What can fully vaccinated people do? Dr. Leana Wen says some CDC advice too cautious

The US Centers for Disease Control and Prevention issued long-awaited guidance on what fully vaccinated people can safely do, and with it, an opening: There’s more opportunity to see our loved ones again.

White House Senior Adviser for Covid Response Andy Slavitt told CNN chief medical correspondent Dr. Sanjay Gupta we should expect to see more guidance on how to return to normal as we see the rate of vaccination increase.

“The rate at which new guidance will develop is directly related to how quickly we vaccinate the country,” Slavitt told Gupta. “This is the key point. At 10% vaccinations we have this guidance. At 20-30%, we will have new guidance.”

So what can we really do? We discuss the major takeaways with CNN Medical Analyst Dr. Leana Wen, an emergency physician and visiting professor of health policy and management at the George Washington University Milken Institute School of Public Health. Here’s her advice.

CNN: When is someone considered to be fully vaccinated?

Dr. Leana Wen: A person is fully vaccinated at least two weeks after the one-dose Johnson & Johnson vaccine or two weeks after a second dose of the Pfizer/BioNTech and Moderna vaccines.

CNN: What’s the CDC’s guidance for fully vaccinated people getting together?

Wen: The CDC says that people who are fully vaccinated can see one another, indoors, without masks or social distancing. This will come as a huge relief to many people. Those who live alone and have been isolated for many months can be with one another after vaccination. Couples who are vaccinated can see other fully vaccinated couples for dinner inside their private residences.

CNN: Is there a size limit to how many fully vaccinated people can get together?

Wen: Because vaccination status is so important, I would make sure that you trust that the people you are seeing are vaccinated. You should feel free to ask them directly and to see proof of vaccination. The larger the group, the more likely it is that you don’t know someone in that group well. If you’re not sure about their vaccination status, don’t get together indoors with them.

CNN: What about dating? Can you and a partner finally get together if both are vaccinated?

Wen: Yes, if you and the person you’ve been dating are both fully vaccinated, you can certainly be with one another again. The issue of trust comes up here for people who are newly dating or if you’re meeting up with someone you don’t know well. Make sure to verify that the other parties truly are vaccinated. If you can’t be sure, pass up on the in-person get-together or see those people outdoors only, spaced at least 6 feet apart.

CNN: What about visiting a family where some or all of the individuals are not yet vaccinated? A lot of grandparents really want to see their grandchildren.

Wen: The CDC provides very good guidance here that should be a relief to a lot of grandparents. They say that visits are fine for vaccinated people with unvaccinated people from a single household, as long as the unvaccinated people are at low-risk for severe Covid-19.

Let’s say that both grandparents are vaccinated. They’re visiting a so-called “mixed” household where only one parent is vaccinated and none of the children are. If all unvaccinated people in the household are generally healthy, that visit can happen — indoors, without masks or distancing, with the grandparents free to hug their family.

This becomes trickier if someone in the house is at higher risk for severe Covid-19. This is where there is a lot of nuance and complexity. What if a parent, for example, has asthma and high blood pressure, or a child is immunocompromised? We know the grandparents are well-protected and probably have a substantially reduced risk of carrying coronavirus. I’d say that the safest thing is for the grandparents to reduce their other risks prior to seeing the family. For example, they shouldn’t see other unvaccinated people in the 10 days preceding.

If you are unsure which underlying conditions put a person at higher risk for severe Covid-19 illness, you can look at the CDC’s guidance, which is updated as more information from research becomes available.

CNN: What about a family reunion, with several families that have unvaccinated members?

Wen: The CDC is pretty clear here. This shouldn’t happen, except outdoors, with masks and distancing. The key is that the unvaccinated people from different households shouldn’t mingle, as they could be carriers and infect others.

CNN: A lot of families live apart from one another. What does the CDC say about traveling to see loved ones?

Wen: Here’s where I disagree with the CDC’s guidance. The CDC still discourages non-essential air travel, which would include visits to family. I don’t think this meets a common-sense test. Another part of the CDC guidance says that fully vaccinated people don’t need to quarantine if they are exposed to someone known to have coronavirus. That’s a very high-level exposure. The risk of exposure on a flight or train or driving is already low. If someone is vaccinated, that risk is even lower.

I think that fully vaccinated people should feel free to travel to see their families, but of course please take every precaution during the travel — including wearing a well-fitting mask at all times in public places, trying to stay physically distanced where possible, and washing hands well.

CNN: The CDC doesn’t say much about other activities like going to the restaurant or the gym. What about these settings?

Wen: Again, this is where I disagree with the CDC’s overly cautious guidelines. I understand that they don’t want people to let down their guards completely, but clinicians know that we have to meet people where they are and address each situation with the nuance it deserves.

Let’s say that someone is vaccinated and really wants to attend in-person church services and to go back to their senior center for indoor activities. The risk to them is very low, and their risk to others is also low. On the other hand, the cost of continued isolation is going to be high.

I think they should be able to return to the activities they most care about, while, again, making sure to wear masks and staying physically distanced. I’d go so far as to say that a couple that really wants to eat out in a restaurant again could do so occasionally but not night after night.

People should use caution and not go to crowded bars. Definitely make sure to wear masks in public. Just because something is open in your state, doesn’t mean that it’s safe to visit. We need to incentivize vaccination as the pathway to returning to pre-pandemic life, and work with people to reduce their risk.

CNN: What do you say to someone who wants to go to these: a church, a restaurant, a museum, a movie theater, a concert — all indoors?

Wen: This is what I would say — it depends on your individual situation.

First, look at your own risk factors. Remember that the vaccine is not a bullet-proof protection. It offers very good protection, especially against severe disease — but there is still going to be some level of risk. Masks provide an additional very good layer of protection, as does distancing, ventilation and so forth.

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If you are very high risk yourself because of age and underlying medical conditions, consider limiting yourself to the CDC guidelines and see only other vaccinated people in private, social settings. If you have high-risk conditions but also have something that you really want to do, think about your own values and priorities. For some people, going to church service is so essential that the benefits far outweigh any possible risk, for example.

Then, look at the setting itself. A restaurant is still safest outdoors. Indoor dining has some risk, but again, if people are wearing masks except while eating and there’s good spacing and ventilation, that risk is low enough for some people to choose to dine indoors after vaccination. The other settings are similar. Most museums allow for good distancing and should be fine. Look at the movie theaters and concert venues you’re thinking of. If they offer good ventilation and spacing, and everyone is wearing masks, this will be relatively low-risk.

Vaccines offer so much hope. I think the CDC and the entire public health community needs to do a lot more to convey exactly how much incredible hope there is. We are not going to reduce risk to zero, but we can reduce it to a low enough level for vaccinated individuals to get back to a lot of pre-pandemic normal.