You’ve had your two mRNA shots from the Pfizer or Moderna vaccines or one shot of the Johnson & Johnson vaccine. That makes you “fully vaccinated” by the government definition. Now what are your chances of getting Covid-19?

It depends – on your age, your time since vaccination, and your co-existing medical conditions such as diabetes, heart disease, chronic lung or kidney disease, or diseases that compromise your immune system. The greatest factor is age, just as it was found to be when Covid-19 first became a pandemic in 2020.

Getting Covid after vaccination is real. Though data is inconsistent, state reporting suggests there have been more than 1.89 million cases of Covid after vaccination according to The Wall Street Journal. Jon Kamp and Melanie Evans report at least 72,000 hospitalizations and 20,000 deaths among fully vaccinated people in the U.S. this year.

To be sure, the unvaccinated are still the driving force behind the pandemic numbers which have been declining in recent months. Breakthrough infections, however, are making up a growing portion because of rising numbers of vaccinated people and waning immunity among people who got their shots early on. The Journal recently studied the number of infections in the vaccinated population and found the CDC doesn’t publish a running tally on such cases. However, the Journal reviewed medical record data for a total of more than 21 million fully vaccinated people, and an array of state reports, to compile its analysis.

What they found was that people with diabetes, chronic lung and kidney disease and compromised immune systems were at much higher risk of serious outcomes from breakthrough cases. But the unvaccinated still remain those at highest risk. They are nearly five times as likely to get Covid-19 and about 29 times as likely to be hospitalized as fully vaccinated people.

The rising number of Covid infections in those who have been vaccinated led to booster shots for those over 65 years and the immunocompromised. A Mayo Clinic study estimated the efficacy of the Pfizer vaccine at only 47% and the Moderna vaccine at 75% after six to eight months. I was one of the first to get the booster shot. Recently the FDA approved booster shots for all adults. The graph below reflects this declining efficacy over time.

The risk of serious disease in the vaccinated population under 65 with no comorbidities is quite low. But for those over 65, especially with comorbidities as stated above, the risk is far higher.  Truveta, Inc., a firm that aggregates hospitals’ medical data, found among 1.7 million fully vaccinated people that those with diabetes, chronic lung disease and chronic kidney disease were about twice as likely to be hospitalized for breakthrough cases as vaccinated people with these conditions.

The likelihood of having a breakthrough infection was still low, though confirmed infections were more common for people with these illnesses. About 1.5% of roughly 110,000 people with chronic kidney disease had one, for example. (Your chances of a breakthrough case if you’re healthy is far less.) But ,Truveta found about 25% of breakthrough patients with chronic kidney disease wound up hospitalized. The likelihood of hospitalizations for people with breakthrough cases but without underlying problems was about 7.5%.

I would strongly recommend the booster shot for anyone over age 65. The recent FDA ruling that any adult can get the booster shot reflects their growing concern for breakthrough cases in all age groups.

Aaron Rodgers has Covid toe – or maybe it’s a fracture, or not. It certainly didn’t seem to bother his play much Sunday as the Green Bay Packers beat the Los Angeles Rams 36-28 at Lambeau Field.

This somewhat bizarre story was reported by Andrew Beaton in The Wall Street Journal this week, adding new dimensions to the complications of Covid-19 infection. Rodgers did indeed have Covid-19 after testing positive, causing him to miss the Packers game November 7th. He sat out 10 days because he was unvaccinated, but returned to the field to play on November 14^th against Seattle.

Rodgers first described a mysterious and painful toe injury as a “Covid injury.” At a press conference last week, he referred to his injury with the term “Covid toe,” a medical condition that can arise from the body’s response to the disease he had recently contracted.

After the WSJ ran a story reflecting his remarks, he said he had never heard of “Covid toe” and instead insisted he had a fractured toe. “I mentioned yesterday that it’s worse than a turf toe and it must be a bone issue,” Rodgers said. “I’ve never heard of Covid Toe before. I have no lesions on my feet.”

This all started on a sports talk program called the Pat McAfee show where, among other topics, Rodgers discussed the toe injury that has hobbled him since he returned to the field. “I didn’t have any lingering effects, other than the Covid Toe,” Rodgers said on the program. But he later pushed back at this characterization of his toe problem, insisting his comment was because of a joke by McAfee. The Packers declined to comment on a player’s medical issues.

What is the truth about Covid Toe?

There really is a condition known as Covid Toe. The more formal medical term is pernio or chilblains, which is a condition that causes symptoms such as discoloration and lesions. It can be extremely painful and turn the toes purple, a sign of the body’s strong immune response to the virus.

