Breakthrough Covid Cases: Uncommon and Often Mild, but Not Always

For Moira Smith and her mother, after months of isolation, July promised a glimmer of normalcy. The two flew from Alaska to Houston and visited the family to celebrate their cousin’s granddaughter’s first birthday. Ms. Smith’s mother bought a patterned pink romper to give away, and they all took pictures of the baby’s face covered in chocolate.

Ms. Smith, 46, knew her cousin’s family was not vaccinated but tried not to address it. She and her mother had received their Pfizer vaccinations both months earlier. One evening in the hotel room, Ms. Smith’s mother made a casual remark to her relatives: “You can take off your masks, but you must promise to get vaccinated,” she said.

The next morning, Ms. Smith and her mother were making their way home while stopping at the Seattle airport when they received the call: their relative’s baby had developed a fever and had tested positive for Covid-19.

Two days later, Ms. Smith woke up feeling “hit by a Mack truck,” with aching limbs and a sore throat, and tested positive for the coronavirus. The next week, her mother, who is 76 years old and has lung cancer, sent her a thermometer emoji indicating that she too had a fever and later ended up in the emergency room with Covid.

Ms. Smith and her mother are part of a wave of Americans who contract Covid, despite being fully vaccinated, from what are known as breakthrough infections.

Public health experts continue to believe that breakthrough infections are relatively rare and rarely result in serious illness or hospitalization. The vaccines available in the US offer strong protection against serious Covid illness, hospitalization and death. A recent analysis of government-reported data from the Kaiser Family Foundation found that more than nine out of ten Covid-19 cases that resulted in hospitalizations and deaths occurred in people who were not fully vaccinated.

“We always expected that there would be some breakthrough infections because the vaccines were 95 percent effective at their best,” said Dr. William Schaffner, professor of infectious diseases at Vanderbilt. “The vaccines are designed to prevent serious diseases and they are doing spectacularly.”

However, as the more transmissible Delta variant becomes prevalent in the United States, an increasing number of breakthrough cases are being reported, although most are mild.

“Delta is much more contagious, so if it does spread among the unvaccinated, it will spread to the vaccinated population,” said Dr. Conductor. “The unvaccinated are a great transmission line. The vaccinated are a small side street. “

Since people infected with the Delta variant have far more of the virus in their nose and upper respiratory tract, wearing masks is paramount. After the Centers for Disease Control and Prevention changed their guidelines on masking and recommended vaccinated people in hot-spot areas again wear masks in public indoor spaces, millions of Americans who are fully immunized struggled to meet their expectations to adapt to the autumn months, which offer a semblance of festivity. And a small subset of Americans have seen their routines turned upside down by breakthrough infections.

Stimulated by concerns about breakthrough infections, federal health officials recently recommended that Americans who received the Pfizer or Moderna vaccines receive a third dose in the coming months. This week Johnson & Johnson reported that a booster shot of its vaccine raised antibody levels to the coronavirus.

For some, breakthrough infections have felt like mild allergies accompanied by symptoms like a cough, runny nose, and sore throat. Others had more severe cases where they were bedridden with aching limbs, fever, and chills. And still others had some of the tell-tale signs of Covid such as loss of taste and smell, “Covid rash” and brain fog.

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Aug. 26, 2021, 6:16 p.m. ET

“We called it floaty head syndrome,” said Molly O’Brien-Foelsch, 47, a Pennsylvania marketing executive who tested positive for Covid after traveling with her husband to the British Virgin Islands last month. “It felt like there was a giant marshmallow on my head.”

Scientists believe breakthrough infections rarely lead to serious illness, but there have been cases of prolonged hospital stays. Elaina Cary-Fehr’s father Isaac, a 64-year-old Uber driver in Austin, was moved to a long-term care facility after hospitalized with Covid pneumonia in June and later with a tracheostomy tube. He was released from the facility this week.

“I believe in the vaccine, I kept hoping it would work, and it made it,” said Ms. Cary-Fehr. “But I hate that this had to happen to my family.”

Dr. Rebecca Hughes, 32, works as an emergency doctor in Boston so she had spent the last year with a simmering sense of fear of Covid exposure. She can still remember the fear she felt during the first treatment of a Covid patient and wondered for hours whether her mask might have slipped and put her in danger. But all year round, she was protected by her protective gear.

