Coronavirus FAQ: You're Vaccinated. Cool! Now About Those 'Breakthrough' Infections...

You can do a lot of things with minimal risk after being vaccinated. Although our public health expert says that maybe it's not quite time for a rave or other tightly packed events. Above: Fans take photographs of Megan Thee Stallion at a London show in 2019.
You can do a lot of things with minimal risk after being vaccinated. Although our public health expert says that maybe it's not quite time for a rave or other tightly packed events. Above: Fans take photographs of Megan Thee Stallion at a London show in 2019.
Ollie Millington/Getty Images

Each week, we answer "frequently asked questions" about life during the coronavirus crisis. If you have a question you'd like us to consider for a future post, email us at goatsandsoda@npr.org with the subject line: "Weekly Coronavirus Questions."

I've been hearing about breakthrough infections in people who have been vaccinated. Should I be worried? What can I do to protect myself?

The short answer:

You don't need to worry — only 5,800 out of 66 million fully vaccinated Americans have contracted COVID-19 — but you should still take steps to protect yourself and others. Getting COVID after the vaccine is a good reminder why your vaccination card is not a get-out-of-jail-free card.

The long answer:

At this point, many of us can rattle off the COVID vaccine efficacy rates by heart: about 95% for Pfizer and Moderna; 66% for Johnson & Johnson globally, 72% in the U.S. (Remember, that means your chances of getting COVID after vaccination is way less than 1%.)

"Everybody sees that the stats are not 100%, but that immediately goes out the window and people just think, 'I've been vaccinated!'" says Charlotte Baker, assistant professor of epidemiology at Virginia Tech.

As powerful as these vaccines are, no vaccines offer 100% protection in the real world, Dr. Anthony Fauci pointed out in a press conference this week. So with the virus circulating at high rates in most communities, breakthrough infections shouldn't come as any surprise.

(Once we reach herd immunity and circulation levels drop, breakthrough infections will become even rarer. When was the last time you worried about getting diphtheria or pertussis? The vaccines that prevent them have similar efficacy rates — 97% for diphtheria, and a range between 71 and 98% for pertussis — as the COVID vaccines.)

"As long as the virus is not circulating and there's a high enough vaccine immunity in the community, then the risk is minimal, but if there is ongoing transmission at high levels it's still possible to get infected," says Dr. Jill Weatherhead, assistant professor of adult and pediatric infectious diseases at Baylor College of Medicine. "So that risk is still there and as we get more people vaccinated and the community spread goes down, the risk of breakthrough infections goes down significantly."

Until a much higher percentage of us are vaccinated, then, it's prudent to continue the "big 3" precautions we've all come to know and tolerate — masking, physical distancing and washing your hands — in most public or group situations.

In addition, consider these modifications and additions once you've been vaccinated:

Count to 2. Make sure to wait until you're fully vaccinated — that's two weeks after your final dose — before taking off your mask (and then only with other vaccinated folks, of course!)

Ask the question. If you don't know if someone you'll be seeing has been vaccinated, don't be shy. "With close friends, I just ask them," Baker says. "I say, I'd love to see you soon, so let's figure out the timeline [of who's been vaccinated when]." It feels like a fair question, she says. "If you're in a group of people going to see a play or a concert [in the same car], I'm comfortable asking if they are vaccinated. And if I don't know, I wear a mask," she says. (You'll still need to wear one once you get to the event, anyway!) Of course, getting over the initial fear of asking strangers if they're vaccinated may be trickier. "In those cases you're not sure, that's when you wear your mask," she says. "If you're unsure and it's not people you know or feel comfortable asking, keep your mask on."

Pack a spare mask. Speaking of masks, find one you really like if you haven't done so already. As you ease back into society, you'll still want a mask in your purse or pocket just in case, says Baker. That way, if you need to make a pit stop at a public restroom or dart into a grocery store, you'll be prepared.

Table space. If you're dining out, opt for outdoors at restaurants where tables are spaced at least 6 feet apart (considering tossing a measuring tape in your purse or backpack along with your emergency masks!)

The outdoors is still your best friend. Keep in mind that kids under 16 are not eligible to be vaccinated yet, so if you're visiting with multiple families, consider staying outside as much as possible.

If all this sounds like a damper on your newly vaccinated freedom, don't despair: Early data shows that even if you get a breakthrough infection, you may be less likely to pass it on to others, Weatherhead notes. Also, like all the other phases of the pandemic, this one won't last forever.

The bottom line? "Enjoy yourself a little more, but don't go crazy," Baker says. "Don't go to a huge rave."

Sheila Mulrooney Eldred is a freelance health journalist in Minneapolis. She's written about COVID-19 for many publications including Medscape, Kaiser Health News, Science News for Students and The Washington Post. More at sheilaeldred.pressfolios.com. On Twitter: @milepostmedia

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