Despite the fact that vaccines provide strong protection against COVID-19, recent news about breakthrough infections and updated guidelines on mask-wearing for vaccinated individuals have caused confusion and concern. While it is true that vaccinated individuals can still get infected with and carry high levels of the virus, these cases are rare. The majority of infections are still occurring among the unvaccinated population. Even though no vaccine can guarantee complete immunity, being vaccinated is the most important step in keeping yourself and others safe. According to Gregg Gonsalves, an assistant professor of epidemiology at Yale School of Public Health, vaccinated individuals have more freedom but should not assume that everything is back to normal. Erin Bromage, a biology professor at the University of Massachusetts, Dartmouth, compares vaccine antibodies to a sea wall that protects a town from a storm surge. While the wall usually holds up against strong waves, a powerful hurricane like Delta can breach it. Delta is more infectious and poses a greater threat to vaccinated individuals. Vaccines provide additional protection, but may not be completely effective against high viral loads from unvaccinated individuals. Fortunately, current vaccines in the US are highly effective in preventing severe illness, hospitalization, and death. More than 97 percent of individuals hospitalized with COVID-19 have not been vaccinated. Recent data from Singapore reveals that vaccinated patients who are hospitalized with delta breakthrough infections are less likely to require supplemental oxygen and clear the virus faster than unvaccinated patients. Breakthrough infections are rare, despite making headlines. The Centers for Disease Control and Prevention no longer tracks all breakthrough cases, but approximately half of states provide some data on these occurrences. The Kaiser Family Foundation conducted an analysis of state-reported data and discovered that breakthrough cases, hospitalizations, and deaths are uncommon among individuals who have been fully vaccinated against COVID-19. According to the Kaiser analysis, the rate of breakthrough cases among fully vaccinated individuals is less than 1 percent in all reporting states, with numbers ranging from 0.01% in Connecticut to 0.29% in Alaska. However, many breakthrough infections may go unreported since infected individuals may not show symptoms or only 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 while breakthrough infections are rare, the true extent of their rarity is unknown without a population-based sample. Many individuals who experience a mild sore throat for a couple of days may have had breakthrough cases, but it is not due to the vaccine's failure. It has been estimated that the vaccine campaign has prevented 100,000 to 200,000 deaths. The risk of a breakthrough infection is higher when delta has more opportunities to challenge the protection provided by the vaccine. Large events, such as a July 4 celebration in Provincetown, Massachusetts, or the crowded Lollapalooza concert in Chicago, significantly increase the chances of a vaccinated individual coming into contact with an infected person carrying a high viral load. The risk also depends on the number of people one interacts with and the local risk level. In the near future, there may be a surge in Lollapalooza outbreaks due to large crowds creating an ideal environment for the delta variant to spread. The CDC recommends wearing masks in areas designated as orange or red zones on their color-coded map of COVID-19 outbreaks in the United States. These zones indicate high levels of infections, with over 50 cases per 100,000 people in the past week, which currently includes approximately 80 percent of counties in the country. Infection rates are staying relatively low in many parts of the Northeast and Upper Midwest, while the delta variant has caused significant increases in cases in Missouri, Arkansas, Louisiana, and Florida. The issue with relying on a map to monitor case counts is that the numbers are constantly changing and may rise in your local area before the map is updated. Even if you believe you are in a highly vaccinated community with minimal cases, it is important to also consider the case counts and vaccination rates in neighboring areas since people and viruses can easily cross state and county lines. While most experts agree that wearing a mask outdoors is unnecessary if you are not in a crowded setting and are keeping a safe distance from others, it is still recommended to wear a mask at a packed outdoor event to reduce the risk of transmission. J Alex Huffman, an aerosol scientist and associate professor of chemistry and biochemistry at the University of Denver, recommends wearing a mask indoors when around people whose vaccination status is unknown, especially if close proximity or a long duration of time is expected. Although fully vaccinated individuals like himself may not wear a mask in all indoor situations, he still opts for an N95 mask in public indoor spaces. For optimal protection, upgrading to a high-quality medical mask such as an N95, KN95, or KF94 is suggested. Double masking with a surgical mask under a cloth mask is also effective if a medical mask is not available. Wearing a mask with an exhale valve is not recommended as it can allow viral particles to escape, and counterfeit masks may have faulty valves that let germs in. It is important to choose the right mask for the setting. A cloth mask may be sufficient for a short visit to a deserted convenience store in a highly vaccinated area, but a higher-quality mask is more appropriate for air travel or crowded grocery stores, especially in areas with low vaccination rates and high case counts. Masks that have 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 masks, to combat the delta variant. He advised upgrading to masks with high filter quality that fit tightly to the face, ensuring a seal around the edges. According to Huffman, a well-sealed mask is more effective in preventing the spread of the virus than a loose-fitting one. Vaccinated individuals are at a very low risk of contracting the virus when they are with their vaccinated friends and family without masks, according to Huffman. Wearing masks indoors with a small group of vaccinated individuals is not a