Although vaccines provide strong protection 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 individuals can still get infected with high levels of the virus, such cases are rare compared to the unvaccinated population who are primarily spreading the virus. According to Gregg Gonsalves, an assistant professor of epidemiology at Yale School of Public Health, being vaccinated is crucial for keeping yourself and others safe. While vaccinated individuals have more freedom, it's important to remember that the situation is not the same as it was before the pandemic. Despite being vaccinated, there is still a need to be cautious about the Delta variant as no vaccine can offer complete 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 most of the time the wall is effective, a powerful hurricane could breach it, allowing some water to get through. The Delta variant of the virus is like a viral hurricane, as it is highly infectious and poses a greater challenge to even a vaccinated immune system. Vaccinations provide additional protection, but in the face of a strong challenge, such as being near an unvaccinated person with a high viral load, the protection may not be sufficient. However, the current vaccines in the United States are doing a great job in preventing serious illness, hospitalization, and death. Over 97 percent of COVID-19 patients in hospitals are not vaccinated. Even vaccinated patients who are hospitalized with delta breakthrough infections in Singapore are less likely to require supplemental oxygen and clear the virus faster than unvaccinated patients. Breakthrough infections, while garnering attention, are still rare. While the CDC stopped tracking all breakthrough cases in May, approximately half of states provide some data on breakthrough occurrences. The Kaiser Family Foundation recently analyzed state-reported data and discovered that breakthrough cases, hospitalizations, and deaths are uncommon occurrences among individuals who have been fully vaccinated against COVID-19. The rate of breakthrough cases among fully vaccinated individuals is less than 1% in all reporting states, with the lowest percentage being 0.01% in Connecticut and the highest being 0.29% in Alaska, as per the Kaiser analysis. However, many breakthrough infections likely go unreported because infected individuals may 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, stated that while breakthrough infections are rare, without a population-based sample it is difficult to determine their exact frequency. It is uncertain how many people with a mild sore throat for a few days may have actually 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 increase the likelihood of vaccinated individuals encountering someone with a high viral load. The more people you come into contact with, the higher the risk, but this also depends 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 classified as orange or red zones on their color-coded map of COVID-19 outbreaks in the United States. These zones have seen more than 50 cases per 100,000 people in the past week, covering approximately 80 percent of counties in the country. Infections are staying low in the Northeast and Upper Midwest, but the delta variant is causing a sharp increase in cases in Missouri, Arkansas, Louisiana, and Florida. The issue with relying on a map for case counts is that numbers are constantly changing and may rise in your area before the map is updated. Even if you live in a highly vaccinated community with low case counts, it's important to also consider neighboring communities' data, as viruses can easily spread across state and county lines. While experts generally agree that wearing a mask outdoors is unnecessary if you're not in a crowd and are keeping a safe distance from others, it is still risky to attend crowded outdoor events. If you choose to go to a packed outdoor concert, wearing a mask is advised. 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, particularly if you will be in close proximity to them for an extended period of time. Despite being fully vaccinated, he still wears an N95 mask in indoor public spaces. For maximum protection, it is advised to use a high-quality medical mask like an N95, KN95, or KF94 from Korea to avoid counterfeit products. If a medical mask is not available, double masking with a surgical mask underneath a cloth mask provides strong protection. Wearing a mask with an exhale valve is not recommended because it can release viral particles and counterfeit masks may have faulty valves. It is important to choose the right mask for different settings. A cloth mask may be sufficient for a brief visit to a sparsely populated convenience 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 that have straps or ties around the back of the head provide a tighter seal compared to masks with ear loops. Huffman stated that in order to combat the delta variant, all previous mitigation efforts need to be improved, including the use of masks. He suggests upgrading to masks with high filter quality that fit tightly to the face, ensuring a good seal around the nose, cheeks, and chin. According to Huffman, a tight-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 mask-wearing is not considered essential in such situations, extra precautions may be necessary in certain circumstances. Although it is rare for a vaccinated person to transmit the virus to another vaccinated individual, there is still a theoretical possibility. Therefore, a vaccinated