Are we worried about the CDC’s new guidance for fully vaccinated people?

Yesterday, the CDC released new guidance for fully vaccinated people in response to very encouraging real-world data about COVID-19 vaccines. To reflect this growing body of evidence, the CDC updated their guidance to recommend that: 

“fully vaccinated people can resume activities without wearing a mask or physically distancing, except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance.”

This means that the CDC recommends that fully vaccinated people do not need to mask or physically distance anymore. This essentially removes all precautions if you are fully vaccinated. But remember that the CDC only issues recommendations. Continue to follow all of your state and local guidelines, as well as guidelines at business and workplaces. 

At this time, the immediate effect of this guidance on what we are required to do is still unclear because, at least for now, these other guidelines remain in place. However, the new CDC guidance may increase political pressure on state and local authorities, businesses, and workplaces to further relax their preventative measures. 

The guidelines include additional information regarding travel, testing, and quarantine for fully vaccinated people. You can find these here.

What am I encouraged about?

The vaccine data is encouraging! These vaccines are safe, they are effective, and now our older kids can also be protected. Even though vaccination rates are slowing, we are still vaccinating more people every day. We are so close to controlling this and protecting even the most vulnerable in our communities.

How safe are fully vaccinated individuals?

The data shows that the vaccines are very safe and effective for preventing severe COVID and slowing the transmission of COVID-19, even among the variants of concern. Your Local Epidemiologist regularly updates a vaccine data table. The May 5 update is the most recent.

In other words, fully vaccinated people are very unlikely to get very sick with COVID, very unlikely to die from COVID, and less likely to be infected and transmit SARS-CoV2 (the virus that causes COVID) to others. This is all great news! 

Thankfully, the vaccine news just keeps getting better. If you had asked me a year ago if we would be here today with multiple highly effective vaccines available, I would have sat you down for a conversation about how we had never developed a vaccine faster than 4 years (mumps). But thanks to unprecedented levels of resources and scientific collaboration, existing research on some novel technologies, and the use of EUA protocols, scientists were able to develop these vaccines at an incredible speed (See our FAQ: Is the vaccine being rushed?). 

Don’t forget that you are not considered fully vaccinated until two weeks after your second dose of Pfizer-BioNTech or Moderna or your single dose of Janssen/Johnson & Johnson. 

So, that’s the good news. Great news, even! But there are some reasons for caution. This new guidance for fully vaccinated people scientifically reflects this growing body of evidence, but ignores some very important things about human behavior.

What am I worried about with the new guidelines for fully vaccinated people?

This data on vaccines means I am not worried about risks to fully vaccinated individuals, but we need to remember that the number of fully vaccinated individuals is still a minority of Americans. While the risk to fully vaccinated individuals is low, we live in neighborhoods and communities where not enough people are vaccinated yet.

I fear that this will effectively end masking and distancing, even where it is still needed, and increase political pressure for state and local authorities to further relax their preventative measures before communities are ready. What do I mean by “ready”? High vaccination rates and low transmission rates. Currently, even the states/territories with the highest vaccine coverage are only at 50 percent fully vaccinated; the national average is 35 percent. This is especially concerning given that the most vulnerable counties have the lowest vaccination rates

Consistent with the age-old American tradition of prizing individualism, this new guidance seems very focused on individuals and ignores the community aspect of infectious disease. 

I agree that we need to have things to look forward to. However, the timing of these changes, especially those about indoor masking and distancing in public places, makes me concerned. 

How will we know who is vaccinated?

The core of my concerns about this new guidance for fully vaccinated people stems from the huge implementation and enforcement problem. Since we cannot identify who is vaccinated and who is not, this guidance seems unenforceable.

I know the vaccination status of my family and my close friends. I will confidently gather with them outside, and a bit more reluctantly inside as I learn to renavigate the world.

However, in public, I do not know the vaccine status of the strangers around me. How do I know if the person next to me is vaccinated or an anti-masker? At a gym that uses the honor system, how do I know if my sweaty, heavy-breathing treadmill neighbor is vaccinated or hates running in a mask so much that they lie about their vaccination status? 

Without a system for verifying vaccine status, enforcement of this new guidance requires the honor system, but I am concerned that people will not be honest about their vaccination status. The behavior I have seen from people over the course of this pandemic does not inspire confidence that those who are most resistant to COVID precautions will suddenly act in the best interest of their community. The absence of a verification system puts the responsibility on individuals and businesses to enforce. We have seen how that turned out for store employees attempting to enforce mask mandates. Remember the verbal abuse and, in some cases, violence?

Why is this new guidance for fully vaccinated people not tied to vaccine and transmission benchmarks?

Because aspects of the new guidance are unenforceable, I would prefer that the relaxing of this guidance was tied to vaccination and transmission rates rather than providing a blanket recommendation, like Michigan’s Vacc to Normal Challenge. Vaccination and transmission rates vary greatly across the country; few, if any, places in the US have reached adequate vaccination coverage and low transmission rates. Under this model, as communities around the country hit these benchmarks, they could relax their precautions. Some communities are very close, but we are not there yet at a national level. 