top concern, but certain situations may call for extra precautions. While it is rare for a vaccinated person to transmit the virus to another vaccinated person, it is still a possibility. A vaccinated individual who engages in activities such as going to crowded bars, packed concerts, or traveling to COVID hotspots poses a higher risk compared to someone who avoids large gatherings and spends time with other vaccinated individuals. Bitton recommends prioritizing outdoor gatherings, especially for families with unvaccinated individuals or those at high risk, due to the spread of the delta variant. It is suggested to host events in a backyard or patio to reduce the risk of COVID-19 transmission, and to minimize time spent indoors. Spending time with small groups of vaccinated friends is safer than attending large parties, even if everyone is believed to be vaccinated. If indoors, opening windows can help improve ventilation. For individuals at very high risk, such as the elderly or immunocompromised, it is reasonable to request even vaccinated individuals to get tested before visiting. A quick and easy home test can be given to guests to ensure they are free of COVID. Whether or not you can still dine at restaurants depends on factors such as local conditions, your comfort level with risk, and the health of those around you. The lowest risk is in communities with high vaccination rates and low case counts. 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 as much protection from vaccines according to studies, may opt to order takeout or eat outside as an extra safety measure. Is it advisable to travel? Should I avoid peanuts and water and continue wearing my mask? While airplanes are generally 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 the airport terminal, while dining at airport restaurants and bars, or going through security. Air on airplanes is replenished every two to three minutes, a faster rate than in grocery stores and other indoor settings. Passengers are required to wear masks, but can remove them to eat or drink. Airplane ventilation systems limit airflow to a few rows to prevent it from circulating throughout the entire cabin, meaning an infected passenger poses the greatest risk to those nearby. Experts recommend using high-quality medical masks like N95 or KF94 when flying. If you do not have a mask, it is recommended that you double mask. For individuals who have been vaccinated, the risk of briefly removing a mask to eat or drink during a flight is low, but it is preferable to keep it on as much as possible. According to the CDC, it is advisable for unvaccinated individuals, including children, to avoid flying. Bromage shared that he recently traveled by air and briefly removed his mask to have a drink, but kept it on for the majority of the flight. He mentioned that he would feel more at ease taking off his mask to eat if he knew that the people next to him were vaccinated. He mentioned that he would be particularly worried if the person sitting next to him did not seem to be taking COVID precautions seriously, such as wearing a mask improperly. He emphasized the importance of keeping a mask on, especially when sitting next to a talkative stranger. The safety of buses, subways, and trains for vaccinated individuals depends on the precautions taken by others, as most public transportation still requires mask-wearing. Although vaccinated individuals are well-protected, the risk of viral exposure is higher on longer rides or in crowded train cars or buses. Many individuals rely on public transportation to commute to work or school, and it is advised to wear a properly fitted medical mask or two masks. If using public transit is not necessary, individuals should take into account the local vaccination rates and the trend in case counts before deciding. As for hugging and visiting older relatives or unvaccinated children, vaccinated individuals can generally do so safely without masks. However, parents of unvaccinated children need to consider additional risks, especially when visiting older family members. In communities where there are few COVID-19 cases and high vaccination rates, it is generally considered safe for unvaccinated children from a single household to visit vaccinated grandparents. However, with the spread of the delta variant and children returning to school, the risk of close contact also increases for older or immune-compromised individuals who are more susceptible to complications from COVID-19, even if they are vaccinated. When families plan a visit to a high-risk relative, it is recommended to limit other exposures by avoiding activities like dining out or going to the gym in the week leading up to the visit. Although the risk of a vaccinated person spreading COVID-19 is low, vaccinated grandparents should also minimize their personal exposure when spending time with unvaccinated children. Aerosol scientist Huffman mentioned that he has not been wearing masks indoors with his elderly parents because he is 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 indoors when with vulnerable individuals. Rapid home tests are an additional precaution to take when visiting elderly relatives or those with weakened immune systems. 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. By testing before gathering, you can ensure everyone is clear and enjoy your time together." If you are diagnosed with COVID-19 in the United States, it is highly likely that you have the delta variant. The CDC estimates that delta now makes up over 82 percent of cases in the US, and it has also become dominant in many other countries. The World Health Organization reported in late July that delta accounted for at least 75 percent of cases in countries such as Australia, Bangladesh, Botswana, China, Denmark, India, Indonesia, Israel, Portugal, Russia, Singapore, South Africa, and the UK. However, standard COVID tests cannot determine if your infection was caused by the delta variant or another strain of the virus. Although health departments may utilize genomic sequencing to determine the prevalence of various variants within a community, this data is usually not disclosed to individuals. It is still important to isolate and consult a healthcare professional if experiencing low blood oxygen levels, difficulty breathing, or other concerning symptoms.