Infected vaccinees alert: "We can't let our guard down"

BarcelonaCovid does not discriminate between vaccinated and unvaccinated people. Everyone can get infected and transmit the virus. What vaccines do do in general is protect people from the most serious forms of the disease: they reduce symptoms, hospitalisations and deaths. Now, the message that has taken hold of part of the population is that being vaccinated allows them to make up for lost time: having an active social life, taking masks off and mixing bubble groups, as if the virus can't infect them. "And this is bad communication: getting vaccinated does not allow you to live a normal life, you have to maintain all protective and preventive measures," warns Salvador Macip, who yesterday learned that he and his family had been infected.

Marta had never considered that she could be infected after being vaccinated. And she wouldn't even have known if she hadn't been tested due to being a close contact: she was asymptomatic. On the other hand, Berta and Ramon have developed symptoms, although they are not serious. "Each person is different: we have to take into account the immune response capacity of each person and the aggressiveness of the circulating virus", says Carlota Dobaño, an immunologist at the Institut de Salut Global de Barcelona (ISGlobal). With the delta variant, which is more contagious, more cases of vaccine failure can be seen, according to the expert, who nevertheless insists that vaccination works.

But preventing infection and preventing disease are different things. Vaccines induce two linked immune responses: neutralising antibodies, which prevent the virus from infecting cells, and T-lymphocytes, which destroy it. When one fails, the other kicks in.

However, and although at the moment all vaccines authorised in Europe work against variants, including the delta variant, there are cases like Miquel Àngel's: despite having had covid and having antibodies -which in practice work as having received a first dose-, now he has been infected again. This time in a more serious way.

Ramon Casanovas, a pediatrician since 2005 at the CAP Ramon Turró in Barcelona, was one of the first Catalans to receive the Pfizer vaccine: he received the first dose on January 7, and the second on February 1. He admits that getting vaccinated calmed him down. "Until then I was worried. I'm 53 years old and I didn't want to catch it because I knew I could end up in hospital," he explains. Fully vaccinated, he has continued to work all these months "taking all the safety measures" and leading "a religious life": "Work and family life, that's it". Until last week when his 24-year-old son came home with a runny nose and he carried out an antigen test on him, assuming, he says, "it was impossible that it was a covid". The test came back negative, as he expected. But the next day he had a temperature of 39ºC. "I tested him again and almost broke the device: he had tested positive," he recalls. Hours later he also began to feel "strange" and also took an antigen test. He had been infected.

In Catalonia there are about 700 health professionals on sick leave due to covid. "The mistake was mine. If he had been a patient I would not have been infected. I have done many tests at the health centre, the problem was to let my guard down and trust him because he is my son," Casanovas regrets, who points out that although he wore the mask at the time of the test, he did not wear it at home. His wife and his daughter, however, have not been infected. However, his case is not exceptional. In double-dose vaccines, protection does not increase to optimal levels until the second dose is injected. However, this protection decreases over time and the immunological memory will depend on the individual: some people can keep it up for years and others need boosters after six, eight or twelve months. Those who lose antibodies more quickly are more at risk of suffering from the disease with symptoms if they become infected.

Casanovas has had a fever for a couple of days, cough and snot, but luckily the symptoms "have not gone any further". Now he is just "a little shaken" and admits that what he is finding hardest is isolation: "I am isolated in a room and I feel totally useless because the health centre is completely saturated. I'm worried: there are colleagues on vacation, others are on sick leave, and all you want to do is help." He especially regrets not having been able to participate in the vaccination marathon at the health centre last weekend, where a thousand vaccines were administered in a matter of hours. Now Casanovas has a clear lesson to learn from this contagion: "Being vaccinated does not mean not being vigilant. Covid is not over and we have to avoid crowds and always be protected". He says that despite having been infected he is still "utterly convinced about the vaccine": "Otherwise, I could be intubated in the hospital"

Miquel Àngel takes the call from his room at Son Espases Hospital in Palma, to which he was admitted a week ago. He has pneumonia affecting both lungs due to covid, a virus that he already had in February. Doctors have told him that his case is "very strange", because most people who have had the disease develop a protective immunity that lasts at least a few months after infection. "I never thought I would end up in hospital," he admits.

This 55-year-old architect arrived last Monday with his family in Mallorca, where he went to spend a few days and see his parents. The previous Friday, as he already had a headache, he had gone to the health centre and the doctor told him that it was almost impossible that he had been reinfected. They didn't do any tests. So on Monday he flew to Palma. Two days later he went to the clinic because he had a fever and by Friday he was admitted to hospital. "I had had a fever for a few days and they did an x-ray and found that I had pneumonia. They told me that it seemed mild, but both my lungs have been affected. I thought it was impossible because I had already had the virus," he says. Miquel Àngel is one of the 1.1% of people who have had covid and become infected again, according to data from the Department of Health.

To generate immunity, it is not only necessary to be vaccinated: people who are infected also produce it. However, in these cases there is also much room for susceptibility. There are people who become infected and, given this stimulus, are able to defend themselves and experience the disease in a mild or asymptomatic form. However, as the protocol indicates, you will have to wait six months to get the vaccine, a single dose that has to reinforce your immune response if you are under 66, as is the case of Miquel Àngel. If in this period of time he gets infected again, although it is expected to be with an even milder condition, the severity of the disease will depend not only on how good his immune response is, but also on whether the circulating virus is more virulent and can attack him more severely.