In an October study published in the British Journal of Dermatology, research found that Covid Toes typically occur in younger patients who experience mild Covid symptoms. The condition is believed to be caused by the body producing too much interferon in response to the virus. “The way I would think about it is it’s basically a side effect of how your own immune system is fighting the virus,” said Esther Freeman, a doctor and principal investigator for the Covid-19 Dermatology Registry. “It’s part of our body’s response to the response to the virus. It’s almost too much of a good thing.”

Dr. Freeman, who’s also an associate professor of dermatology at Harvard Medical School, admits the incidence of Covid Toe isn’t precisely known. She did note the condition tends to occur one to four weeks after infection. That timeline aligns well with Rodgers’ symptoms. News of Rodgers’ positive test first emerged on November 3. After that sidelined him for 10 days, missing one game, he returned to play against the Seattle Seahawks on November 14, but was listed as having a toe injury. In the game the following week against the Minnesota Vikings, Rodgers was briefly replaced by his back-up before halftime to tend to his toe.

“The best way to avoid Covid Toes is to get vaccinated,” said Dr. Freeman. But now, Rodgers insists he suffered an injury to his toe during his quarantine while he was doing his own workouts and trying to ramp up his conditioning. He said he didn’t know what it was until he got back in the team’s facility and got it x-rayed.

Covid Toe or fracture? Apparently, it doesn’t really matter to the Packers as long as they keep winning. But it does represent another good reason to get vaccinated.

President Joe Biden says Omicron, the new Covid variant discovered last week in South Africa, is a cause for concern but not panic. But his rush to block air travel from several countries in southern Africa on Friday would seem to be just that – panic.

The stock market responded by dropping over 900 points, the worst day of the year and the worst Black Friday on record. Fortunately, cooler heads began to prevail on Monday as the market regained about a quarter of the losses. The World Health Organization didn’t help matters when they warned Monday that the new variant poses “a very high risk.” Yet the truth is we have very little information that suggests such alarmism is indicated.

South African doctors say Omicron cases they’ve seen are milder and cause different symptoms, notably fatigue. Many are young people who might be expected to have milder symptoms. But breakthrough infections have also been mild. “I don’t think it will blow over but I think it will be a mild disease hopefully,” said South African Medical Association chair Angelique Coetzee. “For now, we are confident we can handle it.”

South African President Cyril Ramaphosa said Sunday the country won’t impose a lockdown or increase restrictions. “When we encountered previous waves of infection, vaccines were not widely available and far fewer people were vaccinated,” he noted. “We also know that the coronavirus will be with us for the long term. We must therefore find ways of managing the pandemic while limiting disruptions to the economy and ensuring continuity.” No panic in those words.

Fortunately, Biden said new lockdowns aren’t being considered, at least at the federal level. But leave it to the state of New York to miss the memo. New York Governor Kathy Hochul, successor to disgraced former governor Andrew Cuomo, invoked Omicron to declare a disaster emergency that will let the state suspend elective procedures at hospitals if their staffed-bed capacity falls below 10%.

The Wall Street Journal says the real “disaster” is her mandate requiring that healthcare workers be vaccinated. Hochul has refused to allow even religious exemptions to her mandate. In September she issued an executive order that would allow the National Guard to fill staffing shortages at hospitals and nursing homes if needed. By mid-October, the state reported that 4,100 unvaccinated workers were put on furlough or unpaid leave, 3,100 had been fired and another 1,300 quit or retired. That’s a loss of 8,500 hospital or nursing home staff by order of the governor. Now she has a real emergency on her hands!

The result is postponement of all elective surgical procedures, which represent a crucial source of hospital revenue. Just like her predecessor, Ms. Hochul is defending her destructive vaccine mandate while compensating for its unintended harm with another destructive policy. What is it about government officials that makes them lose their minds when they get authority to control the lives of others?

Some help has come from the saner judicial branch of our government. A federal judge halted the Biden Administration’s vaccine mandate for health workers at hospitals that receive federal funding. The ruling applies to 10 states that sued to block the November 5 rule. Judge Matthew Schelp wrote, “The scale falls clearly in favor of healthcare facilities operating with some unvaccinated employees, staff, trainees, students, volunteers and contractors, rather than the swift, irremediable impact of requiring healthcare facilities to choose between two undesirable choices – providing substandard care or providing no healthcare at all.”

WSJ sums up the situation: “Lockdowns don’t stop the virus, and vaccine mandates are hurting hospitals. The Omicron variant is no excuse for more of either one.” South Africa, where the new virus variant was discovered, is not in a panic. Neither should we be.