Soon after Marc Wilson gets his second dose of coronavirus vaccine, he plans to resume one of his pre-pandemic joys: swimming laps with his friends. But most other activities - including volunteering at a food pantry and homeless shelter - will be off-limits until the outbreak is curbed and scientists know more about the threat of emerging variants.
“I can definitely broaden the things I do, but I still have to be quite cautious,” said Wilson, 70, a retired accountant in Norman, Okla., who has diabetes and other health problems. “When your doctor tells you, ‘If you get covid, you’re dead,’ that gets your attention real good.”
The arrival of coronavirus vaccines is beginning to have an impact on everyday life, with millions of newly inoculated Americans eagerly anticipating a return to long-postponed activities and visits with sorely missed relatives and friends. But with Anthony S. Fauci, the nation’s top infectious-disease expert, warning that vaccinations are not a “pass,” the recently inoculated are engaged in a new round of complicated risk-benefit assessments. What can I safely do? Where can I go? And how do I interact with peoplewho are not vaccinated?
The answers aren’t simple. In the meantime, the asymmetric nature of the rollout - with many older Americans and health-care workers receiving shots first, while tens of millions of others await their turns - is shifting relationships in families and in society more broadly. Grandparents who once hunkered down at home, most vulnerable to a virus that preys on the elderly, now are likely to be better protected than younger relatives who are waiting to be vaccinated.
Experts agree broadly on many issues people have questions about. But they differ on details and lack some important information. They still don’t know, for example, whether people who are vaccinated can get asymptomatic infections and pass them on to those who are not inoculated - which is why they urge people to continue to wear masks and practice social distancing even after receiving their shots.Scientists also are racing to determine how much protection vaccines offer against the highly transmissible variants popping up in the United States.
The Pfizer-BioNTech and Moderna vaccines are about 95 percent effective against the original version of the virus and highly effective against a variant first found in Britain. New data show vaccines by Novavax and Johnson & Johnson also provide robust protection. But, based on early data, the vaccines appear less potent against a variant that was first identified in South Africa and has been found in the United States.
One thing is clear: Reports of mutated coronaviruses are fueling anxiety and confusion in a populace already worn out by conflicting advice on a pandemic that has been raging for nearly a year in the United States.
“It’s brutally hard,” said Robert Wachter, chief of the medicine department at the University of California at San Francisco. “For the past year, we have had our game plan for living and now we have these curveballs - the increased prevalence of the virus, the variants and the vaccines. We have all had to learn to be armchair epidemiologists and now we have these new realities.”
Wachter, 64, who recently got his second shot, said he feels comfortable doing a few things he did not do before being vaccinated, such as going to the dentist and having his hair cut professionally, rather than by his wife, who has not been vaccinated. But he is careful to avoid doing anything that could increase her risk.
He does not plan to dine indoors with people outside his household, even if they are vaccinated, until the coronavirus is much less prevalent and not able to circulate freely. Earlier in the pandemic, experts thought such herd immunity could be achieved after 70 to 75 percent of people were vaccinated or had developed natural immunity from previous coronavirus infections. But the level of coverage may need to be even higher - 80 to 85 percent - if a more transmissible strain becomes dominant, a top official at the Centers for Disease Control and Prevention said Friday. That could delay herd immunity until the fall or later, scientists say.
Wachter and several older Americans who were recently vaccinated told The Washington Post that they consider themselves fortunate to have gotten the shots and realize navigating the uncertainties of a post-vaccine life is a good problem to have. Many are being conservative - birthday parties in crowded bars are not on their agendas - and using their new status to help others who remain unprotected, including adult children who previously had been anxious about their parents’ vulnerability.
For months, Jan Solomon, 69, has been doing the grocery shopping so her 72-year-old husband does not have to go to the store. Now she and her husband, both of whom are getting vaccinated, are focusing on their 35-year-old son, who is temporarily living at their home in Washington and unlikely to be inoculated for months.
“We will definitely still wear masks, not go into restaurants and keep our distance” from others, she said. “We need to protect our son and don’t want to be carriers.”
Many public health experts say that while vaccinated people can enjoy a bit more freedom - flying while masked, for example, is far less of a risk after inoculation - behavior should not change much. Besides the concern that inoculated people might serve as carriers of the virus, they note a small number might still get covid-19 while the virus is circulating so widely, although the chances of hospitalization or death are low.
