Delta Variant, Breakthrough Infections & What You Need to Consider

As a primary care physician treating older adults fifty years of age and older, I am starting to be involved in the treatment of “breakthrough” COVID-19 cases in vaccinated adults. At the end of June 2021, just prior to the July 4th holiday, we were told to enjoy the summer if we were vaccinated. Many in my patient population took this to mean book flight and cruise reservations and begin travelling. Others started meeting friends to shop again, exercise together in gyms or eat lunch socially indoors.  Experts at the CDC felt it was safe to take off our masks indoors.  Then came the Delta variant – a far more transmissible virus. 

I first read about breakthrough cases in a peer reviewed medical journal discussing the widespread outbreak of COVID-19 in Israeli citizens vaccinated with the Pfizer Vaccine. The message was clear, if vaccinated, you can still get the viral infection with the Delta variant, but you won’t require hospitalization and you have a minimal chance of dying. 

With that news many of my patients continued resuming their lives and normalizing to pre-pandemic routines without masking or distancing in public areas.  Three weeks ago, our local hospital had no breakthrough cases. Two weeks ago, there were five. All the breakthrough cases in individuals 65- years of age, or older, or with symptoms, are invited to receive the monoclonal antibody treatment which shortens the course of the illness and the severity.   Treatment should be within 10 days of first developing symptoms. The cases are so numerous this week that there is a wait of days to get treated.

In discussing the breakthrough cases with my ill patients, they all feel miserable.  They are exhausted, coughing, some febrile with high fevers and severe joint and muscle aches. Some have lost their sense of taste and smell. They say the monoclonal antibodies help, but a week later most of my patients are too weak and tired to do much beyond their necessary activities of daily living. They call daily asking how much longer this will last.  My answer is, “I just do not know.”

I also do not know If their viral load was high enough to transmit the disease to the unvaccinated, the immunosuppressed vulnerable vaccinated patients or even other vaccinated individuals.  The experts are not sure either. Will these vaccinated breakthrough patients become “long haulers” with chronic symptoms stretching to months post infection?  We don’t know – it’s too soon to tell. 

I am also getting calls from patients who were out socially unmasked with close friends and relatives and have now received a phone call that their friends have the COVID-19 infection, and they were exposed.  These patients need to be tested for the disease a few days after exposure but, with the closure of all the state-run testing sites locally, you are limited to going to your pharmacy or some walk-in clinics for COVID testing. Take my advice, get the nasal PCR test sent to the lab which takes longer than the quick test but produces fewer incorrect results.

What I do know is this is a disease well worth avoiding.  Get vaccinated if you haven’t already done so.  Wear a good N95 or KN95 mask if you must go out in public to an indoor facility, and you have no idea who is vaccinated, and who isn’t, and who might be spreading the disease prior to developing clear cut symptoms.  Yes, this is retreating and taking a step backwards into a bunker mentality.  If you don’t believe me, just ask my COVID-19 breakthrough patients. They will tell you this is more than just a “bad flu.”

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