Despite the vaccines' strong protection against COVID-19, reports of breakthrough infections and new guidelines about vaccinated individuals wearing masks have caused confusion and concern. Recent studies indicate that vaccinated people can still get infected with high levels of the virus, but 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 most crucial step in keeping oneself and others safe. Even though vaccinated individuals have more freedom, it is not the same as pre-pandemic times. No vaccine can guarantee complete protection, including against the Delta variant. 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 most of the time the wall is effective, a powerful hurricane like the Delta variant can overwhelm it, allowing some water to get through. Vaccinations provide additional protection, but when faced with a significant challenge, such as being near an unvaccinated person with a high viral load, the protection may not be sufficient. Fortunately, the current vaccines in the United States are highly effective at preventing serious illness, hospitalization, and death. Over 97 percent of individuals hospitalized with COVID-19 are not vaccinated. Recent data from Singapore indicates that vaccinated patients hospitalized with delta breakthrough infections are less likely to require supplemental oxygen and clear the virus faster than unvaccinated patients. Breakthrough infections, while rare, do make the news. Although the CDC stopped tracking all breakthrough cases in May, 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 occurrences among individuals who have been fully vaccinated against COVID-19. According to the analysis, the rate of breakthrough cases among fully vaccinated individuals is less than 1 percent in all reporting states, with figures ranging from 0.01% in Connecticut to 0.29% in Alaska. However, many breakthrough infections may go unreported because infected individuals either do not exhibit symptoms 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, emphasized that while breakthrough infections are rare, the true extent of their rarity remains unknown without a population-based sample. It is possible that many individuals with a mild scratchy throat for a few days may have experienced breakthrough cases, but this is not a failure of the vaccine. Estimates suggest that 100,000 to 200,000 deaths have been prevented since the start of the vaccine campaign. The risk of a breakthrough infection increases with more exposure to the delta variant. Large events, such as the July 4 celebration in Provincetown, Massachusetts, or the Lollapalooza concert 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 situation. In the near future, there may be a surge in Lollapalooza outbreaks due to the close proximity of people, creating an ideal environment for the delta variant to spread. The CDC has a color-coded map indicating COVID-19 outbreak levels in the US, with blue and yellow zones having low infection rates and orange and red zones having higher rates. The agency recommends wearing masks in orange and red zones, which currently include around 80 percent of US counties. Infection rates are currently low in many parts of the Northeast and Upper Midwest, but the delta variant has led to a significant increase in cases in Missouri, Arkansas, Louisiana, and Florida. The issue with relying on a map for case counts is that numbers are changing quickly, and outbreaks may occur in your area before the map is updated. Even if you believe your community is highly vaccinated with low case counts, it is important to also consider neighboring communities as viruses can easily spread across state and county lines. Many health experts recommend not wearing a mask outdoors if you are not in a crowded area and are at least 6 feet away from individuals whose vaccination status is unknown. However, it is still considered risky to attend a crowded outdoor event, 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 or prolonged exposure is expected. While he no longer wears a mask in all indoor situations due to being fully vaccinated, he opts for an N95 mask in public indoor spaces. For optimal protection, upgrading to a high-quality medical mask like an N95, KN95, or KF94 from Korea is advised, although ensuring authenticity is important. Double masking with a surgical mask under a cloth mask can also provide strong protection if a medical mask is not available. Wearing a mask with an exhale valve is not recommended because 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 based on the situation. For example, a cloth mask may be sufficient for a short visit to a vacant convenience store in a highly vaccinated area. However, a better quality mask is more appropriate for air travel or crowded places like 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 compared to masks with ear loops. Huffman emphasized the need for improved mitigation efforts, including the use of high-quality masks that fit tightly to the face, to combat the delta variant. It is important to ensure that the mask is sealed well around the edges to effectively protect against the virus. Vaccinated individuals face minimal risk when interacting without masks with other vaccinated friends and family members, according to Huffman. While wearing a mask is not considered crucial in small indoor gatherings with vaccinated individuals, precautions may be needed in certain situations. Although the chances of a vaccinated person transmitting the virus to another vaccinated individual are slim, it is still a theoretical possibility. Those who frequent crowded places or COVID hot spots pose a greater risk compared to those who limit their exposure to crowds and primarily socialize 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. Hosting events in a backyard or patio and reducing time spent indoors can decrease the risk of exposure. Being with a smaller group of vaccinated friends is safer than attending a large party, even if everyone there is vaccinated. Opening windows for ventilation when indoors is also advised. For individuals at very high risk, such as elderly or immunocompromised individuals, it is reasonable to request even vaccinated individuals to get tested before visiting. A quick and easy at-home test can be provided to guests to ensure everyone is free of COVID before dining together. Whether or not you can still dine at restaurants depends on factors such as local conditions, your comfort with risk, and the health status of those around you. The lowest risk is in communities with high vaccination rates and minimal case counts. 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 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, taking precautions is still recommended. The risk of coming into contact with an infected person may be higher in the airport terminal, while dining at airport restaurants or bars, or going through security screening. On airplanes, the air is exchanged every two to three minutes, which is more frequent than in grocery stores and other indoor environments. Passengers are 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 cabin, meaning that an infected passenger poses the highest risk to those nearby. Experts recommend using a high-quality medical mask, such as an N95 or KF94, when flying. If you do not possess one, it is recommended to wear two masks. For those who have been vaccinated, 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 often as possible. The CDC suggests that it is safest for unvaccinated individuals, including children, to avoid air travel. Bromage mentioned that he recently flew and briefly removed his mask to drink a beverage, but kept it on for the majority of the flight. He expressed that he would feel more at ease taking off his mask to eat if he knew the individuals next to him were vaccinated. He expressed greater concern if the person beside him did not follow COVID precautions or wore the mask incorrectly. He emphasized the importance of keeping the mask on, especially when sitting next to a talkative person. Despite being vaccinated, it is still recommended to wear a mask on buses, subways, and trains as they reduce the risk of viral exposure. The risk of exposure increases with longer rides and crowded train cars or buses, 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 using public transit is not necessary, one should consider local vaccination rates and the trend of case counts before deciding to ride. Questions about hugging and visiting older relatives or unvaccinated children arise. While vaccinated individuals can typically safely hug and spend time together without masks, parents of unvaccinated children need to weigh more risks, especially when visiting elderly relatives. In areas where there are few COVID cases and many people are vaccinated, 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 also increases 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 advisable to limit other exposures by avoiding 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 own exposure when spending time with unvaccinated children. Huffman, the aerosol scientist, 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 when 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 at the moment. By testing before coming together, everyone can ensure they are clear of the virus and enjoy their 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, which now accounts for over 82 percent of cases in the country according to the CDC. The delta variant is also dominant in many other countries, with the World Health Organization reporting that it makes up 75 percent or more 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 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 generally not disclosed to individuals. It is still important for individuals to isolate and consult a healthcare professional if they experience low blood oxygen levels, difficulty breathing, or other concerning symptoms.