After nearly a year of lockdowns and uncontrollable spread of the coronavirus, Americans are desperate for life to return to normal. The commonly-understood answer answer is "when we're all vaccinated." Indeed, since the beginning of the pandemic, COVID-19 vaccines have been a symbol of hope — yet the newly-vaccinated are being confronted with a different reality. Instead of feeling confident about safely mingling with people unmasked and inside, the vaccinated aren't rushing out to host raves and make-out parties (nor are they encouraged to by public health experts). As some experts have mused, getting vaccinated isn't a "get-out-of-jail-free card."
The confusion and disappointment over what you can actually do differently once vaccinated is in part due to Dr. Anthony Fauci's comments and verbal guidance. Fauci, the director of the National Institute of Allergy and Infectious Diseases, has previously warned that vaccinated people shouldn't dine indoors or go to movie theaters just yet. Doctors largely agree that even the vaccinated have to take similar pandemic safety precautions — such as avoiding close contact with others, wearing a mask, and avoiding indoor gatherings.
Of course, with such a high unvaccinated population, safety precautions in public spaces have become normalized, and will be for a while. But what about in private? How does gathering work when some people have, and haven't, been vaccinated? What about if you throw a COVID-19 survivor into the mix?
The Centers for Disease Control and Prevention (CDC) has yet to provide specific guidance on the more real-world situation vaccinated people are encountering. Fortunately, Fauci said he anticipates that the CDC will soon update its guidelines to include more direct guidance for fully vaccinated people.
"I believe you're going to be hearing more of the recommendations of how you can relax the stringency of some of the things, particularly when you're dealing with something like your own personal family when people have been vaccinated," Fauci said. He added that the CDC wants "to make sure they sit down, talk about it, look at the data and then come out with a recommendation based on the science."
However, Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center, tells Salon he's worried that all the focus on what you can't do has been undermining the benefits of the vaccine. And he thinks people should feel free to do what they want once they're vaccinated, especially with other vaccinated people.
"There has been, I think, an overemphasis on things not changing when you're vaccinated — and I think that really is underselling the benefits of this vaccine," Adalja said. "I tell people to pursue whatever activities they want to pursue as long as they're vaccinated and wait two weeks [after the second dose], and if you're doing activities with another vaccinated person on the same timeline, there's really no issue at all."
However, Adalja added that he's somewhat in the minority with his opinion.
"I think you'll talk to somebody else and they'll say something completely opposite," Adalja said.
Indeed, Adalja's comments highlight an ongoing dilemma, that public health officials, doctors and scientists are divided on what vaccinated individuals can and cannot do in society. That's because the data is still forthcoming — and data is at the core of the mass confusion.
When asked what vaccinated people can and cannot do, right now, Dr. George Rutherford, a professor of epidemiology at the University of California–San Francisco, answered with more caution.
"There are some things you can do differently, if you're around other vaccinated people you don't have to wear a mask all the time, but that really applies to small gatherings, in a house — that doesn't mean 80 people," Rutherford said. "But until we get most people vaccinated, you're always going to have to take some precautions."
Rutherford said he suggests that vaccinated people assume they're part of the 5 percent "failed vaccination" group. As explained by the World Health Organization, vaccine efficacy is the percentage of "reduction in disease incidence in a vaccinated group compared to an unvaccinated group under optimal conditions." Both the Moderna and Pfizer vaccines have nearly 95 percent when it comes to vaccine efficacy, while the forthcoming Johnson & Johnson vaccine has about 66 percent efficacy. Rutherford said there's a small chance that vaccinated people can get infected — with either symptomatic or asymptomatic cases — and spread the virus.
"There's a five-percent failure rate, so there's a chance that they might not be immune," Rutherford said.
But as Salon has reported, the efficacy of these vaccines is extremely high — especially when compared to other vaccines, like the flu vaccines, which are often below 50 percent efficacy. And then there's the nagging question as to whether or not vaccinated people can spread the coronavirus to unvaccinated people. Notably, new data published by researchers in the United Kingdom indicated that the vaccine stops transmission. A separate study from Israel found similar results. More data is expected within the next couple of months, perhaps making this concern a moot issue.
Monica Gandhi, a professor of infectious diseases at the University of California-San Francisco, told Salon the real-world data that's emerged over the last week has been "incredible," in part because it indicates that the vaccines are reducing transmission and keeping people nearly 100 percent safe from getting severe cases of COVID-19.
"So, what can vaccinated people do after they're vaccinated? Well, they're safe from what led us to pay attention to SARS-CoV-2 to begin with, which is severe disease, and I mean 100 percent safe, and they are also not likely to transmit it to others," Gandhi said. "So, with fellow vaccinees, they should do whatever they'd like — they should have dinner, they should gather in groups, they should go to the indoor dining rooms that are opening."
All three experts agreed that in private spaces, all vaccinated people should feel free to do whatever they want—no masks, no distance. However, the opinions on how vaccinated people can safely mingle with unvaccinated people — and people who had COVID-19 but still aren't vaccinated — differed.
When asked if people who are unvaccinated can visit with vaccinated people now, Adalja said he thinks it's safe, specifically in the situation where, let's say, a younger person wants to visit with their vaccinated grandparents.
"Obviously, nothing has a zero risk, but yes I think it's safe," Adalja said. "I don't think that there is a very high risk of a vaccinated person getting an asymptomatic infection."
What about a vaccinated, small group of friends having an unvaccinated group over for dinner? Rutherford said he doesn't think that's safe.
"That's a bad idea, eating and drinking are the worst because you take your masks off," Rutherford said. "But if everybody's been vaccinated, that's different — I would feel comfortable having a dinner indoors without masks."
Gandhi said everyone has to "decide with their level of comfort, based on the data" how willing they are to mingle unvaccinated and vaccinated people together.
"A vaccinated person against an unvaccinated person in your family, and your decision to want to be close to that person, I think depends on your personal comfort level with the data," Gandhi said. "The problem is that restrictions in society are not going to ease until everyone is vaccinated, so when they go to indoor dining they will have all of those restrictions in place, including the waiters wearing masks and distancing from other people, and that's absolutely fair because we have an massive unvaccinated portion of our society."
But what about vaccinated people hanging out with people who have recovered from having COVID-19, but aren't vaccinated?
"Natural immunity generates a strong antibody, T cell and B cell responses, and you likely cannot get it [COVID-19] again, and likely you can't pass it on," Gandhi said. "It's absolutely true that naturally immune people could certainly, as they have been by the way, hang out without restrictions."
Rutherford said he would advise the two groups mingling based on when the person had COVID-19.
"If you had it in December, CDC guidance is that you should wait 30 to 90 days to get vaccinated, and what that means is that you're not high priority because you have naturally acquired immunity," Rutherford said. "If they had it in March or April of last year, they need to get vaccinated."
"For all intents and purposes I would treat a recovered person, especially if it's been within several months that their recovery has been, in many ways as a vaccinated person," Adalja "Those two can interact without fear. I think the risk is very low."