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By Christian Green
As nearly 2 million North Carolinians have received at least one dose of a vaccine against the deadly coronavirus, individuals are beginning to ask questions about what practices they need to continue in a post-vaccinated world.
On Monday, the national Centers for Disease Control and Prevention released the first set of guidelines for fully vaccinated individuals, which provide recommendations for how people can safely interact without social distancing or masking and possibly begin to return to a version of pre-pandemic normalcy.
The initial changes are relatively small, but they are significant for families and friends who want to see each other safely. They also set the stage for the CDC to gradually recommend a stepwise loosening of restrictions as more people become vaccinated and data continues to show the vaccine’s effectiveness at protecting individuals and preventing the spread of disease.
What does it mean to be ‘fully vaccinated’?
According to the CDC guidelines, a person is fully vaccinated beginning two weeks after receiving the second dose of a two-dose vaccine (Pfizer-BioNTech or Moderna) or two weeks after receiving a single-dose vaccine (Johnson & Johnson).
The vaccines require two weeks to allow the immune system to produce enough antibodies to establish a robust immunity to SARS-CoV-2. It is possible to contract COVID-19 in the period between vaccination and antibody production, so it is important to continue to follow all safety measures in the meantime to ensure a high level of immunity, the guidelines said.
What can happen once one is fully vaccinated?
Answers to some common questions about post-vaccination behavior.
“Can I eat dinner with other fully vaccinated people?“
Yes, according to the latest guidance. There is “likely a low risk” for fully vaccinated individuals to meet each other indoors without wearing masks or social distancing, the guidance stated.
If everyone is vaccinated, it is safe to hug family members and eat a private dinner with friends indoors, according to the guidelines.
“Can I socialize with people who are not fully vaccinated?“
It depends. Here’s where things get a little tricky.
According to CDC guidelines and current understanding of immunity from vaccinations, vaccines not only protect people from getting seriously sick, but there is also growing evidence that they also keep people from developing asymptomatic COVID-19 and that vaccinated people are less likely to spread SARS-CoV-2 even if it is in their systems.
Because of this, the CDC says that the decision to meet unvaccinated individuals indoors, without social distancing or masks, depends on the unvaccinated people’s susceptibility to severe infection from SARS-CoV-2.
In other words, if the unvaccinated people are not at high risk for severe COVID-19 symptoms, they can be around a fully vaccinated household, according to the guidelines.
For example, two fully vaccinated grandparents are fine to visit with unvaccinated grandchildren, provided that no grandchildren have any serious underlying health conditions such as immunocompromised systems or heart conditions, according to the CDC.
However, if any single individual in a household is unvaccinated and is at high risk of developing severe COVID-19, then the CDC recommends that the entire household still follow masking and social distancing guidelines, even when visiting with fully vaccinated people. Because scientists are unsure if vaccinated individuals might pass even a small amount of SARS-CoV-2 to an at-risk individual, these gatherings are not currently recommended.
If a fully vaccinated person wants to visit an unvaccinated friend who is 70 years old, that meeting should still take place outdoors and with necessary precautions for now, the guidance said.
As the research about how much vaccination affects a person’s ability to transmit even small amounts of Sars-CoV-2 continues to develop, the recommendations may change. Because there is no definitive answer at this point, the CDC recommends an abundance of caution for now.
“Can I get together with a large number of unvaccinated people?”
At this point, no.
Because community spread of COVID-19 is still high, the CDC still recommends that, in any situation where two or more households are not vaccinated, the meeting should still take place outside and with necessary precautions.
As of March 4, six counties in North Carolina were listed as “red status,” or areas of critical spread, down from 27 red counties in the prior reporting period. Thirty-four counties were still listed as “orange status,” denoting substantial community spread. The number of percent positive tests across the state is still around 5%, meaning precautions such as outdoor gathering and mask wearing are still important.
If three households meet and only one is vaccinated, there is still the possibility for one unvaccinated household to infect the other, so proper precautions should still apply, the guidance said.
The CDC also advises against medium and large gatherings of crowds, regardless of vaccination status.
“Do I still need to quarantine after contacting someone with COVID?“
No, though one should still monitor for symptoms. Fully vaccinated individuals are very unlikely to contract COVID-19, so new CDC guidelines do not recommend quarantine after contacting a person who is diagnosed with COVID-19.
Though quarantine is no longer required, a person has been in contact with someone who is COVID positive should still monitor for symptoms of COVID-19, such as fever, shortness of breath, persistent coughing, or any of these other symptoms.
A person who has been exposed and experiences any symptoms related to COVID-19 should immediately isolate and get tested.
For a test, contact a doctor or a local health department. Testing locations are also on the N.C. Department of Health and Human Services website, and testing is still free in many locations.
There is an exception to the quarantine exemption for members of congregate housing, like homeless shelters, where transmission is much easier. In those situations, even vaccinated people are urged to quarantine after exposure to prevent possible spread. Individuals in congregate living, except for those in long-term care facilities, are not scheduled to be eligible for the vaccine until March 24 under current DHHS guidelines.
“Do I still need to wear a mask in public?“
“People who have been vaccinated still need to wear masks when they are in public settings and around those who are not vaccinated,” DHHS advised in an email Monday.
That’s because, at this point, only around 10% of the U.S. population has been fully vaccinated for COVID-19, and roughly 10% of North Carolinians have been fully vaccinated.
Even though fully vaccinated people appear unlikely to contribute to disease spread, it is unrealistic for someone in public to be able to know who has been vaccinated and who has not.
“Even if they (fully vaccinated people) are at much lower risk, it’s not reasonable to expect a grocery store to try to verify who’s vaccinated or to have two classes of people with different rules.” Zeynep Tufecki, associate professor at the University of North Carolina wrote in The Atlantic.
“For now, it’s courteous and prudent for everyone to obey the same guidelines in many public places.”
Unless guidance changes, even fully vaccinated people should continue masking in public.
Looking to the future
The set of guidelines was a “first step,” and more updates can be expected as more people are vaccinated and COVID-19 cases and deaths fall across the country, CDC Director Dr. Rochelle Walensky said in a White House press briefing Monday.
Future updated guidelines are contingent on three key areas, she said: getting more people vaccinated; seeing a continued decrease in new COVID-19 cases and deaths; and further studies to determine exactly how effectively vaccines reduce disease transmission in the rare cases of “breakthrough disease,” wherein a vaccinated individual contracts COVID-19.
Breakthrough cases are very rare, and even when they do occur, Walensky said, the severity of the disease is much milder. Additional research, such as a preprint study from Israel, has found vaccinated individuals carried lower levels of virus, suggesting that breakthrough cases are less infectious and lead to milder disease.
“While we are seeing COVID trends moving in the right direction, cases and hospitalization numbers remain elevated, and we still have work to do,” a DHHS spokesperson wrote. “We need to keep protecting each other while we get everyone a spot to get their shot.”
In the CDC’s “Science Brief,” a document containing its rationale for recommendations, describes the future timeline: “As vaccination coverage increases, a balanced, stepwise approach to phasing out certain prevention measures in fully vaccinated people, ideally those that are the most disruptive to individuals and society, can be taken.”