The test results that hot day in early August shouldn鈥檛 have surprised me 鈥� all the symptoms were there. A few days earlier, fatigue had enveloped me like a weighted blanket. I chalked it up to my weekend of travel. Next, a headache clamped down on the back of my skull. Then my eyeballs started to ache. And soon enough, everything tasted like nothing.
As a reporter who鈥檚 covered the coronavirus since the first confirmed U.S. case landed in Seattle, where I live, I should have known what was coming, but there was some part of me that couldn鈥檛 quite believe it. I had a breakthrough case of covid-19 鈥� despite my two shots of the Pfizer-BioNTech vaccine, the second one in April.
I was just one more example of our country鈥檚 tug and pull between fantasies of a post-covid summer and the realities of our still-raging pandemic, in which even the vaccinated can get sick.
Not only was I sick, but I鈥檇 exposed my 67-year-old father and extended family during my first trip back to the East Coast since the start of the pandemic. It was just the scenario I had tried to avoid for a year and a half.
Where did I get it? Who knows. Like so many Americans, I had loosened up on wearing masks all the time and physical distancing after getting fully vaccinated. We had flown across the country, seen friends, stayed at a hotel, eaten indoors and, yes, even gone to a long-delayed wedding with other vaccinated people.
I ended up in quarantine at my father鈥檚 house.聽(taken a day apart) came back negative, but I could tell I was starting to feel sick. After my second negative test, the nurse leveled with me. 鈥淒on鈥檛 hang your hat on this,鈥� she said of the results. Sure enough, a few days later the results of a PCR test for the coronavirus (this one sent to a lab) confirmed what had become obvious by then.
It was a miserable five days. My legs and arms ached, my fever crept up to 103 and every few hours of sleep would leave my sheets drenched in sweat. I鈥檇 drop into bed exhausted after a quick trip to the kitchen. To sum it up, I鈥檇 put my breakthrough case of covid right up there with my worst bouts of flu. Even after my fever broke, I spent the next few weeks feeling low.
Of course, I am very lucky. I didn鈥檛 go up against the virus with a naive immune system, like millions of Americans did before vaccines were widely available. And, in much of the world, vaccines are聽蝉迟颈濒濒听a distant promise.
鈥淵ou probably would have gotten much sicker if you had not been vaccinated,鈥澛燚r. , an infectious-disease physician at the University of California-San Diego, explained to me recently.
As I shuffled around my room checking my fever, it was also reassuring to know that my chances of ending up in the hospital were slim, even with the delta variant. And now, about a month later, I鈥檝e made a full recovery.
The reality is breakthrough cases are becoming more common. Here鈥檚 what I wish I鈥檇 known when those first symptoms laid me low.
1. Is it time for a reality check about what the vaccines can 鈥� and can鈥檛 do?
The vaccines aren鈥檛 a force field that wards off all things covid. They were given the green light because they greatly lower your chance of getting seriously ill or dying.
But it was easy for me 鈥� and I鈥檓 not the only one 鈥� to grab onto the idea that, after so many months of trying not to get covid, the vaccine was, more or less, the finish line. And that made getting sick from the virus unnerving.
After all, there were reassuring findings聽that the vaccine was remarkably good at stopping any infection, even mild ones.
鈥淭here was so much initial euphoria about how well these vaccines work,鈥� said Dr.聽, an infectious-disease physician and the public health officer for Seattle and King County. 鈥淚 think we 鈥� in the public health community, in the medical community 鈥� facilitated the impression that these vaccines are bulletproof.鈥�
It鈥檚 hard to keep adjusting your risk calculations. So if you鈥檇 hoped to avoid getting sick at all, even slightly, it may be time for a 鈥渞eset,鈥� Duchin said. This isn鈥檛 to be alarmist but a reminder to clear away expectations that covid is out of your life, and stay vigilant about commonsense precautions.
2. How high are my chances of getting a breakthrough case these days?
It used to be quite rare, but the rise of delta has changed the odds.
