Even though vaccines are highly effective in preventing serious illness from COVID-19, recent news about breakthrough infections and recommendations for vaccinated individuals to wear masks in certain situations have caused confusion and concern. While studies have shown that vaccinated people can still get infected and carry high levels of the virus, these cases are rare compared to unvaccinated individuals who are more likely to spread the virus. It is important to remember that being vaccinated is the best way to protect yourself and others. While there is more freedom for vaccinated people, it is not the same as before the pandemic. It is still possible for vaccinated individuals to contract the Delta variant, as no vaccine provides 100 percent protection. 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 the waves, a powerful hurricane like the Delta variant can sometimes breach it. This variant is highly infectious and poses a greater threat to vaccinated individuals. Despite this, vaccines provide additional protection, although they may not always be able to withstand major challenges, such as coming into contact with an unvaccinated person with a high viral load. The good news is that current vaccines in the United States are highly effective in preventing severe illness, hospitalization, and death. Over 97 percent of people hospitalized with COVID-19 are not vaccinated, according to recent data. In Singapore, vaccinated patients 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 receive attention in the media, they are still rare. The Centers for Disease Control and Prevention stopped tracking all breakthrough cases in May, but approximately half of states provide some data on breakthrough events. The Kaiser Family Foundation recently examined state-reported data and discovered that breakthrough cases, hospitalizations, and deaths are uncommon among fully vaccinated individuals against COVID-19. The rate of breakthrough cases among fully vaccinated individuals is below 1 percent in all states, with Connecticut at 0.01% and Alaska at 0.29%, according to the Kaiser analysis. However, many breakthrough infections may go unreported because infected individuals may not show symptoms or only experience mild symptoms that resolve before testing. Dr. Asaf Bitton from Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health stated that while breakthrough infections are rare, without a population-based sample, the true level of rarity is unknown. It is uncertain how many people with mild scratchy throats for a few days may have had breakthrough cases, but it is not due to the vaccine failing. 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 the Lollapalooza concert in Chicago, pose a higher risk for vaccinated individuals to come into contact with someone carrying a high viral load. The more people you interact with, the higher the risk, depending on the local level of risk. In the near future, there may be a surge in Lollapalooza outbreaks due to large crowds, creating an ideal environment for the spread of the delta variant. The CDC recommends wearing masks in areas designated as orange or red on their color-coded map of COVID-19 outbreaks, which currently includes approximately 80 percent of counties in the United States. Infection rates are staying relatively low in many parts of the Northeast and Upper Midwest, but there have been significant increases in cases in Missouri, Arkansas, Louisiana, and Florida due to the delta variant. The issue with tracking these cases on a map is that the numbers are changing quickly, so it's possible for cases to surge in your local area before the map updates. Even if you live in a highly vaccinated community with low case counts, it's important to also consider the numbers and vaccination rates in nearby areas since people and viruses can easily cross state and county lines. According to most experts, 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 individuals whose vaccination status is unknown. However, attending a packed 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 when around people whose vaccination status is unknown, especially if close proximity will be maintained for an extended period of time. Although fully vaccinated, Huffman still wears an N95 mask in indoor public spaces. For maximum protection, upgrading to a high-quality medical mask like an N95, KN95, or KF94 is recommended. Double masking with a surgical mask underneath a cloth mask also provides strong protection if a medical mask is not available. Wearing a mask with an exhale valve is not recommended as it can release viral particles, and counterfeit masks with faulty valves may allow germs to enter. The type of mask you choose should be based on the situation. 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 more appropriate for air travel or crowded grocery stores 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 than masks with ear loops. Huffman stated that in order to combat the delta variant, all previous mitigation efforts must be improved, including the use of masks. He recommends upgrading to masks with high filter quality that fit tightly to the face, emphasizing the importance of a well-sealed mask around the edges, including 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 minimal risk of spreading the virus when in close contact with other vaccinated individuals without masks. While mask-wearing is not considered crucial in such scenarios, certain situations may necessitate additional precautions. Although rare, there is a theoretical possibility of a vaccinated person transmitting the virus to another vaccinated individual. Those who engage in high-risk activities like attending crowded venues or traveling to COVID hotspots pose a greater risk compared to those who avoid such scenarios and primarily interact with vaccinated individuals. With the delta variant spreading, Bitton recommends prioritizing outdoor gatherings, especially for families with unvaccinated children or members at high risk. Moving events to a backyard or patio and reducing indoor time can decrease the risk of exposure. Spending time with smaller groups of vaccinated friends is safer than attending large parties, even if all attendees are believed to be vaccinated. When indoors, opening windows for better ventilation is advised. For individuals at very high risk due to age or immunocompromised status, it is reasonable to request testing for even vaccinated individuals before visits. One option is to provide guests with a quick home test to ensure they are not infected with COVID-19. Whether or not you can still eat at restaurants depends on factors such as the local situation, your own willingness to take risks, and the health of those you are with. Communities with high vaccination rates and minimal cases have the lowest risk. For example, dining at a restaurant in Vermont, where two-thirds of the population is vaccinated, is safer than eating 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 research, may opt to order takeout or eat 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 in airport restaurants and bars, or while going through security. On airplanes, the air is replaced approximately every two to three minutes, a faster rate than in places like grocery stores. Passengers are still required to wear masks, but they can remove them to eat or drink. Airplane ventilation systems limit airflow to a few rows to prevent circulation throughout the entire cabin, which means an infected passenger poses the most risk to those nearby. Experts recommend using a high-quality medical mask, such as an N95 or KF94, when flying. If you do not have a mask, it is recommended to double mask. For vaccinated individuals, the risk of briefly removing a mask to eat or drink during a flight is low, but it is advisable to keep it on as much as possible. The CDC suggests that it is safest for unvaccinated individuals, including children, to avoid flying. Bromage mentioned that he recently flew and briefly removed his mask to drink, but kept it on for the majority of the flight. He stated that he would feel more at ease removing his mask to eat if he knew the people sitting next to him were vaccinated. He expressed more worry if the person next to him didn't seem to be concerned about COVID precautions or wore their mask incorrectly. He emphasized the importance of keeping the mask on, especially when sitting next to a talkative person. The safety of buses, subways, and trains for vaccinated individuals is relatively high, as most still enforce mask-wearing which reduces the risk of exposure. However, the longer the ride and the more crowded the transportation, the higher the risk of viral exposure, 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 while using it. If using public transit is not necessary, one should consider local vaccination rates and the trend of case counts before deciding whether to ride. When it comes to hugging and visiting older relatives, vaccinated individuals can generally do so safely without masks, but parents of unvaccinated children need to consider more risks, especially when visiting older family members. In communities where there are few cases of COVID-19 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 going back to school, the risk of close contact increases for older or immunocompromised individuals who are more susceptible to complications from the virus. When families plan to visit 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. While the risk of a vaccinated person spreading COVID-19 is low, vaccinated grandparents should still take precautions 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 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 and on the day of the visit. Home tests are a great option for those feeling anxious about the virus. By testing before coming together, everyone can ensure they are clear of the virus and enjoy their time together. " If you test positive for COVID-19 in the United States, it is highly likely that you have the delta variant. According to the CDC, delta now makes up over 82 percent of cases in the US and is also dominant in other countries. The World Health Organization reported in late July that delta accounts for 75 percent or more of cases in many 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 strain 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 a healthcare professional if experiencing symptoms such as low blood oxygen levels, difficulty breathing, or other concerning signs.