Even though vaccines are highly effective in protecting against COVID-19, recent news of breakthrough infections and updated guidelines on mask-wearing for vaccinated individuals have caused confusion and concern. While studies have shown that vaccinated people can still get infected with high levels of the virus, these cases are rare compared to the unvaccinated population. It is essential to remember that being vaccinated is the most crucial step in keeping yourself and your loved ones safe. Although vaccinated individuals have more freedom, it is important to recognize that the situation is not the same as it was before the pandemic. While vaccines provide strong protection, they do not offer complete immunity, so it is still necessary to be cautious, especially with the Delta variant circulating. 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 withstands the pounding waves, a strong hurricane, like the Delta variant, can sometimes break through. Delta is more infectious and poses a greater challenge to vaccinated immune systems. Vaccinations offer additional protection, but may not always hold up against a significant threat, such as being near an unvaccinated person with a high viral load. Fortunately, the current vaccines in the United States are highly effective in preventing severe illness, hospitalization, and death. Over 97 percent of COVID-19 hospitalizations involve individuals who 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. Breakthrough infections are rare, although they receive widespread media coverage. While the CDC no longer tracks all breakthrough cases, approximately half of states provide some data on such occurrences. The Kaiser Family Foundation recently conducted an analysis of state-reported data and discovered that breakthrough cases, hospitalizations, and deaths are uncommon occurrences 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 percentages ranging from 0.01% in Connecticut to 0.29% in Alaska. However, many breakthrough infections likely go unreported because those infected may not show symptoms 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 while breakthrough infections are rare, the true rarity of these occurrences is unknown without a population-based sample. It is uncertain whether many individuals with a mild scratchy throat for a few days have actually had breakthrough cases, but it is not a failure of the vaccine. Estimates suggest 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 in crowded events, such as the July 4 celebration in Provincetown, Massachusetts, or the packed Lollapalooza concert in Chicago. The more people one comes into contact with, the higher the risk, depending on the local risk climate. In the near future, there may be a surge in Lollapalooza outbreaks due to large crowds, which is conducive to the spread of the delta variant. The CDC has a color-coded map indicating COVID-19 outbreaks in the US, with blue and yellow zones representing low infection levels and orange and red zones indicating areas with more than 50 cases per 100,000 people in the past week. The agency recommends wearing masks in orange and red zones, which currently includes about 80 percent of US counties. Infection rates in the Northeast and Upper Midwest are still relatively low, whereas there have been significant spikes in cases in Missouri, Arkansas, Louisiana, and Florida due to the delta variant. The issue with relying on a map for case counts is that the numbers are changing quickly and may increase in your local area before the map is updated. Even if you believe you are in a highly vaccinated community with low case counts, it is important to also consider the situation in nearby communities as people and viruses move across state and county lines frequently. Experts generally agree that wearing a mask outdoors is not necessary if you are not in a crowd and are at least 6 feet away from individuals whose vaccination status is unknown. However, attending a crowded outdoor event is still considered risky, and if you do choose to go, it is recommended to wear a mask. 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 you will be in close proximity to them for an extended period of time. Despite being fully vaccinated, Huffman still wears an N95 mask in indoor public spaces for added protection. For the best protection, it is advised to use a high-quality medical mask like an N95, KN95, or KF94, with a preference for authentic products. If a medical mask is not available, double masking with a surgical mask under a cloth mask can still provide strong protection. 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 advisable to choose your mask based on the situation – a cloth mask may suffice for a brief visit to a deserted 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 with straps or ties around the back of the head provide a tighter seal than those with ear loops. Huffman stated that in order to combat the delta variant, it is important to enhance previous mitigation efforts, including the use of masks. He strongly advises people to switch to masks with high filter quality that fit tightly to the face. The most important factor, according to him, is to ensure the mask is sealed well all around the edges, including over the nose bridge, by the cheeks, and under the chin. Therefore, 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 with other vaccinated friends and family members without masks, according to Huffman. While wearing a mask may not be necessary in indoor settings with a small group of vaccinated individuals, certain situations may warrant extra precautions. While it is uncommon for a vaccinated person to transmit the virus to another vaccinated person, it is still theoretically possible. A vaccinated individual who frequents crowded places or travels to