As more patients and friends get fully vaccinated, Dr. William Schaffner’s phone has been ringing constantly, his email box flooded.
The fully vaccinated — people who are two weeks past their second dose of the Moderna or Pfizer Covid-19 vaccines, or after a single dose of Johnson & Johnson’s — have many questions for the professor of infectious diseases at Vanderbilt University.
They ask if it’s OK to hug their grandkids now. Can they play cards with their vaccinated friends? Can they host a small indoor dinner party, but should they forget to invite Uncle Frank who has been unmasked at the bar a lot?
“I try to answer as many of those questions as I possibly can, because these are very thoughtful people,” Schaffner said. “These are the people who are trying to do the best in these circumstances.”
For others who don’t happen to have a favorite infectious disease expert on speed dial, the US Center for Disease Control and Prevention will soon publish guidelines for the fully vaccinated.
More than 82 million vaccine doses have been given out in the US, and after a year of takeout and Zoom-only visits with mom, the vaccinated want direction.
“I think people need practical advice about how to go about their everyday lives,” said Julia Marcus, an infectious disease epidemiologist at Harvard. “I think without guidance, people may make decisions that are not informed.”
Official: Nothing ‘nefarious’ about delayed guidelines
The Biden administration has been saying it’s been working on these guidelines for weeks. They were widely expected to come out Thursday, but they’re still in the works, according to an official involved in the drafting process.
During the Trump administration, White House officials sometimes had a heavy hand with CDC guidelines, dictating what the agency could and could not say, according to CDC officials.
But that is not what is currently happening with these new guidelines, according to the Biden administration official.
“I don’t think anything nefarious is going on,” said the official.
The official said a draft of the new guidelines likely has been sent to the White House and the Department of Health and Human Services so staff there could be aware ahead of time of what they said.
“I don’t envy the writers of those guidelines,” Schaffner said. “You can paint some pictures with a fairly broad brush, but people want to apply general guidelines to specific life, and that gets very, very nitty gritty. There’s no way to capture everything.”
Vaccines offer really good protection for the vaccinated, research shows, and there’s good evidence they help prevent the spread of Covid-19, but the vaccines are not total “armor,” Schaffner said. People still need to make informed decisions about risk.
The CDC needs to strike a tricky balance with these guidelines, the experts said.
Guidelines need to encourage people to get vaccinated, help the vaccinated understand that they still need to be careful, and manage the expectations of the unvaccinated.
“We don’t want people who are not fully vaccinated to think that that everything has been lifted and already we can put things behind us, and the pandemic is over, because it’s not,” the official said.
There were more than 64,000 newly diagnosed cases of Covid-19 in the US just on Thursday.
It’s not like going back to 2019
While the guidelines will not give the vaccinated permission to start living like it’s 2019 again, according to a Biden administration official, the guidelines do offer some hope that the end of total social isolation is near.
For instance, you will finally be able to show your vaccinated friends all your home DIY projects from the past year.
The CDC confirmed that a Politico article accurately characterized the guidelines as recommending that the vaccinated can have social interactions at small home gatherings with other fully vaccinated people.
“I think that’s certainly a very reasonable first step,” said Dr. Aaron Richterman, an infectious disease physician at the University of Pennsylvania.
Don’t however, throw away that cloth mask yet. The guidelines will advise the vaccinated to continue to wear masks in public and keep a good physical distance from others.
“While we’re still vaccinating everyone, our primary societal goal remains to protect the unvaccinated,” Richterman said.
Masks help do just that. And there’s no guarantee that vaccinated people may not still carry virus in their noses or throats — virus that may not make the carrier sick, but that could be spewed out and infect someone yet unvaccinated.
“Masks continue to work, and we need them against the variants,” Schaffner said. Public health experts worry that the spread of the more contagious variants could prolong the pandemic.
The guidelines should also help the vaccinated navigate interactions with loved ones at their nursing homes who have been kept behind locked doors for more than a year. They should also include travel advice.
Unfortunately, vaccination is not a “free pass to travel,” Dr. Anthony Fauci said at a CNN Global Town Hall in early February. The director of the National Institute of Allergy and Infectious Diseases said “essential” travel is a yes, “but we don’t want people to think because they got vaccinated, then other public health recommendations just don’t apply.”
The guidelines won’t be totally prescriptive and tell you exactly what you can and cannot do once you are fully vaccinated.
The guidelines won’t tell you if you can or can’t bowl with Auntie Mary, for example, nor will it tell you if you can or can’t meet grandpa at the coffee shop for a game of Settlers of Catan with the new “sheep strategy” you learned while stuck at home.
“It’s impossible to get to that level of detail. We can’t predict every situation that human beings will be in,” the Biden official explained. “What we can do is give principles for people to think through. It will give people the means to think through it and then they can choose what level of risk they wish to take.”