Covid-19 vaccines are very strong at preventing infection, but none are 100% effective. Fully vaccinated people can become infected. It is not known exactly how many of these cases of immune escape are occurring in the US, as the Centers for Disease Control and Prevention (CDC) is not collecting national data to this extent. But based on reports from 25 states that track this data, the Kaiser Family Foundation estimates the rate of infections in vaccinees to be well below 1% in the US.
Many people are unsure of what to do if they are vaccinated, but their test for Covid-19 is still positive. Should the person be isolated? And for how long? What about family members, should everyone get tested? What kind of symptoms should make a person concerned about the possibility of immune escape? And how to deal with skeptics who still question the vaccine?
To answer these questions, we turned to the medical analyst at CNN, Dr. Leana Wen. An emergency physician, Wen is also a visiting professor of health policy and management at the George Washington University’s Milken Institute of Public Health School of Public Health.
CNN: What should people do if they get Covid-19 even after getting vaccinated? Should they isolate themselves from other family members? Does it make a difference to have or not have symptoms?
Dr. Leana Wen: A person who has been vaccinated and tests positive for Covid-19 must of course follow strict isolation protocols, because we have to assume that the person is contagious and capable of infecting others. If the case is symptomatic, the person should be isolated for at least ten days from the first day they started having symptoms, according to the CDC. You can get out of isolation if there is no fever for more than 24 hours and the other symptoms are improving. If the person is asymptomatic but still tests positive, they should remain isolated for ten days after testing positive.
Isolation means not to go out in public so as not to broadcast to other people. And also isolate yourself from contact with close family members. This means, if possible, staying in a part of the house away from others, in your own room. In summary, once a person is infected with Covid-19, it does not matter, in terms of isolation, whether they have been vaccinated: they can be contagious to others and need to follow standard isolation procedures.
CNN: If a person in the household gets sick even if vaccinated, should everyone get tested?
Wen: Yes. All close contacts must be tested. “Close contact” is defined as someone who was 5 feet away for a total of at least 15 minutes in a 24-hour period during the potentially contagious phase. The CDC differentiates the orientation between those who are vaccinated and those who are not. Unvaccinated ones, if exposed to close contact who have Covid-19, should be quarantined for ten days. They can shorten the quarantine to seven days if they test negative for at least five days after exposure. During this quarantine period, they cannot go out in public.
On the other hand, fully vaccinated ones, when exposed to a close contact who has Covid-19, do not need to be quarantined unless they develop symptoms. But they still must get tested within three to five days of exposure and wear a mask in public for extra protection.
CNN: Does this mean that a vaccinated person who has been exposed to coronavirus can still go to work?
Wen: According to CDC guidelines, yes, as long as that person has no symptoms, keep the mask on at all times and get tested three to five days after exposure.
But this CDC guidance needs to be well evaluated. Think about it this way: Would you feel safe sitting next to a co-worker at a conference table if you knew that person’s spouse had just been diagnosed with Covid-19? Even though CDC guidance says it can be done, I think we need to use common sense as well. If your spouse or child has Covid-19 and you are still waiting for the result of your coronavirus test, I recommend that you inform your superior at work and see if you can work from home at least until a negative result comes out.
I would also distinguish the level of exposure to the person testing positive. If you were at an outdoor party and next to someone who tested positive, you should still get tested, but the risk of having the coronavirus is very low and it may be reasonable to continue working – wearing a mask, of course. But if that person is your child or partner, people you spend a lot of time together with indoors, you are at a much higher risk of getting Covid-19 and therefore you should try not to expose others if possible.
CNN: What are the symptoms of Covid-19 immune escape infections, ie those in vaccinates?
Wen: The main benefit of vaccination is that it reduces the likelihood of serious illness. Vaccinated people who still contract the coronavirus are much more likely to have mild symptoms than if they had not been vaccinated. An individual who, before (without the vaccine), could have become very ill, with a high fever, a severe cough and so much difficulty breathing that they would need oxygen or a respirator, may now only have body aches, fatigue and a type of cold . That’s the power of vaccination: to reduce the severity of the disease.
Since the symptoms in the vaccinated are much milder than in the unvaccinated, it is good to be aware of at least one of the symptoms of Covid-19. They are fever, chills, cough, fatigue, muscle or body aches, headache, sore throat, runny nose, nausea, diarrhea, and loss of taste or smell. Of course, this is a broad list and could indicate other viral illnesses as well.
Considering how many coronavirus cases are re-emerging, keep your radar on high alert. If something looks a little weird, get tested.
CNN: If you test positive, should you tell your peers? And if you were at a party, should you tell the host?
Wen: You must follow the procedures indicated at your place of work. Talk to your manager, who can refer you to the company’s human resources department or someone else who can help locate contacts. That is, you need to identify people with whom you had close contact during the period when you could be contagious, which usually includes up to 48 hours before the onset of symptoms.
Of course, it’s good to remember the social activities you participated in during the potentially infectious period. If you’ve been to a party, you should tell the host as well as the guests you remember spending long periods with.
This is a job local health department contact trackers should do, but they are overwhelmed in many places. Also remember that contact trackers depend on you to tell them where you’ve been, and who you’ve been with and when. It’s important to let people know that you could have infected someone as soon as possible; we want the same courtesy for ourselves.
CNN: Do I have to take the test again before being released to go back to work?
Wen: No. Assuming you have not had a fever for more than 24 hours and your other symptoms are improving, ten days after your symptoms start is the CDC-recommended isolation period. After that, you can break the isolation and go back to working and interacting with other people.
CNN: Would a booster dose help reduce immune leaks?
Wen: Probably. US federal health officials have said that people who are moderately or severely immunocompromised, who have received Pfizer or Moderna vaccines, can now receive a third dose. The White House announced that from the week of September 20, pending final approval from the FDA and CDC, permission for people with at least eight months of initial vaccinations to receive a booster dose should begin. This is because the effectiveness of the vaccine against symptomatic diseases seems to diminish over time (although vaccines still protect very well against serious diseases), so one might expect that a booster dose would prevent future immune escapes. I advise everyone to discuss this with their doctor. The decision for a booster dose is probably not a valid recommendation for everyone, but an individual decision depending on your health condition.
CNN: Some people may be wondering what’s the point of being vaccinated if immune escape can still happen.
Wen: We are vaccinated for two reasons. Keep in mind that vaccination reduces the likelihood of serious illness – by about 25-fold according to estimates using CDC data. Second, vaccination also reduces the chance of getting Covid-19 about eight times. A vaccinated person is much less likely to get sick with Covid-19 and spread the virus compared to someone who has not been vaccinated.
Why do immunological escapes still happen? We can think of vaccination as a very good raincoat. A raincoat will keep you dry in a drizzle. It might even work in a storm. But if you’re experiencing storms every day, and sometimes you’re going through hurricanes, at some point, you can get wet. The problem isn’t that the raincoat isn’t working: it’s that there’s a lot of rain falling on you.
That’s what’s happening right now with Covid-19 across the country. The virus level is so high that the vaccine alone may not be enough to protect you. That’s why a mask can help, as well as reduce the number of high-risk environments you find yourself in. In short, we need to reduce the level of viruses around us. And the best way to do this is if everyone is vaccinated.
(Translated text. Click here to read the original in English).