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You are vaccinated.
Now what?

Don Mosier, MD, PhD

On March 8th, the CDC issued guidelines for individuals who have been fully vaccinated, meaning that at least 2 weeks have elapsed since their second dose of the Pfizer or Moderna vaccine, or the single dose of the Johnson & Johnson vaccine. These general recommendations acknowledge that we still have more to learn about COVID-19 transmission after vaccination, and the recommendations leave a lot of room for interpretation. Here are the recommendations with my comments in italics:

1. Fully vaccinated people can:

• Visit with other fully vaccinated people indoors without wearing masks or physical distancing – Great news, but safer if a small number of guests who have adhered to all precautions under #2 below and the meeting space is well ventilated. Including children in the gathering is not recommended, but all should be masked if they are present.

• 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 – The current incidence of documented infections in San Diego County (3-5% positive tests in mid-March) and the high incidence of asymptomatic infections in younger individuals makes this seem like a difficult choice. I would not recommend this until more is known about vaccine protection from infection.

• Refrain from quarantine and testing following a known exposure if asymptomatic. – How will we learn if vaccination prevents transmission if you follow this recommendation?

2. 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 – Don’t presume that you know or can find out whether people have medical conditions that increase the risk of severe disease, like cancer therapy or treatment for autoimmune diseases. Just wear your mask.

• Wear masks, maintain physical distance, and practice other prevention measures when visiting with unvaccinated people from multiple households – Good advice.

• Avoid medium- and large-sized in-person gatherings – Agree, but even small sized meetings with unvaccinated individuals carry a risk.

• Get tested if experiencing COVID-19 symptoms – Agree. Remember, some 5% of vaccine recipients will not make a protective response.

• Follow guidance issued by individual employers – Depends on who you work for.

• Follow CDC and health department travel requirements and recommendations – You are likely to need an international vaccine certificate (not your CDC card) for international travel. Vaccine coverage is lagging in Europe, and other countries. Coordinate your travel plans with current risk assessments.

 

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