COVID hotspots poses a greater risk compared to someone who avoids large gatherings and primarily interacts with other vaccinated individuals. With the delta variant becoming more widespread, Bitton recommends prioritizing outdoor gatherings, especially for families with unvaccinated individuals or those at higher risk. Moving your event to a backyard or patio and reducing indoor time can decrease the chances of exposure. Opting for smaller gatherings with vaccinated friends is safer than attending large parties, even if everyone claims to be vaccinated. When indoors, opening windows can help with ventilation. For those at a very high risk, such as older individuals or those with weakened immune systems, it may be appropriate to request testing for even vaccinated individuals before a visit. A straightforward and quick home test can be provided to guests to ensure that everyone is free of COVID-19. Whether or not you can still dine at restaurants depends on various factors such as local conditions, your comfort level with risk, and the health status of those around you. The risk is lowest in areas with high vaccination rates and minimal case numbers. 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 receive less protection from vaccines according to studies, may consider ordering takeout or dining outdoors for additional safety measures. Is it safe 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 advisable to take precautions. The risk of being exposed to an infected person may be higher in airport terminals, airport restaurants and bars, or while going through security. On airplanes, the air is circulated every two to three minutes which is more frequent than in grocery stores and other indoor spaces. Passengers are allowed to remove masks to eat or drink, but ventilation systems keep airflow contained to a few rows to prevent spreading throughout the cabin. Infected passengers pose the most risk to those sitting nearby. Experts recommend using high-quality medical masks like N95 or KF94 when flying. If you do not possess a mask, it is recommended to wear two. While the risk is low for vaccinated individuals to briefly remove their mask to eat or drink during a flight, it is better to keep it on as much as possible. The CDC advises unvaccinated individuals, including children, to avoid flying. Bromage shared that he recently flew and removed his mask briefly to drink, but kept it on for the majority of the flight. He expressed that he would feel more at ease removing his mask to eat if he knew his neighboring passengers were vaccinated. He mentioned that he would be more worried if the individual next to him appeared unconcerned about COVID precautions or wore their mask improperly. He suggested keeping the mask on when seated next to strangers, especially talkative ones. Despite being vaccinated, the safety of buses, subways, and trains for vaccinated individuals is still a concern. Most public transportation systems still mandate mask-wearing, which reduces the risk of exposure. However, the longer the ride and the more crowded the vehicle, the higher the risk of viral transmission, even for vaccinated individuals. Many individuals rely on public transportation to commute to work or school, and it is advised to wear a properly fitting medical mask or double mask. When considering whether to use public transit, it is important to take into account local vaccination rates and the trend of case counts. As for hugging and visiting older relatives, vaccinated individuals can generally do so safely without masks. However, parents of unvaccinated children should be more cautious, especially when visiting older relatives. In areas with few COVID-19 cases and high vaccination rates, it is generally considered safe for unvaccinated children from one household to visit vaccinated grandparents. However, as the delta variant spreads and children go back to school, the risk of close contact increases for older or immunocompromised individuals who are more susceptible to complications from COVID-19, even if they are vaccinated. When families plan to visit a high-risk relative, it is advisable to minimize other exposures by avoiding activities such as dining out or going to the gym in the week leading up to the visit. While the risk of a vaccinated person spreading COVID-19 is low, vaccinated grandparents should also reduce their personal exposure when spending time with unvaccinated children. Aerosol scientist Huffman mentioned that she has not been wearing masks indoors with her elderly parents as she is still cautious about wearing masks in public places. "If my interactions increased my overall risk of exposure, I would strongly consider wearing a mask indoors with vulnerable individuals. Rapid home tests are an additional precaution when visiting grandparents or immune-compromised family members. Taking a test a few days before and on the day of the visit can provide peace of mind. Home tests are a great option for those feeling anxious about the virus right now," Bromage explained. "By testing before gathering, we can ensure everyone is clear and safely enjoy time together." If you are diagnosed with COVID-19 in the US, it is highly likely that you have the delta variant, according to the CDC. The delta variant has become the dominant strain in the US and many other countries, including 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 is specifically caused by the delta variant or another variant of the virus. Health departments may utilize genomic sequencing to determine the prevalence of various variants within a population, but this data is usually not disclosed to individuals. It is important to continue isolating and consulting with medical professionals if experiencing low oxygen levels, difficulty breathing, or any concerning symptoms.