The vaccines are still highly effective against COVID-19, but reports of breakthrough infections and new guidelines on mask-wearing for vaccinated individuals have caused confusion and concern. Recent research shows that vaccinated people can still get infected with high levels of the virus, but these cases are rare compared to unvaccinated individuals who are the main source of transmission. While vaccination is crucial for safety, it's important to remember that no vaccine is perfect. 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 waves, a powerful hurricane could allow some water to get through. The Delta variant of the virus is like a viral hurricane, more infectious and challenging for even vaccinated immune systems. Vaccinations provide additional protection, but may not always be effective against high viral loads from unvaccinated individuals. Thankfully, current vaccines in the United States are effectively preventing serious illness, hospitalization, and death. Over 97 percent of COVID-19 patients in hospitals are unvaccinated, according to recent data. In Singapore, vaccinated patients hospitalized with delta breakthrough infections require less supplemental oxygen and clear the virus faster than unvaccinated patients. While breakthrough infections are often highlighted in the news, they are still rare. Although the CDC stopped tracking all breakthrough cases in May, about half of states provide some data on these events. The Kaiser Family Foundation recently examined state-reported data and discovered that breakthrough cases, hospitalizations, and deaths are infrequent occurrences among individuals who are fully vaccinated against COVID-19. The rate of breakthrough cases among fully vaccinated individuals is less than 1 percent in all states, varying from 0.01% in Connecticut to 0.29% in Alaska, according to the Kaiser analysis. However, many breakthrough infections may go unreported because 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 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 few days may have had breakthrough cases of COVID-19, but this is not a failure of the vaccine. It has been estimated that the vaccine campaign has prevented 100,000 to 200,000 deaths. The risk of a breakthrough infection increases with more exposure to the delta variant. Large events like the July 4 celebration in Provincetown, Massachusetts, or Lollapalooza in Chicago, pose a greater risk for vaccinated individuals to come into contact with someone carrying a high viral load. The level of risk also depends on the local COVID-19 situation. In the near future, there may be a surge in Lollapalooza outbreaks due to the close proximity of a large number of people, which creates 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, where cases in the past week have exceeded 50 cases per 100,000 people. Currently, approximately 80 percent of counties in the United States fall into this category. Infection rates are staying relatively low in many areas of the Northeast and Upper Midwest, but there have been significant increases in cases due to the delta variant in Missouri, Arkansas, Louisiana, and Florida. The issue with relying on a map for case counts is that the numbers are changing quickly and a surge could happen in your community before the map is updated. Even if you live in a highly vaccinated area 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. It is generally agreed by experts that wearing a mask outdoors is not necessary if you are not in a crowded area and can maintain at least 6 feet of distance from others whose vaccination status is unknown. However, attending a crowded outdoor event is still considered risky, and if you choose to do so, wearing a mask is recommended. J Alex Huffman, an aerosol scientist and associate professor of chemistry and biochemistry 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. Although he is fully vaccinated and does not wear a mask indoors in all situations, he puts on his N95 mask when entering indoor public spaces. It is suggested to upgrade to a high-quality medical mask such as an N95, KN95, or KF94 for maximum protection, ensuring it is not a counterfeit. If a medical mask is not available, double masking with a surgical mask under a cloth mask also provides strong protection. Wearing a mask with an exhale valve should be avoided as it can release viral particles and counterfeit masks may have faulty valves. It is important to choose the appropriate mask based on the situation. For example, a cloth mask may suffice for a brief visit to a vacant convenience store in a highly vaccinated area, but a higher-quality mask is recommended for air travel or crowded grocery stores, particularly 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 masks with ear loops. Huffman stated that previous mitigation efforts must be improved to combat the delta variant, including the use of masks. He advised people to upgrade to masks with high filter quality and a tight fit to the face, emphasizing the importance of a well-sealed mask around the edges. According to him, 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. Wearing masks indoors with a small group of vaccinated individuals is not considered essential by some experts, but there may be situations where additional precautions are necessary. Although it is unlikely for a vaccinated person to transmit the virus to another vaccinated person, there is still a theoretical possibility. Those who frequent crowded places or travel to COVID hot spots pose a greater risk compared to those who avoid