![Jolanta Gawlik gives Juliana Cepeda a dose of the Pfizer vaccine Friday in New York. Cepeda, 20, of Bogota, Colombia, traveled to New York to be vaccinated. “I want to be safe,” she said. “And in my country the vaccination [process] is slow.”
(AP/Mark Lennihan)](https://wehco.media.clients.ellingtoncms.com/img/photos/2021/07/31/1ANatcorona_t800.jpg?90232451fbcadccc64a17de7521d859a8f88077d)
Fully immunized people with so-called breakthrough infections of the delta variant may spread the virus to others just as easily as unvaccinated people, the Centers for Disease Control and Prevention said in a report published Friday.
Health officials released details of that research, which was key in the agency's decision this week to recommend that vaccinated people return to wearing masks indoors in parts of the U.S. where the delta variant is fueling infection surges. The authors said the findings suggest that the CDC's mask guidance should be expanded to include the entire country, even outside of hot spots.
Critically, the study found that vaccinated individuals carried as much virus in their noses as unvaccinated individuals, strongly suggesting that vaccinated people could spread the virus to one another. The CDC was criticized this week for changing its mask guidance without publishing the data it relied on. The report released Friday contains some of that data.
The vaccines remain powerfully effective against severe illness and death, and infections in vaccinated people are thought to be comparatively rare. But the revelation follows a series of other findings this week about the delta variant, all of which have changed scientists' understanding of the coronavirus.
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The agency's report described a single outbreak in Provincetown -- a seaside tourist spot on Cape Cod in the county with Massachusetts' highest vaccination rate -- that has so far included more than 900 cases. About three-quarters of them were people who were fully vaccinated.
"This finding is concerning and was a pivotal discovery leading to CDC's updated mask recommendation," CDC director Rochelle Walensky said in a statement. "The masking recommendation was updated to ensure the vaccinated public would not unknowingly transmit virus to others, including their unvaccinated or immunocompromised loved ones."
Like many states, Massachusetts lifted all covid-19 restrictions in late May, ahead of the traditional Memorial Day start of the summer season. Provincetown this week reinstated an indoor mask requirement for everyone.
An internal agency document, which was obtained Thursday night by The New York Times, raised even more questions about the virus and its trajectory. Taken together, the data gathered by the CDC throw into question the country's plans to return to offices and schools this fall, and revive difficult questions about masking, testing and other precautions.
"We spent so much time and energy and treasure trying to figure out this d* * * virus last year, and how it works and all the things it does," said Dr. Robert Wachter, chairman of the Department of Medicine at the University of California, San Francisco.
Learning just how different the delta variant is from the original virus is "just jarring," he added. "The brain doesn't like to keep being jerked around like this."
The delta variant, first detected in India, causes infections that are more contagious than the common cold, flu, smallpox and the Ebola virus, and it is as infectious as chickenpox, according to the documents, which mentioned the Provincetown cases.
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Breakthrough infections among vaccinated people were always anticipated, but until the delta variant arrived, vaccinated Americans were not expected to be sources of new infections.
The vaccines remain the one reliable shield against the virus, in whatever form it takes. Nationwide, about 97% of people hospitalized with covid-19 are unvaccinated, according to data from the CDC.
"Full vaccination is very protective, including against delta," said Angela Rasmussen, a research scientist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan in Canada.
"Masks are a wise precaution, but the bulk of transmission is among the unvaccinated, and that's still who is most at risk," she added.
PACE OF VACCINATIONS
The gathering research underscores the urgency to pick up the pace of vaccination in the U.S. and decrease the numbers of people susceptible to severe illness. This week, the pace of vaccination in the European Union exceeded that in the U.S. for the first time.
The agency stepped up concern over the spread of the virus in its report Friday, urging even jurisdictions with undetectable levels of the virus to put into effect precautions. But the CDC's internal document advocated for universal masking -- for everyone, whatever the local transmission levels.
The documents appear to contain talking points for the CDC staff to use with the public. One point advised: "Acknowledge the war has changed," an apparent reference to deepening concern that many millions of vaccinated people could be a source of wide-ranging spread.
An agency spokeswoman declined to comment on the documents.
The White House on Friday defended its approach to rising virus cases and shifting public health guidelines, repeatedly deferring to the CDC while stressing the need for vaccinations.
"The most important takeaway is actually pretty simple. We need more people to get vaccinated," White House spokeswoman Karine Jean-Pierre said.
With the number of daily cases up to nearly 72,000 on average as of Friday, immunized people with young children, aging parents, or friends and relatives with weak immune systems may need to wear masks to protect vulnerable people in their orbit -- even in communities with lower infection rates.
The outbreak in Provincetown this month strongly supports the idea that even fully immunized people can unwittingly spread the virus. "We believe at individual level they might, which is why we updated our recommendation," Walensky said in an email to The Times this week.
SPREADER EVENT
The outbreak sprouted after more than 60,000 revelers celebrated the Fourth of July in Provincetown, gathering in densely packed bars, restaurants, guesthouses and rental homes, often indoors.
