Even though vaccines are highly effective in preventing serious illness from COVID-19, recent headlines about breakthrough infections and updated guidelines on mask-wearing for vaccinated individuals have caused confusion and concern. While research has shown that vaccinated individuals can still get infected and carry high levels of the virus, such cases are rare compared to the unvaccinated who are more likely to spread the virus. Vaccination remains crucial in protecting oneself and others, according to Gregg Gonsalves, an assistant professor of epidemiology at the Yale School of Public Health. It's important to recognize that no vaccine provides complete immunity, even against variants like Delta. Erin Bromage, a biology professor at the University of Massachusetts, Dartmouth, explains that vaccine antibodies can be compared to a sea wall that protects a town from a storm surge. While the wall usually holds up against waves, a powerful hurricane could cause some water to seep through. The Delta variant of the virus is like a viral hurricane, being highly infectious and posing a significant challenge even to vaccinated individuals. Although vaccinations provide additional protection, they may not always be sufficient when faced with a strong threat, such as being in close proximity to an unvaccinated individual with a high viral load. However, the current vaccines available in the United States are effective in preventing severe illness, hospitalization, and death. Over 97 percent of individuals hospitalized with COVID-19 have not been vaccinated. Recent data from Singapore indicates that vaccinated individuals who are hospitalized with delta breakthrough infections are less likely to require supplemental oxygen and clear the virus faster than unvaccinated patients. While breakthrough infections do occur, they are still rare. Despite the Centers for Disease Control and Prevention no longer tracking all breakthrough cases, approximately half of states provide some data on these occurrences. The Kaiser Family Foundation recently examined state-reported data and discovered that breakthrough cases, hospitalizations, and deaths are highly uncommon among individuals who have been fully vaccinated against COVID-19. The rate of breakthrough cases among fully vaccinated individuals is less than 1% in all reporting states, with numbers ranging from 0.01% in Connecticut to 0.29% in Alaska, as per the Kaiser analysis. However, many breakthrough infections may go unreported as infected individuals may be asymptomatic or have mild symptoms that resolve before they consider getting tested. Dr. Asaf Bitton, executive director of Ariadne Labs at Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health in Boston, stated that although breakthrough infections are rare, without a population-based sample, it is difficult to determine their exact frequency. It is uncertain if many individuals who experienced a mild sore throat for a couple of days actually had breakthrough cases of COVID-19. The occurrence of breakthrough cases is not a failure of the vaccine, as it has been estimated that the vaccine campaign has prevented 100,000 to 200,000 deaths. The risk of a breakthrough infection increases when individuals are exposed to the Delta variant multiple times, such as in large events like the July 4 celebration in Provincetown, Massachusetts, or the Lollapalooza concert in Chicago. The more people one comes into contact with, the higher the risk of infection, depending on the local risk level. In the near future, there may be a surge in Lollapalooza cases due to the large crowds creating an ideal environment for the delta variant to spread. The CDC's color-coded map of COVID-19 outbreaks in the United States shows that people should wear masks in orange or red zones, where cases in the past week exceeded 50 cases per 100,000 people. Currently, approximately 80 percent of counties in the United States fall into these higher risk zones. Infection rates are still low in the Northeast and Upper Midwest, but the delta variant has led to significant increases in cases in Missouri, Arkansas, Louisiana, and Florida. The issue with relying on a map for case counts is that the numbers can change rapidly, potentially leading to a surge in cases in your local area before the map is updated. Even if you are confident that your community is highly vaccinated with low case counts, it is important to also consider the situation in nearby communities, as people and viruses can easily cross state and county lines. While most experts believe it is unnecessary to wear a mask outdoors if you are not in a crowd and are at least 6 feet away from others whose vaccination status is unknown, attending a crowded outdoor event still carries risk and wearing a mask is advisable in such situations. J Alex Huffman, an aerosol scientist and associate professor at the University of Denver, recommends wearing a mask indoors with people whose vaccination status is unknown, especially if you will be close to them for an extended period. While he is fully vaccinated and doesn't always wear a mask indoors, he opts for an N95 mask in public spaces. For maximum protection, consider upgrading to a high-quality medical mask like an N95 or KN95. A KF94 mask from Korea is another good option, as counterfeits are less common. If you don't have a medical mask, double masking with a surgical mask underneath a cloth mask can still provide strong protection. Wearing a mask with an exhale valve is not recommended because it can allow viral particles to escape, and counterfeit masks with faulty valves may let germs in. It is important to choose the appropriate mask based on the setting. A cloth mask may suffice for a brief visit to an empty convenience store in a highly vaccinated area, but a higher-quality mask is more appropriate for air travel or crowded grocery stores, especially in communities with low vaccination rates and high case counts. Masks with straps or ties around the back of the head provide a tighter seal compared to masks with ear loops. Huffman emphasized the need for improved mitigation efforts, including the use of high-quality masks that fit tightly to the face, to combat the delta variant. He recommended ensuring the mask is sealed well around the edges, such as over the nose bridge, by the cheeks, and under the chin. According to Huffman, a tightly fitting mask is more effective than a loose-fitting one. Vaccinated individuals have a very low risk of contracting the virus when they are in the company of their vaccinated friends and family without masks. Wearing a mask is not seen as essential in such situations, according to Huffman. However, certain situations may call for additional precautions. Although it is uncommon for a vaccinated person to transmit the virus to another