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There are so many mysteries connected with the novel coronavirus. Why are children not as susceptible as adults? Why do some people become desperately ill while others have only mild symptoms? Why do some experience the so-called “long-haul” aftereffects for months, while others recover quickly?

One of the newest puzzles involves those who have been fully vaccinated but still go on to test positive for the virus.

High-profile cases

Two of the highest-profile examples of this that our concierge doctors have noted in the last few weeks are those of comedian Bill Maher and baseball’s New York Yankees.

Earlier this month, Maher canceled the taping of his HBO series “Real Time with Bill Maher” after announcing he had tested positive for COVID-19, even though he’d been fully vaccinated. (“Fully vaccinated” means having received both doses of either the Moderna or Pfizer vaccines or a single dose of the Johnson & Johnson vaccine, and having waited an additional two weeks for the vaccine’s immunity to take full effect.)

Maher’s test was part of a routine weekly check of the show’s staff, and he has no symptoms.

That same week, the Yankees announced that nine members of their traveling staff, players, and coaches had tested positive, despite being fully vaccinated. All but one of these were asymptomatic.

Proof of efficacy

Does this mean the vaccines don’t work? Quite the contrary, according to public health experts. The Centers for Disease Control and Prevention (CDC) says that vaccine breakthrough cases are to be expected, because no vaccines are 100 percent effective at preventing illness in vaccinated individuals.

Still, the numbers regarding efficacy so far are pretty impressive. The CDC reports that of the 95 million Americans who had been fully vaccinated by April 26, just 0.01 percent of them (9,245) are known to have caught the virus. Of those, 132 people—just over one percent—died from the disease.

“When people hear about breakthrough infections, they automatically think ‘oh, these vaccines are not working,’ or ‘they’re not effective,’ ” Richard Teran, an epidemiologist with the CDC’s Epidemic Intelligence Service, told Science News. “That is just not true. The majority of individuals who do get the vaccine are protected against COVID [-19] infection and also from severe disease.”

Zach Binney, a sports epidemiologist and assistant professor at Oxford College of Emory University, and Angela L. Rasmussen, a research scientist at the University of Saskatchewan’s Vaccine and Infectious Disease Organization, supported that view.

In an opinion piece for The Washington Post, they wrote:

“While [the vaccines] don’t eliminate the possibility of becoming infected, they virtually eliminate the risk of severe disease and death by preparing your immune system to fight the virus so it can respond more quickly and strongly. Cases that would have been hospitalizations become colds, and symptomatic cases become asymptomatic. Most infections are avoided entirely.”

Should you still wear a mask?

Which brings us to the question of masks. Once you’re fully vaccinated, do you still need to wear a mask? Local regulations continue to vary, as do requirements in private businesses such as stores and workplaces. But from a medical standpoint, “If you’re vaccinated, you’re very safe,” Dr. Anthony Fauci told MSNBC recently.

Of course, children under the age of 12 are not yet eligible for the vaccines. While many believe that children can’t get COVID-19, they can and do. Over 3.7 million children have done so. Of those, approximately 250 have died.

Earlier this month, the American Academy of Pediatrics (AAP) reported that children now make up 22.4 percent of all new weekly cases.

Two weeks ago, West Palm Beach County health director Dr. Alina Alonso reported that 15 percent of new COVID-19 cases in Palm Beach County on May 16 were among 5- to 14-year-olds. That’s an increase from 10 percent of new cases in the same age group two weeks earlier.

Other reasons to wear a mask

Besides protecting children, others may choose to continue wearing masks despite being fully vaccinated. For instance, anyone who is immuno-compromised should continue to wear masks in crowded indoor spaces where everyone present may not be fully vaccinated.

“If you are a cancer patient on chemotherapy, or you are on an immunosuppressive for a kidney transplant, you also will have a much higher chance of becoming infected despite being vaccinated,” Dr. Leana Wen, an emergency physician and public health professor at George Washington University, told MarketWatch.

The CDC further clarified its guidance on masks with a warning: “If you have a condition or are taking medications that weaken your immune system, you may NOT be fully protected even if you are fully vaccinated. Talk to your healthcare provider. Even after vaccination, you may need to continue taking all precautions.”