Vaccinated People Are Getting COVID-19. How Concerned Should You Be?
Breakthrough infections among the vaccinated are rare, but experts say some precautions are warranted
When Dr. Leslie Kantor bought tickets for the Citi Open tennis tournament beginning August 1 in Washington, D.C., she was told the outdoor stadium hosting the event would only be filled to 50% capacity due to COVID-19 precautions. But by the time the tournament started, its organizers decided to fill it with 7,500 fans — none of whom were required to wear masks.
Despite the summer heat and the fact that she's fully vaccinated against COVID-19, Kantor opted to wear a mask at the tournament.
"I moved around a lot because I was very nervous about all the people yelling around me," Kantor says.
"What that data showed was that people who are fully vaccinated can become infected and can transmit the virus."
Kantor's cautious stance stemmed not just from the news about the aggressive delta variant of the virus, but also from her expertise. She's a professor at the Rutgers University School of Public Health in N.J. and reading recent reports from the Centers for Disease Control (CDC) and other public health agencies has opened her eyes, she says.
Biden Administration to Offer COVID-19 Boosters
The Biden administration announced it will offer Americans booster shots, eight months after their second dose of the Pfizer or Moderna COVID-19 vaccine. In a joint statement from top public health officials and medical experts, they said: "The COVID-19 vaccines authorized in the United States continue to be remarkably effective in reducing risk of severe disease, hospitalization, and death, even against the widely circulating Delta variant." The boosters will be made available September 20. As for the Johnson & Johnson vaccine, a booster will likely be needed for that shot, as well.
"I think we're learning that delta is a much more infectious variant than we have encountered in the past, and cases are increasing rapidly," Kantor notes. "So I wouldn't wait for the prevalence to be extraordinarily high to start taking some precautions."
Follow the COVID-19 Data
Several recent reports are shedding some light on the delta variant and the risks it poses.
The data show that breakthrough infections are still rare: The Kaiser Family Foundation (KFF) drilled down into the numbers on COVID-19 infections provided by 25 states and found that in more than 9 in 10 cases, hospitalizations and deaths occurred in unvaccinated or partially vaccinated people. And a New York Times analysis of 40 states found that fewer than 5% of hospitalizations and 6% of deaths there occurred among vaccinated people.
But a separate report from the CDC raised serious questions about whether it's all that safe for anyone, including vaccinated people, to return to pre-pandemic, freewheeling social activities.
That report covered breakthrough cases that occurred after crowded summer celebrations in Barnstable County, Mass. on Cape Cod, which included Provincetown. The CDC reported 469 COVID-19 cases, 74% of which occurred in fully vaccinated people. Among those breakthrough cases, 79% were symptomatic and four required hospitalization.
"What that data showed was that people who are fully vaccinated can become infected and can transmit the virus," says Dr. Jennifer Kates, senior vice president and director of global health and HIV policy at KFF. "That's an alarm bell. It warns people who are fully vaccinated that they should be extra careful," particularly if they spend a lot of time with children who are too young to get the vaccine or other unvaccinated people, she says.
Mask Mandates in School
The issue of precautions is one that hits home for Pati Dunn, 58, who lives in Phoenix with her husband and two adopted grandchildren, age 14 and 16. Dunn's husband is fully vaccinated, but she is undergoing treatment for colon cancer and has been advised to hold off on the vaccination. Her teens are in the process of returning to school full-time, and neither has been vaccinated because of medical conditions that raise the risk of side effects from the vaccine.
"I wish people would use common sense. The only way we can get rid of this is if we mask up and vaccinate."
Dunn is happy the children are back to in-person learning, but masking is not required in the schools, and now several parents and teachers are trying to change that.
"Because of the new variants, I think we should go back to masking," says Dunn, who often wears a mask, particularly when she's needed on site for her job as a food-service supervisor at sports events. The school district is weighing a new mask mandate and Dunn hopes a decision will come soon.
Time For More Mitigation Strategies
Dr. Adupa Rao, a pulmonologist and clinical associate professor at the University of Southern California Keck School of Medicine in Los Angeles, believes public health agencies and local governments should consider bringing back mask mandates.
"The vaccines are doing what they're supposed to do, but we should try to minimize those infections by wearing masks and using good hand hygiene," Rao says.
The CDC reported that as of August 9, there were 8,054 COVID breakthrough infections and 1,587 deaths among the more than 166 million people who had been vaccinated. That backs up the prevailing opinion that most breakthrough cases are asymptomatic or mild.
But what does "mild" mean?
"The vast majority of people who are getting infections after receiving the vaccines seem to have bad cold symptoms that last from one day to a week," Rao says.
"Each prevention strategy is like a piece of Swiss cheese: Each one has some holes — none of them are perfect."
Linda Haynes, 73, a part-time medical records administrator who works at home in Woodburn, Ore., is vaccinated but still wears her mask in indoor public spaces and stays socially distanced in outdoor crowds. She was spooked after a young relative came down with a breakthrough case of COVID-19.
"She was young, healthy and vaccinated, and only took her mask off for a very short time," Haynes says. "I wish people would use common sense. The only way we can get rid of this is if we mask up and vaccinate."
Another strategy vaccinated people should consider, says Kantor, is to take advantage of COVID-19 testing, which is usually available free-of-charge for insured patients, regardless of whether they have symptoms.
Planning a large family wedding? Ask your guests to get tested for COVID-19 a few days before, she suggests. Going out to dinner with friends who recently attended a rock concert? Ask if they plan to get tested. If they say no, consider putting off the get-together for a couple of weeks.
"Each prevention strategy is like a piece of Swiss cheese," Kantor says. "Each one has some holes — none of them are perfect. But if you layer up a bunch of them, you end up with a solid block."