Today, Explained - You’re vaccinated. Now what?

Episode Date: March 9, 2021

New guidelines from the CDC for fully vaccinated people suggest it’s finally time to hug your grandparents. Dr. Kavita Patel explains the do’s and don’ts as we inch back towards “normal” life. Transcript at vox.com/todayexplained. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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Gambling problem? Call 1-866-531-2600 or visit connectsontario.ca. New guidelines released by the CDC on Monday suggest that that thing we colloquially call normal life may be within reach, at least in the United States. But before we get there, hold the phone. The CDC? We're trusting the CDC again? I hope so. I think it's a great question. We asked Dr. Kavita Patel this morning. She's a primary care physician and also worked in public health under President Barack Obama.

The CDC has had a poor track record, especially in COVID, but they're trying to put out guidance, but also put the evidence supporting that guidance into it. And I will be honest, I'm seeing the CDC director speaking much more candidly about not just that set of guidances, but also any questions that are coming up and tackling them very honestly. We've been through a lot this past year, and with more and more people getting vaccinated each day, we are starting to turn a corner. This is a new CDC leader, yeah? It is. Dr. Rochelle Walensky, she is a bit of a celebrity in the infectious disease

and public health community. This is why today CDC is releasing its initial guidance for the public that, for the first time, lays out some of the activities considered safe for those who are fully vaccinated. Borg was primarily in HIV, but she is an incredible infectious disease public health leader, and I think she's doing a really great job at a pretty pressured time. Sure. Well, what are these new guidelines? Let's talk about them. Yeah, I think the guidelines are probably easiest to break down in kind of three quick hits. Number one, if you're fully vaccinated, you can get together with other fully vaccinated people

in a small setting, but no masks, no distance, none of the things that we've unfortunately gotten used to. If you're fully vaccinated, you can also get together with unvaccinated people as long as they're not at risk of getting severely ill from COVID. And that's where there's a big asterisk. Like, what does that mean? The third is that if you are fully vaccinated and you're exposed to somebody who tells you I have COVID or I might have COVID. Instead, you do not need to quarantine for 14 days like we would previously recommend. And that's a big deal as well.

And you mentioned there being more Canada over there at the CDC now. What's the science behind these updated guidelines? Yeah, so the science in the footnotes and those of us that are big science dorks will read the footnotes. The footnotes contain studies that really do point to an interesting kind of risk in that we have more and more evidence that if you are fully vaccinated, your risk of transmitting the virus to someone who is not vaccinated is incredibly low.

We're still waiting for what the major manufacturers are working on, which is kind of that, quote, definitive evidence. But we already have now emerging studies, by my count, seven, and many of those are cited in the CDC guidance, that tell you if you're vaccinated, you're at very low risk of giving this virus to someone else. And that does mean we'll have a future soon without masks and without distance.

That's a game changer now. Yeah, it is. I think that's, you know, it's funny, like in healthcare policy, sometimes we always say like, you know, our communications are so poor, we bury the lead. I personally think that was my big takeaway.

The guidance is a big deal and I know everybody's talking about it. The CDC is essentially by putting out this guidance saying, hey, we know it's pretty low risk that if you get vaccinated, you will not give COVID to someone else. And that should make all of us really anxious and excited to get vaccinated whenever we're eligible and as soon as possible. It feels like we're still trying to convince people in this country to wear a mask. And all

of a sudden now the CDC is saying, if you get the vaccine, you don't need the mask. Yeah, that's a great question. This is actually where the CDC guidance has been pretty conservative because it basically states very clearly if you're in a public space, no matter what that public space is, gyms, restaurants, bars, airplanes, travel, you have to wear a mask. And I'll tell you even further some criticism, which I share, but on reflection, I understand. They did not say anything about travel. They're still basically recommending that people do not travel. I was a

