White House chief medical adviser Anthony Fauci said he will not go into restaurants or movie theaters, even though he’s vaccinated. The Centers for Disease Control and Prevention says vaccinated people should continue masking up indoors and avoiding large gatherings. News outlets have reported on “breakthrough infections” of Covid-19 among the fully vaccinated.
All of this can make it seem like getting vaccinated may not be enough to liberate people from the fear of getting sick and the precautions they’ve taken to avoid the coronavirus in the past year. So I posed a question to experts I’ve talked to throughout the pandemic about Covid-related precautions: How worried are you about your personal safety after getting vaccinated?
They were nearly unanimous in their response: They’re no longer worried much, if at all, about their personal risk of getting Covid-19. Several spoke of going into restaurants and movie theaters now that they’re vaccinated, socializing with friends and family, and having older relatives visit for extended periods.
“I’m not particularly worried about getting ill myself,” Tara Smith, an epidemiologist at Kent State University, told me. “I know that if I do somehow end up infected, my chances of developing serious symptoms are low.”
Instead, experts said they mostly remain cautious to protect others who aren’t yet vaccinated. The vaccines are extremely effective — dramatically cutting the risk of any symptoms, and driving the risk of hospitalization and death to nearly zero. There’s some evidence that these vaccines also reduce the risk of transmission, but we’re still learning how much they prevent someone who is vaccinated from infecting another person. When experts are still taking precautions, it’s this concern for others that primarily drives them.
But, over time, they see even those concerns for others becoming less necessary, too.
“It’s about protecting others. Vaccination makes me essentially safe,” William Hanage, an epidemiologist at Harvard University, told me. “There’s accumulating evidence, too, that breakthrough cases are less likely to transmit (they have lower viral loads), so by being vaccinated I’m already helping protect others. But I’m also going to continue with behaviors consistent with lower contact rates in the community overall. As more and more are protected through vaccination, I’ll feel less and less of a need for that.”
As vaccination rates climb and daily new cases and deaths drop, experts said that people should feel more comfortable easing up on precautions, shifting the world back to the pre-pandemic days. That might happen sooner than you think — Israel’s experience suggests that cases could start to sustainably plummet once about 60 percent of the population is vaccinated, a point that could be just a month or two away in the US. And with 46 percent of Americans getting one dose so far, cases in the US have already started to decline.
As more of the population gets the vaccine, it’s prudent to keep masking and avoiding large gatherings, and for people who’ve been vaccinated to share their stories and encourage their friends and family to get vaccinated, too. But that’s not because those who are vaccinated are in any trouble. Even with the spread of the variants, the consensus among experts is that vaccinated people shouldn’t worry much about their own risk of Covid-19.
The clinical and real-world evidence for the vaccines is now pretty clear: They are extremely effective at protecting a person from Covid-19.
The clinical trials put the two-shot Moderna and Pfizer/BioNTech vaccines’ efficacy rates at 95-plus percent and the one-shot Johnson & Johnson vaccine’s at more than 70 percent. All three vaccines also drove the risk of hospitalization and death to nearly zero.
The real-world evidence has backed this up. In Israel, the country with the most advanced vaccination campaign, the data shows that the Pfizer/BioNTech vaccine has been more than 90 percent effective at preventing infections, with even higher rates of blocking symptomatic disease, hospitalization, and death. You can see this in the country’s overall statistics: After Israel almost fully reopened its economy in March, once the majority of the population had at least one dose, daily new Covid-19 cases fell by more than 95 percent. And daily deaths are now in the single digits and, at times, zero.
The research also shows the vaccines are effective against the coronavirus variants that have been discovered so far. While some variants seem better able to get around immunity, the vaccines are so powerful that they still by and large overwhelm and defeat the variants in the end.
It’s this evidence that’s made experts confident the vaccines let them stop worrying about their own Covid-19 risk. “I am fully vaccinated and have resumed normal activities,” Monica Gandhi, an infectious diseases doctor at the University of California San Francisco, told me. “I have gone indoor dining, went to my first movie theater, and would go to a bar if there was an opportunity!”
