Hot Topics in Infection Prevention: Vaccination Push, Mask Mandates, Breakthrough Infections

The issue of breakthrough infections is increasingly coming up. How frequent are they? How infectious are they? Simply put, we know the COVID-19 vaccines do not offer sterilizing immunity.

Push to Encourage Vaccination

COVID-19 cases across the United States are rising. In the last 5 weeks, there has been a 300% increase in cases across the country, as the Delta variant takes hold and preys on the unvaccinated or partially vaccinated. In response to growing cases and data showing that breakthrough infections can spread SARS-CoV-2, several larger initiatives have been put into place. First, all civilian federal employees and contractors need to be vaccinated against COVID-

19 or undergo regular testing and mask wearing. In addition, those unvaccinated will have limits on travel. As CIDRAP, a publication out of the University of Minnesota, reports President Biden “also announced a new incentive program that calls on states and territories to give the newly vaccinated $100 when they get the shot. ‘It's time to impose requirements, and incentives,’ said Biden, who said 90 million Americans are eligible for vaccination but have not yet gotten the vaccines. ‘This is an American blessing, we cannot waste it’.”

Masking Mandates Being Imposed

Across the United States, mask and vaccine mandates are underway as over 68 thousand cases were reported yesterday (July 29). Early this week, the Centers for Disease Control and Prevention (CDC) also changed its guidance on mask wearing and post-exposure testing for fully vaccinated people. In a stark change from the controversial May guidance, the CDC is now recommending fully vaccinated people in areas of substantial or high transmission wear a mask when indoors in public due to the Delta variant. Moreover, the CDC is now recommending that all children and adults wear masks this fall when returning to school. Perhaps 1 of the more forgotten changes in recommendations is in regard to testing for vaccinated individuals following an exposure. The CDC now recommends—“If you’ve been around someone who has COVID-19, you should get tested 3-5 days after your exposure, even if you don’t have symptoms. You should also wear a mask indoors in public for 14 days following exposure or until your test result is negative. You should isolate for 10 days if your test result is positive.”

Breakthrough Infections Cause Concern

The issue of breakthrough infections is increasingly coming up. How frequent are they? How infectious are they? Simply put, we know the COVID-19 vaccines do not offer sterilizing immunity. They are very effective at keeping people from getting seriously ill and/or dying. In all honesty, understanding breakthrough infections will be challenging, especially if they are in asymptomatic people. Some studies have shed light on them, such as a new Israeli study which found a 2.6% breakthrough rate in health care workers. As these infections are frequently asymptomatic and the Delta variant is much more transmissible than the alpha strain, it’s important to understand these infections and the risk they pose, which is higher for those unvaccinated or immunocompromised. Right now, though, the goal is to get a handle on the rise in cases within the US and increasing vaccination rates (globally as well!). In the last 14 days, there has been a 141% increase in cases within the US and we are still hovering at 49% of the country being fully vaccinated.