Feb. 3, 2021 -- People have a lot of questions about COVID-19 vaccines -- not just how to get them, their efficacy, and their safety -- but real-world questions, too, about what habits and pandemic practices will change in their daily life once they get vaccinated. Can you hug relatives who live outside your home, travel more freely, and go through life without a mask?
Many people remain confused about the answers to these and other real-world, practical questions. Doctors say there’s a good reason for that confusion -- this is all very new, and the answers aren’t always easy to come by.
“Nobody’s done controlled clinical trials around these specific, real-life scenarios, so this is a confusing point for people,” explains Greg Poland, MD, a vaccinologist and director of the Mayo Clinic’s Vaccine Research Group. “We do not have precise data on this, so health experts are doing their best to answer these questions because people so desperately want answers. But in some ways, we have to acknowledge that we are speculating based on what we know about the vaccine and the biology and immunology of the virus.”
The Real-World Effects of the COVID-19 Vaccine
Doctors say the good news is that 95% of people are protected from getting the virus and 100% are protected from severe disease 2 weeks after getting the second dose of the vaccine (either the Pfizer or Moderna version). But Poland points out that means 5% of people could still get sick from the virus because, for some reason, their body didn’t mount a protective response to the vaccine.
While the risk is low, people can still also get COVID if they’re vaccinated.
“We expect their symptoms would be milder but they could still transmit the virus. The new strain adds some unknowns into the mix, too, and we’re not yet entirely sure if people who are vaccinated can also still transmit the virus to others. So even once you’re vaccinated, things can still remain complicated,” explains Poland.
Lucy McBride, MD, a primary care doctor in Washington, DC, says all of that is scientifically true, but she thinks those risks are quite small and focusing on them, in her mind, puts too negative a spin on the vaccine and its promise for patients.
“We can and should allow ourselves the pleasure of looking forward to the days when we and our loved ones are vaccinated, because our risks of being together will be so very low and the benefit to our mental health high,” she says. “The currently available vaccines are incredibly safe and effective, and being vaccinated is our ticket to a better future.”
So what does actually change for you once you get the vaccine and wait the 2 weeks it takes for its full effect? Public health officials say they know people are looking for clarity on real-world situations, so WebMD took some common questions to several doctors: McBride; Poland, who is also editor-in-chief of the journal Vaccine; David Cohn, MD, chief medical officer at the Ohio State University Comprehensive Cancer Center in Columbus; Anita Gupta, DO, a critical care doctor at Johns Hopkins University; and Sarah Schaffer DeRoo, MD, a pediatrician at Children’s National Hospital in Washington, DC. Here are their responses, based on what is known about vaccines and the virus at this moment.
Does life return to normal once I’m vaccinated?
“I know everyone wants to get the vaccine and go right back to normal, but it’s unfortunately just not that simple,” Poland says. “Vaccines plus masks allow us to start expanding our bubble among other people who have gotten vaccines and wear masks. As enough of that happens and time goes by, we will have more and more data and precise estimates of when we are clear to return to normal, but we just don’t know those things yet. It also gets even more complicated as new variants arise that may lead to a reduction in vaccine efficacy.”
“Immunity is our path forward to be back towards normal,” agrees Cohn. “Only when the vast majority of the population is vaccinated or immune to COVID will this occur.”
“Vaccines are one part of the prevention strategy,” Gupta adds. “Wearing masks, hand-washing, and social distancing are part of the comprehensive solution to this global pandemic impacting millions of lives.”
McBride says she’s stressing to her patients that vaccination speeds up the path to normal. “The current vaccines are highly effective. Widespread vaccination is our golden ticket to a better future.”
Can I stop wearing a mask once I’m vaccinated?
“Two weeks after your second Pfizer or Moderna vaccine dose, for example, you are essentially immune to COVID-19” McBride says. “But we haven't yet proven that vaccinated people can't carry and transmit the virus to other people. And until we have that information and have achieved herd immunity, whereby the virus can’t infect most of the population, we need to adhere to the standard risk mitigation protocols: masking, hand-washing, distancing, and avoiding poorly ventilated, crowded indoor spaces.”
New strains of the virus also add unknowns.
Once one person gets the vaccine and waits 2 weeks, can they hug family members who live outside their household who aren’t yet vaccinated?
The answer to this question is unclear.