Melanie Swift, co-director of the Mayo Clinic’s vaccination-distribution program, said she would not fly for pleasure, only for work. And, given the high level of virus in much of the United States, geriatrician June McKoy of Northwestern Medicine said even people who are vaccinated need to be careful when visiting inoculated elderly relatives, and should wear masks and sanitize their hands.
“The vaccine is not a get-out-of-jail-free card,” she said.
Robert Califf, 69, a cardiologist and Food and Drug Administration commissioner during the Obama administration, agreed that people need to take precautions after being vaccinated. But he cautioned doctors against being overly rigid in their prescriptions for post-vaccine life. “People won’t believe you,” he said.
A few weeks after he and his wife get two doses of vaccine, they plan to fly from North Carolina to Colorado to see both sets of grandchildren and will use “testing, masking and modified social distancing” during the trip to keep risks low.
Some doctors say public health experts should emphasize the upside of vaccines and not dwell on what people can’t do after being inoculated. “Doom-and-gloom messaging” is not an effective way to encourage people to get the shots, said Monica Gandhi, an infectious-disease specialist at UCSF. “You have to message hope and optimism.”
She said she doesn’t see a problem with two couples who are vaccinated having dinner indoors together - something Swift and some other doctors advised against until the pandemic is curtailed.
Gandhi said her parents, who are in their 80s, plan to fly to California to visit her after they are vaccinated and then go on to Boston to see her sister and brother. “It’s the only thing they can talk about,” she said, adding, “We need to recognize plain old loneliness. To think it isn’t real belies the very process of evolution that led primates to gather together in groups. It is actually what makes us human.”
She also doubts that people who have received both doses of the vaccines will be able to transmit much of the virus, and points to data from Moderna that showed a sharp drop in transmission after the first dose. Many other scientists say she may be right but that more data is needed.
As the debates among experts continue, many older people who are being vaccinated welcome the possibility of returning to favorite pastimes, hugging a loved one and taking better care of themselves.
Barry MacKichan, a 76-year-old software developer in Hillsborough, N.C., is eager to resume photographing wildlife from somewhere other than his backyard. He also hopes his daughter and three grandchildren, who live in New Zealand, will be able to visit him this summer, an annual tradition disrupted by the pandemic. That may not be until July, after the children are vaccinated.
In the meantime, MacKichan and his wife plan to continue to wear masks “in moral support for everyone else who has to.”
Angela Rasmussen, a virologist at Georgetown University’s Center for Global Health Science and Security, welcomes that attitude. She is worried that unless people who are vaccinated continue to wear masks, the United States could become a two-tiered society in which people who are inoculated say, “I can do what I want.” She added: “It causes a social hierarchy based on immune status, and that is bad news.”
Erin Fusco, 45,a nurse and assistant professor at Quinnipiac University in Connecticut, will soon receive her second dose of vaccine. Fucso has gone back to the gym she missed badly and uses the treadmill and weights. And she has scheduled a mammogram and a colonoscopy that she postponed last year.
But as for other pre-pandemic behaviors, she said: “I’m waiting for someone to tell us that it’s safe.” She said she wants politicians including New York Gov. Andrew Cuomo, D, Connecticut Gov. Ned Lamont, D, or President Joe Biden to authorize a return to normalcy.
Katie Clapp, 56, is more expansive about her post-inoculation plans. After she gets her second dose, she plans to restart horseback riding lessons for children at the stable she runs in Stillwater, Minn., to go out to dinner with friends and to visit a new grandchild in Malibu, Calif.
“I’m so excited,” said Clapp, who got vaccinated at a Minneapolis clinic that had extra doses.
But she has become a bit more cautious as virus variants emerge. “If variants make the vaccines less than 95 percent effective, what does that mean?” she said. “Ninety-five percent to what percent?”
The answer to that question and others, experts hope, will come in the next several months, as vaccine makers and the government scrutinize the effect of the variants on the vaccines.
Fauci, director of the National Institute of Allergy and Infectious Diseases, told NPR recently that the government and industry are trying to stay “a step or two ahead” of the variants and that the manufacturers are coming up with new versions of their vaccines “just in case” they are needed.
In the meantime, he said, he continues to wear a mask and take other precautions even though he has been vaccinated.