From NYT:
“What You
Can Do Post-Vaccine, and When”
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.)n 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.
What’s safer
to do once I’m vaccinated? 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. But vaccinated
people should still wear masks and avoid large groups and indoor gatherings.
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 U.S. reduce people’s risk of developing COVID-19
by around 95%, 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 percent of a really high number is still a high number, and
what you want is 5% 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% 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.”
What’s safer
to do once my friends and family are vaccinated? If you and the people you
want to see are all vaccinated, it should be safer to socialize 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 theater. “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 have loved ones who will be vaccinated before they are,
such as those who are at high risk because of their age or underlying conditions.
Socializing with them before you are vaccinated is a harder question, experts
said. It would certainly be safer than it is now, but the small chance of
infecting someone who is at high risk may not be worth it. Other people will be
vaccinated early because their jobs leave them highly exposed to the virus; it
will continue to be risky to spend time with them before you also have
immunity, experts said.
What’s safer
to do once most of the population is vaccinated? It should be much safer to
move around once your community achieves herd immunity — the point when the
vaccine can’t easily spread because enough people have become vaccinated or
have already had the illness. Many scientists think at least 70% 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 large 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.”
Why do we
still need a risk budget after vaccines? 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 behaviors, 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% efficacy will be especially powerful once the number of coronavirus
cases diminishes. “The take-home to me is nothing is 100%, 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.
What will
the new normal look like? 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 socialize outdoors.
But expect an uptick in cases and hospitalizations 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.
^ While these
scenarios seem good I believe the majority of people will return to what we had
in 2019 sooner rather than later – whether it is safe to or not. ^
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