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When I was vaccinated against Covid-19, I felt a deep sense of relief: no more worries about personally catching the disease.

So when I noticed mild, Covid-19-like symptoms two months later — stuffy nose, chest congestion, and an upset stomach — I thought they were due to seasonal allergies. I was shocked a few days later when a test for Covid-19 done in preparation for an unrelated medical procedure came back positive.

Not believing the result, I got tested again. And again. Over a five-day period I had four PCR tests — two were positive, two were inconclusive — and a false negative rapid antigen test.

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I quickly went about quarantining and notifying recent contacts. I soon began receiving multiple calls from my city’s Board of Health, whose representative told me she knew of several other people who had also tested positive even though they were fully vaccinated.

My experience shows that testing for Covid-19 isn’t perfect. Rapid antigen tests detect proteins that are part of SARS-CoV-2, the virus that causes Covid-19. They have a fast turnaround time, but aren’t as accurate as the gold-standard PCR test. In people with Covid-19 symptoms, rapid tests correctly detect the virus only 80% of the time. In those without symptoms, it drops to 40%.

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PCR tests, in contrast, tend to have much higher sensitivities, above 95% across the board.

How samples are collected can also affect the results of Covid-19 testing. I know this happens because I have had many Covid-19 tests over the past year. At some test centers, the clinician inserted the swab into the very back of my nose, known as the nasopharyngeal space. Some say it feels like the swab is heading into the brain. In other tests centers, the clinician barely scraped the lower rim of my nose; that’s called a nasal swab. Those made me wonder if it collected any sample at all. I’ve since learned that nasal swabs can miss detecting the virus in those with low viral loads.

While vaccination confers essentially 100% protection from Covid-19-related hospitalization and death, it doesn’t entirely prevent people from catching the infection in the first place.

A recent study from the University of California, San Francisco, tracking more than 30,000 health care workers showed an infection rate after vaccination of approximately 1%, meaning that infection is rare but still a threat. The Minnesota Department of Health announced it was investigating several of these “breakthrough” cases, as has the Oregon Health Authority. In mid-April, the Centers for Disease Control and Prevention reported 5,800 breakthrough infections to date among the millions of Americans who have been fully vaccinated.

Reports of 95% efficacy rates in vaccine clinical trials do not necessarily translate to real-world effectiveness of that magnitude, and can create a false sense of reassurance when it comes to asymptomatic or mild infections. The Pfizer trials only tested volunteers for SARS-CoV-2 if they developed symptoms after getting the vaccine or the placebo, leaving out those who may have been asymptomatically infected. Moderna trials also primarily looked at preventing symptomatic disease.

The lower efficacy rates in the clinical trials of the J&J vaccine may be more real-world, as they included asymptomatic PCR testing of participants, had more diverse patient populations, and were done later in the pandemic, when more viral variants had been identified. These differences may account for the lower efficacy rate of this vaccine — 74% for preventing asymptomatic infections — compared to 80% for Pfizer and Moderna’s vaccines, according to a recent Mayo Clinic study.

Here’s what I think all this means.

No vaccine is 100% effective at preventing Covid-19. The ones we have, though, are very effective at preventing severe illness, death, and reducing viral load in people unlucky enough to contract post-vaccination breakthrough infections. The focus now must remain on getting as many people vaccinated — and tested — as quickly as possible, so we can bring the pandemic to an end as soon as possible. To do this, we need more streamlined access to vaccinations and testing.

Regardless of vaccination status or prior infection, anyone with signs or symptoms of Covid-19 should get tested, as well as anyone who has been in close contact (within 6 feet for 15 minutes or more) with somebody with confirmed Covid-19. According to the CDC, people who have been fully vaccinated and have no symptoms following an exposure do not need to be tested.

In Massachusetts, where I live and work, the Stop the Spread initiative and organizations such as Transformative Healthcare are making free Covid-19 testing more widely available.

On the federal level, the Biden administration has already issued multiple executive orders to tackle the virus and expand Covid-19 testing for children and underserved populations, including a $650 million investment for K-8 schools and homeless shelters.

Even with nearly 25% of the U.S. population fully vaccinated, I — and others like me — are proof that now is not the time to let our guards down. Vaccines are necessary, but not sufficient for addressing Covid-19. Get vaccinated, but do not throw caution to the wind with regard to mask-wearing, basic hygiene, and physical distancing. It won’t be until we establish herd immunity that we can achieve our goal of eradicating this virus.

Stephen M. Tourjee is a child and adolescent psychiatrist; founder of Northshore Minds, a mental health practice north of Boston; associate director of Massachusetts General Hospital’s Transitional-Age-Youth Program; and an instructor in psychiatry at Harvard Medical School.

  • I guess this “journalist” didn’t read the articles saying that the COVID vaccines are 95% effective, not 100% effective. If she had, she would have realized that there’s nothing unexpected about some people getting COVID despite a vaccination.

