My husband felt invincible after becoming fully vaccinated, but he got breakthrough Covid last month.  He thinks he caught it on a plane.  By then he was wearing a mask, just for show, really, and the comfortable cloth mask he wore was thin.  As was the mask worn by his seatmate who hunkered down in her hoodie during the two hour flight, refusing all snacks and beverages.  In retrospect, this was a huge red flag.  Because who turns down free Cheezits and Popcorners on Jet Blue? He had very little contact with anyone else before he became symptomatic three days later, so he is probably correct.

This is how it went down, with an onset that was slow and gradual: he started to get what he thought was a sinus infection, to which he is prone, followed by post nasal drip, some congestion and that was about it for a few days.  He began taking an antibiotic because of his long-standing sinus issues.  But unlike before, he didn’t get better after his third dose of Augmentin.  In fact he thought he might be feeling worse, more tired than usual.

I suggested testing and we kept googling (yes, even health care providers google, more than you’d think or maybe want to know) — sinus infection vs Covid symptoms, and Is it a cold or Covid?  Really it is impossible to tell because there are so many presentations and everyone is different.

I left, encouraging him to get tested but unaware that he was feeling progressively worse.  He bought a home Covid test and it was almost immediately, and very clearly, positive.  These OTC rapid tests are very reliable when the result is positive, especially in an area with high incidence.  (This was Florida.)  So we knew he had to self-isolate for 10 days from when he was first symptomatic. 

We kept in close touch and Facetimed.  I’d say he had about 2 ½ days of feeling quite miserable.  He had all the symptoms of a bad case of influenza: headache, fever, chills, fatigue, muscle aches, congestion and cough.  He never lost his sense of taste or smell nor did he have a sore throat.  He never experienced chest pain or shortness of breath but his pulse ox (which tells us how well the blood is being oxygenated) at the lowest was 92.  (Normal is 96-100, and we start to pay attention when it is heading down towards 90.)  When he started feeling better, his metrics improved accordingly.  We shudder to think what would have happened had he not been vaccinated.

At that time he was commuting to Florida about every other week for work and I spent an occasional weekend there.  I did not get sick even though we spent three days together unmasked indoors and in a car.  I took two OTC tests — one when I got home (three days past the first exposure) and one three days after that, both negative.  I never developed symptoms but if I had, and the OTC test was still negative, I would have gone for a PCR test. Of note, he had 2 Pfizer vaccines and I had 2 Moderna.

Having a background as I do in community health, it’s not lost on me that this breakthrough, likely caused by the Delta variant, will not become part of the data. I think this is the norm, unfortunately, rather than the exception and I’ll tell you why.  PCR testing is nowhere near as available and accessible as it needs to be. Really it should be on speed dial, 24/7, where someone will come to you and administer the test.  For free. Then we would have some real data.  But the reality is that, depending on the time of day, it can be difficult to get a timely appointment.  Plus going out is miserable when you don’t feel well and you run the risk of exposing other people.  

The next best thing is an OTC test for people who want to do the right thing and protect others.  Anecdotally I know of six individuals with breakthrough cases in my immediate familial, friend and professional circle.  All of them relatively young (well, under 65) healthy people. They all did the right thing.  To me it is apparent that breakthroughs are way more prevalent that the CDC would have us believe.  Maybe it’s because they don’t have the data but also likely due to a reluctance to say anything negative about the vaccines. Understandable given all the negative misinformation out there and the need to get more people vaccinated.  Sure it was always mentioned that the vaccines were not 100% effective at preventing symptomatic disease, but until Delta, people did think they were bulletproof. Maybe that’s just human nature.  And we were all very tired of masking and distancing.

But picture this.  I am flying home, double-masked (cloth over surgical) and notice many children with “colds” on the plane.  Lots of coughing and sneezing.  These families were returning home from vacation.  Were they going to have their child tested in Florida at the first sniffle and then isolate in a hotel room waiting for results and possibly a longer isolation?  No.  They needed to get home and get back to their lives.  Maybe they thought, ostrich-like, if there was no test, there was no Covid, or maybe they didn’t think about it at all.   I don’t know if the parents were vaccinated and of course, I don’t know if these children actually had Covid.  But they certainly could have, given the circumstances.  I wonder how many people on the plane later got sick.  

Would requiring a negative test or proof of vaccination decrease transmission during travel? Might a mandate like that also increase vaccination rates?  To me it’s clear that it would, but not without a great deal of pushback and negative impact on the airline and travel industries.  Apparently it’s hard enough to get some people to keep their masks on when traveling. It’s easy to imagine that such a mandate would simply transfer the disruptive behavior of anti-maskers on planes to the lines at the airport when the non-compliant are prevented from boarding.

There are no easy answers.  While some of us would do a great deal to end this pandemic, there are still some who doubt its very existence or have gone down the rabbit hole of misinformation, unlikely to surface.  For now, this much I do know: the fully vaccinated are not invincible and should continue to be careful when the situation warrants, especially when travelling or in areas with high incidence.  Stay safe out there, and do the right thing.