By Kim Bellware
The United States is at an unprecedented juncture of the pandemic, where just under half the population is fully vaccinated, health and safety restrictions are looser than they have been in 18 months, and cases of new coronavirus infections are once again on the rise after months of decline. “The pandemic is not over, and delta changes the calculus,” Joel Wertheim, an associate professor in the Division of Infectious Diseases and Global Public Health at the University of California at San Diego, told The Washington Post. As the delta variant spreads, the messaging from public health experts and officials is unequivocal: Vaccines are the best protection against severe illness and hospitalization. More than 97 percent of new hospitalizations from the delta variant are from people who are unvaccinated, making what Rochelle Walensky, director of the Centers for Disease Control and Prevention, calls “a pandemic of the unvaccinated.” In this summer of covid freedom, disease experts warn: ‘The world needs a reality check’ Health experts said even though the delta variant is more infectious than the original strain that first took hold in the United States last year, precautions can help both vaccinated and unvaccinated people limit their risk.Los Angeles County recently decided to reinstate indoor mask rules — regardless of a person’s vaccination status — on account of rising coronavirus infections and hospitalizations. Some other cities have also begun urging the vaccinated to wear masks inside again. Here’s what to know: If I’m fully vaccinated, do I need to wear a mask indoors? The CDC announced in the spring that people who are fully vaccinated can go without masks in most indoor settings, except when required by certain federal, state and local guidelines. Several health experts who spoke to The Washington Post said the CDC mask guidance is insufficient.Emily Landon, chief infectious-disease epidemiologist at University of Chicago Medicine, said the CDC should have included parameters on the mask rules, such as establishing a threshold allowing unvaccinated people to go without masks only if a certain percent of the population is inoculated. “I think the CDC in May made a mistake,” Landon said. “They made a recommendation based on biological science, but not any social science. Unfortunately, the policy of letting people self-sort into vaccinated and unvaccinated resulted in a sort of behavioral science problem.” Several experts consulted by The Post said it is safe for fully vaccinated people to spend time indoors with others who are fully vaccinated. The shots have proved widely effective, even in crowded indoor settings. But they said it is nonetheless a smart practice to continue wearing masks in environments where there might be people who are not inoculated. Masks can help prevent the wearer from getting covid-19, and also protect those who haven’t gotten the shot and could be at risk of complications if they get sick. Though “breakthrough infections” are rare among the fully vaccinated, some, mostly mild, cases have been reported. Experts say it is smart to try to avoid getting even a mild case of the virus. “If you yourself have been fully vaccinated for at least two weeks and if people you are spending time with have been fully vaccinated for a least two weeks, you can feel relatively safe about not having to mask indoors,” said Betty Jean “BJ” Ezell, who serves as a vaccine hesitancy outreach coordinator for Citrus County, Fla. Is attending a big outdoor gathering such as a wedding or a concert high-risk? On the spectrum of risk, an outdoor setting for fully vaccinated, masked and socially distanced people is the safest — but maybe not an ideal party situation. Ezell said it’s a good idea to mask up or socially distance if you’re at a large gathering outdoors and don’t know whether the people around you are vaccinated as “the delta variant has shown that it’s rampant and unforgiving in its ability to spread.” “When you talk about outdoor weddings and parks, I think physical distancing is still a good thing because an infected person may be asymptomatic,” Ezell said. While the outdoors is generally less risky for coronavirus transmission because of ventilation, Yonatan Grad, an associate professor at the Department of Immunology and Infectious Diseases at the Harvard T.H. Chan School of Public Health, said to stay aware of your exposure to other people, noting that an experimental outdoor music festival in the Netherlands in early July has since been linked to nearly 1,000 new infections. Grad encouraged people to look at risk not just through a binary lens of “safe” or “unsafe.” Other factors such as the rates of infection and vaccination in a given area are key. Going to a party in a community with rising covid-19 cases and lackluster inoculation numbers, for example, could be riskier than attending one in an area with a strong vaccination rate. “'Safe' can imply that you’re totally protected,” he said. “The goal for many people is to be at the lowest risk possible.” I’ve had only