I was sitting on an examination table at an urgent care clinic in Timonium, giving my history to a physician’s assistant. An hour later, she would call me to confirm that I was positive for COVID-19.
Given the way that I felt, it was what I expected. But it wasn’t supposed to happen: I’ve been fully vaccinated for months.
Five days earlier, I had gone to a house party in Montgomery County. There were 15 adults there, all of us fully vaccinated. The next day, our host started to feel sick. The day after that, she tested positive for COVID-19. She let all of us know right away. I wasn’t too worried. It was bad luck for my friend, but surely she wasn’t that contagious. Surely all of us were immune. I’d been sitting across the room from her. I figured I’d stay home and isolate from my family for a few days, and that would be that. And even that seemed like overkill.
The official Centers for Disease Control and Prevention guideline stated that, since I was fully vaccinated, I didn’t need to do anything different unless I started developing symptoms. I’m an epidemiologist at a major medical research university, which has a dedicated COVID exposure hotline for staff. I called it, and workers said I didn’t need to do anything.
Then, I started to hear that a few other people who had been at the party were getting sick. Then a few more. At this point, 11 of the 15 have tested positive for COVID.
Fortunately, none of us seems to be seriously ill. When fully vaccinated people experience so-called “breakthrough” infection, they tend not to progress to serious disease requiring hospitalization, and I expect that will be the case for us. But I can tell you that even a “mild” case of COVID-19 is pretty miserable. I’ve had fever, chills and muscle aches, and I’ve been weak enough that I can barely get out of bed. I don’t wish this on anybody.
Our research group at work has shown that the COVID vaccine isn’t always fully effective in transplant recipients. I’m proud of the work we’ve done. But once I got the vaccine, I figured the COVID battle was over for me. Out of an abundance of caution I took an antibody test shortly after my second vaccine dose. It was off the charts.
As much as I hate me and my fully vaccinated friends being sick, I’ve been thinking about what our little outbreak among means for the rest of us. Here’s what I’ve concluded:
State and local health departments, and the CDC, need to do a better job collecting and reporting data on breakthrough infections. The CDC announced in May that it was only going to collect data on breakthrough infections that led to hospitalization or death, which are fortunately rare. But that means that outbreaks like ours will fly under the radar. Any of us could infect others, apparently including other vaccinated people. It’s not clear if our group got sick because of a particularly virulent variant, because the vaccine is wearing off or for some other reason. Without good data, we’ll never know.
Fully vaccinated people exposed to COVID need to isolate at home and get tested. I thought I might be overreacting by leaving work in the middle of the day and immediately moving to our basement at home. Now I’m glad I did.
Governments and businesses should consider bringing back masking requirements, even for vaccinated people. We’re still at risk of getting sick, and we’re still at risk of infecting others. The CDC recently recommended masks for vaccinated people in areas with over 50 new infections per 100,000 people per week. In the seven days before my exposure, Montgomery County had 19.4 new infections per 100,000 people.
Pharmaceutical companies, research institutions and governments should prioritize research into booster vaccines. At one point it seemed like two mRNA doses or a single Janssen dose might be the answer. But apparently, whether because of variants or fading immunity, being “fully vaccinated” doesn’t necessarily mean you’re immune.
COVID-19 vaccines do an enormous amount of good. I expect a milder course of disease since I’m vaccinated. But COVID-19 isn’t over, even for the vaccinated. As the pandemic continues to evolve, we need to evolve with it.
Allan Massie (amassie1@jhmi.edu) is an epidemiologist and biomedical researcher at the Johns Hopkins School of Medicine. The views expressed here are his own.