By July 10, there was a noticeable uptick in cases among residents of the county, including among people who were fully immunized. A week later, the county's daily average shot up from zero cases to 177 cases per 100,000 people.
Travis Dagenais, who was among the many vaccinated people infected, said "throwing caution to the wind" and partying in crowds for long nights over the July Fourth holiday was a mistake in hindsight.
"The dominant public messaging has been that the vaccine means a return to normal," the 35-year-old Boston resident said Thursday. "Unfortunately, I've now learned it's a few steps toward normal, not the zero-to-60 that we seem to have undertaken."
Dagenais credits being vaccinated with easing the worst of the flu-like symptoms in a couple of days. He has recovered.
"Vaccines are like hip waders," Rasmussen said. "They keep you dry if you wade through a river, but get too deep and water will start pouring in over the top. That seems to be what happened in the Massachusetts outbreak."
Three-quarters of the people infected in Provincetown reported having a cough, headache, sore throat or fever -- symptoms of an infection in the upper airway -- and 74% were known to be fully immunized.
"This shows the delta is formidable," said Larry Corey, a virologist at the Fred Hutchinson Cancer Research Center. "We can't take one report of packed bars and extrapolate and say the sky is falling. The sky is not falling. But it does say the vaccine is not infallible."
"Common sense has to be used," Corey said. "It's a learning moment, it's a teaching moment. You can't overlook the vast data we have on the effectiveness of the vaccine."
Of the five people who were hospitalized, four were fully vaccinated -- one with the Pfizer-BioNTech vaccine and three with the Johnson & Johnson vaccine. Two of the patients had underlying medical conditions. Genetic analysis of 133 cases identified the delta variant in 119 and a closely related virus in one case.
Scientists warned even last year that the vaccines might not completely prevent infection or transmission. But experts did not expect that these events would figure significantly in the fight against the virus, nor did they anticipate how quickly the delta variant would tear through the country.
CDC officials say more data is coming. They are tracking breakthrough cases as part of much larger studies that involve following tens of thousands of vaccinated and unvaccinated people across the country over time.
"If getting to 70 or 75% immunity doesn't protect the community, I think it's very hard to extrapolate what happens to a place that is 30% vaccinated," Wachter, the doctor from the University of California, said. "Humility may be the most important thing here."
CRUISE SHIP CASES
Six passengers who sailed on a Royal Caribbean ship tested positive for covid-19 near the end of their cruise and were immediately quarantined, the company said Friday.
The passengers -- four adults and two minors -- were on the Adventure of the Seas ship for a 7-day trip that left the Bahamas last Saturday and returned Friday, said Royal Caribbean spokeswoman Lyan Sierra-Caro. They were tested Thursday while the ship was at sea.
The adults were all vaccinated against covid-19, Sierra-Caro said, and one has mild symptoms of the virus while the other three do not. They were not traveling together.
The two minors -- who were in the same group but not traveling with any of the four adults who tested positive -- were not vaccinated and were not showing symptoms, the spokeswoman said.
All six are American citizens, Sierra-Cano said. They were quarantined, and people traveling with them were traced and tested negative, she said.
Sierra-Cano said the six passengers would fly back to the U.S. on private transportation at Royal Caribbean's expense and won't need to quarantine in the Bahamas.
The ship was in Freeport, Bahamas, on Friday, where other passengers were free to go on shore, and the cruise will end today in Nassau as scheduled. Sierra-Cano said the company would tell other passengers about the infections once they were all back on board Friday.
Royal Caribbean Group says it requires passengers who are 16 or older to be fully vaccinated and provide a negative test for covid-19 before boarding, and children who aren't old enough for the vaccines must test negative. All crew members are fully vaccinated, according to the company.
BROADWAY RULES
Broadway theatergoers will need to prove they've been vaccinated for covid-19, and masks will be required when theaters reopen in coming weeks, producers announced Friday.
Audience members will have to wear face coverings and show proof that they are fully vaccinated with a vaccine approved by the Federal Drug Administration or the World Health Organization when they enter the theaters until at least the end of October, the Broadway League said in a news release.
"Get vaccinated, and we'll see you in the fall," tweeted Broadway and TV star Jeremy Jordan.
There will be exceptions to the vaccine rule for children under 12, who are not yet eligible for any of the approved shots, and for people with medical conditions or religious beliefs that prevent vaccination, the theater operators said. Those individuals will need to show proof of negative covid-19 tests. Masks are required for the audience except while eating or drinking in designated locations.
The league said theater owners anticipate a review of the safety policies in September and may include a relaxation of certain provisions if the science dictates after October.
"This is what we have as a community on Broadway decided, and then we're going to reevaluate it in October. It's still fluid," Bonnie Comley, board president of The Drama League, told The Associated Press. "This should be a positive thing. All these different unions that don't always agree have come together to be able to do this before people come into the theater."
Information for this article was contributed by Apoorva Mandavilli of The New York Times; by Lindsey Tanner, Mike Stobbe, Philip Marcelo and Mark Kennedy of The Associated Press; and by Carolyn Y. Johnson, Yasmeen Abutaleb and Joel Achenbach of The Washington Post.