Tiffany Doherty, a Minneapolis teacher, knew the COVID-19 vaccine might keep her from becoming seriously ill, even if it couldn't guarantee protection against infection.

"But I didn't expect to be one of those who got it," said Doherty, 43, of Crystal.

For Doherty and others who've been inoculated, the vaccine allowed life to return to near normal.

"You want to run around and lick doorknobs and shout, 'I'm free of this,' " she joked. But Doherty remained cautious, wearing a mask once again to protect her unvaccinated 11-year-old son when the delta variant emerged.

So, she was shocked when she tested positive for COVID ­­­­­— a feeling echoed by others who have had breakthrough infections. Such infections are rare.

Of more than 3 million fully vaccinated Minnesotans, fewer than 1% have experienced a breakthrough COVID-19 infection. Hospitalizations and deaths among the vaccinated are even less frequent — 0.047% of the vaccinated have been hospitalized and 0.004% have died.

Unknown is how many breakthrough cases go undetected because many people have mild symptoms or none at all.

Some with breakthrough infections describe days of feeling miserable with coughs, chills, fevers, body aches, extreme fatigue and sometimes loss of smell and taste. The vaccine likely kept them from worse, they say.

Dianne Honermann, a healthy 77-year-old from Mankato who got her second Pfizer vaccine dose in March, wasn't as fortunate. She died of COVID-19 complications.

"Once vaccinated, we felt if we got a breakthrough, at least it wouldn't be a severe case," said her husband, Alan, 81.

"My immune system was able to fight it off. We don't have an answer as to why my wife couldn't."

Saying goodbye

The couple, along with about 60 other people, attended a friend's 80th birthday party July 23 in Waseca, Minn. When Dianne started coughing a few days later, they assumed it was a summer cold. Then Alan began feeling ill.

They soon learned a woman who attended the party tested positive for COVID and some guests were unvaccinated. The couple were among about 30 guests who eventually tested positive.

When Dianne's energy dwindled and her breathing became labored, Alan took her to the hospital in Mankato, where she was admitted Aug. 1. Alan was admitted for observation and released the next day.

"I was doing OK," he said, noting he received a monoclonal antibody infusion after he left the hospital.

But his wife struggled.

After watching Dianne spend 17 days in the hospital, including ­seven in intensive care, Alan and their three children said goodbye to her.

The family is frustrated, even angry, with those who are still unvaccinated. "A lot of heartache could have been averted," Alan said.

Besides being older than 65, Dianne had no health conditions that would have made her more vulnerable to a severe case of COVID-19, her son Brian said.

"Mom fell into a sliver of a sliver — a little crack" of vaccinated people who die of COVID, he said. Still, he and his family firmly believe in the vaccine.

"We know they're not perfect," Brian said. "It only works when everyone is vaccinated. That's our only path out."

Surviving COVID-19

With a large pool of people still unvaccinated, the virus continues to circulate, and when it does, new variants can emerge, said Dr. Raymund Razonable, infectious disease specialist at Mayo Clinic. With the highly transmissible delta variant now widespread, more breakthrough infections may be happening, he said.

Still, the vaccines are effective, he added. Most breakthrough cases are mild, which in COVID terms means people are less likely to be hospitalized, Razonable said.

However, some who are 65 or older, as well as those with underlying health conditions, may be susceptible to more severe cases even if vaccinated, he said. If they get a breakthrough case, he advises them to seek a monoclonal antibody treatment.

"Without the vaccine and monoclonal antibodies, I might not have survived," said Leonard "Leibl" Cohen, 72, who has had blood and bone cancers. After more than a week in the hospital, including time in intensive care, he returned to the Minneapolis home he shares with his partner of six years, Lisa Goldish, who recovered from a milder case.

It's not over yet

For many like Goldish and Cohen, breakthrough infections are a harsh reminder that the pandemic is not yet over.

Long before vaccines were available, Rob Marshall, a 39-year-old paralegal who works in downtown Minneapolis, got COVID-19 in early summer 2020. He developed bad headaches, and his sinuses felt as if they were burning. He lost his sense of smell; his sense of taste was altered.

After his second dose of the Moderna vaccine in late April, he slowly returned to the normal rhythms of life. He didn't mask nearly as often and sometimes shopped in the grocery store and ate at restaurants.

In August, he and his husband were set to leave for a Caribbean vacation when he tested positive for COVID.

"I had no symptoms, and I attribute that to being vaccinated," Marshall said.

For now, however, he's once again wearing a mask in public places and has scaled back his outings. "I'm a little bit gun-shy," Marshall said.

For Jonathan Comito, 51, getting a breakthrough case was unexpected given how cautious he's been.

"I hadn't gone to any Twins games, and I'm a big baseball fan. No concerts. No big gatherings," he said. Eating at a restaurant was his biggest social outing.

Working in marketing for Hennepin Healthcare, he was among the first to be vaccinated, getting his second dose of Pfizer in January. In early August, he woke up with a scratchy throat. Then came body aches, bad headaches and a fever.

"I thought two or three days of this and it would be no big deal," Comito said. "Then it turned. … I'd wake up gasping for air because I couldn't stop coughing."

Extreme fatigue and constant sleep turned days into a blur. He lost his sense of smell for four days.

None of his three teenage children, who were vaccinated in June, became infected. "I firmly believe the Pfizer vaccine, while immensely effective, may not be as effective against the delta variant once you get past six months," he said. "I was 7½ months out."

Still, he and others who have developed breakthrough infections haven't lost faith in the vaccines.

"I'm proof of what we always knew: They aren't 100%, and really nothing is," said Doherty, the teacher.

She likely was infected after having dinner Aug. 10 with friends, one of whom she learned was unvaccinated and tested positive for COVID-19.

Three days later, she was hit with nausea, fever and fatigue. "My body ached in places that shouldn't," she said. "My ankles hurt."

Worse, she feared she might have unknowingly passed the virus to others — people like her son, nephew, friends and their babies — before learning she had been exposed.

"We're still in the middle of this crazy thing that we need to get out of," she said. "We can't get out of this until more people are vaccinated."

Mary Lynn Smith • 612-673-4788