Then, last month, her family went on vacation to visit their grandparents in Utah. It was a trip they had hoped for last February but postponed as Covid case rates rose. Four days after landing, Dr. Hughes, the way her throat scratched. She was sure it was allergies, but did a Covid test just in case; it came back positive. Shortly thereafter, her newborn baby, who was 9 weeks old, began to sneeze and also tested positive, along with Dr. Hughes aged 8, 6 and 3 years.

“It felt ironic after looking after Covid-positive patients on every shift for so long since the beginning of the pandemic,” said Dr. Hughes. “My 8-year-old knows that I’ve seen people die from it. She looked at me and said, ‘Am I okay?’ “

Although some breakthrough infections like Dr. Hughes are hard to attribute to an exact exposure event, other Americans have found their vacation plans overlap with known outbreaks.

Understand US vaccination and mask requirements

    • Vaccination rules. On August 23, the Food and Drug Administration fully approved Pfizer-BioNTech’s coronavirus vaccine for people aged 16 and over, paving the way for increased mandates in both the public and private sectors. Private companies are increasingly demanding vaccines for employees. Such mandates are legally permissible and have been confirmed in legal challenges.
    • Mask rules. The Centers for Disease Control and Prevention in July recommended that all Americans, regardless of vaccination status, wear masks in public places indoors in areas with outbreaks, reversing the guidelines offered in May. See where the CDC guidelines would apply and where states have implemented their own mask guidelines. The battle over masks is controversial in some states, with some local leaders defying state bans.
    • College and Universities. More than 400 colleges and universities require a vaccination against Covid-19. Almost all of them are in states that voted for President Biden.
    • schools. Both California and New York City have introduced vaccination mandates for educational staff. A survey published in August found that many American parents of school-age children are against mandatory vaccines for students but are more likely to support masking requirements for students, teachers and staff who are not vaccinated.
    • Hospitals and medical centers. Many hospitals and large health systems require their employees to have a Covid-19 vaccine, due to rising case numbers due to the Delta variant and persistently low vaccination rates in their communities, even within their workforce.
    • New York City. Proof of vaccination is required by workers and customers for indoor dining, gyms, performances, and other indoor situations, though enforcement doesn’t begin until September 13th. Teachers and other educational workers in the city’s vast school system are required to have at least one vaccine dose by September 27, without the option of weekly testing. City hospital staff must also be vaccinated or have weekly tests. Similar rules apply to employees in New York State.
    • At the federal level. The Pentagon announced that it would make coronavirus vaccinations compulsory for the country’s 1.3 million active soldiers “by mid-September at the latest. President Biden announced that all civil federal employees would need to be vaccinated against the coronavirus or undergo regular tests, social distancing, mask requirements and travel restrictions.

Jimmy Yoder, 25, felt no fear as he and his friend, both vaccinated, packed their bags for a weekend in Provincetown in July. And because their days and nights there were hazy with clubs and dances, he assumed the Monday morning tiredness that greeted him in Brooklyn was just a bad hangover.

“I felt a little run down, but attributed it to a party weekend,” said Yoder. “In the back of my mind, I thought, ‘There’s no way I’m going to get Covid, I’m immune.’ ”

On Wednesday morning, Mr. Yoder no longer felt so safe. “I felt like I had a really bad flu,” he said with a high fever and clogged sinuses. He and his friend both tested positive that day. Mr. Yoder slept for the next 18 hours, and when he and his friend felt better, they ordered a celebratory pizza. It was then that they realized that they had both lost their sense of taste and smell.

Mr. Yoder was relieved to find that of all the people he’d exposed – friends who drove him home from Provincetown, an office full of coworkers – only one tested positive. “Obviously it shows that the vaccines are still doing a lot,” he added.

While many Americans begin the familiar practice of questioning and abandoning plans, scientists stress the continued importance of wearing masks to reduce transmission and infection.

“If you get infected and you breathe out the virus, your mask will trap it,” said Dr. John Moore, Professor of Microbiology and Immunology at Weill Cornell University. “These viruses don’t have scissors that can cut through masks.”

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