little upset about it initially, and after processing it, I can see why they said that. Why were you upset? So I was upset because, you know, by saying, Sean, that you're fully vaccinated and you're not going to transmit this, why shouldn't people get on a plane and travel? Why would they feel like they can't travel? And when I thought about it, you always have to remember that the CDC is acting on behalf of the whole population, not the individual. And we still have cases right now, we still have positivity rates in parts of this country that are near or over 10%. We still have incredible kind of concerns about these variants that are spreading. And so when people travel, even if we don't intend

to, we can change the patterns of these variants of these viruses. And so for that reason, I think today they were silent on it. I suspect, Sean, as more and more Americans are vaccinated, that travel guidance will get updated. Well, I got great news for you, Kavita. Travel bookings are surging irrespective of CDC guidelines. Senator Ted Cruz is taking heat for his trip to Mexico this week, but he's not alone. Thousands of Americans are also flocking to Cancun and other resort cities. Royal Caribbean, yeah, look at this stock. It's jumping more than 4% right now, edging very close to a one-year high

after announcing a 30% increase in new cruise bookings since the beginning of the year compared with just last November to December. Let's talk about how safe it's going to be for people to travel once they're vaccinated. It seems like you're suggesting it'll be pretty safe. Yes. People are going to develop immunity sooner rather than later. So I personally do think that if you're a grandparent or you're a grandchild or me, I haven't seen my parents in over a year and a half, you know, then I would feel comfortable taking precautions and you're going to have to wear a mask. You're going to have to try to kind of consciously stay socially distanced. So if

you're traveling today, that's what it'll look like. If you're booking for 2022, I think it'll be pretty normal and what it felt like in 2019. So when traveling right now after you get a shot, let's say if you're in the United States or elsewhere, you should still have some precautions about mask wearing. But does that prevent people from hugging their parents? I think the CDC actually said something about that, right? No, hugs all around, yes, yes, yes. If you have, especially the high risk, which I'm just going to make assumptions, parents, grandparents, because of their age, they're high risk by definition. As long as they're vaccinated and you are either vaccinated yourself or not vaccinated, but at low risk, yes, you should

feel comfortable hugging and touching and being kind of incredibly close. I think the blind spots for some people are that pregnant women are still high risk if they're not vaccinated. And here's just something interesting to consider. So are smokers. And we have a lot of Americans who are smokers. They are considered at high risk of getting severe COVID. If you are a smoker and you are not vaccinated, even if you're 25 and totally healthy, we would recommend that you don't actually touch others and you would need to wear a mask and be distanced. What about some of the other stuff that people really miss, like attending a concert or a sporting event? I know sporting events are now sort of ramping up, reintroducing fans into the atmosphere right now. Is that safe? Is that dangerous? Yeah. So I do think that sporting venues that are kind of doing like 25% capacity,

there's still a risk, but I do think that that's way more, you know, responsible or it's lower risk. I would say that we're not going to be kind of seeing major tours of concerts advertised right now, but I would predict by fall that would be safe to do. And I think, Sean, everybody wants to know when can they attend a concert and not wear a mask. And that's where I do think we're going to have to wait till we get to herd immunity to be candid. Yeah. By when? So the numbers around herd immunity, you know, you've heard everybody, including people, people, I myself and people I work with say somewhere between 70 and 85%. Remember, herd immunity is not going to be like a light switch. If you're in a part of the country where you're getting people vaccinated more efficiently than other parts, let's say West Virginia, Connecticut, some other states,

you're going to probably get to herd immunity sooner. And so that might be, for example, in the summer when you'll have the ability to safely gather. I think that's where I'm hoping the CDC gets more aggressive about updating their guidance. And how big an issue is the fact that, you know, for a lot of people, herd immunity is the goal. And for a lot of people, they never really stopped doing what they were doing anyway. And we're seeing states start to like roll back any sort of mass guidance in advance of the CDC. I mean, it feels like they're just two, if not more, different cultures operating in the United States, at least, where some people are trying to be cautious and follow guidelines, and a whole lot of people are just doing whatever they

want. It does all of society no good to fight to get to herd immunity if you have 14 states that say, you know, you don't need to wear masks, and let's all accept, quote, personal responsibility. And if you're not wearing a mask, you are a prime target. So if you're really thinking about personal responsibility, wearing a mask is the most responsible thing you can do, not just for yourself, but think about the people who don't have like a sign on their forehead that says I'm immunocompromised

or I have a child that's battling leukemia. We just don't know what people in society are experiencing. And so if you're trying to exhibit personal responsibility, think about your neighbor and think about people that you don't know their status of vaccination. Sean, we still have as good as this news is out of the CDC. Let me just be blunt. We still have 2000 people dying a day. And they're not all just older people. There are young people in that category. And that's partly all just older people. There are young people in that category. And that's partly why we're being conservative about things.

