What to do if you’re exposed to COVID-19 after being fully vaccinated, according to experts

Californians at farmers market without masks
People make their way down the aisle at the Farmers Market in Irvine Regional Park on Tuesday, June 15, 2021 in Irvine, CA. Restrictions are lifted at most businesses, and Californians fully vaccinated for COVID-19 can go without masks in most settings.

  • If you’re vaccinated and exposed to COVID-19, most of the experts Insider spoke to said you don’t need to worry unless you have symptoms.
  • You should get tested if you’re symptomatic, but some experts say to get tested after any exposure.
  • If you’re sick, stay away from others – even if it’s not COVID.
  • See more stories on Insider’s business page.

So your roommate has a cold.

You both got vaccinated months ago, yet every time you hear a cough from the next room, you can’t help but wonder if you should get tested for COVID.

Most public health experts would say you’re in the clear – probably not sick and probably not infectious – unless you start to feel symptoms. (Your ailing roommate, however, should get tested.)

Although the COVID-19 vaccines are highly effective at preventing severe illness, “breakthrough” infections are occurring in fully vaccinated people. It might feel like a bad cold, or carry no symptoms at all.

The Delta variant has increased the odds of such an infection, but there are plenty of other viruses going around, Amesh Adalja, senior scholar at Johns Hopkins Center for Health Security, told Insider.

The only way to know for sure is to get tested. But if your roommate’s test comes back positive for COVID-19, what do you do?

Get tested if you develop cold-like symptoms

If you develop a cough, congestion, or a loss of taste and smell after a known exposure, you should get tested regardless of your vaccination status.

Start with a rapid antigen test. In studies, rapid tests were about 72% effective at identifying COVID-19 in symptomatic people and correctly ruled out COVID for about 99.5% of people who had symptoms for other reasons.

You can also take a rapid test at home. They’re more accurate if you get tested every few days, so if you’re initially negative, you might want to test again to be sure. You could also follow up with a PCR test that looks for other viruses as well, Adalja added.

“You also have to remember that now that many people are socially interacting, other viruses have come back – things like rhinovirus and seasonal coronaviruses – so there are other causes of cold-like symptoms,” Adalja said.

If you don’t have symptoms, many experts say you’re probably in the clear

The CDC recommend vaccinated people get tested or quarantine only if they have symptoms of COVID-19.

If you’re symptom-free for more than a week after an exposure, you can relax, according to Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia.

“The only time you should get tested if you’re fully vaccinated is if you’re symptomatic, no matter what the exposure,” Adalja said.

Charity Dean, a former top-tier official at the California Department of Public Health, told Insider she was “very disappointed” the CDC is not seriously tracking mild or asymptomatic infections in fully vaccinated people. Without that information, we risk missing a more dangerous “escape variant,” Dean told Insider’s Hilary Brueck.

So if you’re making your decision with public health in mind, you may want to get tested even if you don’t have symptoms.

Quarantine if you feel sick or test positive for COVID

COVID-19 or seasonal virus symptoms indicate that you could be infectious to others.

“If the virus reproduces itself well enough in you to cause symptoms, I think that means that you’re likely to be contagious,” Offit told Insider.

Vaccinated people who get COVID may be less contagious than unvaccinated infected people, if their reduced viral loads are any indication.

However, other experts recommend using common sense before deferring to CDC guidelines, which “lack nuance,” emergency physician Leana Wen told CNN.

“I don’t want someone coming into work, who then tells me that they just spent the entire night caring for their spouse who’s ill from COVID,” Wen told CNN. “Should that person really be in a crowded conference room with a whole bunch of other people? Does that sound right? It doesn’t meet the common sense test.”

One thing experts generally agree on: stay away from people if you’re not feeling well.

The norms of the pandemic – mask-wearing, quarantining – still apply if you’re sick and it’s not COVID-19. But if you’re vaccinated and feeling fine, there’s no need to worry, Offit said.

“I think we’re going to drive ourselves crazy if we’re expecting this vaccine to prevent asymptomatic or mildly symptomatic disease,” Offit said. “Just use common sense. If you develop respiratory symptoms, I think it’s probably a good idea to wear a mask.”

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Black Americans have legitimate reasons to be skeptical of getting the COVID-19 vaccine – a bioethicist explains why

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It’s important to learn the painful medical histories of Black people to help combat their trust in the medical system.

  • Black Americans are being hospitalized and dying from COVID-19 at higher rates than white Americans, says bioethicist Esther Jones.
  • Still, many Black people are skeptical about receiving the vaccine due to distrust of the American medical system. 
  • Jones says healthcare workers and policymakers can help close racial health gap by understanding the source of this skepticism. 
  • Visit the Business section of Insider for more stories.

