Although seemingly uncommon, some Americans are falling sick with the coronavirus even though they are fully immunized, in what are known as breakthrough infections.
Public health experts continue to believe that these breakthrough infections are relatively uncommon and rarely result in severe illness or hospitalizations. The vaccines available in the U.S. offer powerful protection from serious covid illness, hospitalization and death. A recent analysis of state-reported data from the Kaiser Family Foundation found that more than 9 in 10 covid-19 cases that resulted in hospitalization and death occurred among people who were not fully vaccinated.
"We always anticipated that there would be some breakthrough infections, because the vaccines at their very best were 95% effective," said Dr. William Schaffner, professor of infectious disease at Vanderbilt University. "The vaccines were designed to prevent severe illness, and they're spectacularly successful at that."
But as the more transmissible delta variant becomes dominant in the U.S., rising numbers of breakthrough cases are being reported, although most are mild.
For Moira Smith and her mother, July promised a glimmer of normalcy after months of isolation. The two flew from Alaska to Houston and visited relatives, celebrating the first birthday of their cousin's granddaughter.
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Smith, 46, knew that her cousin's family was not vaccinated but tried not to dwell on that. She and her mother had both received their Pfizer shots months earlier. In the hotel room one evening, Smith's mother made an offhand comment to her relatives: "You can take your masks off, but you have to promise to get vaccinated," she chided them.
The next morning Smith and her mother were headed home, on a layover in the Seattle airport, when they got the phone call: Their relative's baby had come down with a fever and tested positive for the coronavirus.
Two days later, Smith woke up feeling like she had been "hit by a Mack truck," with body aches and a sore throat, and tested positive for the coronavirus. The next week, her mother, who is 76 and has lung cancer, texted her an emoji of a thermometer indicating she, too, had spiked a fever, and she later wound up in the emergency room with covid.
Despite the threat to at-risk groups, like Smith's mother, experts emphasize that the threat to the vaccinated is limited in scope.
"Delta is vastly more contagious, so as it is spreading among the unvaccinated there is spillover into the vaccinated population," Schaffner said. "The unvaccinated are a big highway of transmission. The vaccinated are a little side street."
Because people infected with the delta variant have far more of the virus in the nose and upper respiratory tract, the importance of mask-wearing has become paramount. After the Centers for Disease Control and Prevention shifted its guidance on masking, recommending that vaccinated people in hot-spot areas resume wearing masks in public indoor spaces, millions of Americans who are fully immunized struggled to adjust their expectations for the fall months that had seemed to offer some semblance of festivity. And a small subset of Americans already has seen their routines upended by breakthrough infections.
Spurred 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 levels of antibodies against the coronavirus.
For some, breakthrough infections have felt like mild allergies, coming with symptoms including a cough, sniffles and a scratchy throat. Others have had more severe cases, where they are bedridden with body aches, fevers and chills. And still others have had some of the telltale signs of covid such as loss of taste and smell, "covid rash" and brain fog.
"We were calling it floaty-head syndrome," said Molly O'Brien-Foelsch, 47, a marketing executive in Pennsylvania who tested positive for the virus after a trip to the British Virgin Islands with her husband last month. "It felt like there was a huge marshmallow on my head."
Scientists believe that breakthrough infections rarely result in severe illness, but there have been cases of prolonged hospitalizations.
Elaina Cary-Fehr's father Isaac, 64, an Uber driver in Austin, Texas, was transferred to a long-term care facility after being hospitalized with covid pneumonia in June and later receiving a tracheotomy tube. He was released from the facility this week.
"I believe in the vaccine, I kept holding on to hope that it would work and it did," Cary-Fehr said. "But I hate that this had to happen to my family."
As many Americans begin the familiar exercise of questioning and calling off plans, scientists are stressing the continued importance of mask-wearing to reduce transmission and infection.
"If you get infected and breathe virus out, it will get trapped by your mask," said John Moore, a professor of microbiology and immunology at Weill Cornell. "These viruses don't have pairs of scissors that can cut through masks."