My name is Linda Lowe. I am 72 years old and I live in La Jolla, California. I got my vaccine in late January, my first one. And then my second dose was February 24th or 25th. It was Moderna. Obviously, the thing we plan to do when the world feels safe and we can is we want to travel. I will be flying across the country and I will be visiting my daughter, son-in-law,

and our new granddaughter, who I've only seen once since COVID started, because she was born in March. I'm Victor Poloschuk. I'm a retired physician in Rochester, New York. I got vaccinated for the first time with the Pfizer vaccine about four weeks ago and got the second shot two weeks ago. We have been extraordinarily careful. We were not with people. We did not put ourselves at risk. I have two daughters.

They're both here in Rochester. Five grandchildren. But we have not been able to gather since the weather turned last fall. We did gather outdoors, separated, distanced, and so on, but we have not gathered indoors since the winter began. And now we have. We've hugged our grandchildren for the first time in months, and we've been able to visit with them and actually eat with them, share a meal together.

So my name is Terry Binder. I live in Germantown, Maryland. I'm 67. I am very much looking forward to seeing my grandchildren. I have two that live in Philly, and their parents are both doctors, and they feel it's safe. They've had their shots. So we're actually going to get together the end of March. So I'm very excited by that. And the other thing I think I'm probably looking forward to is actually shopping for myself. I found a friend whose son is in his 20s and who is not too concerned about going into the grocery store. So, you know, sometimes you'll get low fat when you wanted full fat or you'll get, you know, no salt when you wanted salt or that sort of thing. So if you're particular about your groceries, then it can get a little frustrating. I think one of the biggest changes for me with the vaccine is that I feel a weight

has been lifted. There's no longer the stress in my mind that, oh, we might get COVID, my husband or I. And so that's really a non-tangible thing that I really feel is a big difference with this vaccine. Support for Today Explained comes from Aura. Aura believes that sharing pictures is a great way to Thank you. and videos directly from your phone to the frame. When you give an AuraFrame as a gift, you can personalize it, you can preload it with a thoughtful message, maybe your favorite photos. Our colleague Andrew tried an AuraFrame for himself. So setup was super simple. In my case, we were celebrating my grandmother's birthday and she's very fortunate. She's got 10 grandkids.

And so we wanted to surprise her with the AuraFrame. And because she's a little bit older, it was just easier for us to source all the images together and have them uploaded to the frame itself. And because we're all connected over text message, it was just so easy to send a link to everybody. You can save on the perfect gift by visiting AuraFrames.com to get $35 off Aura's best-selling Carvermat frames with promo code EXPLAINED at checkout. That's A-U-R-A-Frames.com, promo code EXPLAINED. This deal is exclusive to listeners and available just in time for the holidays. Terms and conditions do apply. So, Kavita, it sounds like a lot of people might hear these new CDC guidelines and think, like, wow, once I get the vaccine, I'm pretty much set.

