Small, maskless gatherings with other fully vaccinated people and with low-risk unvaccinated people are OK, but continue to take precautions in public.
Is it wise to return to indoor dining once you’ve been fully vaccinated? Is it foolish to go to the movies? There’s been a lot of confusion around what sort of pre-pandemic activities you can or should resume once you’ve had your COVID-19 shots (or shot, in the case of the Johnson & Johnson vaccine).
Now the Centers for Disease Control and Prevention (CDC) is providing some long-awaited direction. The advice amounts to a huge step forward for millions of people yearning for some level of normalcy.
In guidelines released today, the agency gives the green light for people who are fully vaccinated to have small, maskless gatherings with low-risk unvaccinated people. It defines fully vaccinated as two weeks after receiving the second dose of the Moderna or Pfizer vaccine or two weeks after the single-dose Johnson & Johnson vaccine. Specifically, CDC says fully vaccinated people can visit with unvaccinated people from a single household who are at low risk for severe COVID-19.
“The level of precautions taken should be determined by the characteristics of the unvaccinated people, who remain unprotected against COVID-19,” CDC notes.
The guidelines also state that fully vaccinated people can socialize indoors with other fully vaccinated people without distancing, and that they can skip quarantine and testing if exposed to an asymptomatic COVID-19 case. (However, they should still monitor for symptoms for 14 days.) This marks a greater return to normal than was anticipated by the CDC’s draft guidelines, which were widely reported last week. A vaccinated healthcare worker might now be able to see her unvaccinated sister for the first time in a year, for instance; vaccinated grandparents can see their unvaccinated grandchildren.
CDC says it will update its recommendations as more people are vaccinated, rates of community spread of the virus change, and additional scientific evidence becomes available.
What you still shouldn’t do
What the guidelines don’t do is give the vaccinated population the all-clear to act like it’s 2019: The CDC still advises that everyone, including vaccinated people, wear a mask and keep good physical distance around the unvaccinated who are at high-risk for severe COVID (or if the unvaccinated person has a vulnerable household member).
The agency also recommends that you continue to wear masks and social distance in public; avoid medium-and-large crowds and poorly-ventilated places; and practice good hand hygiene.
“We still need for a period of time to be cautious,” says William Schaffner, MD, an infectious disease specialist at the Vanderbilt University School of Medicine. “We shouldn’t think of vaccination as a suit of armor, as if you’re just impervious to everything.”
Especially since much of the population has yet to be vaccinated. “Transmission rates are still really high and we still haven’t vaccinated enough vulnerable people,” Kate Grabowski, PhD, an epidemiologist at Johns Hopkins, tells Health. “Now isn’t the time to go buck-wild.”
Can I still spread coronavirus after getting the vaccine?
One cause for confusion has been the lingering uncertainty around whether or not the vaccine protects from contracting COVID-19 and therefore spreading the virus: How can you calculate risk if you aren’t sure what sort of threat you might pose to others?
Serious concern was understandable at first: “When we conducted the trials for the vaccine, the primary outcomes that were assessed were severe disease, death, and symptomatic infection,” Grabowski says. The studies didn’t include asymptomatic infection, which is a key piece to whether a vaccinated person can spread the virus, and so “we were pretty loath to make any statements on [whether the vaccine protects against transmission].”
But now there’s mounting evidence that you’re unlikely to contract the virus if you are vaccinated and therefore unlikely to spread it to others. (One study from Israel, for example, shows that vaccination prevents 89.4 percent of infections, including those that are asymptomatic.) On top of that, preliminary research has shown that nasal viral loads from post-vaccination exposures are low and likely noninfectious because the body’s immune defenses are acting fast to stop viral replication.
“What we should have said [from the start] was, ‘They’re likely to reduce transmission, but we don’t know yet, so let’s wait for some real-world data,'” says Monica Gandhi, MD, an infectious disease expert at the University of California, San Francisco.
“Because now the real-world data has come out in droves: They reduce transmission. And yet we still continue to this day to say that they’re not going to. The idea that they don’t is a December 2020 message.”
Does the vaccine protect against variants?
It seems like there’s a new viral variant, whether from South Africa, California, or Brazil, to worry about each week, leaving vaccinated people with another uncertainty: Am I actually protected against all strains of COVID?
“I don’t think we really know if [the vaccine] protects us [against the variants] at the same level of effectiveness as we saw in the clinical trials,” Grabowski says.
But that doesn’t mean you’re entirely without protection. “I think the key thing to keep in mind is that the reason this disease is so bad is that it’s novel,” she says. “Our body has never seen anything like this type of coronavirus before. [But] if you get the vaccine, your body has seen something like it before.” (After all, that’s what the vaccine does: it prompts the body to recognize the virus so that the immune system will be prepared to fend off this foreign enemy when it encounters it in the future.)
Dr. Gandhi is even more optimistic about the vaccine’s ability to protect against variants. “When we think about antibodies we can endlessly worry, because it does actually look like after you’ve been vaccinated, these antibodies do not work as well against the various variants,” she says. “But, essentially, vaccines generate two types of immune responses — antibodies and T-cells.” The latter works against multiple parts of the virus, she explains, including those parts that are the same across variants.
Weighing the risks—What’s safe? What’s not?
Dr. Schaffner recommends using vaccination as an opportunity to adjust your risk budget. Perhaps you’re now willing to shop at the grocery store after months of having your food delivered; maybe you’re comfortable going to the salon after a year of cutting your own hair. (Again, while following public-safety guidelines.)
For her part, Grabowski is now comfortable having her vaccinated parents visit with her two-year-old son, but she isn’t planning to eat at an indoor restaurant — despite being vaccinated herself — just yet. She’s waiting for infection rates to go down substantially.
“If you have the vaccine, your risk is much, much lower,” she says. “[But] is it zero? No. So are you willing to accept some of that risk knowing that the background transmission rates are quite high? I don’t know. That’s up to you. For me, personally — and I think a lot of these will come down to individual decisions — small, incremental increases in my exposures with family members or friends that are vaccinated are probably fine, but I’m not going to continue to resume my normal activities, pre-pandemic, until enough people in my community have been vaccinated, and especially those who are most vulnerable.”
The good news is that she doesn’t see that version of life as being very far off at all. “We are in the final stretches of this thing,” she says. “We literally have a couple of months left. If we can just all sit tight, it’s not always going to be this way.”