individual who frequents crowded places or travels to COVID hotspots poses a higher risk compared to someone who avoids large gatherings and primarily interacts with other vaccinated individuals. Bitton recommends prioritizing outdoor gatherings, especially for families with unvaccinated individuals or those at high risk, due to the spread of the delta variant. Hosting events in a backyard or patio and reducing time spent indoors can help decrease the risk of exposure. Smaller gatherings with vaccinated friends are safer than large parties, even if all attendees are vaccinated. Opening windows for better ventilation when indoors is also advisable. For individuals at a very high risk, such as the elderly or immunocompromised, it is reasonable to request that even vaccinated individuals get tested before visiting. A quick and easy home test can be given to guests to ensure they are COVID-negative. Whether or not you can dine at restaurants depends on factors such as local conditions, your comfort level with risk, and the health of those around you. Communities with high vaccination rates and low case counts have the lowest 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 weakened immune systems, who may not receive as much protection from vaccines according to research, 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? Although 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 dining in airport restaurants and bars, or going through the security line. On airplanes, the air is exchanged approximately every two to three minutes, a faster rate than in places like grocery stores. Passengers must wear masks but can remove them to eat or drink. Airplane ventilation systems limit airflow 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 don't have a mask, it is recommended to wear two masks. For those who are vaccinated, the risk of briefly removing a mask to eat or drink during a flight is low, but it is preferable to keep it on as much as possible. The CDC advises that it is safest for unvaccinated individuals, including children, to avoid flying. Bromage mentioned that he recently traveled by air and briefly took off his mask to drink a beverage, but kept it on for most of the flight. He stated that he would feel more comfortable removing his mask to eat if he knew that the people next to him were vaccinated. He mentioned that he would be more worried if the person next to him showed a lack of concern for COVID precautions or wore their mask improperly. He stated that it is important to keep the mask on especially when sitting next to a random or talkative person. The safety of buses, subways, and trains for vaccinated individuals depends on factors such as mask-wearing policies and the level of crowding. Despite being well-protected, the risk of exposure to the virus is higher on longer rides and in crowded train cars or buses. Many individuals rely on public transportation to commute to work or school, and it is advised to wear a properly fitted medical mask or double mask while using it. When deciding whether to use public transit, it is important to consider local vaccination rates and the trend of increasing case counts. While vaccinated individuals can safely hug and spend time together without masks, parents of unvaccinated children need to assess the risks, especially when visiting older relatives. In communities where there are few COVID cases and many people are vaccinated, 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 illness from COVID-19, even if they are vaccinated. 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. Even though the chances of a vaccinated person transmitting COVID-19 are low, vaccinated grandparents should also take steps to reduce their own exposure when spending time with unvaccinated children. "I have not been wearing masks indoors with my elderly parents yet, because I am still cautious about wearing masks in public places," said Huffman, the aerosol scientist. "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 when visiting grandparents or immune-compromised family members. Taking a test a few days before and on the day of the visit is recommended. Home tests are a great option for those feeling anxious about the virus right now," Bromage explained. "We are purchasing these tests and having everyone test before coming together - right before we gather. Once everyone is clear, you can enjoy your time together." How can I determine if I have the delta variant? If you receive a COVID-19 diagnosis in the US, it is highly likely that you have the delta variant, according to the CDC. The delta variant is now the most common strain in the United States, comprising over 82 percent of cases. This variant is also prevalent in other countries, with the World Health Organization reporting that it accounts for 75 percent or more of cases in various nations including Australia, Bangladesh, Botswana, China, Denmark, India, Indonesia, Israel, Portugal, Russia, Singapore, South Africa, and the UK. Despite this dominance, standard COVID tests do not differentiate between the delta variant and other strains of the virus. Although health departments can utilize genomic sequencing to detect the prevalence of various variants within a population, this data is generally not disclosed to individuals. It is crucial for individuals to continue isolating and consulting with healthcare professionals if they experience low blood oxygen levels, difficulty breathing, or other concerning symptoms.