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Doctors Weigh In On How To Navigate A Partially Vaccinated Society


The ultimate goal of COVID-19 vaccines is herd immunity - when most of the population has developed resistance to the coronavirus. What most means is up for debate. Well, whatever the case, as of now, about a quarter of the U.S. population is fully vaccinated. So until many more people get their shots, Americans remain in this sort of hybrid society of the vaccinated and the unvaccinated.

As for how we navigate our own lives throughout this universe, I'm joined by Dr. Monica Gandhi, an infectious disease specialist at the University of California, San Francisco, and Dr. Leana Wen, an emergency physician and public health professor at George Washington University. Welcome to both of you.

LEANA WEN: Great to join you.

MONICA GANDHI: Hello. Thank you.

CHANG: So let's just start with the first question a lot of people are wondering about now, and that is, what can you finally do now that you are vaccinated - or more importantly, what should you still not be doing?

GANDHI: You know, I'll start because I have a very optimistic view of these vaccines, because the real-world data coming out on the effectiveness of these vaccines is so profoundly good. The April 1 Pfizer press release that showed us in 44,000 people, 100% effectiveness against severe disease. That - you don't get these words 100% very often. And in addition, the accumulating real-world data on how vaccines reduce transmission, meaning hard for us to pass it on. I kind of think of it as a vaccinated person is I can do whatever I want as a vaccinated person, but be respectful of our society where some of us are not vaccinated and some of us are. And that - for me, that respect means masking and distancing around others who are unvaccinated out in public spaces.

CHANG: OK. What do you think, Dr. Wen?

WEN: Well, I agree with Dr. Gandhi. I would add a few more things. One is that, at this point in the pandemic, we really cannot answer the question of what is safe. This is the No. 1 question that I get from patients, and so it's a bit difficult to go away from this. But I think that we need to switch the mentality from something that is 100% safe or 100% risk. That's not the reality. Actually, what we should be doing is to think about, how can we reduce our risk for us and for those around us?

And so one concept that I've been talking about is that of a coronavirus budget, just as we have a financial budget, where you realize that you can't do everything, but you also want to prioritize the things that you have to do. For example, you may have to go to work or sending your kids to school is absolutely essential. You want to do what you value the most, recognizing that you can't do it all. And then for those things, try to reduce your risk in those activities. Being vaccinated is a key method for reducing your risk.

CHANG: I think a lot of us who are still unvaccinated are trying to figure out how to hang out with people in this partially vaccinated universe. I'm trying to get vaccinated. I just got my appointment. But it'll be several days before I actually get vaccinated with both doses. So how should I assess my risks when people who are vaccinated or partially vaccinated are inviting me into their homes or other indoor areas and trying to reassure me it's fine because they got the shot? How do I evaluate that risk?

GANDHI: I would go to dinner there. And the reason I would say that is there's now nine studies - there was just one out of yesterday from a nursing home setting - health care workers, nursing home, and also a very large study from the CDC that swabbed first responders and shows the risk of you carrying the virus in your nose after vaccination is reduced between 80 and 94%. And that rate will go down even more as our cases come down with vaccination. And then there's some very nice studies that show the immunoglobulin that goes into your nose and protects you, which is called IgA, are developed by these vaccines, are really generated by these vaccines. So it's very difficult to transmit the virus if you've been vaccinated.

CHANG: Well, that's encouraging.

WEN: Ailsa?

CHANG: Yeah, Dr. Wen?

WEN: I might actually disagree, if I might, with Dr. Gandhi in one aspect. If this were you that I'm advising and you're telling me that you're partially vaccinated and you're about to get your second shot, I would actually ask you to hold off until you're fully vaccinated. And that's because we have the end in sight. If you are within a few weeks of being fully vaccinated, I would say that you should hold off until then to have dinner with others who are fully vaccinated indoors, because I would not want to have the consequence of you getting infected in this period of time when we're really only talking about a few weeks.

But on the other hand, if what you are waiting for is knee replacement surgery that you've been waiting for for a long time, or you're trying to hold off on a colonoscopy or something that is a really acute medical need, I would say you should do that. But if it's a question of a choice of having dinner with a friend, I would hold off on that.

CHANG: OK. Well, then in the meantime, what is the responsibility of fully vaccinated or even partially vaccinated people as they move through their worlds? How would you frame it to them?

GANDHI: You know, I frame it as being polite. I really mean that. There is a social contract to be kept right now. And that social contract is - I think it's profoundly unfair for me to run screaming around public, happily singing at the top of my lungs that I'm vaccinated when other people have not had the chance to be vaccinated. And thus I would ask vaccinated people to please keep their masks and distancing on public spaces, on airplanes, in the grocery store until we get to a point where everyone who wants to be vaccinated has that opportunity above 16 in the current era. And at that point, there'll likely be recommendations that mask and distancing can come off.

WEN: I agree with Dr. Gandhi, although I have a slightly different approach to this. Of course, I agree that we should be masking in public. We should be continuing to practice physical distancing and other good public health hygiene methods. But I also think that people need to see what's in it for them with the vaccination. And if we say to them, you can be vaccinated, but nothing changes in your life, you're just more protected - people are not going to want to do it. And actually, it's just not true that nothing changes in your life. You are very well protected from coronavirus. And you should be able to move about your usual life in many ways.

So I actually think that as we're seeing more and more reports of people going about their normal lives - visiting their grandkids, rejoining choirs, going to indoor gym classes, going on vacations - I think we should advertise this. I really disagree with the CDC in this respect. I think the CDC should actually be saying fully vaccinated people should go about their normal lives as much as possible, including resuming travel, including vacations, including going back to restaurants and bars if they feel safe doing so. And it's in seeing what that pre-pandemic life can look like again.

CHANG: Right, the before times. That's the light at the end of the tunnel, people.

GANDHI: I so agree with you. This is where we are, you know, so aligned on this because I call it vaccine optimism to reduce vaccine hesitancy. And I wrote a paper on this very early on, actually, before people could even be in the general population, get vaccinated, because what it does to me is that motivating factor, because what it does is it gives people all this excitement about, hey, I want to get vaccinated now because I get to go back to the life that I enjoyed.

CHANG: That is Dr. Monica Gandhi, an infectious disease specialist, and Dr. Leana Wen, an emergency physician. Thank you so much to both of you.

GANDHI: Thank you.

WEN: Thank you. Transcript provided by NPR, Copyright NPR.

Ailsa Chang is an award-winning journalist who hosts All Things Considered along with Ari Shapiro, Audie Cornish, and Mary Louise Kelly. She landed in public radio after practicing law for a few years.
Brianna Scott is currently a producer at the Consider This podcast.

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