The Covid-19 vaccine was supposed to bring life back to normal. Then came the Delta variant.
Real-world data collection continues, but it’s clear that the vaccines do offer significant protection against becoming infected by Delta. They offer even greater protection against severe illness: Among states that are reporting breakthrough cases of Covid-19, fully vaccinated people made up no more than 5% of overall hospitalizations.
Nonetheless, doctors and public health experts are now urging even the fully vaccinated to resume mask wearing and some social distancing measures. What those measures should look like may vary from person to person, depending on personal circumstances and community rates of vaccination and transmission.
Does that mean no more air travel? No indoor restaurant dining? According to experts, it’s not quite so simple.
What day-to-day precautions should fully vaccinated individuals take, considering the risks posed by the Delta variant?
Dr Yvonne Maldonado: My behavior didn’t change [with the rise of Delta], because I never stopped wearing a mask in public indoor settings. We’re still going out and eating outdoors. I would send kids to school if the school is making sure that the teachers are vaccinated, and everybody’s wearing masks. Masks work.
But I’m not ready to go into a theater anytime soon. You’re sitting in a room, with probably not-great ventilation, for a few hours. I’d want to go [there] to be entertained. I’m worried about [infection]. Why would I do it?
Dr Gregory Poland: [Ideally, no one] would be indoors with [many] other people without wearing a proper mask. You would not be in crowded outdoor environments without wearing a proper mask. You would not be traveling by airplane, unless it was essential that you do so.
My wife and I will get together in small groups, with other physician friends who are fully vaccinated, or with one or two other couples. With 20 couples? No.
Dr Thomas Tsai: It depends on community-level transmission and the level of vaccination in your community. If you have high rates of vaccination, then indoor activities can be safer; if you have a higher rate of Covid-19 cases, then those indoor activities become riskier.
How risky, in terms of contracting the coronavirus, is flying these days?
Maldonado: Airplanes themselves are very safe. Their ventilatory systems are state of the art. It comes down to who’s sitting next to you for five, six, seven hours – or even one hour – because you can be infected in as little as 15 minutes [per CDC guidance].
In my clinical experience, taking care of Covid patients in the outpatient setting, with proper PPE [personal protective equipment], we did not see infections among our staff because we were taking proper precautions.
I am flying to southern California in two weeks, and I don’t think I’m going to change my mind unless something really drastic happens. I’ll be wearing a face mask to protect others and a face shield to keep [any] droplets away from me.
If I had kids at home, I’d probably get tested when I came back home.
Tsai: A lot of my colleagues and friends are taking vacations and have flown and generally haven’t had any issues or exposures. We haven’t flown, and it’s because of our own family’s calculations about risk versus benefit: we have a three-year-old and our four-month-old.
Pre Delta, we–like most Americans–were looking forward to doing more traveling, but Delta changes the equation quite a bit.
What would it take for you to feel comfortable dining indoors or flying?
Poland: I’m perfectly healthy and have received both doses of an mRNA vaccine. But I’m 65. For me, personally, I would have to see very low levels of transmission – under 1% in a community. I probably will not go to businesses that do not require their employees to be vaccinated.
Do you worry you could become severely ill even though you’re vaccinated?
Poland: My greatest concern is more that I would get infected and spread it to somebody else.
What precautions should people with young, unvaccinated children at home be taking to keep them safe?
Tsai: My wife and I both work in healthcare and were vaccinated early. We still are avoiding taking our kids out to indoor areas. We haven’t been to the museum or the aquarium, but we have been bringing them outdoors, like to the zoo.
We’re especially careful with our baby boy. We’re not bringing him to the grocery store, or anything like that. My daughter is three and she’s grown up in the pandemic. So when she comes to the grocery store with us, she totally expects to wear a mask and is OK with it.
The risk of us transmitting Covid to the infant is very, very low, but the precautions – like wearing a mask in public – are pretty minimal.
Poland: There is no safe. There’s only safer.
Each person’s risk tolerance is different. But if I had a newborn at home, I would not have anybody come into my home or handle my baby who was unvaccinated and unmasked. I would not take that baby into indoor crowded situations, I would not fly with a baby, and I wouldn’t take a baby to daycare under current circumstances.
Maldonado: If I had young kids at home, I probably wouldn’t be eating indoors with them or bringing them to indoor venues unless it was a low density situation and everyone was masked.
How well do we understand how much protection is conferred when someone is vaccinated while pregnant or breastfeeding?
Maldonado: Researchers are trying to do those studies, but we don’t have a good idea yet.
As of now, the vaccines are only available to children age 12 and older. How soon do you think younger children will be able to access the vaccines?
Maldonado: I think there should, hopefully, be some decisions by early fall on authorizing vaccines for five- to 11-year-olds. For children under five, it probably won’t happen until late this year or early next year. As you may have seen in the American Academy of Pediatrics’ letter to the Food and Drug Administration, there’s no reason in our mind that all children shouldn’t have access to vaccines.
This summer has seen surges in the Delta variant, but experts warn about a possible emergence of even more transmissible variants in months to come. What can we expect in the US?
Poland: Over the last 18 months, we’ve seen the generation of more transmissible and severe variants. [The Lambda variant] is responsible for almost all the cases in Peru, [but it] has puttered along here in the US and internationally. It doesn’t look like it has a fitness advantage over Delta. But very early, somewhat shaky preliminary data, suggests it may better evade vaccine-induced immunity.
I’m very concerned about it, but we’ve got to watch and wait.
How do we emotionally deal with this setback? Where do we go from here?
Tsai: The important thing is to remember that all the things that worked over the last year-and-a-half still work. In some ways, we’ve forgotten about testing and good, quality masks. We need to go back to that layered approach to safety.
I think there’s this expectation that we’re going to have this declaration of victory that the pandemic is over. But I think instead it will fade into the background of normal human illness. We will get there eventually.
Dr Yvonne Maldonado, professor and chief of the division of infectious diseases, department of pediatrics at Stanford Medicine
Dr Gregory Poland, vaccine expert and internal medicine physician at the Mayo Clinic
Dr Thomas Chin-Chia Tsai, surgeon and health policy researcher at Brigham and Women’s hospital and Harvard TH Chan School of Public Health