Reading: You’ve Got Your Vaccine. Now What?

More than 50 million Americans have received at least one dose of the COVID-19 vaccine, according to the Centers for Disease Control (CDC), with healthcare workers administering more than 1.8 million shots per day. And while this is definitely reason to be optimistic, health officials warn that vaccination is “not a free pass” to disregard public health measures and throw caution to the wind. In fact, the only change in guidelines the CDC has offered for vaccinated people is that beginning 14 days after vaccination — and for up to three months — they no longer need to quarantine after being exposed to someone with COVID-19. So, what can we safely do once vaccinated? And what precautions are still necessary? Will the current vaccines even protect us against emerging — and more contagious — strains of the virus? 

CoveyClub turned to Leana Wen, MD, an emergency physician and public health professor at George Washington University who previously served as Baltimore’s Health Commissioner, for some answers. 

CoveyClub: As you noted in your recent Washington Post Op-ed, “We finally have vaccines that provide extraordinary protection,” but “people need clear, practical guidance for how to navigate their lives” once they’ve been vaccinated. So, what can we do once fully vaccinated that we couldn’t do before? 

Dr. Wen: This is the number one question I get from vaccinated patients — what can I do now — and telling people you have to do exactly what you did before is not a satisfactory answer. People are not going to do that, so we need to provide practical guidance. The first thing that people should be able to do: essential activities they’ve been putting off for fear of exposure to themselves. Yes, there is a possibility that a vaccinated person can be a carrier to affect others, though there is growing evidence that they may be less infectious when vaccinated as well. But now that they are well protected themselves due to the vaccine, people who have been putting off their colonoscopy, mammogram, or dental cleaning for fear of exposure should be getting those kinds of things taken care of.

The second category: If they are in a household where everyone in their household is vaccinated and want to get together with another household in which everyone is vaccinated, they can even gather indoors to have dinner. It becomes more complicated when there are so-called mixed households. One would have to worry about whether they could contract coronavirus and bring it back to their house. I’m not recommending indoor gatherings for mixed households. 

The other question I often get: Can grandparents that are newly vaccinated now visit their extended family? If the main reason why grandparents have not been able to see their extended family is out of concern for the grandparents’ health, it is probably fine for them to visit their families. They can still, in theory, pose a risk to the rest of the family if not everyone is vaccinated, but that risk can be reduced. Grandparents should still be wearing masks, trying to social distance, and washing hands — and should also be reducing their risk of exposure in advance of the visit by limiting their own social interactions in the week or so prior. And grandparents should be fully vaccinated: They should have had both shots, and the visit should occur at least two weeks after the second shot. 

CoveyClub: What about travel? Public health officials have warned that vaccination is not a  free pass to travel. But doesn’t it at least lower the risk? 

Dr. Wen: The risk of travel right now is already pretty low, and so if one follows the necessary mitigation measures, like wearing masks and washing hands, and then is vaccinated on top of that, it is very low risk to catch the virus from traveling. My concern is not about picking up the virus during travel, it’s the risk of asymptomatic carriers going to a new location, where they are spending time indoors with their loved ones who are coming from all over the country, and then all of them going back and transmitting the virus to others. Again, this risk can be reduced if people limit their social interactions in the week prior to travel. 

CoveyClub: We hear different vaccine effectiveness statistics being thrown around — 92 to 95 percent for the Pfizer and Moderna vaccines, 66 to 82 percent for Johnson & Johnson. When experts talk about vaccine effectiveness, are they talking about how effective they are at preventing serious illness or death? Or how effective they are at preventing people from catching — and spreading — the disease? 

Dr. Wen: Both the Pfizer and Moderna vaccines were shown in clinical trials to be very effective at preventing symptomatic illness — about 95 percent — and nearly 100 percent at preventing severe disease. Out of more than 30,000 people who received the vaccines in both trials, only one person got ill enough to be hospitalized. The Johnson & Johnson trial had a similar result — no one was ill enough to be hospitalized. I’m arguing that the end point that we really care about is whether you get ill enough to be hospitalized. Nothing else really matters. Would you be willing to forgo seeing your family for a year because you don’t want to have a fever or sore throat or cold? We’re not going to shut down the economy for that. The endpoint is to prevent severe illness — that’s the endpoint we should be talking about, and all three vaccines are extraordinarily effective at doing that.

Right now, what we don’t know for certain is whether you could still spread coronavirus if you are vaccinated. In theory, you could carry coronavirus in your nasal passage, but it could be at such a low level that you don’t become sick yourself, and you don’t spread it to others. We do know from other viruses that the lower your viral load, the less likely you are to spread it to others, and this suggests that vaccinated people may also have a lower likelihood of spreading COVID-19. Studies with AstraZeneca and Moderna suggest that if you are vaccinated, you have lower chance of testing positive for the virus. Could you still be infected and could you still be infective? Or can you be infected but not be able to infect others, since your viral load is so low? We do not know the answers to these questions, but we have growing evidence that suggest you may be both less likely to be infected and less likely to be infective. 

CoveyClub: The CDC recommends not taking pain medications like Advil, Motrin and Tylenol before getting your COVID vaccine, because it could reduce the body’s immune response to the vaccination. But what if you experience symptoms like achiness after getting your vaccine? Must you still avoid pain relievers? 

Dr. Wen: Data on pain relievers are mixed. There is not enough data to say you should not take ibuprofen or Tylenol after getting vaccinated. If you have severe symptoms like fever and body aches, it’s fine to take it. But pre-medication is not recommended — you shouldn’t take it preemptively. 

CoveyClub: We’ve all heard that the vaccines may be less effective against the new COVID variants. What does this mean? How worried should we be? 

Dr. Wen: What we know is that the vaccines that we have will be effective against the variants, but there may be reduced effectiveness for some of the variants. That does not mean that you should not take the vaccine. It’s quite the opposite. Now that we know there are variants developing, it is even more important for people to be vaccinated. The reason these variants developed is because there is widespread viral replication: When there is widespread viral transmission in the community, the virus mutates and variants develop. If we don’t want more variants — or these variants to spread — the best thing to do is to limit the transmission of the variant, and the way to do that is to get as many people vaccinated as possible. It may be that we may need to develop booster shots that specifically target these variants; in fact, both Pfizer and Moderna are currently testing additional boosters of their current vaccines as well as working on new vaccine formulations specifically designed to cover the variants. But you should still be getting the vaccines that we currently have, to get immunity now — and if boosters become available later, you can take them then. 

CoveyClub: With more and more Americans getting vaccinated, and COVID rates declining, it sounds like we have reason to be optimistic. But what precautions should we still be taking after vaccination? 

Dr. Wen: Definitely still wear masks and social distance when out in public, since we don’t know for certain whether you can still be a carrier and infect others after being vaccinated. None of us wants to be the person who is protected, ourselves, and spreading the disease to others. The second reason we want to continue with these guidelines is because there are many people who are not yet vaccinated. We don’t want to trigger super-spreader events. I do think it’s important for the CDC to provide more specific guidance soon about what measures can be relaxed after vaccination — for example, I am certain many grandparents are eager to see their grandkids again! 

Vaccine eligibility requirements vary from state to state. To find out when you are eligible to get vaccinated — and how to get an appointment — contact your health department or go to this page at the CDC to find out the rollout plans in your state.  NBC’s PlanYourVaccine website also offers an interactive tool to help you determine when it’s your turn to get vaccinated.