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.
"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."
Over the summer, 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.
How common are breakthrough infections?
A Washington State study of 4 million fully vaccinated people shows about 1 in 5000 experienced a breakthrough case from mid-January through mid-August. Recent data from the Centers for Disease Control and Prevention found that unvaccinated people had a nearly six times greater rate of testing positive for COVID-19 compared to fully vaccinated people, and a 14 times greater risk of death.
In August, NBC News medical contributor Dr. Kavita Patel told TODAY that breakthrough infections seem more common than she expected, which she attributed 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.
Are fully vaccinated people who received boosters less at risk?
"We think there are people who have gotten those three shots and are getting breakthrough infections as well," said NBC News medical contributor Dr. John Torres. "The thing about that though is that they're less likely to get hospitalized and are much, much less likely to get serious disease and their symptoms seem to be mild or we know their viral load goes up and then it goes away very quickly compared to those that are unvaccinated especially."
Experts stress that being fully vaccinated (and boosted, too) doesn't mean you're immune to catching the coronavirus.
"Being cautious is key," stressed Dr. Sheela Shenoi, an infectious disease physician at Yale New Haven Hospital in Connecticut.
When should fully vaccinated people be tested for COVID-19?
According to the CDC, any fully vaccinated person who experiences symptoms consistent with COVID-19 should isolate themselves from others, be clinically evaluated for COVID-19, and tested if appropriate. If their test result is positive, they should isolate at home for 10 days.
What should you do if you're around someone who tested positive?
"If you're in close contact, meaning if you're within 6 feet for 15 minutes or more, then you should get tested," said Torres.
The CDC recommends testing to be done five to seven days following the date of exposure. While awaiting results, wear a mask in public indoor settings for 14 days or until they receive a negative test result.
Here's some advice on how to limit your risk.
Wear masks indoors in public
This fall the CDC 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," 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
"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.
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
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.
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."
This story was updated on Dec. 13, 2021.