  • I also tested PCR nasal swab positive five days after receiving my second Pfizer injection. My symptoms were three episodes of diarrhea and nothing else
    I was colonized while intubating a Covid positive patient who died 30 hours later and also tested positive for TB. I had on a N95 mask and a Papper and her viral load was so high that my nasopharynx was colonized
    Post vaccination caution is required. I do not go to closed spaces activities in the presence of unvaccinated people, I no longer hug anyone other than my wife snd daughter, I shake no ones hand. I call anesthesia when an ICU patient requires intubation. Vigilance is going to be required until Thanksgiving
    The bottom line is that the vaccine probably worked. I was colonized but not infected with symptoms

  • Out of the 6,000 or so breakthrough infections, 396 people were hospitalized and 74 people died, according to CDC data released last week. So your statemen, “While vaccination confers essentially 100% protection from Covid-19-related hospitalization and death, it doesn’t entirely prevent people from catching the infection in the first place.” would be bull caca.

    • Those 74 people are a death rate of 1 out of a million vaccinated people. That means 0.0001% of people who have been vaccinated have since died from COVID. That’s what I believe Dr. Tourjee meant by “essentially 100%”.

  • I have been fully vaccinated for 2 months. I never go out in public without wearing 2 masks. I just had symptoms of mild sinusitis and on 5th day lost smell and taste and tested positive for covid. I understand how vaccine is not 100%, and so far, I am still experiencing only mild symptoms. My concern is how much more do I have to do to still protect myself and family if double masking, social distancing, and hand washing didn’t protect me from contracting this infection. Had to reach out myself to an epidemiologist to have repeat testing for variants. No one has contacted me from cdc or health department to investigate my breakthrough infection.

  • “Catching Covid-19 after being vaccinated isn’t a myth.”

    Who in god’s name told you it was a “myth”?

    How poorly informed does a person have to be to think that these vaccines are 100% effective?

    • What Mot said. Anyone who acts surprised that you can still get Covid-19 even though you’re vaccinated should repeat 7th grade math and re-learn that 95% effective means the same thing as 5% ineffective. That we have to read stories like this makes me ask for whom was it written?

    • Exactly. This is a very strange kind of clickbait headline which unwittingly normalizes the anti-vaxxer refrain that “people are ignoring that you can still catch covid after getting the vaccine”. Never mind how something being less than 100% effective isn’t an argument not to use it; the very idea of people who believe the vaccine is infallible seems to exist only as figments of other people’s imagination.

  • Hi, are you immunosuppressed in any way or on any type of medication? If you don’t want to answer, I understand. I hope you feel better.

  • The trail of the vaccine gave efficacy of 90 to 95% protection and the current global statistic in USA reveal only about 6000 people who are vaccinated twice are affected by virus. 50 million people are vaccinated twice and the efficacy of the vaccine proved much better at 0.01 %

  • The relevant questions which you didn’t really address is what is your risk of getting severe illness and what is your risk of passing on the illness if you continue to follow common sense practices after getting vaccinated (like not meeting with people when you have symptoms). The authorities I’ve looked at on the matter suggest both risks are negligible, so there is no reason not to return to pretty much normal life once vaccinated.

    I would think a MD would have better training in accurately assessing risk. If you advocate continuing social distancing, mask wearing etc. after the vaccine even, you’d be committed to thinking, for example, that we should do it all the time in normal years too because of the possibility of getting the cold and flu. A fully vaccinated individual likely takes more risk getting in their car each time than they do being social again. The evidence also suggests that as a group they won’t contribute meaningfully to the further spread of the disease. I’d consider deleting this article so as not to cause completely unnecessary concern.

  • Uhhh, thanks for writing a non-article? I’m sure people like myself are looking up what it’s like to get COVID-19 while fully vaccinated in order to see how serious the symptoms are. You wrote an article that’s basically a list of other source’s statistics.

    How bad was your nose and chest congestion? How long were you sick for? Was it in line at all with unvaccinated COVID or very mild and manageable, like, able to go to work if it weren’t for the positive test?

    Also Trena P lol go back to Facebook with your nonsense

    Sorry if that was kind of harsh.

  • It’s very unfortunate when we have a society of health professionals who only want to push vaccines instead of pushing and promoting health and well being. Having a strong immune system will either prevent you from catching COVID-19 or keep you from having a severe case of it. Exercise, optimal hygiene, VitD, VitC, Zinc and Elderberry are essential for a strong immune system to help fight against ANY and ALL viruses.

    • Although being in good health minimizes the risk of complications it’s not a guarantee. Healthy individuals with zero risk factors have gotten seriously ill and some have died from SARS-Cov-2 (Covid-19). The MRNA vaccines have shown to be largely protective against serious illness, hospitalization and death from Covid 19. Your simplistic mantra is misinformed. Being in good health and taking supplements won’t prevent measles and won’t prevent infection with Covid. Even those with mild to no symptoms have been reported to suffer from long term neurological issues (as high as 20%) post infection.

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