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I Got a ‘Mild’ Breakthrough Case. Here’s What I Wish I’d Known.

By Will Stone

Monday, September 20, 2021 (Kaiser News) -- The test results that hot day in early August shouldn’t have surprised me — all the symptoms were there. A few days earlier, fatigue had enveloped me like a weighted blanket. It was my weekend away from home so I put it down to that. Next, a headache clamped down on the back of my skull. My eyes began to hurt. Soon, it was like everything had gone away.

As a reporter who’s covered the coronavirus since the first confirmed U.S. case landed in Seattle, where I live, I should have known what was coming, but there was some part of me that couldn’t quite believe it. I had a breakthrough case of covid-19 — despite my two shots of the Pfizer-BioNTech vaccine, the second one in April.

I was just one more example of our country’s tug and pull between fantasies of a post-covid summer and the realities of our still-raging pandemic, in which even the vaccinated can get sick.

Not only was I sick, but I’d exposed my 67-year-old father and extended family during my first trip back to the East Coast since the start of the pandemic. That was the exact scenario that I'd fought to avoid for the past year.

It was a miracle! It is not clear where it came from. As many Americans have done, my vaccinated self had become less strict about wearing masks everywhere and was more comfortable with physical distance. Our trip across America was a success. We met friends, visited family, and even went to a delayed wedding.

I ended up in quarantine at my father’s house. Although my two quick antigen tests came back negative (taken one day apart), I knew I was feeling sick. My second test was negative. The nurse agreed with me. “Don’t hang your hat on this,” she said of the results. A few days later, the results from a PCR test to confirm the existence of the coronavirus (this was sent to a laboratory) proved conclusive.

It was miserable for five days. My legs and arms ached, my fever crept up to 103 and every few hours of sleep would leave my sheets drenched in sweat. I’d drop into bed exhausted after a quick trip to the kitchen. To sum it up, I’d put my breakthrough case of covid right up there with my worst bouts of flu. I felt low for the next several weeks even after my fever went away.

I'm very fortunate, of course. I didn’t go up against the virus with a naive immune system, like millions of Americans did before vaccines were widely available. And, in much of the world, vaccines are still a distant promise.

“You probably would have gotten much sicker if you had not been vaccinated,” Dr. Francesca Torriani, an infectious-disease physician at the University of California-San Diego, explained to me recently.

As I shuffled around my room checking my fever, it was also reassuring to know that my chances of ending up in the hospital were slim, even with the delta variant. And now, about a month later, I’ve made a full recovery.

Breakthrough cases are more frequent. Here’s what I wish I’d known when those first symptoms laid me low.

1. Is it time for a reality check about what the vaccines can — and can’t do?

The vaccines aren’t a force field that wards off all things covid. Because they significantly lower the chance of you becoming seriously ill, or even dying, they were approved.

But it was easy for me — and I’m not the only one — to grab onto the idea that, after so many months of trying not to get covid, the vaccine was, more or less, the finish line. It was unnerving to get sick with the virus.

Even mild infections were prevented by the vaccine, which was shown to be effective in preventing them.

“There was so much initial euphoria about how well these vaccines work,” said Dr. Jeff Duchin, an infectious-disease physician and the public health officer for Seattle and King County. “I think we — in the public health community, in the medical community — facilitated the impression that these vaccines are bulletproof.”

It’s hard to keep adjusting your risk calculations. So if you’d hoped to avoid getting sick at all, even slightly, it may be time for a “reset,” Duchin said. This isn’t to be alarmist but a reminder to clear away expectations that covid is out of your life, and stay vigilant about commonsense precautions.

2. Are my chances of winning a breakthrough case any higher?

It was once quite uncommon, but with the advent of delta, the chances have changed.

“It’s a totally different ballgame with this delta phase,” said Dr. Eric Topol, a professor of molecular medicine and director of the Scripps Research Translational Institute in San Diego. “I think the chance of having a symptomatic infection has gone up substantially.”

But “quantifying that in the U.S. is very challenging” because our “data is so shoddy,” he said.

The vaccinated still have a considerably lower chance of getting infected than those who aren’t protected that way. Los Angeles County collected data as the delta variant surged over summer. The results showed that unvaccinated individuals were five times more likely than those who were vaccinated to get infected.

3. Are you ready to take extra precautions to ensure I don't have a breakthrough?

Looking back, I wish I’d taken more precautions.

My advice for friends and family is to wear masks and avoid large gatherings of unvaccinated persons. Also, cut back on traveling until the situation calms down.

There are now more than 150,000 coronavirus infection per day in the U.S. (about double what was before I got sick), and hospitals across America are overcrowded. The White House proposes booster shots. Scientists are still making sense of what’s happening with breakthrough cases.

In many parts of the U.S., we’re all more likely to run into the virus than we were in the spring. “Your risk is going to be different if you are in a place that’s very highly vaccinated, with very low level of community spread,” said Dr. Preeti Malani, a specialist in infectious diseases at the University of Michigan. “The piece that’s important is what’s happening in your community.”

4. What does a “mild” case of covid feel like?

In my case, it was worse than I expected, but in the parlance of public health, it was “mild,” meaning I didn’t end up in the hospital or require oxygen.

The mild category, which is basically a catchall for most people, Dr. Robert Wachter of University of California San Francisco's Department of Medicine said. “Mild” can range from “a day of feeling crummy to being completely laid up in bed for a week, all of your bones hurt and your brain isn’t working well.”

There’s not great data on the details of these mild breakthrough infections, but so far it appears that “you do way better than those who are not vaccinated,” said Dr. Sarang Yoon, an occupational medicine specialist at the University of Utah who was part of a nationwide study by the Centers for Disease Control and Prevention on breakthrough infections.

Yoon’s study, published in June with data collected before the delta surge, found that the presence of fever was cut in half, and the days spent in bed reduced by 60% among people with breakthrough infections, compared with unvaccinated people who got sick.

If you’re vaccinated, the risk of being hospitalized is 10 times lower than if you weren’t vaccinated, according to the latest data from the CDC. Those who get severely and critically ill with a breakthrough case tend to be older — in one study done before delta, the median age was 80.5 — with underlying medical conditions such as cardiovascular disease.

5. What if I want to spread it? Or do I need the ability to keep it in my own home?

It is still possible to have covid. You will need to show it.

Even though the results of my initial two test were not positive, I began wearing a mask around my home and keeping my distance with my family. I’m glad I did: No one else got sick.

As the delta strain is twice as infectious as the original virus, it can quickly build up in the upper respiratory tract. This was demonstrated in the case of a group of new infections that were linked to Provincetown in Massachusetts this summer.

“Even in fully vaccinated, asymptomatic individuals, they can have enough virus to transmit it,” said Dr. Robert Darnell, a physician-scientist at The Rockefeller University.

The science isn’t settled about just how likely vaccinated people are to spread the virus, and it does appear that the amount of virus in the nose decreases faster in people who are vaccinated.

Darnell stated that it is important to wear masks, and stay isolated from other people if you have any symptoms or test positive.

6. What are the chances of me getting long covid from a breakthrough infected?

While there’s not a lot of data yet, research does show that breakthrough infections can lead to the kind of persistent symptoms that characterize long covid, including brain fog, fatigue and headaches. “Hopefully that number is low. Hopefully it doesn’t last as long and it’s not as severe, but it’s just too early to know these things,” Topol said.

Research from the United Kingdom has shown that people who have been vaccinated are 50% more likely to suffer long-term covid.

The story was produced by NPR and KHN as part of a partnership.