinated.  The Census Bureau indicates a 2019 population of 2,973, so about 2/3 fully vaccinated.


RE: Provincetown Breakthrough Cluster - c200gran - 07-21-2021

Thanks for your response - this is all quite sobering.

I've been alerting folks about my experience as a PSA so I don't mind at all. In fact, I was perturbed that SFDPH mainly asked about our flight info in contact tracing; they said it's up to MA DPH to reach out to us to investigate. In any case, here are my answers- happy to elaborate further.

1. Relative to your 2 or 3 days in Provincetown, when did you or your wife's symptoms first show up? The roughly 10 cases that I personally know that got COVID (not Delta) got symptoms about 2 days after a known exposure.  For me, first symptoms came four days after leaving P-town; for my wife, it was nine days. Seems like I might have gotten it and then passed it on to her or it just took longer for her (she does have a healthier constitution). We did visit other places before and after P-town (our trip east was from 7/1-12) and we had somewhat different symptoms so hard to discern exactly what led to what.
2. Are you fairly certain you weren't exposed/infected before your trip? (For instance, if you took public transport to Provincetown, or attended a large event a day or so before going, then your exposure may be earlier.) Not certain at all - we went many places on the trip. Other than the flights to and back, we drove so transit wasn't a factor. We tried to be careful but did eat indoors at restaurants about four times. We stayed only one night at a hotel, in Providence right after P-town; otherwise, with relatives. Everyone we contacted before P-town has tested negative in the last couple of days. So far, everyone we have been in contact with after P-town is also negative (knock on wood).
3. Did you get your test in Provincetown, or after you got home? After - I did rapid test around noon on 7/17 - positive. Then PCR on 7/19 - positive. Wife did rapid test later in afternoon on 7/17 - negative. PCR on 7/18 - negative. Rapid test today - positive.
4. Was your J&J shot more than 28 days before your visit to Provincetown?  Yes - 4/1 for me. 4/9 for my wife.
5. Has your community's contact tracing team contacted you and connected your infection to Provincetown? Has Provincetown's tracing team or the CDC contacted you? (I'm curious how thorough the health departments are at tracing these inter-community spread.)  As mentioned above, SFDPH contacted me by phone after I completed CDPH's text survey, triggered by my positive PCR test result this morning. At my urging, they put something in the notes about my having been in P-town; it remains to be seen whether they follow up.
6. Am I correct in presuming you haven't had COVID before?  Yes, that's correct.

Our biggest concern is that we hosted relatives right after returning from our trip. In hindsight, we should've waited at least three days after traveling. Though our symptoms are mild, we won't rest easy until the end of the month when we've completed the 10-day self-isolation period and the incubation period has passed for all our contacts.


RE: Provincetown Breakthrough Cluster - c200gran - 07-21-2021

(07-21-2021, 11:38 AM)M_T Wrote: In another thread, I've posted a quick summary of a recent study comparing the various vaccines in their projected effectiveness against the variants.
Hindsight being 20/20, we should've tried to get an mRNA vaccine; being 50+, we were anxious to get any vaccine so took whatever was being administered at the site, which happened to be J&J. Now the question is whether an mRNA booster shot makes sense - I'll be looking out for guidance.


RE: Provincetown Breakthrough Cluster - M_T - 07-21-2021

I misinterpreted your first message as indicating you were from Boston. I now realize you apparently live in SF and visited Boston & Provincetown.

I have a sibling+spouse from another state coming to stay with us for 4 days beginning this weekend. I am anxious, but we will be masked.

As for a booster, I'd consider two routes: 1) Talk to your personal physician. 2) Look for a Clinical Study that is studying boosters.

However, I'll believe that your COVID infection will increase your immunity levels. (again, I am not a MD).


RE: Provincetown Breakthrough Cluster - akiddoc - 07-25-2021

(07-21-2021, 12:24 PM)c200gran Wrote:
(07-21-2021, 11:38 AM)M_T Wrote: In another thread, I've posted a quick summary of a recent study comparing the various vaccines in their projected effectiveness against the variants.
Hindsight being 20/20, we should've tried to get an mRNA vaccine; being 50+, we were anxious to get any vaccine so took whatever was being administered at the site, which happened to be J&J. Now the question is whether an mRNA booster shot makes sense - I'll be looking out for guidance.
At this time, a booster is not an option. But you should be reasonably immune to all known variants at this time. I'm not using the word immune in the sense that you are impervious to infection, but in the we physicians would use it to say that your immune system is primed to fight a particular infection.