Can we clarify what protections you get and do not get from any of the vaccines that are now floating around the United States? The biggest myth, I think, is that if you get vaccinated, you can't, quote, get COVID. That's not true. These vaccines are good all across the board, across the globe. But what they're good at is preventing you from dying or getting hospitalized, which is actually what the manufacturers set up as the primary endpoints of the clinical trials. Because candidly, that's the most important thing we're trying to protect against. And you've probably heard, Sean,

people say, hey, I got my flu shot, but I still got the flu. That's because the flu shot does the same thing. It doesn't prevent you from getting the flu virus and the viruses that cause the flu prevent you from getting sick. Or if you do get sick, you get a milder illness. So that probably is the biggest myth to kind of bust that if you get these vaccines, you could still test positive for COVID. It's not as likely, but it's possible, which is why we've had a lot of confusion as people have tested positive after getting the vaccine, but they're not sick. And they're absolutely all across the board, not to die from it from the evidence we have so far. And it sounds like production is really ramping up on this new Johnson & Johnson vaccine,

which we actually haven't spoken much about on the show yet. People are calling it a game changer. Why is it a game changer, if it is one at all? So for me, I practice in a community setting. It's a game changer for two reasons. Number one, it's one shot and you can get after two weeks from that one shot, you start to develop immunity. It's incredible to think that shot in the arm, two weeks later, you're quote, fully vaccinated. And then number two, for me in a community setting, I work in a pretty primarily Latinx population. We don't have freezers. We don't have that ultra-cold storage that the Pfizer and Moderna and some of the other vaccines require. The Johnson & Johnson vaccine can be stored like other immunizations we're used

to in a fridge. So I would say it's the speed to vaccination immunity and then two, the flexibility to administer this in a broad number of settings. That being said, it doesn't sound like everyone loves it. One of our producers, Amina Al-Assadi, was saying that in her family, people are making fun of each other because some of them got the real vaccine and some of them got that Johnson & Johnson one. Why do people, is it because it's less efficacious? Here's a couple of tangible reasons why. You alluded to it already.

There's already been incredible media headlines about the efficacy compared to Pfizer and Moderna, which were 94 to 95 percent, quote, efficacy. First of all, I don't think anybody in America actually understands what efficacy really means, and I can explain it briefly. comparing 94 to 95 percent for Moderna from their data last year compared to Johnson & Johnson's 72 percent or 66 percent when the variants are taken into consideration. It's apples and oranges between the manufacturers. The Johnson & Johnson trials were done in countries like South Africa where they had the highest degree of these variants, and they were done at different times when we had our surge around Christmas. You could argue Johnson & Johnson is closer to what the reality might be

if Pfizer and Moderna were actually doing their trials right now with the variants and with kind of the high number of cases. Either way, what I want to tell people is that no matter what that level of efficacy is, that it mounts an antibody and T cell response in your immune system that is way higher than what we would need and what we would see, Sean, with people who are naturally infected by COVID. So to me, it's good. Hand in the air, I would say I would take any of them because I was concerned about dying or getting hospitalized.

I was also relieved to see that all three vaccines that have been authorized by the FDA exceed the FDA's own 50% efficacy threshold. So they perform way better than we ever expected them to perform. Even so, the mayor of Detroit rejected the Johnson and Johnson vaccine. Johnson and Johnson is a very good vaccine. Moderna and Pfizer are the best. And I am going to do everything I can to make sure the residents of the city of Detroit get the best. Is it potentially not meeting standards of American mayors, American governors? There was a perception that this vaccine was for, quote, poor populations, and that it would look like it was the vaccine

given to people of color and that it was inferior. And I do think that's because, again, going back to the theme of the year, lessons I've learned after a year, we do a pretty poor job of communicating in public health and science. We just don't communicate well. So those top line numbers, 66, 72, 94, 95,

if you're any human, why wouldn't you, Sean, say, well, if I get a 94, that's better than 66, isn't it? But they don't understand what efficacy means. It means it's a reduction of risk. It doesn't mean that it's a probability of you getting COVID. That's totally different. So when the Detroit mayor did that, and he's quickly kind of walked it back. Well, today his office explained it was a misunderstanding, writing, as vaccine eligibility expands, Detroit will open a second site offering Johnson & Johnson vaccines. I'm pretty sure what happened is he got a call from the White House that said, wait a minute, do you understand what