The diminished concern applies to others who are vaccinated, too. Smith spoke of having her fully vaccinated in-laws visit this coming weekend — “the first time we’ve seen them in person since December 2019.”
There have been some breakthrough Covid-19 cases among those who are vaccinated. But they tend to be milder infections, less likely to transmit, and far from common. “This is less than 0.01 percent of the vaccinated,” Akiko Iwasaki, an immunologist at the Yale School of Medicine, told me, citing CDC data. “So extremely rare!”
To the extent that some experts are still playing it safe for themselves, they cited an abundance of caution — and a lack of interest in certain activities.
“I go out to eat, but still only outdoors. I want to be fully relaxed for a restaurant dining experience. For me, with people I don’t know eating with masks off, I feel safest outside,” Kirsten Bibbins-Domingo, an epidemiologist at UC San Francisco, told me. “I haven’t been to bars, concerts, theaters, but that probably reflects the fact that I’m a rather boring person.”
Some acknowledged that their continuing caution was a habit that needed to be broken: After a year of worrying about the virus, it takes a bit of time to go back to a pre-pandemic mentality. “I am not too concerned about my own safety,” Jorge Salinas, an epidemiologist at the University of Iowa, told me. “I think it is mostly a matter of habits. I think it is okay to go back to restaurants but have continued getting takeout. But whoever is vaccinated and feels ready, I think it is safe for them to do so in most places.”
The one reason experts consistently cited for continued precautions: the need to protect those who are unvaccinated. “We’ll probably be holding off on any indoors activities for now, since we have an unvaccinated 7-year-old at home,” Smith said. “The risk is low for us to catch and transmit anything to him, but after all this time avoiding indoor venues and being careful, a movie theater or dinner at a restaurant just doesn’t seem worth it when we still have great options with home theater and takeout meals. Once everyone is vaccinated, those will be back in our rotation.”
Some recent research found that the vaccines can reduce the chances of a vaccinated person spreading the virus to others. The CDC summarized one such real-world study for the Pfizer/BioNTech and Moderna vaccines, showing the vaccines stop not just symptoms but overall infections and, therefore, transmission:
Results showed that following the second dose of vaccine (the recommended number of doses), risk of infection was reduced by 90 percent two or more weeks after vaccination. Following a single dose of either vaccine, the participants’ risk of infection with SARS-CoV-2 was reduced by 80 percent two or more weeks after vaccination.
But in the typically cautious worlds of science and public health, experts want to see a bit more research and data before they declare that vaccinated people can throw out their masks and gather in large numbers indoors. (Some experts also said they may continue masking and avoiding crowded indoor spaces during flu season, after such measures seemed to crush the flu in the past year.)
Even if the vaccine proves to reduce transmission, it would still be safer for every person who can get vaccinated to get the shot. And as more people get their shots, it’s also safer to stick to some precautions for their sake.
To that end, experts recommended watching a few figures going forward: the vaccination rate, and daily new cases or hospitalizations. As vaccination rates go up and surpass 50 or 60 percent at a local level, a vaccinated person can feel much more confident going out without worrying about potentially infecting others. And as cases and hospitalizations go down, a vaccinated person can also have confidence that there’s not much virus out there — further shrinking their chances of getting infected and spreading it.
In the meantime, those who are already vaccinated can help speed up the process by encouraging their friends, family, and peers to get the shot. Surveys consistently show that around 1 in 3 unvaccinated people are waiting for others around them to get vaccinated first before they do so. Sharing vaccination stories, then, could give people the push they need.
“I’m very cognizant that while I’m vaccinated, many still are not,” Saskia Popescu, an epidemiologist at George Mason University, told me. “So I’m still vigilant in wearing my mask while out in public running errands, or when interacting with servers [and] other patrons if I go to an outdoor restaurant, even though I’m not really concerned for my own risk of getting sick.”
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May 11, 2021 at 07:00PM
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Health experts: Vaccinated people can relax about their Covid-19 risk - Vox.com
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