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Vaccinated, Boosted and Still Caught COVID? Here’s What to Do

Once-rare breakthrough infections are becoming more common in the omicron era 

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How to Protect Against the Omicron Variant

With omicron’s ability to glide past some of the vaccine’s defenses, experts predict that an increasing number of vaccinated Americans will test positive for COVID-19 as the new variant rips through the country. Even some boosted individuals will pop positives on coronavirus tests, although their protection against hospitalization and death from an infection remains strong.

So what do you do if you get a breakthrough case of COVID? AARP spoke with several experts on the topic. Here’s their advice.

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1. Don’t panic

First and foremost, panicking is not advised. In fact, “anytime you're in a stressful health care situation, freaking out is probably the most dangerous thing you can do to yourself,” since it clouds your ability to think clearly and positively about what needs to be done to get better, says Robert Hopkins Jr., M.D., professor of internal medicine and pediatrics and division director of General Internal Medicine at University of Arkansas for Medical Sciences.

Some concern is understandable, especially if you have underlying health conditions that can put you at greater risk for complications from COVID. But it’s important to keep in mind that “the overwhelming majority of people who have a breakthrough infection following vaccination and boosting will be OK,” says Benjamin Springgate, M.D., section chief of Community and Population Medicine at Louisiana State University (LSU) Health New Orleans School of Medicine.  

Emerging research shows that even in the wake of omicron, the booster is about 75 percent effective against symptomatic COVID and may be even higher against severe disease. “And the benefit that we're seeing from being vaccinated and boosted is that people have a lower likelihood of ending up in the hospital, a lower likelihood of severe outcomes and severe illness,” Springgate says.

What’s more, evidence suggests that the omicron variant — which is now responsible for about 95 percent of new COVID-19 cases in the U.S. — causes less severe illness than its predecessors, although research is ongoing.

“We do want to be cautious in that statement as that does not, unfortunately, apply to everyone,” points out Jodie Guest, professor and vice chair of the Department of Epidemiology at Emory University’s Rollins School of Public Health. Plus, the delta variant, which some studies have found causes more severe illness than other versions of the virus, is still circulating and contributing to the current surge in infections and hospitalizations.

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2. Talk to your doctor

Finding out you are positive for COVID almost always warrants a call to your health care provider, the experts say. A doctor who knows your medical history can help you navigate a treatment plan that takes into account any health conditions that could worsen the infection, like diabetes, heart disease, kidney disease, obesity — there are many. If you’re at particularly high risk for hospitalization, your doctor may want to start you on one of a handful of COVID treatments to prevent the disease from progressing to a dangerous state.

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The Food and Drug Administration (FDA) recently authorized two new prescription pills from Merck and Pfizer that help to keep people at high risk for COVID-19 complications out the hospital. These oral antivirals are currently in short supply, but are expected to be more available in the coming months. Monoclonal antibody treatments are another option for high-risk individuals, depending on the variant that caused the infection. Two of the three antibody treatments available are not effective against omicron, just delta. And like the new pills, this omicron-fighting antibody is also hard to find during the current coronavirus surge. 

3. Isolate yourself from others

Catching COVID, even if you don’t come down with symptoms, means you need to isolate yourself from others so you don’t pass on the virus.

If you’re asymptomatic or have mild symptoms, the newly updated guidelines from the Centers for Disease Control and Prevention (CDC) recommend a five-day isolation period — as long as symptoms are resolving (not counting loss of taste and smell, which takes a while to return) and you’re fever-free. Then, follow it up with five days of mask wearing when you’re around others. The decision was based on new data that suggests people are most infectious early in the course of the infection, right around the time the first symptoms appear. What’s more, omicron seems to have a shorter incubation period, meaning there’s a smaller gap between time of infection and symptom onset.

Even if you’re symptom-free after day five, however, Guest recommends taking an at-home antigen test before rejoining others. “If that is positive, you should anticipate that means you are still infectious to others and that your isolation should continue,” she says. People who are severely ill with COVID or who have compromised immune systems may need to isolate longer — at least 10 days, according to the CDC. 