When he was infected again, Miquel Àngel was most worried about the fact that his body was not generating antibodies. "This would mean that I could always be infected," he says worried. But in Son Espases they have tested him and have found that he does have them. "Now I just want to get over it and that's it. I can't do anything else," he says. Although he sound and looks well, Miquel Àngel often coughs while talking. He explains that he is bored, but "fine" and that he is getting better within the gravity of a situation that he did not expect. He doesn't know how he caught it

He is reassured to know that both his parents, his wife and his three children have tested negative, but he feels bad that they have had to be confined and that they have lost their holiday. "I haven't been able to enjoy it very much, to be honest. When I get out, we'll stay on for a few more days to be with my parents before we go back. I think I'll spend the summer very quietly, here nearby, and seeing few people," he explains. And he admits: "I've learned to enjoy the little things, like having lunch, having a snack or talking on the phone". That's why he encourages everyone to get vaccinated. "Having the vaccine does not mean a doing anything you want, nor is it a 100% guarantee, but I think it is very important to get vaccinated to avoid serious symptoms," he says.

Berta works at the Institut de Oncologia de la Vall d'Hebron (VHIO) and has been vaccinated with Pfizer for months, but is part of the 0.12% of vaccinees who have been infected after receiving both doses. "I've been very unlucky," she sums up. For the past few months she has made an effort to make plans only with vaccinated people and always outdoors, but last weekend was her birthday - she turned 26 - and she had a dinner on Friday and a lunch on Sunday. "There were positive people at both places, but we found out on Monday," she recalls. That day she began to feel sick, had a headache and a sore throat. The antigen test was positive.

Berta calls for caution: "I would tell people not to be confident because they are vaccinated, not to go places where there are crowds and do not remove masks. She didn't think she would get infected after the vaccine and warns that the first few days she had a "pretty rough time": "I could hardly move or sleep". She has been recovering and now she is even teleworking. "I was angry for having been infected despite being vaccinated and I was afraid for the people who were there and are not," she says. Of the ten people who were having dinner, seven were vaccinated and only Berta has tested positive. All of them, however, are in quarantine.

It is estimated that approximately 10% of people who are vaccinated do not develop the desired immunity, regardless of the vaccine they are given. And the fact is that, although they are more than 90% effective, none of them is infallible. "The vaccinated person suffers a symptomatic disease when they do not generate enough antibodies or the ones they develop generate a moderate response, when their immune system is weakened or when they do not have specific lymphocytes. In these three cases, the vaccine is considered to have failed," Dobaño summarises.

However, the viral load is also a key factor in defining whether the infection will be symptomatic or whether the body will be able to control it. "The more virus that enters a body, the more likely it is that the body will feel overwhelmed and that the pathogens will overcome the neutralising barriers," Dobaño explains. And this is what is happening now that the predominant delta variant is more contagious. "In my health centre they explained that there are quite a lot of vaccinated people who catch it: maybe it is because of the delta variant", Berta adds.

"I thought I would not catch it, that being vaccinated I could not catch it," admits Marta, operating room nurse at the Hospital de la Vall d'Hebron and who received her second dose in February. She was wrong. Last weekend she was about to go on a trip to Granada, but when she found out that two co-workers had tested positive, she wanted to take a PCR "to be safe": "I was very surprised that I was positive, both me and two other co-workers, all vaccinated". None of them have had any symptoms.

On the other hand, the first co-worker who was infected did have snot and a headache. "That's why we detected it, because he did have symptoms and immediately took a PCR. The other three of us who have been infected had it checked by chance, just in case". It has been proven that immunised people can be infected and not know it (asymptomatic), like Marta, or suffer some mild symptoms, like her colleague, but in both cases they can act as spreaders and infect their environment.

"I doubt very much that we were infected at the hospital," says Marta, who says she was not in contact with the two colleagues who were infected first. "But I met up with a colleague of theirs to go to the beach. She also got infected and had seen the other two outside work. The virus has been jumping from one to the other," she explains. She also regrets that it is so difficult to get a PCR at the health centre or at the hospital: "I had to insist, otherwise I would still be waiting for them to call me".

Age and the fragility of the immune system, such as diseases or treatments that destroy defences, compromise the effects of the vaccine. But there are other unknown factors linked to vaccine failure, which may include genetic or exposure factors, such as diet. These conditioning factors would explain why there are people from vulnerable groups who manage to control severe disease with the vaccine or with their own immune response, and others, who are younger and apparently healthy, who cannot generate a response despite having received the doses. As the percentage of vaccinated people increases, so will the number of people without immunity.

Marta admits that it makes her a little angry to have been infected. First, because she has always taken extreme safety measures: "All I've done is go to work and then go to the beach. I have not gone to a wild party". And secondly, because she knows that there are no spare hands at the hospital: "I know they need people. The operating room is covered, but it is a very specific place and if there are not enough people, we may have to suspend operations". The nurse warns of the risk of believing that the vaccine protects us all: "We have to continue taking measures because there are many vaccinated people who are infected and some can be affected by the virus seriously. We cannot lower our guard."

The doctor Salvador Macip, one of the expert voices on the pandemic, has spent a year leaving home only to go to the laboratory. For him, every precaution seems too little to avoid contagion. Yesterday, however, he found out that he was positive despite being vaccinated with the full guideline. His 13-year-old son had been infected at school and transmitted the virus to the whole family. "The delta variant is more contagious, we have to be very careful," he warns. He also admits that there are many factors that cannot be controlled, such as having a school-age child: "No matter how many layers of protection you put on, none of them protects you 100% and the virus can sneak in". Therefore, he recalls that being vaccinated "does not mean that you cannot get infected". "But it does prevent greater evils. Now it's like a cold and without the vaccine I would surely be crawling to get into bed," he describes.