Black Americans have been the least inclined of any racial or ethnic group to say they’d get vaccinated against the coronavirus. The proportion of Black people who said they’ll probably or definitely take the shot has risen over time – but even by mid-January, with two COVID-19 vaccines authorized for emergency use in the US, only 35% of Black survey respondents said they’d get it as soon as they could, or already had gotten the shot.

At the same time, the COVID-19 pandemic has disproportionately harmed Black, Indigenous and other people of color in comparison to white members of American society. With Black Americans being hospitalized at rates 2.9 times higher than white Americans and dying from COVID-19 at rates 1.9 times higher, you might assume that Black people would be lining up at breakneck speed to receive the vaccine as soon as it’s available to them.

But the Black community has reasons for distrust – even beyond what might be attributed to the mixed messaging of the nation’s COVID-19 response. And it’s not a simple or sole matter of miseducation. I’m a medical humanist and bioethicist who studies history, ethics, and literature to understand racial and gender health disparities. My research explores the history of unethical and abusive treatment Black Americans have experienced at the hands of the medical establishment. Based on past experience, Black people have many legitimate reasons to be in no hurry to get the vaccination.

A troubling track record

The American medical establishment has a long history of unethical treatment of Black research subjects. Medical ethicist Harriet A. Washington details some of the most egregious examples in her book “Medical Apartheid.” There’s the now notorious Tuskegee syphilis experiment, in which the government misled Black male patients to believe they were receiving treatment for syphilis when, in fact, they were not. That study went on for a total of 40 years, continuing even after a cure for syphilis was developed in the 1940s.

Perhaps less widely known are the unethical and unjustified experiments J. Marion Sims performed on enslaved women in 1800s US that helped earn him the nickname the “father of modern gynecology.” Sims performed experimental vesicovaginal fistula surgery on enslaved women without anesthesia or even the basic standard of care typical for the time.

Sims experimented on Anarcha, a 17-year-old slave, over 30 times. His decision not to give anesthesia was based on the racist assumption that Black people experience less pain than their white peers – a belief that persists among medical professionals today. Historian Deirdre Cooper Owens elaborates on this case and many other ways Black women’s bodies have been used as guinea pigs in her book “Medical Bondage.”

Cases of medical malfeasance and malevolence have persisted, even after the establishment of the Nuremburg code, a set of medical ethical principles developed after World War II and subsequent trials for crimes against humanity.

In 1951, doctors harvested cervical cancer cells from a Black woman named Henrietta Lacks without her permission. Researchers went on to use them to create the first immortal cell culture and subjected her descendants to ongoing study for years without informed consent. Investigative journalist Rebecca Skloot details the cascade of ethical violations in her book “The Immortal Life of Henrietta Lacks.” Despite heightened awareness after the book’s publication, the ethical violations continued when a group of scientists mapped the HeLa genome without her family’s knowledge or consent.

Advances in genomics are still being used to resuscitate theories of racial “science.” For example, a now-debunked 2007 study purported to isolate a so-called “warrior gene” in Maori Indigenous men and argued they are genetically “hard-wired” for violence. Scientists and news outlets in the US jumped on board, suggesting there’s a genetic predisposition for Black and Latino males to engage in gang activity.

Legal scholar Dorothy E. Roberts explains in her book “Fatal Invention” how incidents like this one perpetuate the harm of race-based science. Using biological data and flawed reasoning tainted by racial stereotyping reinforces racist beliefs about Black people. Such logic focuses on purely biological factors and ignores the social and systemic factors that produce negative and inequitable health outcomes.

While there is now an ample body of scholarly research that reveals these truths about racism in the medical establishment, Black Americans need only to gather around the kitchen table with a few friends and family to share and hear personally experienced stories of medical malfeasance.

Present day persistence of racism in healthcare

Even though their experiences at the hands of researchers like J. Marion Sims were central to advances in modern gynecology, today Black women have not benefited from these advances to the same degree as white women. Black women still suffer worse outcomes and more deaths from gynecologic cancers and have worse health and more deaths affiliated with childbearing, just to name two.

When tennis star Serena Williams gave birth, she saw firsthand how Black women are disbelieved by the medical establishment. She might have died from postpartum blood clots if she hadn’t advocated for herself in the face of dismissive medical professionals.