Such a benchmarking system could have been used to encourage vaccination: “It’s up to you! Help us reach these benchmarks so we can throw our masks in a bonfire and safely have your daughter’s Bat Mitzvah!” (Well, maybe the CDC wouldn’t word it that way, but I’m ready for a ceremonial mask burning and a big, sweaty horah at my daughter’s Bat Mitzvah in the fall.)

Will this new guidance for fully vaccinated people incentivize vaccination?

Some have speculated that this decision was made to incentivize those who have not yet gotten a vaccine to get a vaccine. Some have also expressed skepticism that this new guidance is enough to motivate people. I land somewhere in the middle. If the guidance were only about masks, I might lean more towards skepticism, but since this also removes distancing restrictions, particularly indoors, it really opens up what fully vaccinated people can do that is “normal.” 

In my experience talking to people who are hesitant or have questions about this vaccine, I don’t hear a lot of complaints about having to still mask up. However, I do hear “why should I get vaccinated if I still can’t hang out with my friends.”

My experience is certainly not a comprehensive survey of the reasons why people are not getting the COVID vaccine. There is likely some group of people who might be swayed by the new CDC guidance. I do not want to dismiss a strategy because it only solves part of the problem. However, I am unsure how big this specific problem is. The question becomes whether this group is big enough to counteract the risk to the unvaccinated posed by relaxing guidelines prematurely. Ultimately, this is a big gamble to take.

What about those who can’t yet (or ever) be vaccinated?

One of the reasons to enforce mask guidelines until things are better controlled is to prevent a stratified society and to protect those who cannot be vaccinated yet (kids) or ever (medical contraindications). Since I am highly skeptical that the honor system will work, I fear this will further endanger people who are unable to get the vaccine (and, yes, even those who choose not to vaccinate). 

The overlap between those most resistant to COVID precautions and those who are not yet vaccinated by choice is significant. This means that mask mandates also protect those not vaccinated by choice. But if this group stops masking and distancing, we now risk allowing COVID to spread largely unfettered through this population. This leaves a pool of virus spreading through the community, endangering those who cannot be vaccinated (yet or ever).

This new guidance for fully vaccinated people has the potential to remove the very measures that protect our most vulnerable neighbors in public spaces.  

What about equity and vulnerable populations?

Because vaccine distribution has not been equitable and the impact of COVID has disproportionately affected vulnerable communities, this guidance puts an even higher burden of risk on our most vulnerable populations and communities. This new guidance will only exacerbate the already stark inequities related to COVID and vaccine access.  

What about variants of concern?

As we have written many times, we are in a race against variants. The faster we can get and keep transmission low, the less we have to worry about new variants arising and spreading. I worry that this new guidance for fully vaccinated people will endanger our progress on this front. 

I am concerned that unvaccinated people will not be honest about their vaccination status and forgo precautions anyway.

I worry that this will increase political pressure for state and local authorities to further relax their preventative measures before communities are ready. 

I fear that this will lead businesses and workplaces to relax their COVID protocols. 

Each of these scenarios risks allowing COVID to spread unfettered among the unvaccinated, greatly endangering the health of those who can’t be vaccinated and those who choose not to be vaccinated alike. Even without the new variants, this means more preventable illness and death. But every new variant could be even more transmissible, more deadly, or evade vaccine protection. 

Will this new guidance for fully vaccinated people change my behavior?

My husband and I are fully vaccinated as of last week, my daughter got her first dose today, and my son is too young to be vaccinated.

This guidance will change very little about our current behavior. Work is still mostly remote for both of us. My kids are in virtual school for the duration of the year. We have started dining outside, but not with the kids. We are starting to socialize with other vaccinated grownups — outside or inside. 

However, our public indoor behavior will remain largely unchanged, especially when our unvaccinated kids are around. We will not have indoor playdates between our kids and other kids until our kids are vaccinated or our local cases drop significantly. If we need to be indoors with people whose vaccine status we don’t know, my kids will definitely wear masks and we will wear masks to support our kids (and I might wear one anyway because I’ve very much enjoyed not getting other illnesses). I will also err on the side of still wearing a mask until the transmission is lower and vaccination rates are higher. This action supports my community members who still need to wear a mask because they are in a high risk group or not yet vaccinated. 

We are looking to the future. We have planned a normal trip and will be staying in a hotel this summer while the kids are at sleepaway camp. Later in the summer, we will be taking a big road trip to visit family, whose vaccination status and precautionary measures we know. We are planning our daughter’s Bat Mitzvah for the fall because we are hopeful, if not optimistic, that by fall, and possibly this summer, this will be under control in much of the US. 

But with this new guidance, we are relying on people’s honesty about their vaccine status to ensure that it remains safe for us to do these things. I hope that people prove me wrong.

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