Stay Cautious Even as Vaccines Free Us from Social Distancing

The past 14 months have been brutal and exhausting. In the midst of a pandemic and one that rocked our health care response in so many ways, something particularly amazing happened—several efficacious vaccines were developed. No small feat, this was an endeavor that took the kind of resources and willpower that only an emergency could harness.

I think that this particular moment in the coronavirus disease 2019 (COVID-19) as being uniquely challenging, though—navigating at a time with the nation partially immunized. Novel variants and concern for vaccine efficacy, questions regarding sterilizing immunity, and states lifting restrictions at a rapid pace are all things that make me pause in the face of new guidance from the Centers for Disease Control and Prevention (CDC). Currently, over 61 million people in the United States have received at least one dose of a SARS-CoV-2 vaccine; 32 million have been fully vaccinated by either the single-dose Johnson & Johnson or the two-dose series by Moderna and Pfizer.

On Monday, the CDC released new interim public health guidance for those people who are fully vaccinated (two weeks after their second dose of the two-dose vaccine, or the single-dose vaccine). This guidance is for the public and specific to households and non-health care settings. Per CDC:

Fully vaccinated people can:

• 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 asymptomatic.

For now, fully vaccinated people should continue to:

• Take precautions in public like wearing a well-fitted mask and physical distancing.
• Wear masks, practice physical distancing, and adhere to other prevention measures when visiting with unvaccinated people who are at increased risk for severe COVID-19 disease or who have an unvaccinated household member who is at increased risk for severe COVID-19 disease.
• Wear masks, maintain physical distance, and practice other prevention measures when visiting with unvaccinated people from multiple households.
• Avoid medium- and large-sized in-person gatherings.
• Get tested if experiencing COVID-19 symptoms.
• Follow guidance issued by individual employers.
• Follow CDC and health department travel requirements and recommendations.

As we roll out education and communication on this new guidance, it’s especially prudent to also share this helpful CDC webpage on what’s changed, what hasn’t changed, what we know, and

Saskia v. Popescu, PHD, MPH, MA, CIC

what we’re still working to understand. Really, this guidance was designed to not only encourage people to vaccinate, but also provide some risk awareness for what can be done safely during this time. Perhaps the hardest piece is the second bullet: visiting with unvaccinated people from a single household. This is really about the risk of severe disease in the unvaccinated household, but I also like to remind people that we’re still learning more about immunity to asymptomatic infection, so it’s important to also be mindful of less safe behavior—even after you’re vaccinated, you still want to take the necessary precautions when you’re outside the home.

Ultimately, this second bullet is about encouraging families and friends who haven’t been able to see each other (example: parents at risk for severe disease are now vaccinated and want to see their child who is not high risk for severe disease) in some time. This new information though does reiterate that guidance needs to be followed at work and to avoid several things, like large gatherings and reiterating the importance of taking precautions when in public.

More and more, this comes down to reviewing what makes things high risk—proximity, duration, and intensity. This new guidance is helpful and should be communicated to health care workers but it’s important to take the time to explain the nuance and that now more than ever, we need to be good stewards of public health and the declining cases we’re seeing.