Of the more than 600 people admitted to San Antonio hospitals with shortness of breath and dangerously low blood-oxygen levels — symptoms of COVID-19 — most have not been vaccinated against the coronavirus. 

Health officials are calling this fourth surge in cases the “pandemic of the unvaccinated” as they implore residents to get shots, and hospitals struggle to find beds, staff, and equipment to care for the growing number of people sick with the virus.

At the same time, reports of infections among people who are vaccinated, referred to as “breakthrough” cases, are occurring in the community. Local health officials estimate that 12 percent of new COVID-19 cases are breakthrough infections — when a fully vaccinated person is found to be positive for the virus two weeks or more after their second dose of the vaccine.

“No vaccine is perfect, and so long as you have new cases, and more transmissible variants of the virus circulating in the community, combined with unvaccinated folks, it is expected that a number of breakthrough infections will occur,” said Anita Kurian, assistant director of the San Antonio Metropolitan Health District.

So far, those cases are more common in older people where vaccine rates are higher. Vaccines trigger a less robust immune response in the elderly, and the chances of a breakthrough infection get higher with increasing age.

Among the breakthrough cases tracked by the Centers for Disease Control (CDC), 75% occurred in patients age 65 and older.

Earlier this month, Oak Hills Church Pastor and Christian book author Max Lucado, who is 66, posted to Facebook about his own experience with a breakthrough infection: “Though miserable, the misery would have been worse with no vaccination. So doing my best to count blessings.”

The slight chance of experiencing a breakthrough infection is no reason not to get vaccinated, no matter your age, said Dr. Jason Bowling, hospital epidemiologist at University Health. The Pfizer, Moderna, and J&J vaccines are considered 89% to 100% effective in lowering hospitalization rates.

“Overall, the majority of fully vaccinated people aren’t getting sick,” he said. “The ones that do, they have milder courses, [and] they’re not very sick.”

Even for those who contracted COVID-19 earlier and recovered, the vaccine is protective. 

“Natural immunity, because it’s largely due to other strains than this delta strain, is not as strong a protection as getting vaccine-induced immunity,” Bowling said, adding, “Just because you didn’t have symptoms the first time doesn’t mean that you couldn’t have severe disease if you get it again.”

That’s important for younger people, where vaccination rates are lower, to understand, he said. And the more people who get vaccinated, the sooner the chain of infections prolonging the pandemic will end. 

“The vaccines are currently very effective against the delta variant,” Kurian said.
“But according to the CDC, this variant represents a set of mutations that could evade our current vaccine efficacy or effectiveness.” 

Area hospitals were already nearing capacity before the recent outbreak, Bowling said, likely due to a growing population and the consequences of delayed care last year. 

When the sickest COVID-19 patients end up in the intensive care unit (ICU), resources are further strained because often the duration of symptoms for patients with COVID-19 lasts much longer than with other respiratory illnesses, Bowling said.

“One of these unfair things is that you could get sick really fast, but getting better takes a long period of time,” he said, and increasingly, those patients are younger than ever.

Bowling has talked recently to several patients who told him they didn’t think COVID-19 was a real thing — until they found themselves in the hospital requiring oxygen supplementation. 

“They recognize now but obviously I wish they would have had that realization sooner,” he said.

Shari Biediger

Shari Biediger is the development beat reporter for the San Antonio Report.