As of Tuesday, 356 Covid-19 patients were being treated in intensive care wards across Australia. Of these, 25 were fully vaccinated.
While the data points to the extraordinary effectiveness of Covid-19 vaccines in preventing people from becoming seriously ill, hospitalized and dying, it begs the question: why do a small number of people become seriously ill and, in rare cases, die, despite being fully vaccinated?
A staff specialist at the intensive care unit at Nepean Hospital in Sydney, Dr Nhi Nguyen, said those who are fully vaccinated and die tend to have significant underlying health issues. Being treated in intensive care, where people may be on a ventilator and unable to move, adds to any existing frailty, especially in the elderly, she said.
“If we think of intensive care patients in general, whether they are there because of Covid-19, pneumonia or any other infection, we know that those who have underlying conditions, those who are fragile and those with co-morbidities will have a higher risk of dying regardless of the cause of their stay in intensive care, ”she said.
“Being fully vaccinated against Covid protects you against serious illness, yes, but it does not fully protect you against Covid. So if you are a person with chronic health conditions, what could be a mild illness or mild infection in a young person or a healthy person will have a bigger impact on you.
She said that was why the Australian Technical Advisory Group for Immunization (Atagi) recommended boosters for people with severe immunosuppression. On Wednesday, the government announced its intention to roll out booster injections in the elderly care sector within a few weeks and to be available to the entire population by the end of the year.
“We do not yet have the final data available on this, but there will also be a proportion of patients who have Covid, but they are already dying for another reason,” Nguyen said. “They may be fully vaccinated, they have a mild form of Covid, but it may have caused more severe heart failure, which they had before.”
Between June 16 and October 18, there were 61 deaths among fully vaccinated people in New South Wales, out of a total of 479 deaths from Covid. Data provided to Guardian Australia by NSW Health shows that the deaths among fully vaccinated people were all 50 years of age or older. Of those who died, five were in their fifties, one in their sixties, 17 in their sixties, 22 in their sixties and 16 in their 90s.
The ABC revealed on Friday that 36 of the 49 elderly care residents who died after contracting Covid during the Delta outbreak in NSW were fully vaccinated. All had underlying health problems or were in palliative care.
In Victoria, 174 deaths from Covid-19 occurred between August 30 and October 19, 2021. Of these, 129 were not vaccinated, 25 were partially vaccinated and 20 were fully vaccinated with two doses. Of the 20 fully vaccinated deaths, one was in his 50s, while the remaining 19 were all 70 and over.
Professor Allen Cheng, director of Alfred Health’s Infection Prevention and Healthcare Epidemiology Unit, said only a small number of deaths have occurred in fully vaccinated people.
“I understand that they mainly concern people over the age of 70, some in care facilities for the elderly,” he said.
The impact of the vaccine on reducing deaths among the elderly has been significant, Cheng said. Last year, before a vaccine was available, the mortality of 80-year-olds with Covid was around 30%, he said.
Cheng said it was likely that given Australia’s extraordinary immunization coverage, the bulk of people who have fallen seriously ill or died with Covid-19 from now on are fully vaccinated.
“At some point there will be more infected people who will be vaccinated than those who will not,” he said. “As a simple thought experiment – if everyone is vaccinated, then the only cases we would have would be in people who have been vaccinated.”
Nguyen agreed that with high vaccination rates, “in the future, a greater proportion of people in intensive care will be those who are fully vaccinated and who are fragile with other conditions, rather than those who are not vaccinated.” .
“But keep in mind that even at 95% of eligible people vaccinated, that still leaves a lot of people unvaccinated. This is why we predict that living with Covid there will be a baseline number of Covid patients in intensive care across NSW for the foreseeable future, and we certainly do anticipate that.
“What is that actual benchmark number, we’re still not quite sure. “
Cheng said steps could be taken to further protect those at risk of serious illness despite vaccination. Atagi, which Cheng co-chairs, is still evaluating the data for the booster shots and may make further recommendations regarding their use.
Once the booster recommendation is confirmed, the additional protection of the general population would further reduce the risk of infection of the most vulnerable.
Australia is also using the new monoclonal antibody treatment sotrovimab, which has been shown to significantly reduce hospitalizations and the risk of death in adults at risk of developing severe Covid-19.
“New monoclonal antibodies can provide additional protection, especially in immunocompromised people,” Cheng said. “Newer antiviral treatments may also become useful, although they are still being evaluated.”