En español | A few days after Judy Knauer and her husband, David, get their second shot of COVID-19 vaccine next week, they plan to head up to Vermont to see their children and grandchildren. The couple, who live in Yarmouth Port, Mass., and are in their 70s, are renting a house near their daughter's home, to allow for social distancing. “We won't be sharing any meals with them,” says Knauer. “We won't be letting them in our house. And we'll be wearing masks when we're with them,” based on the recommendations of experts they've seen on CNN, to prevent spreading the virus despite their own immunity.
Does that mean she won't be hugging her four adorable grandchildren? “I'm pretty sure I will,” she says, after a brief pause. “Because that's one of the things that's just so hard not to do."
While many people who've received their COVID-19 vaccinations are prudently following health officials’ guidance to continue wearing masks in public and follow social distancing guidelines — all of which are recommended by the Centers for Disease Control and Prevention (CDC) — not hugging their loved ones after nearly a year of isolation is one bit of caution some people may be willing to throw to the wind.
But before you decide whether you should start snuggling family members after you've been vaccinated, consider the experts’ advice (which can be confusing) and — especially — the facts.
One challenge when contemplating the hugging question: trying to sort through the different advice from experts. Many doctors in the U.S. are saying, essentially, don't change your behavior until we have herd immunity. That's when enough people (for COVID-19, an estimated 70 to 85 percent of the population) have been immunized that the entire community has a high level of protection from the infection's spread. These experts argue that even those who are vaccinated remain at risk while the virus is on the loose because the two vaccines currently in use in the U.S., from Pfizer-BioNTech and Moderna, are only 95 percent effective in preventing infection.
"It's not like [those who are vaccinated] can avoid getting COVID altogether,” says Gabor Kelen, M.D., professor and chair of the Department of Emergency Medicine at Johns Hopkins University. “The second issue,” he adds, “is even if you are properly immunized, and you come across COVID, you may be a carrier” and infect someone else.
"If we don't have enough people getting the vaccine, we can't go hug grandma, not at this time,” agrees June McKoy, M.D., associate professor of medicine at Northwestern University Feinberg School of Medicine. “I want to hug my patients. I'm a hugger, but remember [the vaccine] is not 100 percent [effective], and so you still have a risk."
But other experts say vaccinated grandparents giving their grandbabies a few hugs may be just fine, especially considering the loneliness and mental health issues many people have experienced after nearly a year of isolation. “It's untenable for us to say that vaccinated people can't do things to get back to normal life,” says Monica Gandhi, M.D., a professor and infectious disease expert at University of California San Francisco who has been critical of some of the hard-line messaging on postvaccination behavior from some health experts. She notes that in Europe, “they have vaccine ads with older people, saying, ‘I can't wait to hug my grandchild.' ”
Gandhi adds that recommendations need to be realistic, keeping in mind the remarkable effectiveness of the vaccines (even if you become infected the case will be mild), their safety (only a small fraction of the more than 26 million people in the U.S. who have had at least one dose of vaccine have had severe allergic reactions), and how important it is to encourage as many people as possible to get their shots.
In other words, hope-sapping finger-wagging is not what we need right now. Decisions need to be based on the facts, and individual judgments may vary based on those facts and different situations, says Aaron Richterman, M.D., a fellow in the Division of Infectious Diseases at Penn Medicine in Philadelphia. “I personally don't like the language of what someone can and can't do,” he adds. “So I kind of try to take an approach of empowering people to make the most informed and correct decision for them.”
1. Once you are vaccinated you have virtually no risk of getting a serious case of COVID-19.
The two vaccines currently in use in the U.S. and others in advanced safety trials (including those from Johnson & Johnson and Oxford-AstraZeneca) are 100 percent effective in preventing hospitalization and death due to COVID-19. “Not even one person who got the vaccine [during trials] snuck through and got very sick,” says Gandhi. “Not even one.”
That means that if you've gone through your full vaccine schedule — waiting two weeks after your second dose to allow your body time to build protection — you are more likely to get seriously ill from the regular flu than from COVID-19. “These vaccines are amazing,” Gandhi says. If you do get the virus, she adds, “it'll be a mild cold."
Some people are concerned that the vaccine won't protect them against the three new and more transmissible variants of the coronavirus, first identified in the U.K., Brazil and South Africa. While public health officials are concerned and studying these new strains closely, the vaccines being administered in U.S. appear to be remarkably effective against all variants, says Gandhi. The confusion about the issue may stem from the news that the one-shot Johnson & Johnson vaccine, which is not yet approved for use in the U.S., was less effective at preventing more moderate COVID-19 infection in South Africa, but it was still able to prevent 100 percent of hospitalizations. (The company is expected to apply to the U.S. Food and Drug Administration for emergency use authorization [EUA] as soon as this week.)
2. Even if you're vaccinated, you may infect someone who is unvaccinated.
This is where the waters get muddy. There is a chance that even if you have been vaccinated you could be an asymptomatic carrier of the virus and infect someone who is unvaccinated.
The jury's still out on how likely it is. Studies have suggested that those who are vaccinated are less likely to transmit the virus to others. A recent preliminary study from Oxford University, codeveloper of the AstraZeneca COVID-19 vaccine (approved for emergency use in the U.K.), found that it cut the risk of transmission by about two-thirds. But because more data is necessary, it's a good idea to wear a mask when you're near unvaccinated people “in case a slight risk of transmission remains,” says Gandhi.
Richterman says people may calculate their risk differently, depending on their situation. If someone is vaccinated and thinking about seeing their grandkids, for instance: “We know that one of the good things about this virus is that it really doesn't have a lot of risk for kids … It's much less risky than influenza, for example, for kids. So when you think about it in that context, some families might say, ‘Well, you know, the benefit to the kid and the benefits to them of being together and being able to hug — with the grandparent being protected — when they add it all up together, [taking that risk] might make sense for them."
But if you're seeing someone who hasn't received the vaccine and has some underlying health conditions, Richterman adds, “that changes the risk calculation again.”
3. If both you and your loved one are vaccinated, your risk of infecting each other is near zero.
You can probably “comfortably abandon masking around each other,” says Gandhi. She adds that her parents, who are in their 80s, will soon be getting their second dose of the COVID-19 vaccine and a few weeks later plan to travel all around the country to visit their three children — all of whom are doctors and have been vaccinated. “We won't worry about anything because I'm vaccinated, they're vaccinated,” she says. “We're going to be very close when they visit.”
In general, says Richterman, two vaccinated people together is “going to be about as safe as you can get.” But, again, he points out, you'll want to consider your own situation: “Let's say you have two vaccinated people, and one of them is a caregiver for someone who has very high risk, who has not received the vaccine. For that person, it might make sense for them to hold off on [unprotected contact with someone who's been vaccinated] until the person that they're caring for has also been protected by the vaccine."
4. Everyone should continue to wear a mask in public.
We all need to continue following the CDC's infection-control guidelines, including mask-wearing and social distancing, while in public and with anyone who's still unvaccinated until we reach herd immunity from mass vaccination.
"We're at a point where very few people are vaccinated and there's just a lot of infection in our communities,” says Richterman. “That, I think, is an additional reason to just be a little bit more careful."