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They followed all the guidance, took every precaution, but got COVID-19 anyway.
Christina Van Norman and David Coe had resumed small gatherings — finally — of their fully vaccinated friends in their home in Montgomery County, where coronavirus transmissions were relatively low.
The day after the last event, she felt run-down. Two days later she had a fever and body aches, and a rapid test confirmed that the infection wasn’t a seasonal cold but the coronavirus. Her husband soon tested positive and they alerted their guests.
“We thought we were vaccinated and safe, and that’s the scary part,” Van Norman said. “I’m not dying, but I’m pretty darn sick and absolutely spreading it to others.”
Ultimately 14 of 17 vaccinated people tested positive after the gathering — results that are becoming more common in Maryland and across the country as more people emerge from COVID lockdowns and mask mandates and run headlong into the more contagious and fast-spreading delta variant. Cases are again on the rise.
Still, the overarching message from public health officials is that vaccines are working and are the best line of defense against serious illness. Official reports of so-called breakthrough cases, fully vaccinated people becoming infected, remain low in Maryland and around the country.
While Van Norman continues to have really unpleasant symptoms two weeks after testing positive, neither she nor the others likely infected at the party have been hospitalized.
“The key message is the vaccine works very, very well,” said Dr. Georges Benjamin, executive director of the American Public Health Association and a former Maryland health secretary. “It is extremely effective in preventing severe illness, hospitalizations and death.”
There were about 3,000 post-vaccination infections recorded in Maryland as of last week, according to data provided by the Maryland Department of Health. There could be more, however, because until recently the U.S. Centers for Disease Control and Prevention didn’t advise vaccinated people who were exposed but asymptomatic to be tested.
Officially, the tally of breakthrough cases accounts for just 0.08% of the more than 3.6 million residents vaccinated in the state — fewer than 1 in every 1,000. The state couldn’t immediately say how many of those infected had been hospitalized, but officials previously said that most of those hospitalized and all those who have died of COVID-19 have not been fully vaccinated.
State health officials continue to “strongly encourage” eligible Marylanders — anyone 12 or older — to get a shot. Children as young as age 5 are expected to become eligible by late fall.
“Vaccinated Marylanders have taken the most important step they can to keep themselves, their families, friends, community and countless others safe from COVID-19 and the highly contagious delta variant,” said Charles Gischlar, a spokesman for the state health department.
The Maryland numbers mirror those from other states reporting post-vaccination infections.
The CDC collects data only on serious breakthrough cases, but a new report from the Kaiser Family Foundation found the infections remain rare in the 25 states publicly reporting some post-vaccination case data, which did not include Maryland.
The report found the rate of breakthrough cases was well below 1% in every state and the rate of hospitalizations ranged from zero in several states to a high of 0.06%. Deaths were reported in two states.
This does not mean people aren’t getting sick. Van Norman said she still has head congestion and some dizziness and fatigue.
“I’m not on a ventilator,” she said. “So, it’s better than it could be. But it’s hanging on.”
Benjamin said a real problem is that infected people who have been vaccinated still can become carriers for brief periods of time and pass on COVID-19, particularly to children or others vulnerable in the household. There also are a lot of unvaccinated people around the country who could be infected.
For this reason, until more people are vaccinated and the pandemic slows, he said, “the best way to protect them is to have everyone wear a mask.”
Matthew Frieman, associate professor in the department of microbiology and immunology at the University of Maryland School of Medicine, said earlier estimates about how many people would need to be vaccinated to achieve herd immunity, when a virus slows dramatically because it can no longer find viable hosts, have been pushed higher due to the delta variant.
But some communities may be able to contain the virus with lower levels of vaccination coverage if they use other public health interventions such as masking, social distancing and ventilating spaces, he said. People in areas with low levels of vaccinations and that are more resistant to using such layered approaches will have higher rates of severe infection and death, he added.
“There’s been pushback from people who don’t want to wear masks and who say, ‘We shouldn’t need to because we’re doing good here,’ and my response to that has been, ‘We know the small inconveniences that can protect our kids and our families work, and we want to keep the virus at bay as long as possible,’” Frieman said.
It’s unclear how willing the pandemic-weary public will be to return to masking, especially those who are vaccinated.
State and local officials are pondering their masking policies — mandates or recommendations — which have changed and diverged over time with circumstances in the community. Some states such as Florida and Arkansas have come out forcefully and legally against masking.
In Maryland, Gov. Larry Hogan said he would not reinstate an indoor mask mandate that expired last month. Some local governments, along with schools and private businesses, have considered or are considering mandates. But the mishmash of advice has likely only been confusing for some, while Van Norman considers it disappointing.
According to the guidance she sought from the CDC, her partygoers didn’t need to wear masks because the level of transmission in the county was not high. Montgomery still is not among the more than half the counties in Maryland now listed as having “substantial” or “high” transmission where masks are recommended indoors for unvaccinated and vaccinated people.
There are sure to be more cases everywhere because there is more virus in the community and more opportunities for spread, said Caitlin Rivers, an epidemiologist and senior scholar at the Center for Health Security in the Johns Hopkins Bloomberg School of Public Health.
“I’m still very confident that I’m protected against severe illness as someone who is vaccinated,” she said, “but I’m reaching for the mask to reduce my risk further.”
Frieman said those cases are sure to rise more as the seasons change, and for children, those who are immunocompromised and others who respond poorly to vaccinations, the impact of the delta variant and future variants could be staggering.
“These cases will go up this winter, there’s no doubt about it, and where do we want to be on the spectrum here?” he said. “I certainly want to be on the low end.”
Baltimore Sun reporter Hallie Miller contributed to this article.