How can vaccinated people avoid breakthrough infections?

Two weeks after Jessica Conrad got the second shot of her Pfizer-BioNTech COVID-19 vaccine, she decided to ditch her mask. When she’d go see her friends play music at bars in downtown Nashville, Tennessee, where she lives, she’d try to maintain distance from other people as a precaution, but she no longer thought covering her face was necessary.

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“I was so extremely careful the entire year of 2020,” she told TODAY’s Vicky Nguyen. “(I) would still wear masks out on the sidewalks. … I was inside a lot. Once I got the vaccine, I was like, I’m OK, I got this now.”

Last month, Conrad developed a breakthrough infection, the term for when a fully vaccinated person tests positive for COVID-19. Some people experience symptoms and some don’t. Conrad initially thought hers were allergies because they felt similar to a head cold. Then she got a sore throat followed by nausea and gastrointestinal problems a few days later. She also lost her sense of taste and smell.

Between January and July, heath departments in 38 states recorded at least 125,000 breakthrough infections, an NBC News analysis found. The Centers for Disease Control and Prevention only track breakthrough infections that result in hospitalization or death; as of last week the agency reported 10,188 hospitalizations and 2,524 deaths out of 182 million fully vaccinated Americans.

NBC News medical contributor Dr. Kavita Patel told TODAY that breakthrough infections seem more common than she expected, which she attributes to the delta variant of the coronavirus, now the predominant strain in the U.S., being more contagious. It also could cause more severe illness in unvaccinated people, according to the CDC.

Still, Patel stressed that the current data shows “these vaccines are miracles. … Almost all throughout these breakthrough cases … we do not see people dying. We do not see people having severe hospitalizations, ending up in intensive care units.”

About 1 in 17,000 vaccinated people with breakthrough infections required hospitalization, according to NBC News data from August. Unvaccinated people face much higher risk of hospitalization and death: For example, in New Jersey, unvaccinated people were 1,058 times as likely to require hospitalization.

While the vaccine is clearly effective at preventing severe COVID-19 and death, more data is needed to determine how easily the delta variant can spread, especially among vaccinated people. A CDC report from late July posited that “breakthrough infections may be as transmissible as unvaccinated cases.”

This means that, right now, if you’re vaccinated, it’s difficult to know the risk that a behavior may pose of contracting and spreading the virus. A Kaiser Family Foundation report from earlier this month found the delta variant has caused 62% of vaccinated adults to mask in public places and 61% to avoid large gatherings. But are these precautions necessary if you’re vaccinated?

“This is a very tentative time in medicine and science and public health,” Dr. Sheela Shenoi, an infectious disease physician at Yale New Haven Hospital in Connecticut, told TODAY. “Unfortunately, given the data that we have, limited as it is, being cautious is key.”

Here, experts weigh in on precautions vaccinated people should be taking as the delta variant surges across the country.

Wear masks indoors in public

The CDC recently issued a recommendation that vaccinated people wear masks indoors in public areas with high virus transmission rates, and all three experts interviewed for this story supported this guidance, whether you’re at a Broadway show or in a common area of your office.

“(The delta variant) can be shared at levels in vaccinated people that may approach that of unvaccinated people so that someone who’s vaccinated, while they may have no symptoms or mild disease, could transmit the virus to someone else. We’re still learning more,” Dr. Mark Mulligan, director of the New York University Langone Vaccine Center, told TODAY. “Because of that, it’s important that even vaccinated people wear masks in indoor environments when they’re mixing with others.”

Mulligan said he’s hesitant to enter indoor settings with people who may be unvaccinated if he’d need to remove his mask, such as restaurants or bars. If you choose to eat indoors at this time, he advised going to places that have distance between tables and only removing your mask to eat or drink.

Avoid large, indoor gatherings

“The biggest issue right now is crowding and environments with large groups of people coming together,” explained Dr. Iahn Gonsenhauser, chief quality and patient safety officer at The Ohio State University Wexner Medical Center, in Columbus.

While large, indoor gatherings are primarily “an issue of the unvaccinated,” he said, whether to attend such events is a choice all people, regardless of vaccination status, “really need to start reconsidering.”