If you live with others, the idea of isolation may seem impossible, but really it just means “trying to limit your contact with them to the extent possible,” Springgate says. If there’s a spare room or empty side of the home, claim it, and if you leave your bubble to go to shared spaces like the kitchen or bathroom, wear a high-quality mask, such as a KN95. “That can really make a difference and reduce the likelihood of infecting those around you,” Springgate adds. However, if others in your home also have COVID, there’s no need to stay apart. 

Live alone? Let a friend or family member know that you have COVID and that you need to stay isolated for a few days, Guest says, and make sure there’s someone who can check in on you by phone, text or email every day. Also, when your isolation period ends and any symptoms clear, don’t hesitate to go back out in the world, says June McKoy, M.D., a geriatrician and professor of medicine at the Northwestern University Feinberg School of Medicine.

“We know how detrimental isolation has been, especially to older adults. I don't want to see seniors going back into panic mode where they don't go anywhere, do anything,” she says. “I'd like them to quickly isolate and when they're feeling better, get out and pick up their lives again,” while still exercising all the recommended precautions.

“Don't forget about the simple things like washing your hands, improving indoor air quality and wearing those masks for the immediate prevention of infection,” Hopkins adds.

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4. Keep an eye on symptoms

If you’re boosted, you’re less likely to experience significant COVID symptoms, Guest says, “but you should anticipate fatigue, fever, possibly a runny nose and a sore throat.”

Plus, any symptoms that you get shouldn’t stick around for too long. “It does appear that people who are boosted clear the virus faster,” Guest adds. “And so you may be in for a slightly longer set of symptoms, if you are [vaccinated but] not yet boosted.”

Mild to moderate symptoms can be managed at home with plenty of fluids and over-the-counter medications such as acetaminophen (Tylenol) and ibuprofen (Advil) to alleviate fevers and muscle aches — just make sure they don’t interfere with any other medicines you are taking. McKoy also recommends vitamin D and zinc supplements, which she says can help to support the immune system, and checking your oxygen levels with an at-home pulse oximeter.

However, if you get to the point where you’re having difficulty breathing — “for example, you simply can't catch your wind,” Springgate says — or if you can’t stay hydrated, it’s time to seek immediate medical attention. Other emergency warning signs include persistent pain or pressure in the chest; confusion; inability to wake or stay awake; a high fever that won’t come down; and pale, gray or blue-colored skin, lips or nail beds.

5. Get your booster if you haven’t already

If you've received your initial vaccine, but not a booster shot, and came down with COVID-19, it’s not too late to get that extra dose. As long as you’re five months out from your second Pfizer or Moderna shot (and two months if you had Johnson & Johnson’s single-shot vaccine), you can get a booster as soon as your symptoms resolve. If you received monoclonal antibody treatment for COVID, you’ll need to wait longer so the two therapies don't interact with each other. “We're hoping to see that the infection [with omicron] will lead to some protection from subsequent omicron infections, but a booster plus that immunity is almost certainly going to be better than that immunity itself,” Springgate says.

Another benefit of getting the booster soon after a breakthrough case: It could lower your risk of experiencing new or lingering symptoms after the illness. “There is some data to support that the faster you get it, the less likely you are to have long-term complications from long COVID,” Guest says.

6. Know that your vaccine didn’t fail

A breakthrough infection is not a sign that the vaccines don’t work, several of the experts emphasize. While vaccinated people are less likely than unvaccinated individuals to contract COVID, the main job of the vaccines is to prevent death, and federal data shows they’re still doing that.

“This is not an indication that the technology behind the vaccine has failed,” Springgate says. “This is a recognition that this is a brand-new organism, a brand-new virus that has newly mutated and is able to evade the prior two-dose series.” The current booster shot seals in an added layer of protection, and it may be the case going forward that another is needed, he adds. All three vaccine makers have announced that they are testing omicron-specific vaccines that could be available as early as this spring.

Rachel Nania writes about health care and health policy for AARP. Previously she was a reporter and editor for WTOP Radio in Washington, D.C. A recipient of a Gracie Award and a regional Edward R. Murrow Award, she also participated in a dementia fellowship with the National Press Foundation.

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