you're doing? And do you understand you're actually prohibiting a large number of your population from getting immunized sooner and exposing them potentially to risk of hospitalization and death? And I think that's the right answer. So I do think these people who are rejecting it, whether they're mayors, governors, or individual patients, have made a mistake. anyone out there is if you can get any of these shots, get it. Is there someone out there who is at risk, who is pregnant, who is, I don't know, you know, 87 years old with lots of underlying conditions who should be shooting for one vaccine over another? I want to answer this by looking at the data. So we know that none of these trials really included pregnant women. Now they are doing trials on pregnant women to answer the question you asked. So we don't have enough data to say, yeah, this vaccine would have performed better or not as good in a pregnant woman. So I would still say to pregnant women after talking to your OB, I would accept any of the vaccines because the risk of getting COVID while pregnant

is far worse and unfortunately far worse for you and the baby. So I would get any vaccine. But you raise a really good question. When you look at the data, over the age of 60 and people with other chronic conditions, there was a wide degree of variation around the performance of the vaccine. It was still good. It's still performed by FDA standards, but there was a wide degree of variability. So my only advice to listeners would be that if you are over the age of 60 and you have chronic conditions, have a conversation with your doctor. But because I truly believe that the reason we're all getting vaccinated is to get to that need of herd immunity, I would still recommend, and I have

to patients over 60, to get the vaccine that's offered sooner and not to delay. But if there is a choice, we might be getting to where in several weeks we have choices. That is a different question, and that's why I do think it's worth having the conversation. But do not wait. I can't tell you how many cases of COVID we're still seeing. And my only regret is that if we could have vaccinated them even a week or two earlier, could they have been protected? You talk about where we'll be in a couple of weeks. It makes me think of where the president says we'll be in a couple of months, which is

that every American should have the opportunity to get a vaccine by, I think he's saying the middle of May. Yeah, it's crazy. Which feels just wildly optimistic and sort of incredible considering where we were just, you know, three months ago, two months ago. What are your thoughts? I mean, does that seem likely, especially when there's a lot of vaccine hesitancy in this country too? The president said by middle of May, there'll be enough supply. You can have vaccines sitting in freezers and refrigerators,

but not in arms. And I think that's what is going to happen. And it's for two reasons. We as a country decided from the get-go, not this current administration, of course, but the Trump administration, that there would be no national strategy for getting the vaccines out. So we left it to states. And what did the states do? In many states, they left it to counties and cities. Who is the most under-resourced, underfunded, non-existent public health infrastructure in the world? Counties and cities. So I think the middle of May kind of thinking the skies are going to open and everything's going to be better is way too optimistic. But my bet is that by June, end of June, July, we will start to see in parts of the country, 70% of people vaccinated.

Maybe sooner, but still, it's going to take a couple of months after the supply is available to make sure it's in people's arms. And to your point, dealing with people who either don't trust it, have questions about it, or are purely just hesitant. And then remember kids, right? We don't have a vaccine approved yet, or authorized, I should say. None of them are approved for under 16. So we still have to deal with children not being vaccinated, which they likely won't be, many of them, until next year. And as we look ahead to next year and the year after, I mean, we did an episode a few weeks ago about vaccinations around the world and vaccine inequity, with the U.S. having ramped up so much so quickly and established a ton of vaccine infrastructure. Have you heard plans

for making sure the rest of the world gets covered? Two things. We rejoin the World Health Organization. And then you may have seen, and by the time people listen to this, it might have already happened. But Vice President Kamala Harris is going to address the United Nations. And then you may have seen, and by the time people listen to this, it might have already happened, but Vice President Kamala Harris is going to address the United Nations. And I think that is going to be an incredible signal. And part of the message is that we're back as part of a global kind of compact to help with vaccines globally. It's not just about us. We can't get to truly kind of widespread herd immunity until the globe has access. I'm looking to the South, to Mexico, and I'm terrified at what I see. And I do think that this is going to become something that Americans should be aware of and we should keep as a

priority. It's not just about us, but we will not get out of this pandemic if we don't have most of the world vaccinated. Doctor, thank you. I appreciate your time. Yeah, thank you. Dr. Kavita Patel. She's a health policy researcher based in Washington, D.C. I'm Sean Ramos-Verm. This is Today Explained.