Health officials: Without herd immunity, vaccination rates do little to stop infections in high-compliance communities

Aug. 1—Lucas County's vaccination rate is stalled and coronavirus infections are climbing again, prompting renewed masking recommendations amid what health officials are now calling a "pandemic of the unvaccinated."

But data suggests everyone needs to be on guard.

The push toward herd immunity — equated to having about 70 percent of the population inoculated — has been based on the premise that the more people who become immune to a disease, the less likely it is to spread, even among the unvaccinated.

It would be expected, then, that areas with higher vaccine uptake would have lower positivity rates.

But local figures don't appear to bear that out.

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Using data provided by the Toledo-Lucas County Health Department, The Blade mapped vaccination rates for each of the county's ZIP codes and compared them to where new infections were reported in the month of July, when the more contagious Delta variant was confirmed to be present locally and cases began to climb.

It didn't show a strong correlation between vaccination and positivity rates.

ZIP code 43537, in Maumee, for example, has the second highest vaccination rate in the county, at 65 percent, yet also reported the third highest number of new infections, 28.

The Ottawa Hills/Reynolds Corner area, in ZIP code 43615, reported the highest number of new infections, 38, and sits middle of the pack with 48 percent of the population vaccinated, though it also is home to more than 40,000 residents.

Rural parts of the county with lower vaccination rates — down to 18 percent in the Swanton area, ZIP code 43558 — didn't report any new infections in July, though it must also be noted their populations are significantly smaller.

Health officials weren't surprised.

Until the vast majority of the county's total population is vaccinated, they said, the protective barrier around communities remains weak, allowing the virus to travel as freely from area to area as residents do for home, work, and play.

"You can make generalizations about different states but when you look at micro communities or ZIP codes in a county, that really is mixed data because those people are moving around, traveling around, and interacting with people doing the same," ProMedica's Head of Emergency Medicine and Vice President of Quality and Patient Safety Dr. Brian Kaminski said. "That's probably the main reason it's not as clean as we'd like it to be."

Dr. Kaminski cited himself as one example. He lives in Bowling Green, but recreates and works in Toledo and its surrounding communities. He received his vaccine in Monroe County.

Other variables such as age and who is being tested may also skew data, Toledo-Lucas County Health Commissioner Eric Zgodzinski agreed.

Currently, vaccination rates among residents 60 and older are all above 74 percent, with the 70 to 74 age group reported to be nearly 89 percent vaccinated.

But many of them are staying put, he said. Comparatively, only about 39 percent of the 20 to 29 age group is vaccinated. But they're more likely to be mobile in the community, so the area where their infection is counted may not reflect where they were actually exposed.

Some residents also are being tested regularly for work or other reasons, which may be catching a higher number of infections, including asymptomatic cases, in certain areas.

There is one causal relationship that officials say is clear:

"I will still say that what we're seeing in general is a very high correlation between disease prevalence, especially severe disease, and vaccination status," Dr. Kaminski said.

On Saturday, Ohio reported 1,469 new coronavirus cases, more than double the 21-day average of 726 cases. Hospitalizations and ICU admissions also increased in July, peaking on Wednesday at 127 and 12, respectively.

Locally, Lucas County reported 100 more new infections in July than it did in June, according to the state's coronavirus dashboard.

Mr. Zgodzinski said that increase is reflected in the county's daily average, which has more than doubled from four cases to 10.

Spikes keep occurring.

He didn't have data to support how many of the new cases were reported in unvaccinated residents.

But he agreed with Dr. Kaminski that patients presenting to area hospitals with severe disease are "almost exclusively" unvaccinated.

"I know that there are stories out there that the vaccine is not working. Well, the vaccine is working," Mr. Zgodzinski said. "We are seeing breakthrough, I think, more than what we all hoped for, but the vaccine is still doing what it's supposed to do. It's keeping vaccinated people pretty much out of the hospital, not having severe issues or symptoms."

Of the 194,000 county residents who are fully vaccinated, 190 are considered breakthrough cases, meaning they tested positive for the virus more than two weeks after their final dose, he said.

They're not the ones requiring a ventilator, Mr. Zgodzinski said.

But now that the Delta variant is moving through the community — the county reported two confirmed cases in July — officials worry what effect it may have.

The latest data from the U.S. Centers for Disease Control and Prevention indicates that those who are vaccinated are three times less likely to catch coronavirus and 10 times less likely to die from it than those who are unvaccinated. But, if infected with the Delta variant, a vaccinated person is just as likely to spread it.

"That really puts the unvaccinated population at significant risk," Dr. Kaminski said. "You combine that with the fact that we've pulled back a lot of our regulations and mandates and recommendations and we now have the most contagious version of the virus that we've seen with still about half of our population being very vulnerable and susceptible to it."

Currently, about 48.6 percent of Lucas County's population is vaccinated, the state's vaccination dashboard shows.

To help curb the spread amid low vaccination rates nationwide, the CDC last week walked back its masking guidance. It now calls for people to wear masks indoors in public areas with high or substantial transmission, even if they are vaccinated.

Neither Lucas or Wood County fall into that high transmission category.

Both currently report "moderate" transmission, the second lowest level on the CDC's four-tier threat chart. Fulton County, directly to the west, is listed as "substantial."

Still, Lucas County took the CDC's guidance a step farther, recommending universal masking in schools, on public transportation, while traveling, and in other public places as required, regardless of vaccination status or the area's transmission rate.

"The idea here is to warn the community before we start having major issues," Mr. Zgodzinski said, stressing his goal is to make sure kids can return to school this month and that people can still go to work. "If we would start talking about masking up two weeks from now, we'd probably be in a worse situation."

Regardless, he's bracing for that hypothetical "worse situation" to become reality within the next two to three weeks.

Because without additional vaccination, he said, the waves of progress followed by regression will only continue, putting all residents at increased risk.

"I hope I'm wrong, I really do, but...I got a feeling we're going to be on for another ride here," he said. "It is riding these waves, and we gotta learn to do that because I don't think COVID is going to be out of our lives anytime soon."

First Published August 1, 2021, 3:13pm