Breakthrough COVID-19 Infections: What Vaccinated People Need To Know

Breakthrough coronavirus cases are disappointing ― but most of them are also evidence that the shots are working.
Perfection wasn't the goal of the COVID-19 vaccines -- preventing hospitalization and death was.
Perfection wasn't the goal of the COVID-19 vaccines -- preventing hospitalization and death was.

Reports of people experiencing breakthrough coronavirus infections after getting vaccinated keep surfacing. It can be alarming to read headlines about more people getting sick or stories about the awful symptoms that come with it.

But these cases don’t mean the shots are a failure ― it means they’re working.

When the scramble for a COVID-19 vaccine started last year, health officials were hopeful one would have even just 50% efficacy against severe disease and death, said Monica Gandhi, an infectious diseases specialist at the University of California, San Francisco. “Even a not-so-great vaccine would make a huge dent in the pandemic,” she added. All three vaccines available in the United States have performed much better than that.

“It was so astounding. And that’s what played out in the real world,” Gandhi said. According to the Centers for Disease Control and Prevention, 97% of people who were hospitalized because of COVID-19 were unvaccinated; 99.5% of fatalities are among unvaccinated individuals. If you’re vaccinated, you don’t have to worry about getting very sick or dying.

That is the goal of the COVID-19 vaccines. That has always been the overall goal. Getting a mild case of the coronavirus after you’ve been fully vaccinated can also be looked at as evidence that the inoculation is doing its job. It’s likely not going to turn into anything worse ― something that wasn’t a guarantee before the vaccines.

It’s fair to be concerned ― after all, no one wants to get sick in any form ― but there’s no reason to panic right now if you’re vaccinated. Here’s why:

Overall, breakthrough cases are the exception, not the rule.

It may appear that there are scads of new COVID-19 cases in people who are fully vaccinated. But keep in mind that social media can be an echo chamber. Additionally, there are more than 200 million people who have received a vaccine, so cases will happen just based purely on mathematical possibilities. Still, they’re rare.

“Of course, you’re going to hear stories here and there of people who are fully vaccinated and catch COVID because there are a lot of us out there who are fully vaccinated,” said Megan Ranney, an associate professor of emergency medicine and associate dean of the School of Public Health at Brown University. “But the people who are in the hospital are people who were not vaccinated. Just remember that although there are those few stories out there, those should not be enough to make you shun the vaccine.”

And this is likely happening because we’re returning to our pre-pandemic lives.

The vaccines aren’t becoming useless. Many are just taking fewer precautions after the shots.

“Back in February, March and April, most folks were still masking, avoiding travel and avoiding restaurants. Now everyone is doing everything,” Ranney said. “The fact that there are infections doesn’t mean that the vaccine is somehow failing. It just means that people are being exposed to the virus with no other protection other than the vaccine.”

“The fact that there are infections doesn’t mean that the vaccine is somehow failing.”

- Megan Ranney, associate dean of the School of Public Health at Brown University

Breakthrough cases are mostly asymptomatic or mild.

A majority of breakthrough cases will either come with no symptoms or what doctors consider mild. That doesn’t mean that the illness won’t feel horrible; it may feel like a terrible cold or the flu.

But, as mentioned, that can be seen as a sign that the vaccine is doing its job. Your immune system is remembering how to fight off the virus and prevent it from becoming severe ― a way better outcome than what happened before the shots were being distributed.

Experts don’t currently believe breakthrough infections will lead to long COVID for most people.

Long-term complications have occurred with even mild cases of COVID-19. Long-haulers are living with debilitating symptoms, such as nerve pain, neurological issues, fatigue and oxygen complications. Experts don’t believe that will be the case following most breakthrough infections because your immune response will attack the virus a lot faster.

“It’s really the disregulated immune response that happens with a natural infection ― where it takes you a while to clear it ― that causes long COVID,” Gandhi said. “With the vaccine in place, your immune system kicks in quickly and ... it goes specifically toward that virus to get it out of your system. It also doesn’t trigger this crazy immune response that can make you so sick.”

That’s not to say that this won’t happen at all. Gandhi noted that this is being studied to confirm the hypothesis. There have been some reports of people experiencing long-term symptoms, and one small study from Israel found apparent long COVID in a few vaccinated healthcare workers after they experienced a breakthrough infection. As time goes on, we’ll have more data to make a definitive conclusion. If anything, all of this is evidence that we need investment in research and care for people with long-haul COVID-19.

If you’re still not convinced, use the seatbelt analogy.

Just because you know someone who got into a car accident while wearing a seatbelt doesn’t mean that you believe seatbelts are useless.

“Seatbelts prevent you from getting really hurt. They don’t prevent you from getting in a crash ― and if you get in a bad crash, you might get hurt even though you’re wearing a seatbelt. But it’s going to protect you, for the most part, from injuries,” Ranney explained.

Think of the vaccines in the same way. At the end of the day, we’re so much better off with them. That’s the point.

This article has been updated to include more information about long-haul COVID. Experts are still learning about COVID-19. The information in this story is what was known or available as of publication, but guidance can change as scientists discover more about the virus. Please check the Centers for Disease Control and Prevention for the most updated recommendations.