It’s been over a year since my office shut down. Over a year since I went to a bar, a fitness class, a movie theater, a concert, a Knicks game, or to the many other public events that were once centerpieces of my social life.
But there’s finally, finally a finish line in sight. There are three safe and effective COVID-19 vaccines authorized and available in the US — and at least 90 percent of all adults will be eligible to receive one by April 19th. If our current vaccination pace continues, 75 percent of adults will have at least one dose by early summer. Reader, I am dying to get back to my favorite activities, and I can tell that people around me are, too.
But according to the Centers for Disease Control and Prevention, vaccinated people aren’t out of the woods yet. The agency’s current guidelines still severely limit some activities that are a big part of many people’s “normal” and some people’s livelihoods: theaters, concerts, bars, sporting events, and the like.
Now, I know concerts aren’t more important than public health, and I’m happy to follow expert advice for as long as needed to stop the spread of COVID-19. But that hasn’t stopped me from wondering “when?” When can our pre-pandemic lives resume, without distancing, capacity limits, quarantines, and other restrictions? When can I go clubbing again?
Lately, there’s been a lot of great writing about what vaccinated people should and shouldn’t do right now. But that didn’t help me get a clear picture of what the future might hold. So I spoke to seven experts, who have all been involved in studying or treating COVID-19, about a slightly different question. I asked them: What signs are we waiting for? When will we know that we can get back to “normal”?
Those are difficult questions to answer because there are a lot of uncertain variables, and the situation is changing rapidly. The US is averaging over 3 million doses per day, and some states are already dropping their pandemic restrictions — but COVID-19 cases are still on the rise, and officials are worried about an upcoming surge. To understand what our “normality” goalposts are, it’s important to first understand what those unknowns are and why the CDC is asking people to keep being patient after they get their shot.
Let’s start with the basics: if I’m fully vaccinated, why should I still avoid crowds?
When you’re fully vaccinated, you want to avoid coming into close contact with unvaccinated people. For one, no vaccine is 100 percent effective. Some experts I spoke to believe they’re effective enough that vaccinated people can justifiably stop worrying about their own risk, while others continued to urge caution. But everyone agreed that while we have data on the efficacy of the vaccines in preventing you from getting severe COVID yourself, we have less information about how well they prevent you from potentially passing it to unvaccinated people. Every expert I spoke to cited this as a reason vaccinated people still needed to be cautious while COVID is widespread in their area. It’s also mentioned in the CDC’s guidance.
I pressed on this, though, because it’s not the case that we have no information on this topic. Preliminary studies from Israel have indicated that Pfizer’s vaccine greatly reduces transmission, and the CDC recently found even more evidence that Pfizer’s and Moderna’s shots are highly effective at preventing infection in vaccinated frontline workers. So I asked the experts how much more information they’d need before they were comfortable with vaccinated people returning to public crowds.
I got a wide variety of responses here. Brian Cruz, regional medical director of PhysicianOne Urgent Care, says he’s waiting for more peer-reviewed studies. The Pfizer data from Israel, for example, isn’t peer reviewed, and the researchers have stated that further study is needed. And while the CDC’s findings indicate that the US vaccines are likely effective in preventing COVID infection, Cruz notes, they don’t settle the question of whether a vaccinated person can be an asymptomatic carrier. He doesn’t think it’ll take too long for all of that to be cleared up. “There’s a strong push to get that information out,” he tells me. “I think we’re getting to that point.”
Others don’t feel that they’ll be satisfied with transmission research at any point in the near future. Before a majority of people are vaccinated, “regardless of the science that might come up ... I don’t think it’s responsible to gather in medium or large-sized groups,” says epidemiologist Matthew Weissenbach, senior director of clinical affairs at Wolters Kluwer.
Epidemiologist Brian Castrucci, who is president of the de Beaumont Foundation, stressed that uncertainty around transmission is less of a concern when a high proportion of people are protected. “This is a novel virus and a novel vaccine. We’re going to be learning for a while as to how it interacts and how it works,” he says. What we do know, he adds, is that “the more people who are vaccinated, the less the virus has a path forward.”
With those answers in mind, I began asking about the future.
When can I go see Hamilton in the room where it happens — instead of on TV?
You can’t control who else attends large public events (theater, clubbing, concerts, religious services, basketball games, and the like), and a vaccinated person will run the risk of coming into close contact with unvaccinated people.
Some of these events can happen in a low-risk manner with modifications — small religious gatherings outdoors with six feet between participants, for example. But I wanted to know what it will take to get the full nine yards back: indoor crowds, full capacity, screaming and cheering, the works.
The big thing to look out for with local events is the pace of vaccination in your community, since most venues like bars, churches, and, yes, theaters, largely draw local patrons. (There are exceptions, of course — more on those later.) The CDC is reporting vaccination rates, case counts, hospital utilization, deaths, and other metrics by county.