large gatherings and primarily interact with vaccinated individuals. With the delta variant spreading, Bitton recommends prioritizing outdoor gatherings, especially for families with unvaccinated children or high-risk family members. Taking events outside to a backyard or patio this summer and minimizing time spent indoors can reduce the risk of exposure. Spending time with smaller groups of vaccinated friends is safer than attending large parties, even if everyone is believed to be vaccinated. When indoors, opening windows can help improve ventilation. If someone in the group is at a very high risk due to age or being immunocompromised, it is reasonable to request that even vaccinated individuals be tested before visiting. A quick and easy at-home test can be provided to guests to ensure that everyone is free of COVID. Whether or not you can still dine at restaurants depends on local circumstances, your willingness to take risks, and the health status of those around you. The risk is lowest in areas with high vaccination rates and low case numbers. For example, dining at a restaurant in Vermont, where two-thirds of the population is vaccinated, is safer than dining indoors in Alabama or Mississippi, where only one-third of residents are vaccinated. Parents of unvaccinated children and individuals with weakened immune systems, who may not receive as much protection from vaccines according to studies, may want to consider ordering takeout or eating outdoors as an extra safety measure. 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 dining at airport restaurants or bars, or going through security. Airplane ventilation systems refresh the air every two to three minutes, a faster rate than in grocery stores and other indoor spaces. Passengers are required to wear masks but can remove them to eat or drink. Airflow is contained to a few rows to prevent circulation throughout the cabin, meaning an infected passenger poses the most risk to those nearby. Experts recommend using high-quality medical masks such as N95 or KF94 when flying. If you do not have access to a mask, it is recommended to wear two masks. While the risk of a vaccinated person removing their mask briefly to eat or drink during a flight is low, it is still better to keep it on as much as possible. The CDC advises that unvaccinated individuals, including children, should avoid flying. Bromage shared that he recently flew and briefly removed his mask to 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 the people next to him were vaccinated. He mentioned that he would be more worried if the person beside him showed no concern for COVID precautions or wore the mask incorrectly. He emphasized the importance of keeping the mask on when seated next to a random or talkative individual. The safety of buses, subways, and trains for vaccinated individuals varies. Although most public transportation systems still mandate mask-wearing, which reduces risk, the level of viral exposure can increase on longer and more crowded rides. Despite being well-protected, vaccinated individuals should remain cautious in such situations. 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 while using it. When it comes to choosing whether to use public transportation, one should take into account the vaccination rates in their area and the trend of rising case counts. When it comes to hugging and visiting older relatives or unvaccinated children, it is generally deemed safe for vaccinated individuals to hug and socialize without masks, but parents of unvaccinated children need to consider the additional risks, especially when visiting older relatives. In areas with low COVID-19 cases and high vaccination rates, it is generally safe for unvaccinated children from one household to visit vaccinated grandparents. However, with the spread of the delta variant and children returning to school, the risk of close contact increases for older or immunocompromised individuals who are more susceptible to severe COVID-19 complications. When families plan visits to high-risk relatives, 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 risk of a vaccinated person transmitting COVID-19 is low, vaccinated grandparents should also limit their own exposure when spending time with unvaccinated children. Aerosol scientist Huffman stated that he has not been wearing masks indoors with his elderly parents because he is cautious about mask-wearing in public settings. "If I had more interactions that increased my overall risk of exposure, I would strongly consider wearing a mask indoors with vulnerable individuals. Rapid home tests are an additional precaution to take when visiting grandparents or immune-compromised family members. It is recommended to take a test a few days before the visit as well as on the day of the visit. Home tests are seen as a helpful option for those feeling anxious about the virus. By testing before gathering, you can ensure everyone is clear and enjoy the time together. How can I determine if I have the delta variant?" 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 now makes up more than 82 percent of cases in the US and has also become dominant in other countries. The World Health Organization reported in late July that the delta variant accounted for 75 percent or more of cases in many 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 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 still important to isolate and consult a medical professional if experiencing low blood oxygen levels, difficulty breathing, or any concerning symptoms.