Black people are acutely aware of this history of racism in the medical establishment, and the ways it persists today on both an individual and a collective level. Stereotypes about Black patients, whether the result of explicit or implicit bias, continue to affect the care they receive and their medical outcomes. Again and again, when surveyed, Black Americans report that medical providers don’t believe them, won’t prescribe necessary treatments, including pain medication, and blame them for their health problems.

And the association between racism and increased disease cases and deaths has held true during the COVID-19 pandemic.

Overcoming these challenges

Ongoing trust issues around the COVID-19 vaccines are just the latest indication of racial health disparities in the US.

Still, there are ways to begin to close the COVID-19 racial health and mortality gap. Vaccinations for Black people may otherwise continue to lag in proportion to population size.

Esther Jones, associate professor of English, affiliate with Africana studies and women’s & gender studies, Clark University

 

The Conversation
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3 ways the US can improve COVID contact tracing efforts and encourage honest participation

A person gets a temperature check before entering an Apple store on June 22, 2020 in the Brooklyn Borough of New York City.
The US has a poor success rate when it comes to contact tracing coronavirus infections thus far.

  • The US has notably been unsuccessful in using contact tracing to reduce COVID-19 outbreaks.
  • A recent study suggests that more than 40% of people would not speak to public health officials when contacted.
  • Kellogg School clinical professor, Sarit Markovich, says that to get people to participate in contract tracing, there needs to be a level of trust.
  • Visit the Business section of Insider for more stories.

As COVID cases surged across the US last December, the CDC reckoned with a stark truth: Contact tracing couldn’t be scaled up to match the virus’ spread.

The practice of contact tracing – or identifying, assessing, and managing people who have been exposed to a disease – is an essential tool for controlling outbreaks by interrupting a disease’s transmission chains. And indeed, combined with lockdowns and mask ordinances, some countries have had great success using contact tracing to reduce outbreaks.

So why have attempts to institute it failed in so many other countries, most notably the US? And given that COVID is likely to be with us in some form for quite a while, are there ways to make contact tracing more effective here?

Sarit Markovich, a clinical professor of strategy at the Kellogg School, says that contact tracing, at its core, hinges on trust. This means that trust will need to be at the foundation of any successful efforts moving forward. This includes building trust in the technology, specifically in terms of false positives, trust that information will be kept private, and trust that people will not suffer consequences for self-reporting.

Here, she offers her thoughts on where contact tracing can fail, and how to do it better.

Consider your social makeup

Contact tracing requires individuals to share private information in service to the public good. In considering how to solicit this information, it helps to understand the difference between centralized and decentralized societies, Markovich said.

In countries with centralized governments, like China or Singapore, contact tracing is mandated and compliance is universal. Governments track people’s movement through a national phone app or wearable tokens, which people scan as they move between locations. Noncompliance is heavily fined. In general, these societies prioritize collective welfare over individual freedoms, like privacy.

“If the government makes you do it, you do it,” Markovich summarized. “And now in many of those places, people are back to their offices and normal life.”

But in democratic societies where government is decentralized, individual rights can be in tension with public health, Markovich said. Strategies that are effective in centralized societies are less likely to work in decentralized ones.

In Israel, for example, the government-mandated digital contact tracing and levied hefty fines for noncompliance. Given the country’s population size and relative homogeneity, it seemed as if national contact tracing would work much like it did in Singapore, Markovich said. But people objected to being tracked. They turned off or left their phones at home, and the initiatives have been unsuccessful.

“In decentralized societies, people do not completely trust the technology and do not completely trust authorities knowing where they are,” Markovich said. “They want privacy.”

Lower-tech approaches, where public health workers individually interview exposed individuals about their contacts, are unfortunately no more promising.

In Israel, for example, a volunteer-led startup tried to launch in-person contact tracing as an alternative to the government’s digital model. The initiative stalled when it turned out residents did not want to share personal information with strangers. That same skepticism exists in the US, where 41% of people in a recent Pew survey said that they wouldn’t speak to a public health official who contacted them by phone or text.

“The goal is to make people get used to contact tracing in a context that’s not scary and in a way where its effect on others is not negative but positive,” she said.

Keep it local

For now, Markovich believes that in decentralized societies, national contact tracing initiatives won’t work. A better option: hand the lead over to local governments and organizations.

At this smaller scale, Markovich says contact tracing becomes easier to centralize. Initiatives can be heavily encouraged or even mandated, and enforcement is also easier when it is tied to the social pressures of local communities or the requests of employers.

“Organizations and municipalities have an advantage because there’s more trust involved,” Markovich said. “They can centralize and mandate it, because if you want to be part of an organization – an employee at your company, for example – there are rules you will have to comply with.”