RE: Provincetown Breakthrough Cluster - ChrisGreene - 07-29-2021

I recommend that you speak with your personal physician regarding your anxiety about the J&J, personal risks, local infections, variants, etc. Go over your risk factors and make sure that he/she hear your concerns. Be explicit that you wish to get the mRNA because the J&J might be less effective. From the last post it appears that the Dr. can not recommend an mRNA vaccine at this time, but it was not explicitly stated. If you do this, you will know that you did all that you can.

My guess is that the Dr. will essentially repeat the content of the last post, pointing out that your immune system is primed. This discussion may give you peace of mind.


RE: Provincetown Breakthrough Cluster - M_T - 07-30-2021

The CDC has released a preliminary report
  https://www.cdc.gov/mmwr/volumes/70/wr/mm7031e2.htm?s_cid=mm7031e2_w

A big elephant in this room is the implied assumption that those that went to the events had similar vaccination status as the population of the state (69%).   They do note that the events were generally designed for men.

All sequenced genomes were Delta variant (119 Delta; 1 Delta AY.3; 13 failed to be sequenced).

The set of cases they looked at were a total of 469 associated with the county.  (That means that they included cases that spread after the event -- which can distort the statistics if you are looking at infectability).


Quote:On July 3, MA DPH had reported a 14-day average COVID-19 incidence of zero cases per 100,000 persons per day in residents of the town in Barnstable County; by July 17, the 14-day  average incidence increased to 177 cases per 100,000 persons per day in residents of the town (2).
177 sure sounds large.  That's 5 cases per day in the town of 3,000 (5*14 = 70 over the 14 days).


Their dates of specimen collection (I don't see info about multiple specimens) that had positive results were July 6 to July 25.  Events were July 3 to July 17.  They didn't indicate min or max time since the person had been in the county.

Quote:Vaccine products received by persons experiencing breakthrough infections were Pfizer-BioNTech (159; 46%), Moderna (131; 38%), and Janssen (56; 16%); among fully vaccinated persons in the Massachusetts general population, 56% had received Pfizer-BioNTech, 38% had received Moderna, and 7% had received Janssen vaccine products.


Roughly, relative risk is much higher for Janssen than Moderna, and Moderna higher than Pfizer.

469 Mass. resident cases included; 346 had full vaccination, leaving 123 of other status.  346 had symptoms consistent with COVID; 274 vaccinated people (of 346 breakthrough cases) had symptoms (leaving 92 non-vaccinated with symptoms).  199 were residents, 270 were not.

92 (75%) of 123 without vaccines had symptoms.  274 (79%) of 346 with vaccines had symptoms

If there were 90 residents that had developed COVID July 3 to July 17, then 109 residents developed COVID July 18-25.

I see no way to guess the number of Mass residents that went to these events. (ie, how many were exposed vs how many were infected)
I can imagine that the residents were more exposed (interacting with the crowd of customers, etc.) per day than the non-residents.


RE: Provincetown Breakthrough Cluster - c200gran - 08-03-2021

(07-29-2021, 06:17 PM)ChrisGreene Wrote: I recommend that you speak with your personal physician regarding your anxiety about the J&J, personal risks, local infections, variants, etc. Go over your risk factors and make sure that he/she hear your concerns. Be explicit that you wish to get the mRNA because the J&J might be less effective. From the last post it appears that the Dr. can not recommend an mRNA vaccine at this time, but it was not explicitly stated. If you do this, you will know that you did all that you can.

My guess is that the Dr. will essentially repeat the content of the last post, pointing out that your immune system is primed. This discussion may give you peace of mind.

SFGH is now offering a "supplemental" mRNA shot to those who had J&J: https://www.newsweek.com/san-francisco-hospital-offers-second-shot-moderna-pfizer-those-who-got-jj-vaccine-1615867.

My wife and I have just come out of self-isolation (we're both fine now). We'll certainly confer with our doc about this offering - maybe we should ask about an antibody test to inform our next step.