Even though vaccines are highly effective at preventing COVID-19, recent reports of breakthrough infections and updated guidelines on mask-wearing for vaccinated individuals have caused confusion and concern. While it is true that vaccinated people can still get infected with the virus, these cases are rare compared to the unvaccinated population who are more likely to contract and spread the virus. It is important to understand that being vaccinated is the best way to protect yourself and others, according to Gregg Gonsalves, an assistant professor of epidemiology at Yale School of Public Health. While vaccinated individuals have more freedom, it is important to recognize that the situation is not the same as it was before the pandemic. It is also important to remember that no vaccine can provide complete protection, including against the Delta variant. Erin Bromage, a comparative immunologist and 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 Delta can breach it and allow some water to get through. Delta is much more infectious than earlier forms of the virus, posing a greater challenge to even a vaccinated immune system. Vaccinations provide extra protection, but may not always be enough when faced with a strong challenge, such as being near an unvaccinated person with a high viral load. Despite this, current vaccines in the United States are effectively preventing serious illness, hospitalization, and death. Over 97 percent of COVID-19 patients who are hospitalized are not 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, while newsworthy, are still rare. Although the Centers for Disease Control and Prevention no longer tracks all breakthrough cases, many states provide some data on these occurrences. The Kaiser Family Foundation recently examined state-reported data and discovered that cases of breakthrough COVID-19 infections, hospitalizations, and deaths are uncommon among individuals who have been fully vaccinated. According to the analysis, the rate of breakthrough cases among fully vaccinated individuals is less than 1% in all states, with percentages ranging from 0.01% in Connecticut to 0.29% in Alaska. However, many breakthrough infections may go unreported because infected individuals may be asymptomatic or only experience 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 level of rarity is unknown without a population-based sample. It is uncertain if many individuals with a mild sore throat for a few days have had breakthrough cases of COVID-19, as it is not a flaw of the vaccine. The vaccine campaign has potentially prevented 100,000 to 200,000 deaths. The risk of a breakthrough infection increases when giving the delta variant more opportunities to challenge the protection provided by the vaccine. Large events, such as the July 4 celebration in Provincetown, Massachusetts, or the packed Lollapalooza concert in Chicago, pose a higher risk of vaccinated individuals coming into contact with someone 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 significant increase in Lollapalooza outbreaks due to the close proximity of large groups of people, making it an ideal environment for the spread of the delta variant. The CDC recommends wearing masks in areas identified as orange or red zones on their color-coded map of COVID-19 outbreaks in the United States. These zones have seen over 50 cases per 100,000 people in the past week and currently encompass approximately 80 percent of counties in the country. Infection rates are staying relatively low in 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 relying on a map for case counts is that the data can change quickly, potentially leading to a surge in cases in your local area before the map is updated. Even if you believe your community is highly vaccinated with few cases, it's important to also consider the case counts and vaccination rates of nearby communities since viruses can easily spread across state and county lines. While experts generally agree that wearing a mask outdoors is not necessary if you are not in a crowded area and can maintain a safe distance from others, it is still risky to attend packed outdoor events such as concerts, and in such cases 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 you are with people whose vaccination status is unknown, especially if you will be in close proximity to them for an extended period of time. Although he, as a fully vaccinated individual, does not always wear a mask indoors, he opts for an N95 mask when entering indoor public spaces. For maximum protection, high-quality medical masks such as N95 or KN95 are recommended. If unavailable, double masking with a surgical mask under a cloth mask can also 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 important to choose the appropriate mask based on the situation. A cloth mask may suffice for a short visit to a vacant convenience store in a highly vaccinated area, but a higher-quality mask is more suitable for air travel or crowded grocery stores, particularly 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 importance of improving mitigation efforts, particularly with the delta variant, including the use of masks. He encouraged people to upgrade to masks with high filter quality that fit tightly to the face, ensuring a good seal around the edges over the nose bridge, 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 when they are with their vaccinated friends and family members without masks. Wearing a mask is not considered critical in indoor settings