Abstract
Background
Both SARS-CoV-2 infection and COVID-19 vaccination contribute to population-level immunity against SARS-CoV-2. This study estimates the immunological exposure and effective protection against future SARS-CoV-2 infection in each US state and county over 2020-2021, and how this changed with the introduction of the Omicron variant.
Methods
We used a Bayesian model to synthesize estimates of daily SARS-CoV-2 infections, vaccination data and estimates of the relative rates of vaccination conditional on infection status to estimate the fraction of the population with (i) immunological exposure to SARS-CoV-2 (ever infected with SARS-CoV-2 and/or received one or more doses of a COVID-19 vaccine), (ii) effective protection against infection, and (iii) effective protection against severe disease, for each US state and county from January 1, 2020, to December 1, 2021.
Results
The estimated percentage of the US populati on with a history of SARS-CoV-2 infection or vaccination as of December 1, 2021, was 88.2% (95% Credible Interval (CrI): 83.6%-93.5%). Accounting for waning and immune escape, effective protection against the Omicron variant on December 1, 2021, was 21.8% (95%CrI: 20.7%-23.4%) nationally and ranged between 14.4% (95%CrI: 13.2%-15.8%, West Virginia) to 26.4% (95%CrI: 25.3%-27.8%, Colorado). Effective protection against severe disease from Omicron was 61.2% (95%CrI: 59.1%-64.0%) nationally and ranged between 53.0% (95%CrI: 47.3%-60.0%, Vermont) and 65.8% (95%CrI: 64.9%-66.7%, Colorado).
Conclusions
While over four-fifths of the US population had prior immunological exposure to SARS-CoV-2 via vaccination or infection on December 1, 2021, only a fifth of the population was estimated to have effective protection against infection with the immune-evading Omicron variant.
