Question: Reading that there is a lower than average vaccination rate among workers in most healthcare related settings, sadly. Our fully vaccinated senior sister returned in March to her supported day program for adults with developmental disabilities. We suspect that many of the workers are not vaccinated and know that the designated worker with our sister is not planning to get the vaccine, citing her own “health concerns”. The masking is VERY loose and they are beginning to have more activities in close contact with one another and other clients. With variants and breakthroughs our concerns are high again.  Do you have any data to share about Covid infections among the DD populations in the US and in North Carolina specifically? It may help in our conversations to encourage a higher vaccination rate in her day program.

Answer: Your sister– an older age individual with intellectual disabilities– is in an extremely high risk category.  It’s fantastic that she’s vaccinated, but recognizing that vaccines are not 100% effective, she still needs protection (e.g. having those around her vaccinated too).  Here’s a synthesis of some research that will hopefully be of help to you as you advocate on behalf of your sister and the other day program attendees.  

• People with intellectual disabilities are at increased risk of COVID. A paper published this March in New England Journal of Medicine Catalyst, The Devastating Impact of Covid-19 on Individuals with Intellectual Disabilities in the United States, provides stark insight into the toll of COVID-19 on people with intellectual disabilities.  Studying the outcomes of 64,858,460 patients across 547 health care organizations, researchers found that intellectual disability is the single biggest risk factor for COVID-19 diagnosis and the second biggest risk factor (after age) for COVID-19 mortality.  Compared with the general population, those with intellectual disabilities were about 2.6 times more likely to be diagnosed with COVID (95% CI 2.5-2.7) and about 5.9 times more likely to die from COVID (95% CI 5.2-6.6). Note, this analysis used data collected in the period before vaccinations were available.  
• Breakthrough infections do occur (residential care facilities).  In April, CDC published two reports studying breakthrough infections in Chicago and Kentucky.  Both reports showed that residents and staff members who have been vaccinated are much less likely to become infected, develop illness, and require hospitalization.  Even so, a small number of fully vaccinated residents and staff acquired COVID.  In the Chicago facility, two fully vaccinated residents were hospitalized, one of whom died.  In Kentucky, one vaccinated resident died.  This doesn’t mean vaccines don’t work!  They dramatically reduce risk!  In the Kentucky example, further synthesized in JAMA, “unvaccinated residents and health care personnel had 3.0 and 4.1 times the risk of infection compared with their vaccinated counterparts.”
• Breakthrough infections do occur (North Carolina). As reported just yesterday by CBS local (WRAL), according to North Carolina’s Department of Health’s figures, “4,659 breakthrough cases have been reported in North Carolina to date, including 321 hospitalizations and 61 deaths. About half of those cases came in the last two months, accounting for 5.6 percent of the total number of infections in that period.”  Overall, breakthrough infections account for <1% of cases (since vaccines began to be administered in mid-December, ~580,000 people have tested positive for COVID).  Experts suggest that the increase in the proportion of cases attributed to breakthrough infections in the past two months is likely due to the more transmissible Delta variant coupled with relaxation of other public health measures (like masking).