my first dose of the vaccine. Do I have enough protection from the delta variant? “The data from the U.K. suggest that the protection from a single dose of the vaccine is low for the delta variant,” Grad said. “There’s a big jump in the level of protection with the second dose for the delta variant specifically.” Wertheim agreed. “We have this large swath of America that has only gotten one dose, and if we could only get them to get a second shot, I think that’s a group where we could make a big difference,” he said. “If you’ve been slow about getting a second dose, now is the time.” Wertheim said people should get their second dose even if they’ve had an extended interval since their first shot. “There’s no evidence to suggest that waiting longer [to get the second dose] is worse.” My children aren’t old enough to get a vaccine. How can I protect them? Even though children tend to have milder cases of covid-19, Landon said infections in children are following the trend lines in delta variant hot spots: States with large outbreaks are seeing more children with infections. “I understand that it’s really enticing to think of covid as just another cold, but it’s not,” Landon said of the typically milder infections in children. “It’s always best to avoid getting sick at all.” For children who aren’t old enough to get a vaccine, Landon said adults and older siblings can reduce the risk to these children by avoiding crowded indoor settings and wearing a mask inside. Experts also advise common-sense precautions to prevent all respiratory illnesses. “We still pay attention to hand-washing — sing that ‘Happy Birthday’ song twice — we still pay attention to masking and the fit of the mask,” Ezell said. However, the intensive surface cleaning that people engaged in early in the pandemic is no longer considered necessary. Can I resume working out at the gym if I’m vaccinated? “I wish there were hard numbers we could give for all of these variations to questions about risk,” Grad said. “But it’s a question of what risk you want to tolerate.”Getting as much ventilation as possible in an indoor setting like a gym, where people may be breathing heavily, is one important way to reduce risk.“If we knew the vaccination status of all the people in the gym, we could have a greater level of comfort,” Grad added. “If we don’t, we might want to be masking — think the same kinds of precautions we have in an airport.” Landon of the University of Chicago said since the chance of catching covid-19 increases with the amount of close contact to infected individuals, even healthy people who are vaccinated run a risk — albeit a low one — when they voluntarily increase their exposure. “The amount of breathing you do matters — that’s why gyms are kind of risky,” Landon said. “The amount of distance and ventilation reduces your risks, so better if your gym is ventilated and you can get some space between treadmills.”
How do I talk to loved ones who are still hesitant about the vaccine?Ezell, the vaccine hesitancy outreach coordinator in Florida, said when it comes to meeting vaccine skeptics, she follows the advice of her pastor: You gain people’s confidence not by “beating them over the head” but by planting a seed. Give someone factual information to get them started, Ezell said, and the next person who comes along follows up by “watering,” increasing the number of times trusted voices have shared sound information.“I think it’s especially important when you’re having these conversations to present with what I call an active listening voice,” Ezell said. “Ask people in particular what their objections are, and don’t interrupt them; let them finish. Then give them the facts in a very calm manner.” If cases continue to rise with the delta variant, will restrictions return? No health expert can predict the future, but most who spoke to The Post were skeptical that there would be a return to widespread restrictions such as stay-at-home orders and shuttered businesses like those in 2020.Some restrictions such as indoor mask rules could return, as seen in Los Angeles County, though Landon and other experts said they are likely to be hyperlocal and responsive to infection and hospitalization rates in a specific area. Landon likened state-imposed measures — such as masking rules - to waging a fight with small children. “It’s like being exhausted and telling your kids, ‘Fine, you can have ice cream for dinner,‘ ” she said. “You don’t have the will to say ‘no’ anymore.“The bottom line, we should have mask mandates indoors,” she said. “In public buildings, there’s no reason we’re not mandating masks. But will we go back to that? I doubt it. Now I think it will be really hard to go back to those restrictions.” Ezell agreed. “The horse has left the barn on relaxing restrictions, so it’s going to be really important that there are perhaps more public service announcements, group meetings, more getting trusted voices involved in communicating information from reliable sources,” she said.
https://www.washingtonpost.com/health/2021/07/17/delta-cases-rising/
