Now that COVID-19 vaccines are being rolled out natinwide, we’re starting to wonder what this means for our families and routines. How will the vaccines change visits with grandparents, who have been prioritized for immunization? And is spring break/summer travel now on the radar? We asked Stephanie Leeds, MD, Yale Medicine pediatric asthma and immunology specialist in Norwalk, Connecticut, some of our most pressing questions.
We read that we should still wear masks when visiting with grandparents—is this true even if they have been vaccinated?
We know that risk for poor outcomes with infection are much higher in the elderly population, so it makes good sense that grandparents are getting vaccinated first. The questions about protocols once a grandparent is vaccinated is an excellent one, and there are still some questions that remain to be answered. The concerns in this scenario are two-fold: 1) Are vaccinated grandparents still at risk for developing disease? 2) Are vaccinated grandparents still able to transmit the virus?
As to the first question, the studies show that the vaccines are incredibly effective against serious disease. In trials with tens of thousands of people, the vaccines showed approximately 95% efficacy at preventing symptoms of illness, including severe symptoms. However, these trials did not evaluate potential for asymptomatic infection, hence the inability to say that they “100%” effective.
The vast majority of people who have had their two dose vaccine series should be adequately protected from clinical disease, with peak immunity developing about 2 weeks after their second dose. There may be individualized circumstances (for example history of significant immunodeficiency) where the immune response to vaccination might not be as robust as expected, but this would be the rare exception rather than the rule.
As to the second question, we still don’t have studies that tell us whether currently available vaccines protect against asymptomatic infection. There is a theoretical risk that people can still transmit the virus after vaccination, and data on this should be forthcoming. However, I remain optimistic that vaccines decrease both infection and transmission. Even if we were to assume that there is still a potential for asymptomatic infection after vaccination, population-based studies suggest that people without symptoms are less likely to transmit the virus to others.
Given that we don’t have definitive data looking at the potential for transmission after vaccination, we are still telling vaccinated people to continue social distancing, masking, and handwashing practices. In a scenario where younger family members are not vaccinated but older family members are, the masking for both parties is mostly to protect the younger family members. Once a large degree of the population is vaccinated, we should be able to resume to social interactions without masks.
That makes sense. What about travel—once you’re vaccinated should you feel comfortable making plans?
After vaccination with a two dose series, it would be reasonable to consider some forms of travel, especially using individual modes of transportation (for example, a road trip). We still do not fully understand the likelihood of asymptomatic spread from vaccinated individuals, so we are not recommending recreational travel on crowded modes of transportation (for example, planes) until a significant amount of the population has been vaccinated.
As with many aspects of living in a COVID world, there is no absolute mitigation of all risk with current interventions. However, the vaccine is very effective on an individual level and will lead to decreases in disease prevalence on a community level over time.
For more information on the COVID vaccine, consider visiting: https://www.nejm.org/covid-vaccine/faq
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