Andy Slavitt, senior adviser to the White House, for the Covid response, said dr. Sanjay Gupta, CNN’s chief medical correspondent, said we should expect to provide more guidance on how to return to normal as we see the vaccination rate increase.
“The pace at which new guidelines will develop is directly related to how quickly we vaccinate the country,” Slavitt told Gupta. “This is the most important point. At 10% vaccinations we have these guidelines. At 20-30% we have new guidance.”
So, what can we really do? We discuss the key take-away with CNN medical analyst Dr. Leana Wen, an emergency physician and visiting professor of health policy and management at the George Washington University Milken Institute School of Public Health. Here is her advice.
Dr. Leana Wen: A person is fully vaccinated at least two weeks after the Johnson & Johnson vaccine or two weeks after a second dose of Pfizer / BioNTech and Moderna vaccine.
CNN: What is the leadership of the CDC for people who are fully vaccinated?
Win: The CDC says that people who are fully vaccinated can see each other inside without masks or social distance. This will be a great relief for many people. Those who live alone and have been isolated for months may be together after vaccination. Couples who are vaccinated can see other couples who are fully vaccinated for dinner in their private homes.
CNN: Is there a size limit for how many people can be fully vaccinated?
Win: Because vaccination status is so important, I’ll make sure you trust that the people you see are vaccinated. Feel free to ask them directly and proof of vaccination. The larger the group, the greater the chance that you do not know anyone in the group well. If you are not sure about their vaccination status, do not come with them indoors.
CNN: What about appointments? Can you and a partner finally get together if both are vaccinated?
Win: Yes, if you and the person you went out with have both been completely vaccinated, you can definitely be with each other again. The issue of trust comes up here for people who are just going out or if you are meeting someone you do not know well. Make sure that the other parties are vaccinated. If you can not be sure, you should surrender the personal meeting or see only the people outside, at a distance of at least 6 feet.
CNN: What about a family where some or all of the individuals have not yet been vaccinated? Many grandparents like to see their grandchildren.
Win: The CDC provides very good guidance here which should be a relief to many grandparents. They say visits are good for vaccinations in harmless people from a single household, as long as the harmless people are at low risk for severe Covid-19.
Suppose both grandparents were vaccinated. They visit a so-called “mixed” household where only one parent is vaccinated and none of the children are. If all people who have not been vaccinated in the household are generally healthy, the visit can take place – indoors, without masks or distance, with the grandparents free to embrace their family.
It becomes more difficult when someone in the house is at a higher risk for severe Covid-19. This is where there are many nuances and complexities. Suppose a parent has asthma and high blood pressure, for example, or if a child is immunocompromised? We know the grandparents are well protected and probably have a significantly reduced risk of carrying coronavirus. I would say that the safest thing is for the grandparents to reduce their other risks before visiting the family. For example, they should not see other unwanted people in the ten days preceding.
CNN: What about a family reunion, with several families having members who have not been vaccinated?
Win: The CDC is pretty clear here. It should not happen except outside, with masks and distance. The key is that the people who are not vaccinated should not mix from different households because they can be carriers and infect others.
CNN: Many families live apart. What does the CDC say about traveling to loved ones?
Win: Here I do not agree with the CDC’s leadership. The CDC continues to discourage non-essential air travel, which will include family visits. I do not think it meets a common sense test. Another part of the CDC leadership says that people who are fully vaccinated do not have to go into quarantine if they are exposed to someone who is known to have coronavirus. This is a very high level. The risk of exposure to a flight or train or driver is already low. If someone is vaccinated, the risk is even lower.
I think people who are fully vaccinated should travel to visit their families, but of course take all precautions during the trip – including always wearing a well-fitting mask in public places, and trying to stay physically away where possible , and hands were good.
CNN: The CDC does not say much about other activities such as going to the restaurant or the gym. What about these settings?
Win: Again, this is where I do not agree with the CDC’s overly cautious guidelines. I understand that they do not want people to let their guards down completely, but clinicians know that we need to meet people where they are and address each situation with the nuances it deserves.
Suppose someone is vaccinated and really wants to attend church services and return to their senior center for indoor activities. The risk to them is very low, and their risk to others is also low. On the other hand, the cost of continued isolation is going to be high.
I think they should be able to return to the activities they pay most attention to, while again making sure they wear masks and stay physically far away. I want to go so far as to say that a couple who really wants to eat in a restaurant again can do so occasionally, but not night after night.
People need to be careful and not go to overcrowded bars. Make sure you definitely wear masks in public. Just because something is open in your state does not mean it is safe to visit. We need to encourage vaccination as the way back to pre-pandemic life, and work with people to reduce their risk.
CNN: What do you say to someone who wants to go here: a church, a restaurant, a museum, a movie theater, a concert – all indoors?
Win: This is what I would say – it depends on your individual situation.
First look at your own risk factors. Remember that the vaccine is not a bulletproof protection. It offers very good protection, especially against serious diseases, but there is still some risk. Masks offer an extra good layer of protection, just like distance, ventilation, and so on.
If you yourself are at very high risk due to age and underlying medical conditions, you may want to consider limiting yourself to the CDC guidelines and seeing only other vaccines in private, social settings. If you have high-risk conditions, but also have something you really want to do, think about your own values and priorities. For some people, church service is so essential that the benefits, for example, far outweigh any possible risks.
Then look at the setting itself. A restaurant is still safest outdoors. Indoor meals involve some risk, but again, if people wear masks except while eating and there is good space and ventilation, the risk is low enough that some people may eat indoors after vaccination. The other settings are similar. Most museums offer good distance and should be good. Look at the movie theaters and concert venues you are thinking of. If they provide good ventilation and spacing, and everyone wears masks, it is a relatively low risk.
Vaccines offer so much hope. I think the CDC and the entire public health community need to do a lot more to convey exactly how much incredible hope there is. We are not going to reduce the risk to zero, but we can reduce it to a low level that vaccinated individuals can return to many pre-pandemics normally.