Over time, Markovich believes that the number of organizations and communities that mandate contact tracing will grow, especially as more local models – a church, a factory, or a city whose leaders have established trust – start to show success.

Reward disclosure without punishing exposure

She also advises that local communities and organizations think carefully about how to encourage people to disclose their contacts. This means, first and foremost, minimizing the negative consequences on all parties: those who have tested positive and are disclosing their contacts, as well as the individuals whom they have exposed.

Here, technology has a powerful role to play. Markovich observes that in some communities, COVID-positive people are blamed for spreading the virus. This practice of “COVID-shaming” could make them less likely to self-report their contacts.

“This is where technology helps,” Markovich said. “You want to use technology rather than rely on people to tell you who they’ve been in contact with or that they’re sick. It’s not about self-reporting. The technology tells you.”

But despite the benefits of technology that can automatically notify people of exposure (see sidebar), Markovich also notes that the human element shouldn’t be ignored. Follow up calls from trained professionals will provide an opportunity for people to ask questions about next steps, express concerns, and learn how to self-isolate, if required.

“The human part is important,” Markovich said. “Technology is great in terms of detection speed, but human contact creates trust.”

And whatever the technology used, if people do have to quarantine because they’ve been exposed to COVID, employers should assure their employees that they will be compensated for the time they self-isolate. Markovich cites incidents in which employees who have been exposed to the virus went to work because they lacked paid sick leave or feared losing their job. Since some sectors are at higher risk for infection, like grocery stores, the government should share these costs with organizations.

“We need incentives to encourage people to tell the truth and feel comfortable staying home,” Markovich said. “If you know that you’re going to be compensated even if you’re home, then you’re definitely going to feel more comfortable self-reporting and self-isolating.”

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India’s sudden drop in coronavirus cases has puzzled disease experts. Strict public-health measures and difficulty recording rural cases may have factored in.

india school coronavirus
A student gets her body temperature taken in Hyderabad, India on February 1, 2021.

  • India’s daily coronavirus cases have plummeted since September.
  • The nation is now reporting just 8 daily cases per one million people, among the lowest per-capita rates in the world.
  • Experts say the decline is puzzling. The difficulty of recording rural cases, combined with strict public-health measures, may offer some explanation.
  • Visit Business Insider’s homepage for more stories.

At the start of the pandemic, few countries were more ripe for a major coronavirus outbreak than India.

Not only is India the world’s second most populous country, it’s also one of the densest, with around 1,200 people per square mile. Cases there climbed steadily from April through September, reaching a peak of nearly 100,000 daily cases on September 16.

Then something unexpected happened: India’s daily cases plummeted from mid-September until February, with average weekly cases dropping by roughly a third each month. The nation is now reporting fewer than 11,300 daily cases, on average – around 8 per 1 million people, among the lowest per-capita rates in the world.

India’s health ministry has attributed this success to a few factors, including a robust testing and contact-tracing effort. But infectious-disease experts say the quick turnaround is puzzling.

India only began administering coronavirus vaccines in mid-January, so it’s probably too soon for vaccinations to affect transmission. Some public-health experts say India’s strict mask mandates may have helped lower cases, but masks have been required there since April, so that don’t fully explain why cases dwindled so dramatically in the fall.

“There are a lot of questions and lessons to be learned, and I think that we need to do a deeper dive into what they’ve done well,” Dr. Krutika Kuppalli, an assistant professor at the Medical University of South Carolina, told Insider.

Kuppalli’s previous research focused on barriers to medical care among women with HIV in southern India.

“I know from having worked and lived in India that they have a lot of challenges in terms of dealing with large populations that are in close quarters, infection control issues, hygiene issues, ventilation issues – all the things that we are concerned about in terms of how this disease spreads,” she said.

Kuppalli added that it’s worth studying whether India’s population may have unique genetic or demographic characteristics that make people less susceptible to symptomatic COVID-19 infection. It’s also possible, she added, that coronavirus cases are simply hard to record in rural areas.

Penalties for not wearing masks 

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Students wearing face masks attend class in Hyderabad, India on February 1, 2021.

Widespread adherence to public-health measures may partly explain why India has gotten its outbreak under control. Several large cities and states there began requiring masks in public places in April, two months before the World Health Organization recommended face coverings for the general public.