Even if there are vaccine requirements for a gathering — for example, at an indoor wedding, a bride and groom require vaccines for their guests — Mulligan would still recommend masking at this time.

Maintain social distance in large, outdoor gatherings

Many social activities are taking place outside because it’s summer, and “in theory, being outside should be lower risk, but we just don’t know,” Shenoi said. To be extra cautious, she recommended maintaining social distance in these situations, especially if you’re bringing an unvaccinated child along.

“If you’re having a picnic with three other people, it’s going to be lower risk than going to a carnival from the town square with 100 people,” she added. “It’s hard to know exactly what’s the right thing to do in these different situations.”

Only consider not masking indoors if everyone is vaccinated

Shenoi recommended masking indoors even if you’re in a small group of vaccinated people because there’s not enough data to suggest masks are not necessary in this situation. She added that while doing so is “ultra cautious,” it’s a good idea to “try to protect everybody as much as possible.”

Gonsenhauser and Mulligan, on the other hand, both said they’re OK with people removing masks indoors in small groups of fully vaccinated people, as long as no one has had a recent exposure.

“Some of the only places that remain low risk for vaccinated individuals are those environments where you know the vaccination status of those who surround you,” Gonsenhauser said. “And even there, with delta, our risk has increased.”

Limit the size of your social circle

Gonsenhauser advised starting to decrease the size of your social circle, even if you’re vaccinated.

“We’ve seen that with delta, there’s still risk of vaccinated individuals spreading COVID, as we’ve been concerned about previously,” he explained. “Yes, the risk is lower, but it’s still significant and real.”

Similarly, Mulligan said even for vaccinated people, the size of your social circle, as well as what activities you’ve done recently and with whom, determine your risk to those around you. You should be more cautious when assessing that risk if you’re deciding whether you can safely remove your mask around an immunocompromised person or someone who’s unable to get vaccinated.

“If the adult coming into the home is entirely masked when they’re out of the home, they’re vaccinated, they haven’t had any known exposures that would require quarantining, and they’re not around a lot of unvaccinated people who are unmasked, it’s probably OK not to wear a mask, but some judgment is required here,” he explained.

Plan any travel carefully

The CDC recommends delaying any travel, domestic or international, until you’re fully vaccinated. Traveling internationally, per the CDC, poses “additional risks, and even fully vaccinated travelers might be at increased risk for getting and possibly spreading some COVID-19 variants.”

If you’re able to choose your destination, select an area where there’s less COVID-19 transmission occurring; the CDC tracks this data. Flying or driving can be done safely, but whatever method you choose, maintain distance and mask around strangers whenever possible. These precautions are especially important if you’re traveling with an unvaccinated child or an immunocompromised person.

If you’re immunocompromised or high risk for developing serious illness from COVID-19, talk to your provider about what precautions make the most sense for you during this time. For example, you may consider double-masking, even though the data at this time doesn’t suggest it’s necessary for most vaccinated people, Shenoi said.

Reduce exposure to unvaccinated people

“One of the best things that you can do to reduce your risk is reduce your exposure to unvaccinated individuals,” Gonsenhauser said. “(Accomplish) that by whatever means are available to you, and whatever control you have over that particular exposure.” Examples include not going places where there may be unvaccinated people, or masking and social distancing in such settings.

If you have a person in your household who can’t get vaccinated, such as a child under 12, then you can reduce their exposure by limiting your own through masking, social distancing and avoiding areas with unmasked, unvaccinated people, Mulligan said.

Related: Vaccination remains a hot-button and politicized issue for many Americans, which can make inquiring about someone’s inoculation awkward.

It’s natural to want to believe that because you’ve done your part by getting vaccinated and the data shows the vaccines prevent severe illness, that you can return to your normal life. But this attitude will actually prolong the pandemic, Gonsenhauser said.

“Acting for the well-being of others, right now, is in our own best interest,” he stressed. “The longer COVID hangs around, the more likely we are to need continued vaccinations, booster vaccinations and see potential additional surges, potential additional restrictions. By doing the right thing for everybody else, we actually serve ourselves by reducing the risk of COVID affecting us in the future.”

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