Get ready to live your life while thinking like an epidemiologist.
Until now, the guidance was simple. Stressful, but straightforward: Leave your home, wear a mask. Get offered a vaccine? Take it.
Those principles aren’t gone, but the realities are now more nuanced. The Centers for Disease Control and Prevention now says fully vaccinated people can unmask in most places. (Gov. Andrew M. Cuomo hasn’t agreed – yet.) Everyone 12 and older can get immunized.
The pandemic is far from over, but this is clear: The world is opening up, and you have to navigate it smartly for yourself – and others.
In this installment of “Pandemic Lessons,” we explore how to create your own pods of safety.
What are the basics we need to remember?
Here are three major points:
1. The coronavirus spreads mostly through the air, and much less via surfaces. At the beginning of the pandemic, there was a stringent focus on cleaning surfaces – which is good, because it can spread that way too. But airborne transmission is far more common, which is why cars and indoor spaces can be dangerous, while breezy outdoor air is considerably safer because it disperses virus particles. Dr. John Sellick, an epidemiologist with Kaleida Health, the University at Buffalo and Veterans Affairs, likes to put it this way: “Whose air are you breathing?”
2. Natural immunity helps, but is imperfect. Recovering from Covid-19 makes you “temporarily vaccinated,” says Dr. Cindy Prins, an epidemiologist at the University of Florida. How long your immunity lasts depends on some nuanced scientific factors, including the number of antibodies your immune system is producing and the ability of your T cells and B cells to vanquish the virus after those antibodies have waned. Scientists generally agree that three months is a solid window of immunity, and your protection may start dropping after that. Variants matter here too, because it’s possible that your immune system may not recognize a different version of the virus. This is why masking and other safety protocols still help.
3. Vaccines are vastly protective. Several months into widespread vaccination, it’s clear that they drive down virus numbers and keep people from getting serious infections. The lower the case count in a region, the less likely you are to be exposed to Covid when shopping, socializing, worshipping or working. “Imagine a dance or a concert with 100 people, and Covid shows up,” said Dr. Thomas Russo, chief of infectious diseases at the University at Buffalo’s Jacobs School of Medicine and Biomedical Sciences. “If only one or two people are not protected through vaccination, the virus is going to have a hard time finding those susceptible hosts.”
Consider this scenario: You’re a parent. Your daughter has recently recovered from Covid-19. So has one of her best friends. Can you let them socialize freely, unmasked, and even have sleepovers? And can you allow a third friend, who never had Covid and is unvaccinated, to join in? Or are you tempting danger and being a bad parent?
You’re probably safe – but vaccination will make it more so.
The first two friends, Prins said, “have got some protection. In a way, that protection is going to protect the friend who hasn’t had it yet, because it’s very unlikely (the friends with immunity) would get it and give it to her, and if she got it, it’s pretty unlikely that she would give it to them. So at this point, they’ve got a little bit of a three-person herd immunity going on.”
From an epidemiological perspective, you can extrapolate this to any scenario involving multiple people: coworkers, a book club, golf pals, a band and so on. If two people in a group have immunity and the third does not, there’s a level of protection for everyone involved. If multiple people are “immunologically naive” – that’s epidemiologist-speak for someone who has never had Covid or the vaccine – then they could be a threat to each other, though likely not to the others.
But the best immunity will come from vaccines, not natural infection. Vaccination is more reliable, measurable, and it can be updated with booster shots if needed.
Are vaccines equally effective for everyone?
No, but that’s why getting vaccinated is key to creating your own pod of safety. Russo offers an example of how: “The unvaccinated person enters that social bubble, let’s say they’re dumping virus,” Russo says. “Of all the vaccinated people, there is one or more who might not have had an optimal response to the vaccine because they’re immunocompromised and could land in the hospital.”
Those people with weakened immune systems – who can be vulnerable even with vaccination – include some blood cancer patients, organ transplant patients, people with HIV infection, and those who are taking immunosuppressant medication for rheumatological disorders. But, Russo added, “If everyone is vaccinated, you’re good.”
Because the vaccine largely stops the virus from spreading, it significantly reduces the chances that an immunocompromised person will be exposed to it.
How worrisome is the idea that the vaccines may not be as helpful for immunocompromised patients?
It’s concerning but not surprising. It’s happened with other vaccines, and doctors anticipated it this time, too. Vaccines, at their most basic level, train your immune system to attack the coronavirus. But if your immune system is already damaged, it may not be able to fight the virus as effectively.
How that plays with the Covid-19 vaccines is the subject of intense study right now. It’s also a highly individual dynamic: In cancer patients, for example, the type of cancer, the therapies being used and the patient’s status on the treatment-to-remission spectrum all affect immune response.
Dr. Brahm Segal, chair of internal medicine and chief of infectious diseases at Roswell Park Comprehensive Cancer Center and his colleague Dr. Elizabeth Griffiths, who is a hematologic oncologist, are monitoring patients’ post-vaccine antibody responses. Segal expects clear information to emerge over the next several months as data is analyzed. Speaking broadly, he said, “In people with hematologic cancers on specific regimens, it’s very clear that they’re not responding well to vaccination” – in terms of antibody response – “and it’s unclear whether they’re really having any protective benefit from it.”
Roswell physicians still “highly, highly recommend” that their immunocompromised patients get vaccinated, Segal said. “Even though you wouldn’t expect full protection from the vaccine,” he added, “even a little bit of protection can help.”
So can you. This is what Segal calls the “altruistic part” of vaccination.
“If you are associated with them as a co-worker or a household member, family member or friend, get immunized,” Segal said. “That’s the best way that you could control the infection within the community and avoid spreading it to them.”
What can we do about kids?
For ages 12 and up, the answer is the same as adults: vaccination.
For younger children, vaccinations won’t come till later – but that can be handled. Take advantage of the late spring and summer outdoors, keep masking whenever needed, and if grandchildren, say, are going to be visiting a grandparent who is fighting a blood cancer, consider having them take Covid tests before the visit. (A PCR test is your most reliable option.)
“It seems that younger kids are less susceptible than older kids – the kids in middle school or high school tend to get more infections,” said Dr. Geovanny Perez, pediatric pulmonologist at Oishei Children’s Hospital. “In pediatrics, the younger you are, probably the less risk of having severe infection – even catching Covid.” (Perez noted two exceptions: children younger than 1, and those with underlying medical conditions.)
While children can contract the virus – and in rare cases, it can be lethal – you can also take cautious comfort in this: If the community rate of infection keeps dropping, there’s less chance of running into Covid-19. And if you do, precautions like vaccination can stop it cold – and keep your circles safe.