“We just don’t know enough information on how transmissible individuals are and under what circumstances,” Gupta says. “It’s best always to keep your loved ones safe, and especially older adults who have higher risk.”
“Since it’s still not yet clear whether the vaccine prevents asymptomatic transmission, if you get the vaccine, you might be protected from any symptoms, but that doesn't mean you couldn't be infected without showing symptoms and transmit COVID to somebody who would then get sick from it,” Poland explains. He does not recommend hugging when only one person involved has gotten the vaccine.
McBride reminds us that in reality, human decision-making naturally involves social and emotional factors.
“If we want to 100% avoid COVID risk, the answer is no. If we want to consider emotional and physical risk and reward in tandem, for our family, the answer is yes because the emotional benefits of hugging an immunized grandparent greatly outweigh the very small risk of sickening or endangering anyone involved,” she says.
Schaffer DeRoo takes a similarly nuanced approach to this question. “Assuming that the relative has produced an immune response to the vaccine, it should be relatively safer for them to hug their unvaccinated children and grandchildren,” she says. “That being said, a certain number of people will not mount an immune response to the various COVID-19 vaccines and so could still be at risk for severe infection requiring hospitalization or death, so common sense should be used.”
If everyone involved in a hug has gotten the vaccine and waited 2 weeks for it to become effective, is hugging safe then?
“I know everyone wants a yes-or-no answer to this question, but I think it’s just not that easy,” Poland says. “The equation really boils down to risk tolerance. … There could still be risk that you’re not protected or the other person isn’t protected, so you have to consider the risk and benefits to you.”
“Despite vaccination, the risk remains that COVID infection can occur and be transmitted even between two individuals who are vaccinated,” Cohn echoes. “While the risk is lower (than) without vaccination, an individual patient must weigh their tolerance for risk, given their increased chance of becoming infected with COVID.”
McBride agrees. “The risk of getting sick with COVID when vaccinated people hang out together, even indoors, even unmasked, is almost zero. Nothing in life is risk-free, but it is extremely unlikely that vaccinated people can carry the virus and sicken one another. Could that change with variants over time? Absolutely,” she says.
Poland says for those who want to begin hugging loved ones again, the safest way would be doing so while using the right mask and wearing it properly. Doing it outside would add another layer of protection, he says.
Can I travel on a plane without worry and without a mask once I'm vaccinated?
Because vaccines don’t completely reduce risk, and with the advent of new, more contagious strains of COVID-19 around the globe, public health experts say real changes in travel patterns aren’t likely until public health guidelines and government travel policies change. But they stress that vaccinations are the first step in a positive direction.
“You should still wear a mask -- even two -- on a plane because even after vaccination, you could possibly transmit the virus to others,” McBride suggests. “But your own risk of getting COVID-19 has been dramatically reduced by getting the vaccine.”
“The evolving concern is the variants that are emerging, which raises questions about the effectiveness of the vaccines and how they will hold up with the new variants,” Gupta says. “Maintaining prevention is still the best strategy when traveling, even with the vaccine and staying vigilant at all times for your safety and that of others.”
Can those who are immunocompromised go out in public with less concern once they're vaccinated?
Doctors say the vaccine does likely reduce COVID risk to an acceptable level where most immunocompromised people will feel more comfortable going out in public more. Mask-wearing will add another level of protection.
When will children be able to get vaccinated?
“Unfortunately, vaccine trials for the two FDA-approved [via emergency use authorizations] vaccines are underway only for children 12 years and older, and do not include younger children,” Schaffer DeRoo says. “As a result, we do not yet have a timeline for vaccinating younger children or even for younger adolescents who are eligible for these trials.”
Are unvaccinated children safer from the virus once their parents and/or teachers are vaccinated?
This issue is certainly up for debate around the country
“We do not know if unvaccinated children are safer from the virus once parents and/or teachers are vaccinated because it is unknown if the vaccine prevents disease transmission,” Schaffer DeRoo says. “In other words, while a vaccinated parent or teacher may be healthy-appearing, they may still become infected with the virus and could be asymptomatic spreaders.”
The CDC says children can return to school when it is safe for them to do so, but with some caveats.
“Proper precautions must be followed, and local officials must be willing to impose limits on settings, including ventilations in gyms and ensuring low infection rates in communities,” Gupta says. “The risk still exists, but in-person instruction will be able to be carried out with mask-wearing and social distancing maintained.”