By August 4, 2021, India had administered 48.52 crore doses of COVID-19 vaccines, and recorded 2.6 lakh breakthrough infections. While the Centers for Disease Control (CDC), USA, defines a breakthrough COVID-19 infection as one that occurs at least 14 days after a person receives the second dose of their COVID-19 vaccine, the Indian Health Ministry appears to define these as COVID-19 infections that occur after taking both one as well as two doses of the vaccine. By August 3, 1.71 lakh breakthrough infections had been recorded in people who were inoculated with just one dose of the vaccine. The number was lower for those who were fully vaccinated with two doses – 87,049 breakthrough infections were recorded by the same date in this demographic.
The Union Health Ministry as well as several experts have pointed out that breakthrough infections are not unexpected, because no vaccine is 100% effective at preventing infections. In fact, INSACOG, the Union government’s genome sequencing consortium, said on September 1 that the breakthrough infections reported in India were well within the expected numbers.
What is it like to get a breakthrough infection? Are the symptoms as severe as they would be if you are unvaccinated? TNM spoke to several people who got breakthrough infections over 14 days after they were fully vaccinated with two doses.
Gopi, a 26-year-old resident of Jangaon in Telangana, tested positive for the SARS-CoV-2 virus that causes COVID-19 on August 7. He had started presenting with symptoms on August 5, and immediately isolated himself at home. “For two days, I had a bad cough, body ache and headache. The remaining 10 days it was quite normal, and I only had a mild fever,” he tells TNM. Although he tested negative on August 18, he still hasn’t regained his sense of taste and smell properly.
Shubh Raithatha, an MBBS student from Ahmedabad, said that his experience of breakthrough COVID-19 consisted of mild fever, blocked nose and body ache for 2-3 days. Beyond this period, he only had a general fatigue and the symptoms abated after a week. However, it took 20 days for his sense of taste and smell to return.
Fatigue and loss of taste and smell were common to almost all of the people TNM spoke to. However, unlike many others, Dr Shalaka Shimpa, a gynaecologist, did not present with fever until the 10th day of COVID-19. The 49-year-old says, “I had a lot of weakness and headache. Though I have migraines, this headache was something else – I couldn’t sleep for three days despite taking two Disprins. We didn’t think it was COVID-19 until the fatigue got so bad after a week that I couldn’t even stand to bathe.” She adds that she lost 4.5 kg during the infection.
Priyanka, a Chennai-based 29-year-old, tested positive for coronavirus on August 31, about a month after taking her second dose. Apart from mild throat pain, backache and fever that did not go beyond 100 degrees Fahrenheit, she too lost her sense of taste and smell. Her husband, however, who had started presenting with COVID-19 symptoms before her, has only had one dose of the vaccine, and was supposed to get his second dose on September 1. “He has been experiencing more pronounced symptoms, like higher temperature,” Priyanka says.
While experts have pointed out that though a breakthrough infection after being fully vaccinated is likely to be milder, and significantly reduces mortality as well as the need for hospitalisation, it does not mean that the affected person is not infectious during this time. However, more study is needed into how vaccines affect infectiousness and the factors determining susceptibility of other vaccinated or unvaccinated persons getting infected.
For instance, Gopi, Shubh and Dr Shalaka note that none of their contacts tested positive for the coronavirus. While Gopi and Shubh isolated at home, Dr Shalaka did not do so as they initially did not suspect she had COVID-19. “But neither my husband, nor my 16-year-old daughter – who even slept with me in the same room on some days – nor our domestic worker got COVID-19,” she says.
In another scenario, Chennai-based Vigneshwar tells TNM that while his father did not, his mother and grandmother both contracted COVID-19 from him in the same household. The latter three were fully vaccinated. The 30-year-old financial consultant had gone to get his first dose on May 13, but a few days later, started showing symptoms of COVID-19. “My doctor said that I was either asymptomatic before I went to get the shot, or that I contracted the coronavirus at the vaccine centre,” Vigneshwar says.
When Vigneshwar got his positive RT-PCR result on May 19, he also got everyone in his family tested. His 58-year-old mother, who has had a history of heart disease, had fever and a cold for 1-2 days, while his 76-year-old grandmother, who has had a bypass surgery and liver ailments, remained asymptomatic throughout. His 58-year-old father had tested negative. Vigneshwar’s wife, who was breastfeeding their infant at the time and was unvaccinated due to lack of clarity on whether pregnant women or lactating mothers could take the vaccine, also tested negative for the virus, though she did have fever for a day. “However, we all had post-COVID fatigue for about a month after recovery,” Vigneshwar says.
None of the people TNM spoke to required hospitalisation and most of them were not prescribed medicines beyond paracetamol, antibiotics and vitamins.
TNM also spoke to people who tested positive for the coronavirus before the 14-day mark after taking the second dose of vaccine. Sugandha*, a 70-year-old from Mumbai, started showing symptoms of COVID-19 soon after her second dose in April. “I had a mild fever and cough for a week, which then increased in intensity. I am an asthma patient and have difficulty breathing. I lost sense of taste and smell, and had to use a nebuliser for the cough,” she says. Both she and her husband were able to recover at home, though they did experience persistent fatigue.
Kolkata-based Anup Jaiswal had a similar experience – he tested positive for the coronavirus on April 15, five days after taking his second dose. “I may have contracted it at the vaccination centre, or when I went to cast my vote in the West Bengal Assembly election, or from people at our factory,” he says. The diabetes and asthmatic bronchitis patient remembers being worried initially due to his co-morbidities. However, the 52-year-old was able to recover after a 14-day medication course, which included steroids for breathing problems he was experiencing. “I am not 100% fit even four months after the infection. I still have some persisting fatigue – my head spins sometimes when I climb stairs – and I have stiffness which restricts my movement.”
*Name changed on request