Many people hope that getting a Covid-19 vaccine will mark an immediate return to normal: no more masks, no more distancing, safe indoor dinner parties and big hugs with friends.
The reality is more complicated. For now, people who have gotten their shots must navigate decision-making in a world where the vaccinated and unvaccinated will coexist for months, even within the same household.
So what should and shouldn’t you do? The U.S. Centers for Disease Control and Prevention issued guidelines Monday. Fully vaccinated people can gather indoors with others who are also fully vaccinated without taking extra precautions, the CDC said. And vaccinated people may gather with one other unvaccinated family without masks and distancing as long as the unvaccinated members are healthy and aren’t at risk for developing a more serious case of Covid-19. But the CDC urged fully vaccinated people to continue taking precautions in public, and in medium or large private gatherings.
“There are some activities that fully vaccinated people can begin to resume now in the privacy of their own homes,” said CDC director Rochelle Walensky. “Everyone—even those who are vaccinated—should continue with all mitigation strategies when in public settings.”
The CDC and most experts agree that until we are closer to herd immunity—when a substantial majority of the population is protected through vaccination or natural infection so the virus can’t spread easily—mask wearing, social distancing and avoiding crowded, indoor gatherings should be standard practice in public spaces. The CDC guidelines note that evidence increasingly suggests that vaccinated people are potentially less likely to transmit the virus through asymptomatic infections, but there are also outstanding questions on the duration of the vaccines’ protection and the effect of emerging variants.
“Particularly for these several months where immunization coverage is low, we’re still learning about the variants, and we still need to know about this onward transmission, the public health messaging really is to maintain these behaviors,” says Chris Beyrer, a professor of epidemiology at Johns Hopkins Bloomberg School of Public Health. “Until we get out of this. We’re not out of it yet.”
Here are recommendations from scientists on how to assess the risks.
Is it OK for vaccinated people to meet with other vaccinated people?
The CDC guidelines and experts agree that once fully vaccinated—at least two weeks after your second dose of the Pfizer or Moderna vaccines or the single Johnson & Johnson shot—it’s safe to meet indoors with other fully vaccinated people without masks or distancing.
Gathering with other vaccinated people is “scientifically very safe,” says Paul E. Sax, clinical director of the division of infectious diseases at Brigham and Women’s Hospital in Boston. Nothing is 100% effective but “gathering with other vaccinated people is pretty darn close,” he says.
“I don’t think people should run to a crowded bar where people are shouting at each other,” he says. “But the kind of socializing that is part of human nature and that has been put on hold for a lot of people—that can resume.”
The larger the group, the riskier the interaction, because you can’t verify that everyone is vaccinated and you don’t know what their exposures are, says Leana Wen, an emergency physician and public health professor at George Washington University in Washington, D.C. “I’m talking one other couple or maybe two other couples at most,” says Dr. Wen. The CDC guidelines say precautions such as wearing masks and social distancing should be taken for medium and large gatherings despite the vaccination status of individuals.
Monica Gandhi, an infectious disease physician and professor of medicine at the University of California, San Francisco, is less conservative, saying there should be no limits on the size of gatherings for fully vaccinated individuals. “They can have dinner parties. They can go to restaurants. They can go to the movies,” she says. But she notes that even vaccinated people will need to follow mask and distancing requirements in those public settings until we reach herd immunity.
What if the adults are vaccinated but the kids aren’t?
There is currently no authorized vaccine for children and adolescents under 16 years old. “This is going to be one of those issues that families are going to have to grapple with and be prudent about,” says Dr. Beyrer.
The CDC guidelines say people who are fully vaccinated can visit indoors with one other unvaccinated household without wearing masks or maintaining social distance if the unvaccinated people are at low risk for severe Covid-19.
There’s a significant difference between young children and adolescents or teens in terms of both transmission of the virus as well as getting the disease, Dr. Sax says. Adolescents get and transmit Covid-19 similarly to young adults, while younger children don’t get symptomatic disease as often and don’t appear to transmit as much. “Every family and every group of friends is going to make decisions based on their own risk tolerance,” says Dr. Sax.
Immunocompromised individuals and their families should be more careful, as vaccines in general can be less effective in them, says Dr. Sax.
Dr. Wen says she recommends that families continue to take precautions during playdates when the adults are vaccinated but the kids aren’t. “If those families are also associating with other families, that’s a risky scenario that I would not recommend at this time,” says Dr. Wen of indoor gatherings. “They could be an asymptomatic carrier who then spread it to their children. And if the children are in school or daycare, there could be additional spread from that.”
Can a fully vaccinated family meet with unvaccinated people indoors without masks?
The CDC guidelines say yes, they can, as long as the unvaccinated people are from one household and have no risk factors that put them at risk of developing severe Covid-19.
Gregory Poland, director of the Mayo Vaccine Research Group in Rochester, Minn. says this could be potentially risky because unvaccinated people may not disclose their medical risks and may not even be aware they have any. There’s not a lot of data of vaccine efficacy among people who are very elderly, on chemotherapy, or immunocompromised, he notes.
What is the latest on whether vaccinated people can spread the virus to unvaccinated people?
Recent studies found that vaccination reduced asymptomatic infection more than 80% when compared to unvaccinated individuals and nasal viral loads are low and potentially noninfectious, says Dr. Gandhi. But other experts say the evidence is preliminary and more conclusive evidence is needed. And new variants raise additional questions about vaccine effectiveness.
What activities should I prioritize after I get vaccinated?
Schedule any routine medical and health appointments that you’ve been putting off, Dr. Wen says. Get your colonoscopy, mammogram or dental cleaning. Schedule an elective surgery. “Anything like that you should resume because you are well protected,” says Dr. Wen.
What about travel?
The CDC guidelines didn’t update travel recommendations. Once you are vaccinated, traveling is lower risk, says Dr. Wen, as is staying at a hotel or going to restaurants, so long as you follow safety protocols. But continue to be cautious about how you meet with people once you arrive at your destination, she says, particularly if they aren’t vaccinated or live in an area that has high transmission rates.
Is it safe for my elderly parents to travel for a visit?
Dr. Wen says fully vaccinated people, including healthy grandparents, should be encouraged to travel as long as they take the appropriate precautions, such as wearing masks when in public. “The travel itself is very low risk,” says Dr. Wen. “If they follow precautions like wearing a mask, the risk of them contracting the coronavirus and passing it on to the rest of the family is extremely low and the benefit is huge. People are eager to see their families.”
But still weigh the specifics of your situation. If you have an unvaccinated older teen and a frail, elderly grandparent, consider more precautions, says Dr. Poland.
Which activities are lower and higher risk, even after vaccination?
Vaccinated individuals can feel comfortable when doing quiet indoor activities where people are generally still required to be masked and distanced, such as visiting an uncrowded museum, says Dr. Sax. Outdoor activities are even safer.
Higher-risk situations include indoor dining, bars, gyms and houses of worship, where people are singing and talking. “We don’t want to push the limits of what the vaccines can do before case numbers drop,” says Dr. Sax. He and his physician wife are both fully vaccinated but won’t dine in restaurants until case numbers and hospitalizations are significantly lower, he says.
Source: The Wall Street Journal