Breakthrough COVID infections a reality check on road to normality

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Washington: I was supposed to meet up with my friend Hugo this weekend, but that won’t be happening anymore.

Hugo, a 28-year old architect who lives in New York, has been diagnosed with the coronavirus despite being fully vaccinated with Moderna for three months.

A day later another friend in New York, who was vaccinated with Johnson&Johnson, also tested positive for the virus.

Such “breakthrough” infections among the vaccinated remain rare, according to the Centres for Disease Control and Prevention (CDC). But it’s clear they are becoming increasingly common in the US as the Delta variant spreads across the country.

Masks are back on in New York, despite the city’s high vaccination rates. Credit:Bloomberg

To be sure, the vaccines remain medical miracles and exponentially reduce one’s chances of getting seriously ill or dying from COVID-19. American doctors report that virtually all the people with COVID-19 in the country’s intensive care units are un-vaccinated - usually because they chose not to get jabbed.

But the fact that new strains of the virus are more likely to evade the vaccines, and then be passed on to other people, is complicating America’s planned return to normality.

It offers a likely preview of the dilemmas Australians will face down the track when the country’s vaccination rate is far higher than it is now.

Just two months after telling vaccinated Americans they no longer needed to wear masks, the CDC this week reversed course and advised them to wear masks in public if they live in places with high or substantial COVID transmission rates. That definition covers two-thirds of all Americans.

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The reason the CDC dramatically relaxed its mask guidance in mid-May was the accumulating evidence that the vaccines were incredibly effective at halting the spread of the virus.

CDC director Rochelle Walesnsky told Americans that “if you are vaccinated, you generally don’t get asymptomatic infection and generally cannot transmit to other people”.

Anthony Fauci, President Joe Biden’s top medical adviser, was even more forceful, saying that once vaccinated “you become a dead end to the virus and when there are a lot of dead ends, the virus is not going to go anywhere”.

That’s not what the experts are saying any longer.

The reason for the new guidance, Walensky said this week, is fresh data suggesting that vaccinated people “may be contagious and spread the virus to others”.

Centres for Disease Control and Prevention Director Rochelle Walensky this week announced changes to mask-wearing guidance. Credit:AP

Particularly worrying, she said, was evidence that vaccinated people infected by the Delta variant appear to carry viral loads that “are actually quite similar” to unvaccinated people who contract it. This means they are highly likely to pass it on to others.

If this trend continues, Australians will have to be prepared for the virus to circulate within the community even if the country achieves an impressive vaccination rate. The risk of people getting seriously ill, however, will be dramatically lower than before the vaccines became available.

The economic implications of breakthrough infections are also significant.

Many American companies were planning for most, if not all, of their employees to return to the office from the start of September after over a year working from home.

The greater transmissibility of the Delta strain - even among the vaccinated - may make some chief executives rethink those plans. This would have a damaging knock-on effect on the restaurants, cafes and dry cleaners in central business districts that rely on office workers to make a living.

Among those who do return to the office, many will be wearing masks throughout the work day. Australian business leaders will face similar complications after lockdowns lift and vaccination rates rise.

The fact vaccinated people are at more risk of contracting COVID-19 than previously thought has also prompted tougher policies to pressure the hold-outs into getting a jab.

Until now, the un-vaccinated were believed to essentially only pose a risk to themselves - as well as children who are too young to get vaccinated and the immunocompromised.

The greater transmissibility of the Delta variant makes it imperative for them to get vaccinated for the good of society. As a result, the land of the free is moving away from vaccine incentives - like free beer or gift cards - to vaccine mandates.

In a major move on Friday (AEDT) Biden will announce that all federal government employees and contractors - a workforce comprising over two million people - will be required to present proof of vaccination.

The mayors of New York or Los Angeles have also announced that all city workers must provide proof of vaccination or submit to weekly testing.

Similarly, vaccine mandates in Australia will likely extend well beyond the aged care worker requirement the Morrison government announced in June.

After his diagnosis, my friend Hugo is isolating at home with a high fever and flu-like symptoms. All things going well, he will be out of quarantine just in time to celebrate his 29th birthday.

The worst part of getting COVID, he says, was the uncomfortable task of having to tell a multitude of colleagues and friends that they were close contacts and needed to get tested for COVID-19.

He’s still glad he was vaccinated: it’s possible his illness would have been more serious if he had not gotten the jab.

He knows that the vaccines remain society’s most powerful tool in our fight against the virus. Even if they are not quite as foolproof as we’d like, and post-vaccination life more complicated than we’d hoped for just a few months ago.

Matthew Knott is North America correspondent for The Sydney Morning Herald and The Age.

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