What You Need To Know About Breakthrough COVID

By Bruce Farber, MD, Chief of Infectious Diseases, Northwell Health. Article published in The Well by Northwell

*Editor’s note: The information in this article is current as of August 16, 2021. We’re updating our COVID-19 and vaccination information as frequently as possible. This data changes quickly, so we urge you to visit the CDC website for the most current information.

It’s a headline you’ve no doubt heard on the evening news, or seen splashed across newsstands: “breakthrough infections” are risingBut what does that mean? In short, a breakthrough infection is what we call it when someone who received a COVID-19 vaccine contracts the virus more than 14 days after getting their final dose.

And, while alarming in their own right, these cases speak to a larger, more troubling trend.

In recent weeks, COVID cases, hospitalizations, and deaths have been rising in nearly every state in the country, fueled in large part by the delta variant—a strain of the virus proving to be far more contagious than its predecessors. However, as with all things related to COVID, there’s a lot of misinformation out there, especially on social media.

As an infectious disease physician who’s been on the front lines of caring for COVID patients, I want to address some of the most common myths about breakthrough COVID and give you the facts.

Myth #1: Fully vaccinated people getting COVID means the vaccine doesn’t really work (and isn’t worth getting)

On the contrary, these cases actually provide even more reason to get vaccinated. That’s because the breakthrough COVID cases we are seeing are much less severe than cases among the unvaccinated. (Well over 96% of people that we see admitted to the hospital with COVID have not been vaccinated.)

While rare, we have seen a few breakthrough cases of vaccinated individuals that required hospitalization. However, the use of ventilators and other advanced lifesaving measures weren’t necessary in those cases in the same way that they have been for those who are unvaccinated. So while the vaccine is not perfect (and there is still a chance you may get COVID after you’re fully inoculated), you’ll be much better off than an unvaccinated person who contracts COVID.

It’s also important to keep in mind that as long as large numbers of people remain unvaccinated, there is a higher likelihood that more of these dangerous variants will emerge. If you want an analogy, it’s like a forest fire that keeps burning until there’s no fuel left. The only fuel that this virus has is humans, and as long as there are unvaccinated people out there who are getting infected, this virus is going to continue to evolve.

Over the last year and a half alone we’ve already seen multiple variants develop. In addition to the delta virus, there’s also the gamma and lambda variants that have begun to spread more widely. And so, the better and quicker that we can control the virus worldwide, the less likely it will be that we see a very resistant strain, which the vaccine might not work against at all.

Myth #2: Only elderly people need to worry about breakthrough infections

While it is true that elderly people may be more at risk for developing a breakthrough infection, they’re not the only ones. Children, who are not yet eligible to receive the vaccine, and immunosuppressed patients, including people with transplants, cancer, rheumatoid arthritis, and lupus, are all at an increased risk too.

The other big unknown is how long the effects of the vaccine last. Some people are now approaching eight months out from getting vaccinated, and we still think that a large group of people are likely to require boosters. But it’s not a one-size-fits-all situation. Elderly and immunosuppressed people will probably need boosters a lot sooner than healthy teenagers will.

Myth #3: If you’re fully vaccinated, you only need to wear a mask in areas with a surge in cases

It’s true that the CDC recently updated its masking guidelines to recommend that fully vaccinated people wear a mask in public when they are in areas with substantial or high transmission. But that kind of recommendation doesn’t really make sense given that local prevalence rates can vary from ZIP code to ZIP code. For example, you’re not going to put your mask on in one town and then take it off the next town over.

The fact is that we are in the midst of a resurgence and so we need to think twice about some of the things that we’ve been doing over the last few months that we should no longer be doing. Given the current situation, I recommend that everybody, whether they’re vaccinated or not, wear a mask inside when they’re in crowded public places, such as a grocery store. And that’s especially true if you live with children who are too young to be vaccinated.

Myth #4: The pandemic will be over soon

We are dealing with an evolving process, and people have to get over this concept that COVID is going to just end. That’s not going to happen. COVID will be here for a long, long time. We need to expect and plan for the long haul. That means masking up, practicing good hand washing hygiene, and taking other precautions to keep ourselves and our loved ones safe.