“What we need to see is that all the trends continue in the right direction.”
Experts say they’ll be watching for a few things. One is case counts. A positive test rate of 0.5 percent or lower would be a good sign, according to Mireya Wessolossky, an infectious disease specialist at UMass Memorial Medical Center and associate professor at UMass Medical School. Another is hospitalizations. “There need to be no people in the hospital, or once in a while,” Wessolossky says. Another is the overall direction of cases and hospitalizations — “What we need to see is that all the trends continue in the right direction as we start to get back to normality,” said Andrew Catchpole, virologist and chief scientific officer at hVivo.
And a fourth is the proportion of people in your community who are vaccinated. Most of the experts I spoke to said they’ll be most comfortable with large, public events when the area in question has a vaccinated proportion sufficient for herd immunity — the point at which enough people are immune to a disease that a community as a whole is protected, including those who don’t have immunity themselves.
When can I have my birthday party?
Here’s the good news: your birthday party, book club meeting, and other personal gatherings should be fine now, provided that everyone invited is fully vaccinated. So if you’ve been holding out on throwing an indoor birthday party, you should be waiting until two weeks after everyone on your invite list has had their shots.
Weddings are the one area where experts seem to diverge. Weissenbach thinks they should wait for herd immunity (or should be held outdoors, with distancing precautions) since there are likely to be outside staff involved with ambiguous vaccination status. “You probably have food vendors, you probably have a DJ,” he says. “I’m not super comfortable with it.”
Others were tentatively okay with indoor weddings of fully vaccinated guests sooner. But everyone did agree that for weddings (or parties or other sorts of indoor, unmasked, and close gatherings) with unvaccinated guests, herd immunity is the goal.
Okay, cool. So how many people need to be vaccinated for herd immunity against COVID-19?
Unfortunately, we won’t know that for a while. The threshold for herd immunity varies between diseases, and COVID-19 is a new virus. The best we can do for now is make educated guesses based on our knowledge of other viruses.
It’s possible that COVID’s number is very high — a population needs a 95 percent vaccination rate to achieve herd immunity against measles. However, COVID is unlikely to be as contagious as measles, and many of the experts I spoke to were comfortable with a rough estimate of 70 to 80 percent. That’s also the range Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, projected in mid-December. “I would feel good about 70 to 80 percent,” says Castrucci.
“I would feel good about 70 to 80 percent.”
Some were more optimistic: Michelle Prickett, an associate professor at Northwestern University’s Feinberg School of Medicine, says she’d be okay lifting some restrictions above the 50 percent mark. And others are less so. Catchpole tells me, “To operate at maximum safety and minimum risk, we’d want to see as close to a 100 percent takeup of the vaccine as possible before pre-pandemic normality is brought back.”
Plenty of factors could impact what those thresholds are, and how long it takes to reach them. But overall, this goalpost is clear: we want a large majority of people to be fully vaccinated.
Got it. So can I plan to attend the Stanley Cup playoffs this year?
This year’s Super Bowl was not a COVID superspreader event, according to health officials. Fifty-seven cases were linked to official Super Bowl festivities, and 25 people were exposed at the events — over 280,000 people participated. That said, this year’s Super Bowl was held in an open-air stadium at less than half capacity, and fans were required to wear masks and adhere to social-distancing measures. So I asked what it would take for the experts to go back to indoor games with full crowds.
Castrucci says nationwide vaccine rates are more important here than local numbers — the 70 to 80 percent threshold is the goal. Even if they’re taking place in your area, big sporting events and gatherings at similar scale may bring in fans from all across the country. You may not know whether other attendees you’ll encounter are vaccinated, where they came from, or what vaccine rates are in their area. “Something like a Super Bowl, that’s something to be thoughtful about,” Castrucci says. “We’re only going to be as safe as the group that is vaccinated least.”
Seventy to 80 percent seems high — are we actually going to hit these numbers?
I got a chorus of emphatic yeses; the experts I asked believe that number is realistic. “A little bit of patience and we’re going to get to that point,” says Cruz.
The segment of people who plan to get a vaccine is promising. A recent poll indicated that 69 percent of US adults had already gotten the vaccine or were willing to get one (and that proportion may be much higher in your region). And nearly everyone who gets the first dose of a two-shot vaccine has been getting their second one within the recommended window. Kids also make up 22 percent of the US population, and it’s looking like 12- to 15-year-olds could have access to shots before the next school year. Opening up that bracket will likely make up for some adult hesitancy.
It’s also likely that more hesitant people will be pushed to get the shot if schools and other institutions make COVID vaccines mandatory. And there’s also a normalization factor at play. “Once someone initially resistant to getting a vaccine shot knows other people within their peer group who have had a vaccination, they’re more likely to change their mind,” says Catchpole.
What about that Cancun vacation I’ve been putting off?