with a small group of vaccinated individuals, according to Huffman. However, there may be certain situations where extra precautions are necessary. Although it is unlikely 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 or travels to COVID hot spots poses a higher risk compared to someone who avoids crowds and spends time with other vaccinated individuals. With the delta variant spreading, Bitton recommends prioritizing outdoor gatherings, especially for families with unvaccinated children or high-risk family members. Holding events in a backyard or patio and reducing time spent indoors can decrease the risk of transmission. Spending time with small groups of vaccinated friends is safer than attending large parties, even if all attendees are vaccinated. When indoors, opening windows can help improve ventilation. For individuals at a very high risk, such as the elderly or immunocompromised, it may be reasonable to request testing for even vaccinated individuals before a visit. A quick and easy home test can be used to ensure that all guests are free of COVID. The decision to dine at restaurants depends on factors such as local conditions, personal health, and risk tolerance. Communities with high vaccination rates and low case counts have lower risk. 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 compromised immune systems, who may not receive as much protection from vaccines according to studies, may choose to order takeout or eat outdoors as an extra safety measure. Is it safe to travel? Should I avoid peanuts and water and keep my mask on? 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 the airport terminal, while sitting in airport restaurants and bars, or while going through security. In airplanes, the air is exchanged roughly every two to three minutes, which is a faster rate compared to grocery stores and other indoor spaces. Although passengers are required to wear masks, they can remove them to drink water or eat. Airplane ventilation systems prevent air from circulating throughout the entire cabin by containing airflow to a few rows, reducing the risk of transmission to nearby passengers. Experts recommend using a high-quality medical mask, such as an N95 or KF94, when flying to further minimize the risk of infection. If you don't have a mask, it is recommended to wear two masks. While the risk of removing a mask to eat or drink during a flight is low for vaccinated individuals, 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 a beverage, but kept it on for most of the flight. He mentioned that he would feel more comfortable removing 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 did not appear to be concerned about COVID safety measures or wore their mask incorrectly. He emphasized the importance of keeping the mask on, especially when seated next to a talkative individual. The safety of buses, subways, and trains for vaccinated individuals depends on factors such as the duration of the ride and the level of crowding. Despite the protection offered by vaccinations, the risk of exposure to the virus rises in crowded and prolonged commutes, as most public transportation systems still mandate the use of masks for all passengers. 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 using public transit is not necessary, it is important to take into account local vaccination rates and the trend of increasing case counts before deciding to ride. When it comes to hugging and visiting older relatives or unvaccinated children, vaccinated individuals can generally do so safely without masks. However, parents of unvaccinated children should carefully consider the risks, especially when visiting older relatives. In communities where there are few cases of COVID-19 and most people are vaccinated, it is generally considered safe for unvaccinated children from one household to spend time with vaccinated grandparents. However, as the delta variant spreads and children go back to school, the risks of close contact increase for older or immunocompromised individuals who are more susceptible to severe illness from COVID-19, even if they are vaccinated. When families plan to visit 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 COVID-19 are low, vaccinated grandparents should also reduce their personal exposure when spending time with unvaccinated children. "I am still very cautious about wearing masks in public settings, so I have not been wearing masks indoors with my elderly parents," said Huffman, the aerosol scientist. "If I were to have more interactions that increase my risk of exposure, I would seriously consider wearing a mask indoors when around vulnerable individuals. Rapid home tests are an extra precaution to take when visiting grandparents or family members who are immune-compromised. It is recommended to take a test a few days before the visit and also on the day of the visit. According to Bromage, home tests are a great option for those feeling anxious about the virus right now. The idea is for everyone to take a test before coming together, right before gathering, to ensure everyone is clear and can safely enjoy their time together. How can I determine if I have the delta variant?" 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 dominant strain in the US and in 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 not usually disclosed to individuals. If you experience low blood oxygen levels, difficulty breathing, or other concerning symptoms, it is important to isolate and consult a healthcare professional.