Pandemic 2.0: Two shots, ready to go, right?

Wrong.



As more states in the US open vaccination to anyone and everyone, we need to be mindful of the new rules.


Just browse the Facebook pages to see people jubilantly holding their shot cards (a bad idea to publish them) and popping the cork on the champagne after a long winter, a long year of isolation.


But before we sweep up the confetti and bring in the marching band, we need to pause and have a wake-up call about what being fully vaccinated really means.


1: Masks are here to stay.


There is a prevailing attitude that once you have completed the vaccine series and once you have waited an additional two weeks after the final injection, you are protected, bullet-proof, immune. You have slain the dragon of COVID-19, and you can rock and roll, so back to business as usual.


The mistaken notion goes something like this. “Now that I am finally protected, I can just roll back restrictions and do just about anything I want.” I know people who booked flights to the Bahamas or made reservations at high-end restaurants in celebration.


Not so fast.


This is a perilous philosophy that will certainly put each of us and our communities at risk. We know the crucial importance of hand washing and avoiding crowds especially in poorly ventilated indoor venues with individuals who are not of our household.


Data are especially overwhelming about the importance of wearing at least one mask until there are definitive and consistent guidelines from healthcare professionals and healthcare policy wonks—no matter your vaccine status.


Masks will continue to be a major barrier in protecting you from COVID variants, highly transmittable and potentially lethal mutations, some of which may not give you full protection by currently available vaccines.


2: Vaccines are not foolproof.


Real-life protection from the currently available and approved vaccines is about 80%. This means 2 out of 10 individuals are at risk for being infected with COVID-19, even if you had a shot (Johnson & Johnson) or two (Pfizer, Moderna). The shots protect you from severe disease and death. In other words, you can still get COVID but are likely to have a less severe case.


The CDC has said you cannot spread virus if you have been vaccinated. Yet a slightly different take comes from a Mayo Clinic study that showed a dramatic decrease in the shedding of virus following vaccination. Yet, even though the vaccines decrease the shedding of the virus by about 80%, there continues to be a small percentage of individuals who could be infected by the virus if you have it (and have been vaccinated). If you wear a mask, you can protect the health and well-being of your neighbors and family.


3: Be cautious about the people you are around.


Despite clear recommendations to limit discretionary travel, airports are overflowing with vacationers as the numbers of travelers is now approaching pre-COVID levels. Although air travel is relatively safe, you will continue to be within risky distances (in airports, in cabs, in planes, in security, in restaurants and hotels) of individuals not of your family and clearly you are putting yourself in harm’s way.


Should you attend a neighborhood outdoor barbeque for 30 to 40 friends or a long-overdue farewell party for someone at the office? Are these functions safe to attend?


As is the case for many controversies, the correct answer is, “Well, it all depends.” If you have not been fully vaccinated and if you are at risk for COVID problems, to attend would be risky. If you are fully vaccinated and if most of the attendees are fully vaccinated and if there was a clear understanding about wearing a mask and keeping some distance (no hugs), the risks are probably low but certainly not zero. Outdoor venues are clearly safer. Yet masks would be prudent.


What about a situation in which a public figure addresses a small audience and is standing at least 6 feet away from the group? Should the speaker wear a mask?


The CDC states that fully vaccinated individuals can gather safely indoors in small gatherings with other individuals who are fully vaccinated. No mask needed in that situation. But the speaker who is fully vaccinated, for example, could not reasonably know if everyone in the group was vaccinated, so on that basis alone, a mask would’ve been reasonable.

However, there are other reasons why a mask would have made sense.


If there was a member of the small, informal audience who is at high risk by virtue of diabetes, high blood pressure other significant illness, by the speaker not wearing a mask those individuals would be placed at risk, even if the individual was wearing a mask too. Speaker + mask; attendees + masks.


The speaker, not to have worn a mask, was at risk of himself becoming infected but also failing to protect those in his immediate environment.


Small gatherings such as teams and coaches, or friends in driveways, or people at the gym, mourners at a funeral, partygoers at weddings—be smart, mask up (or send a card with condolences or congrats).


4: We have suffered enough.


Yes indeed we have. But we’re not home free yet. And we may never be.


I saw a billboard along a major thoroughfare here of a bronzed athletic couple sitting by the pool with their designer sunglasses. Each had a drink. You know, the kind with the little umbrella in the glass. The text on the billboard went something like this, “You have suffered enough. Now is the time to book that trip. You deserve it.”


As much as those of us in the upper Midwest after a brutally long and especially dark and cold winter would like to book a cruise or lounge on a beach with the umbrella drink, it’s not yet safe. The spring breakers are endangering us all by reshuffling the virus and spreading it throughout the country.


5: Watch for the mutants among us.


A lesson in virology 101. As viruses multiply from individuals infected with COVID, the probability increases that there will be a genetic rearrangement, some modification or sabotage of the genetic code in the virus, which lead to mutations. In general, these are harmless twists of the DNA and are of no significance.


But this spring, there are three mutant strains of profound significance. These strains have come from the United Kingdom, South Africa, and Brazil. In the upper Midwest approximately 40 to 50% of the new cases are in the B.1.1.7 variant, which was initially described in the UK. Why is this a big deal and why should we care?


Emerging epidemiologic data now document that aggressive mutations are highly transmissible between individuals and in some people may be highly lethal—more so than the original COVID-19, which is also called the “wild type.” Until the last several weeks, the trajectory of COVID deaths and new cases was clearly heading in a very positive downward direction.


Fueled by these developments (mutants and spring breakers, travelers and vaccinated people thinking they don’t need to take precautions, take your pick), however, and premature relaxing of guidelines and distancing, infection and death rates are going back up. We are getting shots in arms, but we have not achieved herd immunity.


The perfect storm just won’t go away.


So before you get sunscreen and a new swimsuit or book a hotel, pause, take a deep breath and slow down and really pay attention.


6: Be the Lone Ranger.


The Lone Ranger is a character who first came to fame in radio in 1933 and went on to TV fame, as binge-watchers of vintage television can affirm. He conducted himself with a strict ethical and moral code. He always wore a mask. He led the fight for law and order.


Today, the Lone Ranger would advise us to follow the protocols for immunization. He would tell us to stay out of harm’s way. Let’s follow the advice of the masked man.



© 2021  Edward T. Creagan, MD, and Write On Ink Publishing