International travel will take longer. Many countries around the world are not open to US tourists, and some that are have still highly discouraged leisure travel and are requiring arrivals to test and quarantine before they can enter. If you’re planning an international vacation, that’s going to be an even longer waiting game than getting tickets to any big event. Some experts caution that countries might open their borders prematurely but still recommend that fully vaccinated people keep six feet of distance from others during their trips and quarantine before and after.
Wessolossky says travelers should be looking at the proportion of people who have been vaccinated at their destination, once it’s open (as well as other metrics like positive test rates and hospitalizations). That’s especially true because if you’re vacationing, you may want to visit restaurants, bars, or other indoor attractions where the virus and variants of the virus can spread easily.
Shoot, now I’m thinking about variants. How do they factor into vacation planning?
Even if the country you’re aiming to visit is open and vaccinated at high rates, Wessolossky says, it would be a bad idea to visit if there’s a new variant circulating there and you can’t find research on how it interacts with your vaccine.
But like transmission, variants aren’t a topic we know nothing about. Some current research suggests that while our vaccines may be less effective against some concerning variants, they likely still provide some degree of protection. So I asked: what information are we waiting on regarding the variants we’re currently worried about, and given that future variants are a perpetual question mark, will we ever know enough?
“We need a bit more infrastructure here in the US and globally.”
The answer to both questions appears to be infrastructure: tests for detecting variants aren’t yet approved for diagnostic use in the US, and only a small number of US labs can validate them, so variant-focused contact tracing is difficult. “If we had the science infrastructure to sequence variants … things would become clearer,” Castrucci says. “We haven’t made those investments.”
Prickett says she’s waiting for the US to scale up that monitoring and testing capacity before she’ll feel comfortable with total normality. “The best way to get a hold of variants is to do early observation, and we need a bit more infrastructure here in the US and globally,” she says. The Biden administration has committed nearly $200 million to expanding that capacity.
Weissenbach says variants just underscore the need for countries to reach herd immunity. “It’s like a wildfire in California,” he says. “They’re going to continue to crop up. We’re just trying to put a squash on it.”
Bottom line: what are we waiting for?
After getting such a wide variety of answers to so many of my questions, I am left hopeful but also frustrated. How should laypeople like me navigate our lives post-vaccine when even medical experts disagree?
While it may seem tempting to draw the conclusion that this all comes down to a value judgment — you should weigh your risk tolerance against how much you value your wedding or vacation and make your own decision — that doesn’t sit right with me. Our risk is our business, sure, but we’re also asked to restrict our behavior to keep other people safe. And I’ll be brutally honest: I miss live entertainment, traveling, and even indoor dining enough that if I really believed that my post-vaccine decisions came down solely to my own risk-reward calculus, I’d probably drop all pre-vaccine restrictions as soon as I was two weeks out from that last shot. That’s a decision I think every expert in this article would agree is the wrong one because there’s an element of responsibility in the equation as well.
Some folks will certainly disregard all public health guidelines and start globetrotting immediately after their second shot. Others may swear off concerts for the rest of their lives. But many people (myself included) feel an obligation not to contribute to spread but would also benefit from knowing there’s an end in sight — knowing that there’s a time coming when the risk of spread will be low enough that we can go back to our favorite pre-pandemic joys with science on our side.
So here’s my takeaway, for what it’s worth. Experts across disciplines have conflicting advice. As vaccination rates rise, we’ll likely see some authorities relax their demands, while others continue to urge caution. Governors will allow things to open, and people on Twitter will urge you not to go. It’s going to be a confusing time, and different areas will move at different paces. But for the riskiest indoor activities, there’s a tentative finish line in sight: we’re waiting for a large majority of our communities to be fully vaccinated, and for cases and hospitalizations to decline. Here’s my mental finish line: with the caveat that variants and other circumstances could change the equation, and that precautions should be eased carefully rather than thrown to the winds, 70 to 80 percent is the rough threshold I’m watching for.
To gut check this conclusion I turned to Ben Bates, a professor at Ohio University who studies health communication and messaging. He’s not surprised that I’d had trouble finding straight answers. He emphasizes that communicating public-health guidance is challenging, and he thinks some of the expert messaging around COVID has underweighted the value of social gatherings. “The way science and public health work is you want to accumulate as much evidence as possible and test it over and over,” Bates says. “By nature these are very cautious, conservative people. I don’t think we’ll hear for a good long time ‘It is now absolutely safe to go out.’”
But Bates thinks the prospect of US communities hitting a high vaccination threshold, and seeing a subsequent decline in community transmission, is “quite realistic” and agrees that it’s a reasonable milestone to wait for that fairly balances risk aversion against the costs of restrictions and the high value of social gatherings. “Politicians, and business folks, and church leaders and so on will rightly say, ‘This is the kind of number you said would help protect us, and we’ve reached that number,” Bates says. “That’s when I think things will be pretty darn opened up.”