Vaccinated people can still get COVID — what you need to know

Breakthrough cases of COVID-19 are growing probably because more virus is circulating, not because vaccines don’t work against the delta variant, which now accounts for more than half the infections in the United States, experts say.

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Respiratory therapist Robert Blas (left) from Veritas Vaccines administers the Pfizer Covid-19 vaccine at a mobile clinic to residents in an East Los Angeles neighborhood earlier this month.

Respiratory therapist Robert Blas (left) from Veritas Vaccines administers the Pfizer Covid-19 vaccine at a mobile clinic to residents in an East Los Angeles neighborhood earlier this month.

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Everyone wants vaccines to be perfect— and the COVID-19 ones nearly are. Only a tiny fraction of those who are vaccinatedend up seriously ill from an infection.

But still, some fully vaccinated peoplewill get sick, some will pass on the virus, and a very small numberwill die despite their shots.

“The efficacy of the vaccines in preventing hospitalizations and death is unbelievable,” saidCarlos del Rio, an epidemiologist and distinguished professor of medicine at Emory University School of Medicine in Atlanta.”It’s not 100%. But nothing in this worldis 100%.”

At a time when the infection rate has doubled, many remain unvaccinatedandthe delta variantis vastly more contagious than the original, it’s important to recognize vaccines aren’t flawless, he and others said.

“I understand it’s kind of a tough pill to swallowfor many people,”said Anthony Santella,a public health expert at the University of New Haven in Connecticut.

Several recent high-profile cases have brought public attention to the fact that people who are vaccinated can still catch the virus.

A recent Yankees-Red Sox game was postponedbecause six Yankees — most, but not all, of whom were vaccinated — tested positive for the virus. At a homeless shelter in Northern California,a number of vaccinated residents tested positive during an ongoing outbreak. Andsixvaccinated members of the Texas Legislature, who had fled the state to prevent a vote on changes in the state’s election laws,have tested positive for the coronavirusin recent days.

The common thread for all those infections was that they were caught by routine testing, not because peoplefell seriously ill, notedAli Ellebedy, an immunologist at Washington University School of Medicine in St. Louis.

Of the more than 159 million fully vaccinated Americans as of July 12, a reported 5,492havebeenhospitalized, and 791have died related to symptomatic COVID-19,according to the Centers for Disease Control and Prevention.

In May, the CDC stopped tracking all so-called breakthrough infections, focusing only on state and local health department reports of hospitalizations and deaths, so there’s no way to know how many infections there havebeen or whether they are increasing because of the delta variant.

Dr. Leana Wen, an emergency physician and former Baltimore health commissioner, called that decision“inexplicable.”

Without that data, she said, it’s impossible to know how many people are getting infected after vaccination, whether certain people, perhaps senior citizens, are more vulnerable to breakthrough infections, and how easy it is for people who have been vaccinated and then infected to pass on the infection to others.

“We just don’t know the answers to these questions, and that is really preventing clinicians from giving good guidance to our patients,” she said.

Breakthrough cases of COVID-19are growing probably because more virus is circulating, not because vaccines don’t workagainst the delta variant, which now accounts for more than half the infections in the United States, experts say.

Vaccines remain effective against severe disease from the delta variant, said Ellebedy, who studies the body’s response to vaccination.

But the variantis vastly more contagious than the original virus, so the unvaccinated are particularly vulnerable.

“If you’re vaccinated, you should not worry about the delta variant,” del Rio said. “If you’re not vaccinated, you are really in troublebecause it’s likely that you will get infected.”

Range of protection

Even healthy people responddifferently to vaccination, so it is normal to see variation in protection among the vaccinated, Ellebedy said.

For 95 people out of 100, vaccines from Pfizer-BioNTech and Moderna will provide effective protection.

The problem is, it’s essentially impossible to figure out ahead of time who is most vulnerable. Certain factors like age, obesity and lung disease increase the risk of serious disease if someone is infected. So does the load of virus they inhale and what medications they’re taking, he said.

Some people will test positive for the virus despite vaccination, but the immune protection they received willkeep virtually all those people from getting seriously ill.

Vaccination also makes people less likely to shed large amounts of virus, Ellebedy said, meaning they are less likely than an unvaccinated infected person to get someone else sick. Anything that decreases the amount of virus replicating itself in the respiratory tract will decrease the probability of passing on that virus, he said. “Transmission will decrease like everything else.”

And though the data remains thin, vaccination also likely protects against long-haul COVID-19, in which people have symptoms weeks or months after they clear their initial infection, said David Holtgrave, dean of the School of Public Health at the University at Albany, State University of New York.

A previous coronavirus infection provides some protection against the delta variant, but someone who got COVID-19 months ago might not have enough of an immune response left, del Riosaid.

“My adviceif youhave been infected, is you should trust your natural immunity for about three months. But after three months, you should get vaccinated,” he said.

People who were infected and then vaccinated are probably well-protected. Ellebedy said.

Context also matters, Ellebedy and others said. Someone who is vaccinated and who lives in a community with a high vaccination rate and a low infection rateprobably can get away without a mask.

While the CDC said mask-wearing isn’t mandatory except in medical and transportation settings, numerous experts told USA TODAY it’s a good idea to wear a maskin indoor settings with people who are possibly unvaccinated.

Wearing a mask on top of being vaccinated isthe safest way to avoid getting infected or passing on the virus to someone whose weakened immune system prevented them from gettingfull protection from the vaccine.

In the United States,infections have more than doubled since the week of June 22.

That puts vaccinated people at risk because there’s simply more virus out there, said Dr. George Rutherford,an infectious disease specialist at the University of California, San Francisco.

Unvaccinated are getting sick

At Staten Island University Hospital in New York, there are 15 COVID-19 patients, 13 of whomare unvaccinated, said Dr. Theodore Strange, the hospital’schairman of medicine.

Strange said hisCOVID-19 patients are about 10 years younger now than they were a year ago, with an average age of 55-60. Some are even younger, he said, rattling off ages: “29, 38, 42, 50.”

Vaccinations deserve the credit, he said,because about 70% of people on Staten Island over 65 are vaccinated, compared with 38% of those 40 and younger.

He’s disappointed more people haven’t been willing to be vaccinated, despite the risk of infection and of “being the bullet in the gun,” potentially bringing the virus home to older, more vulnerable relatives.

But still, he said, the curve of coronavirus infections is very similar to the one followed by the 1918 flu, a pandemic that lasted three years.

“If we’re not going to avail ourselves of current technology and science,” he said, “then shame on us.”

Contributing: Mike Stucka

Read more at usatoday.com

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