Having an effective vaccine against COVID-19 has been the end goal since the pandemic began,  just over one year ago. Thanks to advanced technologies, incredibly intelligent scientists, and significant government funding, several effective COVID-19 vaccinations have been safely developed within record time. Three vaccines currently have Emergency Use Authorization from the U.S. Food and Drug Administration, and millions of people have been vaccinated to date.  Each vaccine is highly effective at preventing symptomatic and severe COVID-19 disease.  This feat deserves a major celebration, such as a Zoom dance party or happy hour with all of your friends and family to promote the vaccines.  While we must continue proper prevention precautions in public settings, the vaccines are the key to slowly reducing social restrictions.  It is likely that large, unmasked gatherings remain in the distant future.  However, the CDC has recently released new, exciting public health recommendations for people who are considered fully vaccinated that resembles more normal  life in selected low risk situations.

We all want the “old” normal back.

The sooner that everyone gets vaccinated, the closer we get to returning to the “old” normal.  However, we still need to take small steps, and not giant leaps to ensure we do not experience additional surges of COVID-19 cases.  Maintaining our prevention practices will remain important for most settings for several reasons.  First, vaccine distribution will continue to take time. Healthcare workers, and those at highest risk of exposure and severe illness, have been prioritized to get the vaccine first.  While some states have fared better than others with vaccine distribution, approximately 20% of residents in most states have received at least one dose of vaccine.   The newest Johnson & Johnson vaccine requires only one dose and is more easily stored than its predecessors, thus easing some of the challenges with distribution and administration.  Many states are hopeful that vaccination may be available to the general public as early as this spring.  Children are now being enrolled in clinical trials of vaccines, although it is not yet known when the vaccines will be publicly available to young children.

Second, eradicating COVID-19 through vaccination will require the vast majority of us to undergo vaccination. This is because of the concept of herd immunity. Herd immunity occurs when enough of the population has protection from a virus, usually as a result of vaccination, and the virus can no longer spread. Those who are not already immune then benefit from indirect protection. Scientists estimate that approximately 70% of the population must be immune to COVID-19 to reach this level of protection from herd immunity.  

Finally, a small number of people may still go on to develop COVID-19 despite vaccination. While the vaccine studies show very high efficacy rates—around 95%—they aren’t perfect.  Statistics show that some people may not mount protective immunity after vaccination. However, if the COVID-19 vaccines follow suit with other vaccines, like the flu shot, we would anticipate a vaccinated person’s illness to be mild. It is not clear how long the immunity from the vaccine will last or if new strains of the virus will decrease their effectiveness. Widespread vaccination around the globe will likely help to reduce the risk of further viral mutations though. To quote the marvelous Dr. Fauci, “Viruses cannot mutate if they can’t replicate.” For all of these reasons, everyone who can safely receive a COVID-19 vaccine should get one as soon as it is available to them. 

So, what can fully vaccinated individuals change?

First, it is important to define when someone is considered fully vaccinated.  People are considered fully vaccinated two weeks after they have received either their second shot of the Pfizer/Moderna vaccines or their single shot of the Johnson & Johnson vaccine.  This allows time for the body to build the optimal level of immunity.  

According to the newest CDC guidance for non-health care settings, fully vaccinated individuals can now:

• Visit with other fully vaccinated people indoors without wearing masks or physical distancing

• Visit with unvaccinated people from a single household who are at low risk for severe COVID-19 disease indoors without wearing masks or physical distancing

• Refrain from quarantine and testing following a known exposure if they remain asymptomatic

I found this new guidance to be incredibly encouraging.  It is the first time that I have seen “no precautions necessary” listed on the CDC website since the pandemic began.  This guidance will continue to be updated and expanded as time goes on, based on transmission rates, the proportion of people who are fully vaccinated, and the evidence about the vaccines.   This new guidance exists because of emerging evidence that vaccinated people are less likely to have asymptomatic infections and less likely to transmit the virus to others.  

As mentioned above, quarantine restrictions have been lifted for fully vaccinated people, but if symptoms should develop then isolation and testing may be warranted.  The recommendations for visiting others applies to small, private gatherings between individual households.  Behaviors cannot yet change in public.  We must still wear well fitting masks, practice physical distancing, good handwashing, and avoid those closed crowded, poorly ventilated spaces.  I received my second dose of the Moderna vaccine last month. I feel much safer when I go to the grocery store, but I still wear my mask and maintain distance from other shoppers. But now I feel much more comfortable inviting my vaccinated coworker into my home for a meal, and this was something that I was not doing prior to my vaccination.  With a new and unpredictable disease like COVID-19, it is best to take baby steps toward the future.  But even these small steps will bring us closer to each other again, and closer to life before COVID-19. 

Moderate and large sized gatherings are still to be avoided by people who are fully vaccinated, and we must continue to follow local guidance on size restrictions of gatherings.  We all certainly want to keep our loved ones safe, so masking and distancing are still strategies to use when interacting with those who are not yet vaccinated and are high risk for severe infection or those people who have an unvaccinated household member who is high risk.  We also still don’t know how long immunity from the vaccinations will last, and if the variants will play a role.  Thus far, it seems that the vaccines may be protective against the current variants, but additional information is needed, and new variants may emerge in the future.  

Overall, the future seems more promising than it did just a few short months ago.  We have a third, single dose vaccine to add to our arsenal in addition to the other highly effective two dose series.  The vaccines are continuing to show good safety profiles as more and more people get vaccinated.  And while we still cannot have our “mask-burning parties” yet like my eight-year-old son has requested,  we can watch the guidelines change and we can finally begin to hold our vaccinated loved ones close.