These are the questions I receive by email, text, and phone pretty much daily now. People are hungry for an algorithm to understand what they can and cannot do safely, paradigms that have suddenly shifted depending upon who has and hasn’t been vaccinated.
 
I had been planning to write about this topic for a few days when, somewhat coincidentally, I stumbled upon my new favorite podcast series: In the Bubble. The first episode delivered to me – I swear, my phone recommended it from seemingly out of nowhere, though clearly I like to geek out with COVID podcasts – is called Toolkit: Safe or Not Safe, during which the affable Dr. Bob (Wachter) cracks himself up as he pelts his two guests, Dr. Caitlin Rivers and the very funny Dr. Farzad Mostashari, with questions. Because I loved how they framed the conversation, I am going to summarize it for this newsletter.
 
Mostashari makes one overarching point several times throughout the episode that deserves bold font here: once vaccinated, we need to give ourselves permission to live a little. He’s not advocating returning to life like it’s 2019, but being vaccinated allows us to take a giant leap forward (or sticking with the back-in-time analogy, backwards). His point is that messaging matters. If being vaccinated won’t change a thing about the way we can live, then many fewer people will opt to get a jab; and if that happens, we won’t get to herd immunity nearly as fast as we might otherwise. In other words, allowing people to live a little once they have been immunized encourages more people to get the vaccine, eventually hoisting us all over a collective threshold beyond which the community as a whole has enough antibodies to keep COVID at bay. It helps that the vaccines are incredibly effective – precisely because they work so well, living a little is safe.
 
How safe? Israel released data recently showing that only 3.5 out of every 100,000 people vaccinated were subsequently hospitalized with COVID. Compare that to a typical flu season in the US, where about 150 out of every 100,000 people is hospitalized with influenza. I read a great editorial comment about this (no, my currently mushy brain cannot remember where I read this, but I somehow copied and pasted it anyhow!): And yet, the seasonal flu does not grind life to a halt. It does not keep people from flying on airplanes, eating in restaurants, visiting their friends, or going to school or work.
 
So basically, once vaccination is rolled out completely and coronavirus is on the wane, we should be living the same way we live through a flu season. That said, the answer to the big question of who gets to get out now really does depend upon who has gotten a COVID shot. In fact, you can break down the new world order using four scenarios.
 
In scenario 1, two people who want to get together are both vaccinated. The experts say: have at it. Yes, it’s true, we’ve yet to determine whether vaccinated people can carry virus in their airways and pass it along to others. But if two vaccinated people are hanging out, even if one had a small amount of virus and passed it to the other, the other should have sufficient antibodies to ward off serious infection. So, grab dinner, chill out, watch a movie. Yes, it’s all safer done outdoors and with masks, but lots of really smart people say in this scenario, they’re probably not necessary.
 
Before I get to scenario 2, a couple of BIG caveats:

  1. The data shows that people are maximally protected from COVID two weeks after their second dose of Pfizer or Moderna vaccine. Once the single dose J&J vaccine comes to market, we’ll have a better sense of when its maximal protection kicks in.
  2. No one pretends to know how long this protection is going to last. But the sooner we get a vast majority of people vaccinated, the sooner all of us join immunological hands and sing kumbaya and drive down coronavirus penetrance. The less coronavirus we have circulating in our communities, the less likely it is to mutate, the fewer variants we have to contend with, the less likely we all are to randomly cross the path of someone who could infect us with a new strain, and on and on. Herd immunity is one of the most magical features of immunization.
 
Okay, onto scenario 2, where one of the two people getting together is vaccinated. Let’s take the example of vaccinated grandma or grandpa, but unvaccinated grandkids. In this scenario, enjoy one another with limits. Yes, grandparents can finally hug their grandkids… but not for too long. It’s better in masks and, ideally, do the hugging and the hanging out outside. We prioritized the vaccination of older people because they are far more likely to get seriously ill with COVID than younger people; but ironically, the tables have suddenly turned, with vaccinated grandparents presenting the risk to their grandkids, not vice versa. If a vaccinated older person has a little lingering virus in his nose or throat and passes it to someone younger, that recipient could get sick or maybe she’ll just incubate the virus and spread it unknowingly to others. All of this means: hugs are cool, but along with all of your favorite mitigations.
 
Scenario 3 is the inverse of scenario 2, where one of the two people getting together is vaccinated but it’s the younger of the two that’s immunized this time around. No hugging here, because the unvaccinated person in that duo is the higher risk person. This one is for you gen Z folks who have emailed and texted asking if you can go visit your still-unvaccinated parents but you have already had your jabs: you can if you are going to be strict about masking, distancing, staying outside, and so on, but your vaccine does not protect your vulnerable elder. So, if you chose to visit, act exactly how you did before you got your vaccine.
 
And finally, there’s scenario 4, where neither person is vaccinated – the case for the majority of people in this country. While hopefully this state of affairs will change soon, until it does, stick with all of the safety strategies you have been using thus far.
 
The podcast covers flying, general travel, and restaurant dining, too, advice that you’ll start hearing from lots of other outlets soon. Like everything else during this pandemic, you’ll hear plenty of conflicting notions over the next few weeks so when in doubt, take the path that veers closer to quarantine than to free-wheeling, just until we’re all vaccinated enough to live a little. Or hopefully, a lot.
 
And now for this week’s links:
 
  • Really smart people are debating whether we should move from a 2-dose vaccine schedule to just getting one. Michael Osterholm, brainiac heavyweight from the University of Minnesota and director of CIDRAP is lining up to be the first to just get a single dose. His number crunching has him convinced that for the greater good, we all ought to have one dose rather than fewer having two. On the other side of the debate is Anthony Fauci, patron saint of the anti-COVID movement, who says that we should still be getting double doses of the vaccines that were studied that way. 
 
  • There’s a ton of debate about prioritization of vaccines, but not many people want to see teachers sent to the back of the line. Still, vaccinating teachers in Oregon didn’t automatically result in the reopening of schools.
 
 
 
 
Let’s end this newsletter with a challenge: what have you mastered during this year of pandemic? Before all of this isolation is over, I want to get half as good at photoshop as boredpanda!