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Should vaccinated people be breaking infections?

How afraid should vaccinated people be of contracting Covid-19? If you are vaccinated, are you still able to pass the coronavirus on to others, such as young children too young to get vaccinated on their own? Does the more transmissible Delta variant change the equation, and what precautions should vaccine recipients still take?

For advice in these uncertain times, we turned to CNN medical analyst Dr Leana Wen. Wen is an emergency physician and visiting professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also the author of a new book next week, “Lifelines: A Doctor’s Journey in the Fight for Public Health”.
Dr Leana Wen: Yes they can. This is what Covid-19 vaccines are used for. First and foremost, they protect you very well against serious illnesses. This is the key. It is a disease that has claimed the lives of over 600,000 Americans and millions of people around the world. If you get vaccinated, you know that it is very unlikely that you will become so seriously ill that you need to be hospitalized or succumb to the disease. According to federal health officials, 99.5% of deaths from Covid-19 are now among the unvaccinated. This is a real testament to the power of vaccines.
Vaccines also protect against Covid-19 disease, but this protection is not 100%. With the Delta variant, vaccines may be even less effective against mild illnesses, but still effective against serious illnesses.

This means that breakthrough infections – or infections in fully vaccinated people – can and do happen.

CNN: Does it matter if you are in a community with a lot of infections? Are you more likely to get a breakthrough infection?

Magnifying glass: Yes, and that is why what is going on around you matters, even if you are fully immunized. The risk is additive. The vaccine protects you well, but if you are constantly exposed to people with coronavirus, at some point you could have a breakthrough infection.

I have used the analogy of a raincoat before. The vaccine is an excellent raincoat. If you’re in the occasional drizzle, you’ll probably be fine. But if you go from thunderstorm to thunderstorm, at some point you might get wet.

This is also why we should not view vaccination as a simple individual choice. Even if you yourself are vaccinated, it is important that others around you are also vaccinated.

CNN: Do we know how common breakthrough infections are or whether people who are vaccinated but infected are able to spread to others?

Magnifying glass: These are really important questions, and unfortunately we don’t know the answers. In May, the U.S. Centers for Disease Control and Prevention decided to stop tracking mild infections. They only report cases of breakthrough infections severe enough to lead to hospitalization and death. Many of us in public health have argued that we also need to know the data on mild infections. It is important to know how often this happens and among whom. For example, are they more common in the elderly and those with weakened immune systems, suggesting that these people might need a booster sooner? Do they increase in frequency after a certain point after vaccination, and are they more common with one vaccine than with another? Do people with breakthrough infections develop long-distance Covid?
Another key question is whether people with breakthrough infections are able to transmit Covid-19 and infect others. Previous studies have found that vaccination also significantly reduced the amount of virus a person exposed to Covid-19 would carry. That even if they are positive or develop mild symptoms, they are unlikely to infect others. However, these studies were done before the Delta variant became the dominant form of the virus in the United States – the CDC reported that 83% of cases in the United States are now due to Delta.
Should vaccinated people be breaking infections?

Other research shows that unvaccinated people infected with the Delta variant carry 1,000 times more virus than people with the original variant. This calls into question what happens if someone is vaccinated but infected with the Delta variant. We just don’t know, at this point, how likely it is that a person vaccinated with a breakthrough infection from the Delta variant is contagious to others.

CNN: Do the unknowns around the Delta variant change your recommendations for vaccinated people interacting with others?

Magnifying glass: I would be very careful until we have more data. A vaccinated person around other fully vaccinated people is probably quite safe and would not need precautions such as masking and distancing. On the other hand, a vaccinated person who is constantly exposed to unvaccinated people, in crowded indoor places where no one wears a mask, could themselves be infected. And even if they don’t show any symptoms, there is certainly the possibility that they are carriers of the virus and infect other people.

Until we know if people who have been vaccinated but get the Delta variant could pass it on to others, I urge people to be careful if they live at home with unvaccinated or immunocompromised family members. . They should consider wearing masks in indoor spaces like grocery stores and try to avoid high-risk environments like crowded bars where others around them are unmasked and have unknown vaccine status.

CNN: To be clear, would you still recommend vaccines?

Magnifying glass: Absoutely. The most important thing Covid-19 vaccines do is protect against hospitalization and death. They have proven to be remarkably effective at this, even with the Delta variant. Breakthrough infections are to be expected, and the more infections there are among the unvaccinated, the more infections there will be among those who are vaccinated.

The key to stopping the pandemic is for us to achieve a level of immunity high enough that the virus has nowhere to go. We can do it, but we all need to do our part and get vaccinated. Vaccination protects the individual, and it also protects others around us.


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