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The unsettling uncertainty of a breakthrough case

The unsettling uncertainty of a breakthrough case


It’s hard to reconcile breakthrough COVID-19 with the hope of vaccines

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Last weekend, a close friend texted me with the jarring news that her COVID-19 test had come back positive. She was vaccinated and had been since April. She got her first shot just a few days before I got mine. 

Before I got that text, I’d been reminding my friends and family that some people who get vaccinated are going to get COVID-19 anyway. Vaccines aren’t perfect. I cautioned that when cases are surging, like they are right now in New York City, the raw number of vaccinated people who get sick is going to go up. Unvaccinated people still face even higher risks of catching the disease.

I know all of that. I think about those facts and statistics every day when I’m reading studies and checking transmission levels around the country. But even armed with that knowledge, I still spent a solid day and a half suddenly convinced that I was no better off than I was before getting vaccinated. I’m still struggling to work my way out of that spiral. 

It’s unsettling to be mired in uncertainty again after over a year adjusting to a relationship with the coronavirus. After spending the month of June reveling in vaccinated freedom, the whiplash back to fear is jarring. Eve Sneider wrote in Wired this week that the delta variant, which is driving the United State’s fourth wave, has upended our risk perception. 

“Choices that had become refreshingly simple and thoughtless early this summer, like entering a grocery store or a bar without a mask, are again more like skydives—relacquered with a layer of viral risk,” she wrote. “Once again I was asking: How much freedom is too much?”

My friend’s COVID-19 case was a sudden reminder of how much delta changed the game

My friend’s COVID-19 case was a sudden reminder of how much delta changed the game. The fast-spreading variant is driving surges around the US, turning back the clock to mirror the worst outbreaks in the early days of the pandemic in Louisiana and Florida. Places with high vaccination rates are struggling, too, as the virus finds the remaining pockets of the unimmunized in those areas. Everywhere, uncertainty about the safety of daily activities is piling back up. The vaccines are holding fast against hospitalizations and deaths from COVID-19, but they may not be quite as good at staving off symptomatic disease or infection with the virus. Breakthrough infections are still probably uncommon, but they may be less rare than they would have been under previous variants — there isn’t good data yet to say for sure. 

When vaccine development started in spring of 2020, experts aimed their expectations low. Something that was 50 percent effective would have been good enough for the Food and Drug Administration. Instead, we ended up with vaccines that clinical trials said were 95 percent effective against symptomatic COVID-19 — a dream outcome people hardly even knew to hope for. The giddy promise of that high, high number buoyed my hopes through June. Delta knocked them back to Earth. Now, I’m confronted with that yawning gap between 95 and 100, which delta stretched even wider. Emotionally, even if not statistically, it feels big enough to steer a cruise ship through. 

After a few days of what felt like a bad cold, my friend was physically fine. Mentally, she had a harder time, and so did I. It’s hard to reconcile the discord between public health trends and individual health. Despite the breakthroughs, despite delta, the vaccines are working, even if they’re not a solution on their own. Rates of COVID-19 are far lower among vaccinated people than they are for unvaccinated people in cities reporting that data. States with higher vaccination rates aren’t seeing as much of a surge in hospitalization. They’re working for most of the vaccinated people who get COVID-19, too — it just doesn’t always feel that way. It’s hard to process the big-picture safety when you or someone you know is curled up in bed, sick. 

Slipping back into caution after a brief spell of optimism and hope is hard. I’ve spent the week dragging myself back from the edge, again and again, reminding myself that the shots are still working. Public Health England said this week that, so far, vaccines prevented 23 million COVID-19 infections and 84,600 deaths in England. I’m holding fast to the reminders like that one: even though delta makes the virus more frightening, the vaccines are still here, and they’re still keeping people alive. 

Here’s what else happened this week. 


The C.D.C. endorses Covid vaccinations during pregnancy.
Safety data shows there is no increased risk of miscarriage for pregnant people who receive a COVID-19 vaccine. The Centers for Disease Control and Prevention says they should get the vaccine. (Roni Caryn Rabin / The New York Times)

A New Pandemic Reality for America’s Kids
The fast-spreading delta variant of the coronavirus is dangerous for everyone, but it’s been devastating for children — who aren’t able to be vaccinated. Kids are at a lower risk for severe outcomes, but when more kids get sick, more get seriously ill. (Katherine Wu / The Atlantic)

Dissecting the Unusual Biology of the SARS-CoV-2 Delta Variant
Delta is the fastest-spreading version of the coronavirus. Scientists are trying to understand why. It might be able to replicate more quickly, or fuse more easily with cells, but there aren’t conclusive answers yet. (Katarina Zimmer / The Scientist)

Kidney transplant patients will test a COVID-19 booster shot in new trial
The National Institutes of Health is checking to see if a third dose of a COVID-19 vaccine helps kidney transplant patients mount a more effective immune response. (Nicole Wetsman / The Verge)


Pentagon to require COVID vaccine for all troops by Sept. 15
Members of the military will have to get a COVID-19 vaccine. The deadline could come sooner if the Food and Drug Administration fully approves the shot. (Lolita Baldor / Associated Press)

A snort or a jab? Scientists debate potential benefits of intranasal Covid-19 vaccines
Vaccines sprayed into the nose might be able to protect the nasal passages more effectively than shots in arms. But it’s unclear if gene-based vaccines could be reformulated to be administered through that route. (Helen Branswell / Stat News)

The world needs more vaccines, faster. A tiny tube could make all the difference.
Right now, vaccines are made in large vats, which can be inefficient. A team of scientists thinks making them in a continuously running tube might be a better solution. (Roxanne Khamsi / National Geographic)


My deescalation research was all for naught. Nineteen of the 20 people who shuffled up the stairs at the dive bar had their vaccine proof ready for inspection during the first hour I observed Adams and Powers. No one made a fuss, not even the one patron who fumbled for documentation for 10 minutes before giving up and leaving. 

Washington City Paper’s Laura Hayes was expecting the worst on the first night a bar was requiring proof of COVID-19 vaccination. But it went off without a hitch. 

More than numbers

To the people who have received the 4.5 billion vaccine doses distributed so far — thank you.

To the more than 205,202,233 people worldwide who have tested positive, may your road to recovery be smooth.

To the families and friends of the more than 4,330,899 people who have died worldwide — 618,840 of those in the US — your loved ones are not forgotten.

Stay safe, everyone.