Since then, the nation’s largest city, Mumbai, has levied fines against those who violate the rule. By October, Mumbai had collected a total of more than $70,000 in fines from more than 14,000 people who’d failed to wear masks in public. By early December, Delhi had also issued around 500,000 mask fines, The Wall Street Journal reported

For the most part, Indians have been supportive of mask requirements: In an October survey from social media platform LocalCircles (which included more than 15,000 responses across roughly 200 districts in India), nearly 90% of respondents said they were in favor of a mask mandate. About 40% said they would support increased penalties for those who didn’t comply.

The US, by contrast, has struggled to convince large segments of the public that masks are an effective tool. 

“The United States very much failed from a lack of national leadership, miscommunication, and a lack of community engagement. I think we can really boil it down to those three things,” Kuppalli said, adding, “we still have people who don’t believe the pandemic is real in this country.”

A focus on ‘test, trace, isolate’

india contact tracing
A member of the internal medical team at the Ahmedabad One Mall checks a staffer’s Aarogya Setu app, India’s virus contact-tracing app, on June 7, 2020.

Epidemiologists typically rely on a three-step strategy to contain a virus: test, trace, isolate.

Though India’s testing got off to a slow start, it has ramped up considerably since the summer. By August, the nation had nearly 1,600 testing labs, up from just 14 in February 2020. India is administering nearly 486,000 daily tests. Only two other countries, the UK and the US, are testing more.

India’s large population also worked to its advantage when it came to enlisting contact tracers.

From March through April, tens of thousands of health workers traced the contacts of more than 435,000 infected people across two southern states, Andhra Pradesh and Tamil Nadu. The workers reached more than 3 million contacts, around 575,000 of whom had available COVID-19 test results.

These efforts were made easier by a longstanding disease surveillance network that began monitoring COVID-19 cases in late January 2020.

As of April, Indian residents could download the nation’s contact tracing app, Aarogya Setu, to find out if they had been been within 6 feet of an infected person. Indian residents are asked to download the app if isolating due to a positive COVID-19 test and report any symptoms to a local surveillance officer.

Possible immunity to new pathogens

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A healthcare worker collects a swab sample from a resident during a coronavirus screening at a civic clinic in Mumbai on October 12, 2020.

India has indeed seen fewer COVID-19 deaths per million than many developed nations. As of Wednesday, 113 out of every million people in India had died of COVID-19, compared to nearly 1,500 out of every million in the US and 1,755 per million in the UK.

India is now recording fewer than one daily death per million people.

Kuppalli said India’s rapidly falling cases raises another important question: “Are there things about this particular population, this ethnicity, that puts them at decreased risk?” 

An August study suggested that populations with a higher exposure to diverse types of bacteria – predominantly due to poor sanitation – might see fewer COVID-19 deaths per million, perhaps because of an acquired or innate immunity to new pathogens. This line of thinking isn’t new: A 2006 study found that developing countries may have a different “immunological experience” with tuberculosis than the US and Europe.

“Look at the average Indian: He or she has probably had malaria at some point in his life or typhoid or dengue,” Sayli Udas-Mankikar, an urban policy expert at the Observer Research Foundation in Mumbai, recently told NPR. “You end up with basic immunity toward grave diseases.”

The idea remains a theory for now, however.

Rural populations are harder to surveil 

rural india coronavirus
Chhayarani Sahu, an Indian farmer, plucks vegetables at in Bhadrak on September 14, 2020.

The coronavirus spreads best in dense, crowded environments. That means countries like the US, where more than 80% of residents live in urban areas, face an uphill battle to contain the virus’ spread.

India, on the other hand, is less urbanized: Around 65% of Indian residents live in rural areas. 

Though the virus has undoubtedly reached India’s rural population, the nation’s cities have been particularly hard-hit. By May, nearly 80% of India’s total COVID-19 cases hailed from just 30 cities. A January survey found that 56% out 28,000 people sampled in Delhi tested positive for coronavirus antibodies.

But Kuppalli said health trends among India’s rural population are difficult to track.

For one thing, rural areas are larger and more spread out. Many Indians living in these communities also lack internet access, which prevents them from plugging into the nation’s surveillance network.

Kuppalli also noted that it’s difficult for patients who are sick in rural places to get to large urban hospitals because of transportation or financial issues. A 2018 report found that only one state-run hospital is available for every 90,000 people in India’s rural communities. That could mean that India simply isn’t recording as many rural cases.

That too, is just a possibility, though. For now, Kuppalli said, “it’s great that they’ve had this turnaround.”

“It’s an opportunity for us to study this population,” she added. “There are lots of things to think about and try to understand.”

This article was originally published on February 3. It has been updated to reflect the latest data on India’s coronavirus cases.

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