By Chloe Reichel
Recently, a narrative that COVID-19 is now a “pandemic of the unvaccinated” has emerged.
Setting aside the callousness of the claim, the biggest problem with this narrative is that it’s wrong. COVID-19 continues to threaten the health and well-being of all, regardless of vaccination status.
As we now know, vaccinated individuals can be infected with and transmit the delta variant. “Breakthrough” infections are not rare — countries with better data collection efforts than the U.S., including Israel and the United Kingdom, estimate vaccine efficacy against infection by the delta variant at around 40-50%.
This isn’t to say that the vaccines are worthless. We should continue to work to promote vaccine uptake, as the vaccines do provide a level of protection against the most severe outcomes.
But we need to understand: We can’t end this pandemic with vaccines alone.
First, it’s not possible to achieve the level of vaccination needed to reach herd immunity (some estimate 98%). Even if everyone who could get vaccinated did so today, we’d still have millions of unvaccinated children, and countless vaccinated-but-still-vulnerable adults (e.g., people who are immunocompromised, people who still have to wait weeks for their second dose and then two weeks more to mount a full response to the shots).
And, even in a perfect world with 100% uptake, the level of protection offered by the current vaccines likely is not enough to end the pandemic. Because the vaccines do not confer sterilizing immunity — that is, prevention of infection entirely — vaccinated people can get sick with COVID-19, and they can transmit the virus to others, both vaccinated and not.
This is concerning because every COVID-19 infection is an opportunity for onward transmission and mutation of the virus. Every new case and every new variant threatens an even more dire future.
Setting aside the possibility for further mutation, there is cause for concern about so-called “breakthrough” infections in their own right. We do not know the long term effects of these infections, even if they are mild or asymptomatic, but we should not presume there are none.
A small study of such infections in health care workers in Israel found that nearly one in five had symptoms for over 6 weeks — indicative of long COVID. COVID-19 affects nearly every organ system in the body, including the brain. These findings hold even for mild cases.
Stopping the spread of COVID-19 is critical for all of these reasons.
Luckily, the answer to these various concerns — the threats the virus poses to the vaccinated, not-yet-vaccinated, immunocompromised, and conscientious objectors — is the same: a layered defense, combining proven non-pharmaceutical mitigation strategies, such as masking and distancing, with the protection offered by vaccines.
A federal mask mandate in all public settings (including outdoors) should be the cornerstone of these efforts. I specify outdoors because COVID-19 is airborne; aerosols containing the virus behave like smoke — while they dissipate more rapidly in a well-ventilated area, sustained close contact, even outdoors, can lead to transmission. (Think of how you might get a whiff of cigarette smoke while passing a smoker outside.)
In addition to a mask mandate, the federal government should follow the approach some other countries have taken and distribute high-filtration masks widely, free of charge. High-filtration masks are a key non-pharmaceutical intervention for source control (i.e., containing aerosols produced by an infectious individual), as well as for personal protection.
The Biden administration should also consider a paid shutdown to get transmission of the highly contagious delta variant under control.
Additionally, the U.S. Centers for Disease Control and Prevention (CDC) should clearly communicate the need for airborne disease mitigation measures, such as ventilation and filtration. Simple measures like opening windows can reduce risk in indoor spaces.
We also need to step up our national testing efforts, as well as our tracking of infections (and long-term sequelae) in vaccinated (and unvaccinated) individuals.
Lastly, the CDC and the White House need to stop downplaying the risks that COVID-19 continues to present to all of us. The sooner we join forces to eliminate the virus, the sooner the pandemic will end. Declaring premature victory for the vaccinated and dropping mitigation measures will only prolong the pandemic, and possibly give rise to more severe strains.