vaccinated individual, there is still a theoretical possibility. A vaccinated individual who frequents crowded places like bars, concerts, or COVID hotspots poses a higher risk compared to someone who avoids crowds and primarily interacts with other vaccinated individuals. With the spread of the delta variant, Bitton recommends prioritizing outdoor gatherings, especially for families with unvaccinated children or high-risk family members. Holding events in a backyard or patio and limiting time indoors can reduce the risk of transmission. Spending time with small groups of vaccinated friends is safer than attending large parties, even if everyone is believed to be vaccinated. When indoors, opening windows for better ventilation is advised. For individuals at very high risk, such as the elderly or immunocompromised, it is reasonable to request that even vaccinated people get tested before visiting. One option is to provide guests with a quick and easy home test to ensure that everyone is free of COVID. Whether or not it is safe to dine at restaurants depends on factors such as local conditions, your comfort level with risk, and the health of those around you. Communities with high vaccination rates and low case counts have the lowest risk. For example, dining at a restaurant in Vermont, where two-thirds of the population is vaccinated, is less risky than dining indoors in Alabama or Mississippi, where only one-third of residents are vaccinated. Parents of unvaccinated children and individuals with compromised immune systems, who may not receive full protection from vaccines according to studies, may choose to order takeout or eat outside as an extra measure of safety. Is it advisable to travel? Should I avoid peanuts and water and continue wearing my mask? While airplanes are usually well ventilated and not a significant source of outbreaks, it is still wise to take precautions. The risk of coming into contact with an infected individual may be higher in airport terminals, while sitting in airport restaurants and bars, or going through security. In airplanes, the air is exchanged approximately every two to three minutes, which is faster than in grocery stores and other indoor environments. Passengers are required to wear masks on airplanes but can remove them to eat or drink. Airplane ventilation systems limit airflow to a few rows to prevent the spread of air throughout the cabin, meaning that an infected passenger is most likely to infect those nearby. Experts recommend using high-quality medical masks, such as N95 or KF94, when flying. If you do not possess a mask, it is recommended to wear two masks. The risk of taking off a mask briefly to eat or drink during a flight is low for a vaccinated individual, but it is better to keep it on as much as possible. The CDC recommends that unvaccinated individuals, including children, should avoid flying. Bromage shared that he recently flew and removed his mask briefly to drink a beverage, but kept it on for the majority of the flight. He expressed that he would feel more at ease taking off his mask to eat if he was aware that the individuals next to him were vaccinated. He mentioned that he would be more worried if the person beside him appeared to be unconcerned about COVID precautions or wearing their mask incorrectly. He suggested keeping the mask on, especially when seated next to a talkative individual. The safety of buses, subways, and trains for vaccinated individuals depends on the continued requirement for masks on public transportation. Even though vaccinated people are highly protected, the risk of exposure to the virus rises with longer rides and more crowded conditions on public transportation. Many individuals rely on public transportation to commute to work or school, and it is advisable to wear a properly fitted medical mask or double mask while using it. If public transit is not a necessity, one should take into account local vaccination rates and the trend of case counts before deciding to ride. As for hugging and visiting older relatives or unvaccinated children, it is generally safe for vaccinated individuals to embrace and socialize without masks. However, parents of unvaccinated children need to carefully consider the risks, especially when visiting older family members. In areas where there are few cases of COVID-19 and many people are vaccinated, it is generally considered safe for unvaccinated children from one household to visit vaccinated grandparents. However, with the spread of the delta variant and children going back to school, the risk of close contact increases for older or immunocompromised individuals who are more susceptible to severe illness from COVID-19, even if they are vaccinated. When families plan a visit to a high-risk relative, it is recommended to minimize other exposures by avoiding activities like dining out or going to the gym in the week leading up to the visit. Even though the chances of a vaccinated person spreading the virus are low, vaccinated grandparents should also reduce their own exposure when spending time with unvaccinated children. One aerosol scientist, Huffman, mentioned that they do not wear masks indoors around their elderly parents yet, but are still cautious about wearing masks in public places. "If I had more interactions that increased my overall risk of exposure, I would strongly consider wearing a mask when indoors with vulnerable individuals. Rapid home tests are an additional precaution when visiting grandparents or immune-compromised family members. It is recommended to take a test a few days before the visit and also on the day of the visit. Home tests are a good option for those feeling anxious about the virus at the moment. Testing before coming together allows for peace of mind and enjoyment of time spent together." If you test positive for COVID-19 in the US, it is highly likely that you have the delta variant, according to the CDC. The delta variant is now the most common strain in the US, accounting for over 82% of cases. This variant has also become dominant in several other countries, with the World Health Organization reporting that it makes up 75% or more of cases in countries such as Australia, Bangladesh, Botswana, China, Denmark, India, Indonesia, Israel, Portugal, Russia, Singapore, South Africa, and the UK. However, traditional COVID tests cannot determine if your infection is specifically caused by the delta variant or another strain of the virus. Although health departments can utilize genomic sequencing to detect the prevalence of various variants in a population, this data is usually not disclosed to individuals. It is still important for individuals to isolate and consult a healthcare professional if they experience low blood oxygen levels, difficulty breathing, or other concerning symptoms.