The reality of a ‘mild’ COVID breakthrough case

“Mild” — it’s a word we’ve grown used to in discussing COVID-19 and the type of case one might have if they experience a breakthrough infection after being vaccinated. Moderate, severe and critical are the other descriptors, most often applied to cases among people who have not yet received a COVID-19 vaccine.

In medical circles, a mild case of COVID-19 is described as having any of the various signs and symptoms of the disease — such as fever, cough, sore throat, fatigue, headache and muscle pain — without accompanying shortness of breath, labored breathing or abnormal chest X-rays that might send someone to the hospital.

However, for the individuals who have experienced a mild case of COVID-19 — especially after being vaccinated — they might choose another word to describe it, for it can catch them off-guard and lead to discomfort, fear of the illness progressing, and concern about lingering symptoms.

A local news anchor’s surprising case
“I had the Pfizer vaccine,” says Steven Luke, an NBC 7 San Diego news anchor. “I thought I was probably never going to get COVID, and then was surprised when I did.”

Steven joins the just over 21,000 San Diegans who have experienced infection after receiving a COVID-19 vaccine this year. Such cases are commonly known as breakthrough cases, and while they are increasing in number, they remain rare.

To put the number of local breakthrough cases in perspective, there have been nearly 360,000 total cases of COVID-19 in the county. Breakthrough infections account for less than 6% of San Diego’s overall cases.

Breakthroughs aside, vaccines are safe and effective
According to Dr. Andres Smith, medical director of Emergency Services at Sharp Chula Vista Medical Center, the increase in breakthrough infections does not mean that the vaccines are not working. While symptom-free or mild post-vaccination infections — such as the one Steven experienced — are possible, the vaccines are doing an excellent job at keeping vaccinated people out of the hospital.

“Approximately 98% of the patients who are being admitted to the hospital with COVID-19 are folks who decided not to get vaccinated,” Dr. Smith says. “So, with the vaccine, there is a small risk that you might get COVID, but the vaccine is going to prevent you from getting very sick to the point that you get admitted to the hospital.”

Steven reports that his experience of breakthrough infection follows this common presentation of having mild symptoms, but never requiring hospitalization. “It started out feeling like a cold,” he says. “I had some congestion, headache, things like that. But I never got horribly sick.”

He, like many others, saw the combined benefits of his age, overall good health, and receiving a safe and highly effective vaccine.

“The majority of patients who are hospitalized due to complications of a breakthrough infection are older patients,” Dr. Smith says. “They may also have some kind of medical condition, such as an autoimmune disorder, diabetes or rheumatoid arthritis.”

All COVID cases require monitoring
While Steven would describe his case as mild, there were a few moments when he was concerned his illness might progress to something worse.

“I started feeling like I was improving, and then an interesting thing happened where I developed a little bit of a nighttime cough,” he recalls. “It was day four or five into it and I was having some lung issues.”

This rollercoaster effect of symptoms is common, Dr. Smith says. “The virus comes in waves, where some people get sick, then they feel better, and then it kind of hits you all over again.”

He recommends that people with COVID-19 — vaccinated or not — use a pulse oximeter to measure their blood oxygen level at home. If their oxygen level falls below 90%, it is time to seek medical care.

The Centers for Disease Control and Prevention (CDC) also recommends that if people experience a breakthrough infection, they should follow the same guidance as those who have COVID-19 but have not yet been vaccinated:

• Stay home except to get medical care.

• Separate themselves from other people in their home.

• Always wear a mask over their nose and mouth if they must be around others.

• Monitor their symptoms.

• Cover their coughs and sneezes.

• Clean their hands often.

• Avoid sharing household items with others.

• Regularly clean all frequently touched surfaces.

When to seek treatment for COVID
Dr. Smith joins the CDC in recommending that people with COVID-19 watch for emergency warning signs — trouble breathing, pain in the chest, confusion, inability to stay awake, and pale or gray skin, lips or nail beds. Seek emergency medical care immediately if you experience any of these symptoms or other symptoms that are severe or concerning to you.

People who are considered at high risk of severe COVID-19 illness — those who are age 65 or older, overweight, or pregnant, or have underlying medical conditions — should also talk with their doctor about available treatments, including antiviral medications, soon after receiving a positive COVID-19 test result. However, while monoclonal antibodies provide an effective way to prevent the development of severe COVID-19 in those who have already been infected, Dr. Smith and public health experts agree that COVID-19 vaccination remains the best method to prevent infection, severe symptoms, hospitalization and death.

Learn more about Sharp’s COVID-19 information and resources and watch an NBC 7 San Diego interview featuring Steven Luke and Dr. Andres Smith discussing breakthrough infections.