The same week that the Centers for Disease Control and Prevention relaxed mask recommendations for Americans fully vaccinated against COVID-19, a couple of high-profile cases of breakthrough infections among vaccinated people have raised some questions about whether it’s safe to remove masks indoors just yet.
HBO host and comedian Bill Maher revealed Thursday that he tested positive for the coronavirus despite receiving the vaccine. And this comes on the heels of eight vaccinated New York Yankees members also testing positive for COVID.
Most of these cases are asymptomatic, which suggests that the vaccines are doing their job: reducing the severity of COVID illness if one does get infected, as well as lowering that person’s risk of spreading it to others.
But some people have expressed concern on social media that perhaps the CDC was premature in recommending that vaccinated people don’t have to wear masks inside. “Now we learn Bill Maher has COVID? He is fully vaccinated. This is why I will still wear a mask,” reads one tweet that has been “liked” more than 1,000 times.
So MarketWatch spoke with a couple of health experts to answer questions about breakthrough infections and their implications for easing mask guidelines. The bottom line: a small number of breakthrough cases were always expected, and there is no need to panic over them. But it is important to get vaccinated and stay vigilant, and to follow public health guidelines. Keep in mind that this information is subject to change as we learn more about the virus that causes COVID-19 illness.
Why do breakthrough infections still happen?
Even though the COVID-19 vaccines from Moderna
and Johnson & Johnson
have had high efficacy rates both in clinical trials and in the real world so far, no vaccine is 100% perfect at preventing infection.
“Despite being vaccinated, you have a low but still existent risk of becoming infected,” said Dr. Leana Wen, an emergency physician and public health professor at George Washington University. “Now, the great thing about the vaccines is that they prevent you from becoming severely ill.” So if you do still catch the coronavirus, even though you were vaccinated, “chances are you will have a mild illness, you will not end up in the hospital … and your chance of spreading it to anyone else is very low,” said Wen.
Besides the fact that no vaccine is perfect, breakthrough infections might also occur if a person is immunocompromised, or if their age or medications might weaken their immune system.
“If you are a cancer patient on chemotherapy, or you are on immunosuppressives for a kidney transplant, you also will have a much higher chance of becoming infected despite being vaccinated,” said Wen.
The COVID-19 variants from the U.K., South Africa, India and Brazil may also be more resistant to the vaccines currently available. Immunity also wanes over time, which is why people need to get annual flu shots to boost their immune response to influenza year over year. And infectious disease expert Dr. Anthony Fauci has noted the possibility that a shot could be damaged due to a storage issue, which could lower the effectiveness of a vaccine dose.
How common are breakthrough COVID-19 cases?
Breakthrough cases are rare. As of April 26, 2021, more than 95 million Americans had been fully vaccinated against COVID, and of that 95 million, 9,245 breakthrough infections were reported to the CDC. Among the breakthrough cases, 27% were asymptomatic, 9% went to the hospital, and 1% died.
How do breakthrough infections compare to infections when you’re not vaccinated?
“Even if people do get infected, which is very, very rare breakthroughs, they virtually never get severe disease,” Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, told MSNBC on Friday.
“The primary purpose of the vaccine is really to make sure that, even if there is a rare possibility that you get COVID-19, that you don’t get seriously ill from it,” said Dr. Shobha Swaminathan, associate professor at the Rutgers New Jersey Medical School, and the medical director of the infectious diseases practice at University Hospital. “And it significantly reduces your risk of getting hospitalized or having serious complications or death.”
In the cases of Maher and the Yankees, for example, only one person showed COVID-19 symptoms; the rest were asymptomatic. “We don’t know how these players and coaches would have done clinically if they hadn’t been vaccinated,” said Swaminathan. “We don’t know if they would have gotten much sicker.” In fact, 99.75% of patients hospitalized with COVID-19 between Jan. 1 and April 13 were not fully vaccinated, the Cleveland Clinic reported. And the CDC notes that asymptomatic people are potentially less likely to spread the virus that causes COVID-19 to others, although this is still being investigated.
Do breakthrough infections suggest that we should keep wearing masks indoors?
Health experts say that the real question to ask before deciding to mask up or not is whether you have been vaccinated. If you’re vaccinated, “You’re very safe,” Fauci said on MSNBC on Friday. And the fact is, when you go into a restaurant, store or another place, “you’re not gonna know who’s vaccinated or not,” he added. “But we felt that, all things considered, given the high degree of effectiveness of the vaccines, that you’re OK [to remove your mask indoors if you’ve been vaccinated] because your risk is very, very low.”
Now, could wearing a mask while vaccinated further reduce your risk of getting a breakthrough infection? “Yes,” said Wen, making an analogy to a thunderstorm; the more layers of protection you have, like a raincoat and an umbrella instead of just one or the other, the less likely you are to get wet. Similarly, being vaccinated and wearing a mask can provide extra protection against infection. It’s a personal decision — unless your workplace or a private business keeps a mask mandate on the books.
“The key to your decision-making should be, are you unvaccinated, or are you around people who are unvaccinated?” said Wen. “I’m not worried about being in a room with other people who are fully vaccinated. I’m worried about going into a crowded room with a bunch of people who are not vaccinated and not wearing masks.”
What’s more, Wen says to consider whether community transmission is high in your area, which puts you at higher risk of getting infected whether you’re vaccinated or not, as well as whether you or someone in your household is immunocompromised. In these situations, you should check with your healthcare provider about whether you should still wear a mask indoors, even if you’ve been vaccinated.
What if I think I may have a breakthrough COVID-19 infection?
Getting vaccinated doesn’t mean you should stop getting tested for COVID-19. Quite the opposite; even though we’ve been living with it for more than a year, this is a new virus that health officials are still learning about. So any information about breakthrough cases is vital. “Get tested so we know the type of viruses and variants that are circulating around, so we can have more knowledge and see if [vaccines] need to be fine-tuned and modified,” said Swaminathan. “It’s really important for us to keep an eye on variants, and to see if people will need [vaccine] boosters.”
If you experience COVID-19 symptoms such as fever, a dry cough and shortness of breath, or other signs such as nausea, extreme fatigue and a sudden loss of taste or smell, it’s important to test for COVID-19. Here is the CDC’s current list of symptoms. So if you or someone in your household is showing COVID-19 symptoms, call your doctor or contact your local health department (check out this list of websites to find yours) for guidance on where to get tested and what to do next.
“It is right to be concerned and to be on the lookout, but not to be alarmed,” said Swaminathan.