鈥淚t鈥檚 a totally different ballgame with this delta phase,鈥� said聽, a professor of molecular medicine and director of the Scripps Research Translational Institute in San Diego. 鈥淚 think the chance of having a symptomatic infection has gone up substantially.鈥�
But 鈥渜uantifying that in the U.S. is very challenging鈥� because our 鈥渄ata is so shoddy,鈥� he said.
The vaccinated still have a considerably lower chance of getting infected than those who aren鈥檛 protected that way. Los Angeles County collected data over the summer as the delta variant started to surge: Unvaccinated people were聽聽than those who were vaccinated.
3. How careful do I need to be if I want to avoid a breakthrough?
Looking back, I wish I鈥檇 taken more precautions.
And my advice to friends and family now is: Wear masks, stay away from big gatherings with unvaccinated people and cut down on travel, at least until things calm down.
The U.S.聽is averaging a day (about twice what it was when I fell sick), hospitals are overwhelmed, and the White House has proposed booster shots. Scientists are still making sense of what鈥檚 happening with breakthrough cases.
In many parts of the U.S., we鈥檙e all more likely to run into the virus than we were in the spring. 鈥淵our risk is going to be different if you are in a place that鈥檚 very highly vaccinated, with very low level of community spread,鈥� said Dr.聽, a specialist in infectious diseases at the University of Michigan. 鈥淭he piece that鈥檚 important is what鈥檚 happening in your community.鈥�
4. What does a 鈥渕ild鈥� case of covid feel like?
In my case, it was worse than I expected, but in the parlance of public health, it was 鈥渕ild,鈥� meaning I didn鈥檛 end up in the hospital or require oxygen.
This mild category is essentially a catchall, said聽, who chairs the Department of Medicine at the University of California-San Francisco. 鈥淢ild鈥� can range from 鈥渁 day of feeling crummy to being completely laid up in bed for a week, all of your bones hurt and your brain isn鈥檛 working well.鈥�
There鈥檚 not great data on the details of these mild breakthrough infections, but so far it appears that 鈥測ou do way better than those who are not vaccinated,鈥� said, an occupational medicine specialist at the University of Utah who was part of a by the Centers for Disease Control and Prevention on breakthrough infections.
Yoon鈥檚 study, published in June with data collected before the delta surge, found that the presence of fever was cut in half, and the days spent in bed reduced by 60% among people with breakthrough infections, compared with unvaccinated people who got sick.
If you鈥檙e vaccinated, the聽that of the unvaccinated, according to the latest data from the CDC. Those who get severely and critically ill with a breakthrough case tend to be older 鈥� in one study done before delta,聽聽鈥� with underlying medical conditions such as cardiovascular disease.
5. Can I spread it to others, and do I need to isolate?
Unfortunately, you still have covid and need to act like it.
Even though my first two tests were negative, I started wearing a mask at my house and keeping my distance from my vaccinated family members. I鈥檓 glad I did: No one else got sick.
The delta variant is more than twice as contagious as the original strain of the virus and can build up quickly in your upper respiratory tract, as was shown in聽, over the summer.
鈥淓ven in fully vaccinated, asymptomatic individuals, they can have enough virus to transmit it,鈥� said聽Dr. Robert Darnell, a physician-scientist at The Rockefeller University.
The science isn鈥檛 settled about just how likely vaccinated people are to spread the virus, and it does appear that聽聽faster in people who are vaccinated.
Still, wearing masks and staying isolated from others if you test positive or have symptoms is absolutely critical, Darnell said.
6. Could I get long covid after a breakthrough infection?
While there鈥檚 not a lot of data yet, research does show that breakthrough infections can lead to the kind of persistent symptoms that characterize , including brain fog, fatigue and headaches. 鈥淗opefully that number is low. Hopefully it doesn鈥檛 last as long and it鈥檚 not as severe, but it鈥檚 just too early to know these things,鈥� Topol said.
Recent research from the United Kingdom聽聽are about 50% less likely to develop long covid than those who are unvaccinated.
This story is from a reporting partnership that includes NPR and KHN.