Question: Our developmentally disabled sister has her mojo back after her breakthrough infection 11 days ago. Technically, she could return to her supported day program (in North Carolina), but there have been at least 4 cases there in the past 10 days with some workers still unvaccinated. We are trying to assess our sister’s risk of returning and we cannot risk her health! How at risk do you believe our sister is to return to the day program under these circumstances? Any data or advice? What constitutes a cluster and should the day program close temporarily?
Answer: The good news is that the risk of your sister acquiring another COVID infection is extremely low for the foreseeable future (see Q&A of 8/12/21). She now has vaccine-derived antibodies + infection-derived antibodies, so her immune system is even better prepared for any near-term COVID threats.* The bad news is– based on my limited knowledge of the situation– her day program doesn’t seem to value her safety and the safety of others in their care given their approach to vaccination and outbreak response. And that is deeply disturbing. Flu season will soon be upon us, and other viruses are circulating as well (ex: RSV). What protocols is the day program implementing to protect staff and workers? How is the day program responding to its current outbreak? Now that Pfizer has been fully approved by the FDA, is the program moving towards vaccine mandates? I would push the day program to provide satisfying answers to these questions before your sister’s return. And in terms of cluster definition, North Carolina defines a cluster in non-congregant living setting as, “A minimum of 5 cases with illness onsets or initial positive results within a 14-day period AND plausible epidemiologic linkage between cases.” In that vein, I’d also inquire as to whether the NC or local Department of Health is conducting an outbreak investigation in the facility. If not, I would get in touch with the local health department to request an investigation and ensure that onward transmission is minimized.
*Note: to my knowledge, we do not have data about risk of reinfection after breakthrough infection, but we would expect the risk to be very low. For example (though it’s a stretch of an example as it’s far from an apples to apples comparison) a recent study published in CDC’s MMWR on the risk of reinfection by vaccination status found that people who had been previously infected and later vaccinated had much lower odds of reinfection than those previously infected and unvaccinated (the idea here being that previous infection + vaccination is more protective than previous infection alone).