Those who have been vaccinated might need to hang onto their masks for a while. Photo / Getty Images
Particularly in the early months of vaccination, many activities should wait, experts say — and plan to keep your masks.
Vaccines are here, bringing hope of the pandemic's end. But even when you get your dose, it won't mean an immediate return to life as you knew it.
Scientists cite several reasons for staying masked and cautious as you start your post-vaccine life. Vaccines don't offer perfect protection; we don't yet know whether vaccinated people can spread the virus; and coronavirus is likely to continue its rapid spread until a large majority of the population is vaccinated or has survived a natural infection.
Because vaccines will not be a ticket back to 2019, Uma Karmarkar, a neuroeconomist at the University of California, San Diego, recommends that people think about "how we are moving forward" instead of "getting back to normal." (Neuroeconomics bridges neuroscience, psychology and economics.)
Vaccination provides you and society the best way to move forward. Some parts of life will begin to feel different as soon as the vaccine kicks in. Other changes will take longer. When it comes to thinking about what's safe, it may help to think of post-vaccine life in several phases.
When people are fully vaccinated (a week or two after the second dose), but most others aren't yet, their lives probably shouldn't change very much, experts say. It will most likely be safer for them to do things like visit the grocery store or the post office. People who work in places that leave them highly exposed will significantly decrease their risk — which is why frontline workers are among the first to be eligible for the vaccine. But vaccinated people should still wear masks and avoid large groups and indoor gatherings when possible.
That's important for both their health and the health of others, experts said. Scientists are waiting to learn if vaccinated people can spread the virus to others. (Early data on transmission seems promising, but vaccines are very unlikely to curb contagiousness entirely.) Also, while early evidence suggests that the first vaccines in the US reduce people's risk of developing Covid-19 by around 95 per cent, that still means a small fraction could get sick — and as long as the virus is as widespread as it is now, even that small share could be a big number.
"Five per cent of a really high number is still a high number, and what you want is 5 per cent of a relatively medium or low number," said Dr. Ashish Jha, a physician and the dean of the School of Public Health at Brown.
In an informal survey of 700 epidemiologists by The New York Times, less than a third said they would change their behavior after they were vaccinated; half said they would wait until at least 70 per cent of the population was vaccinated.
Kelsey Vandersteen, a trauma ICU nurse at UW Health University Hospital in Madison, Wisconsin, will receive her first injection on Wednesday — probably months ahead of her young daughters and husband, who works from home for a software company.
Even after her second shot, she doesn't intend to change her behavior, including wearing a mask. She says she hopes this will model good behavior for others. Besides, she said: "I prefer the mask. It protects me from other stuff as well. We've been completely healthy — not a sniffle since March."
If you and the people you want to see are all vaccinated, it should be safer to socialise with them, including indoors, experts said. But being in large groups or traveling, when there's no way to know if the people around you have been vaccinated, will remain risky, they said.
Eric Lofgren, an infectious disease epidemiologist at Washington State University, said at that point, he would restart in-person board game nights and one-on-one meetings with students, but he wouldn't fly on vacation or go to a movie theatre.
"Immunity is not an on/off switch; it's a dial," he said. "If you're below herd immunity, the virus is still happily circulating in the population and there's always a chance the vaccine isn't working for you."
In some ways, this may be the hardest phase of post-vaccine life to navigate. Deciding which risks to take will involve calculations that can prove exhausting, said Elizabeth Dorrance Hall, an assistant professor of communications at Michigan State University: "Our brains just get so tired of weighing each and every thing that we just run out of brain power on gradients."
Many people will be vaccinated at a different time than their loved ones, such as those who are at high risk because of their age or underlying conditions or whose jobs leave them highly exposed to the virus. Socialising before everyone in the group is vaccinated is a harder question, experts said. It would certainly be safer than it is now, but spread is possible before everyone has immunity, and people will still need to consider the small chance of infecting someone who is at high risk.
It should be much safer to move around once your community achieves herd immunity — the point when the virus can't easily spread because enough people have become vaccinated or have already had the illness. This also helps protect people who can't get vaccinated for health reasons, and people who work in crowded or indoor places. Many scientists think at least 70 per cent of people need to have acquired immunity for the whole community to be protected. That number is just an estimate, though, and might need to be revised once we know more about how vaccines affect the virus' ability to spread.
When a majority of people are vaccinated, scientists said, it will be safer to do things in your community, like eat at indoor restaurants, attend a party or ride a bus. Next Christmas, families can probably gather in ways they should avoid this year, they said.
It's too early to know exactly when we'll hit that threshold. Although federal officials have said the United States should have the resources to vaccinate hundreds of millions of people by summer, many scientists say that timeline is optimistic. There could be logistical challenges to vaccinating everyone, and some people have expressed hesitancy about getting the vaccine.
It's likely that some regions will have higher vaccination rates than others. Just as some communities have found themselves vulnerable to measles because of low childhood vaccination rates, areas with low Covid-19 vaccination rates may see outbreaks even if the country has reached a herd immunity level overall. Knowing that context will be crucial for decision making.
Also, experts stressed that even when herd immunity is reached, Covid-19 is not likely to disappear outright. Outbreaks could still be likely, probably in winter.
"Winter is going to start being flu and Covid season," said Andrew Noymer, an epidemiologist studying Covid-19 at the University of California, Irvine. The last things he will return to, he said, are international travel and crowded events like concerts — but he expects to do those again at some point. He is waiting not just for the vaccine, but also for the virus' spread to decrease greatly and for hospitals to have more capacity: "I intend to go back bit by bit."
During the pandemic, experts have asked people to think of themselves as having a risk budget: If you spend some of that limited supply by engaging in riskier behaviours, you will need to cut back in other aspects of your life. Vaccines can expand an individual's risk budget, Lofgren said. But they do not make the budget infinite: If you travel to see friends, you might still want to offset that decision by avoiding indoor restaurants.
The most effective route to more freedom is for as many people as possible to be vaccinated, experts say. Even though risks will remain, vaccines with 95 per cent efficacy will be especially powerful once the number of coronavirus cases diminishes.
"The take-home to me is nothing is 100 per cent, but it's very good," said Gypsyamber D'Souza, a professor of epidemiology at Johns Hopkins University.
It may be frustrating to keep waiting, but as people get extra protection from the vaccine, the daily decisions will get easier as everyone's risk budget balloons.
Scientists said they were waiting to learn many things before they would feel comfortable doing more high-risk activities, like how many people wind up being vaccinated, how long immunity lasts (after vaccination and after infection) and whether the virus evolves.
This summer will probably be more open because more people will be vaccinated, and the virus seems to slow in warmer months as people can more easily socialise outdoors. But expect an uptick in cases and hospitalisations next winter, scientists say.
"It's a really exciting time for science, but I would maintain that caution," said Delivette Castor, an infectious disease epidemiologist at Columbia. "For me personally, I will not be at ease until we have sufficient coverage in the community and we've had it for a durable period of time."
Scientists also say it's unlikely that life will look exactly like 2019 again. In the new normal, there may be more mask-wearing during flu season or in crowded places because awareness has been raised. And there will probably be more systems in place to prevent pandemics from being as deadly, Castor said. These include methods for tracking emerging infections and screening before activities like flying.
That is a hopeful development, experts say. This year, rates of seasonal flu are substantially lower than usual, a shift they say is partly explained by the widespread use of masks and physical distancing. If we keep them up, the changes that coronavirus has wrought — like the decline of handshaking — may have payoffs in reducing risks of other diseases in the future.
Written by: Claire Cain Miller, Margot Sanger-Katz and Katherine J. Wu
© 2020 THE NEW YORK TIMES
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