My Guide to Fully Vaccinated Living

Sunday was a huge day in our household. Yes, it was the 8^th and final day of Pesach. Yes, my Christian friends were celebrating Easter. But what made this momentous was that we became a Fully. Vaccinated. Family.

What does this mean? And how do we start to change or unlearn our behavior after a year? I’ll attempt to take you through my thought process and let you make your own, better-informed decision for you and your family. I fully realize that the guidance can be confusing and even at times contradictory, so I will use my resources to explain to you what my family feels comfortable with after a year of stress and neuroses.

• What’s the point in getting vaccinated if I already had COVID? Isn’t natural immunity stronger than vaccinated immunity? Many diseases give us natural immunity far superior to anything a vaccine could create. But not this time. If you get COVID you can only count on immunity lasting 3 months or so, maybe 6. And you don’t develop any neutralizing antibodies, whereas these scientifically proven vaccines create 2 things we know for certain and 1 possible gain from the vaccines:

1. Neutralizing antibodies
2. Memory cells
3. Not yet proven, but it appears you may also gain lymph node responses, which could also become a third benefit of protection

• When am I fully vaccinated? – Although the CDC says 2 weeks after your one dose of Johnson & Johnson, there is a far more significant response after 4 weeks, so I would suggest waiting 4 weeks after that J&J before considering myself the immunized equivalent of the other brands.

As for Moderna and Pfizer? 2 weeks after your second dose. Not a day sooner.

I’ve said this before and it warrants repeating: ignore the articles explaining how wonderfully protected you are after your first dose. You don’t gain the awesome memory cells until your second dose, which creates what we expect to be a far stronger and longer lasting immunity.

• How long will these vaccines protect me? It’s too early to know for sure. The possible answers range from something we need annually with our flu shots, to something similar to Measles where most of us get far longer, if not lifelong, immunity from the vaccines.
• Can I still catch COVID and its variants once fully vaccinated? Yes, but the chances are significantly lower. And although the variants suck and are easier to catch, these vaccines will still prevent hospitalization and death in all but the extremely unlucky/unlikely cases.

If you get fully vaccinated, you can realistically expect it to mean you are far less likely to catch COVID, but that even if you do, you should expect to have a case no worse than what you expect from the flu after your flu shots. Will there be breakthrough cases of deaths? I expect to hear that at some point, because realistically some people are so old/frail/vulnerable that any fever can unfortunately kill them. There will always be exceptions to the rule (of efficacy in preventing all deaths), and breakthrough cases. As awesome as vaccines are, I don’t believe any are 100% effective. I’m sure that amongst the millions of doses given there are some people who simply will not achieve immunity. But realistically you can expect the vaccines to give you a life without being scared of COVID.

• Why wear a mask once vaccinated? Once vaccinated, it becomes predominantly for the protection of others around you, and only mildly for your personal safety. The chances you are carrying it have gone down, which is great. And even if you are infected with it, the chances of your viral load being large enough to transmit to others is even lower, which is also great. And we’ll come back to this soon, but the fact is, you still can get it, and you still can transmit it. This means anyone who is high risk and unvaccinated is especially vulnerable; and it’s for those people that you still need to wear a mask for the time being – to prevent them from catching it and dying. All of us know people who are highly immunocompromised due to frailty or a medical condition. Some of them are on immunosuppressant medications, which make it harder for vaccines to help them, and far easier for a smaller viral load to infect them. This is why you might wish you could still enter a store or walk around in public without a mask, but from a public health perspective, it is simply not the responsible thing to do. Not unless we can definitively prove that you could not possibly transmit it.

Damn Headlines – I have to point out that many of the headlines, articles, and even quotes are highly misleading. Sometimes a quote is taken out of context, other times a statement should have been said more carefully. The Director of the CDC was recently widely quoted saying you cannot transmit COVID once you’ve been vaccinated. But when you read on it clarifies that it is less likely to catch and thus unlikely to pass on. Everyone loves sweeping generalizations, but it is still important to remember that the devil is in the details. Just because post-vaccination you are extremely unlikely to give COVID to your healthy young friend does not mean you cannot still give it to the immunosuppressed cancer patient buying groceries next to you at the market. Wearing a mask in public and outside of targeted, safe people is still the responsible thing to do.

Shut up already Boaz, just tell me who I CAN take my mask off with already?! Let’s play the game of Life. You have been “fully vaccinated.” The first thing you do is ask yourself if there is anyone in your household who is unvaccinated and high risk. If the answer is yes, you make no changes until every high risk person in your household is vaccinated. Everybody. (If you live in a household where someone high risk is unable to be vaccinated due to their severe health status, such as ongoing chemotherapy, you should not make these other changes yet; your priority should be to continue and protect them until we definitively know you will not potentially infect them.) If and when the answer is that all high risk members of the household are fully vaccinated, you can advance to removing your mask with the following people and parameters:

1. Fully vaccinated others. You just have to ask the other person one simple question: are there any high risk people in their household who are not yet fully vaccinated? If that fully vaccinated friend/family member has no high risk unvaccinated people left in their household, take off your mask and breathe the same air as them. Indoors. Outdoors. 1 foot apart, 6 feet apart. Doesn’t matter! Enjoy that person’s company and don’t worry about the mask. Celebrate. But this leads to knowing how many at a time you can do this with…
2. Two other households at a time, 15 maximum people. You can gather with up to two other fully vaccinated households together at the same time. A dinner party of 3 families, let’s say. But the maximum parameters are 15 vaccinated, unmasked people.
3. One other unvaccinated low risk household. That’s right, if a single person or household is not vaccinated, but they are all low risk, you can do the same thing and enjoy their company without masks. But please be aware these gatherings are limited to include only one unvaccinated low risk household at a time, so do not pair two unvaccinated or partially vaccinated households. And still 15 people maximum per gathering.
4. Keep track of the date and people you are seeing without masks. This is for contact tracing purposes. It makes it much safer for our communities if, when a strain has tested positive among the people you are seeing without masks, we can let anyone relevant know so they can be safer themselves.

• What about children of two vaccinated families playing? This is probably the most complicated thing I’m addressing here. Their families may be fully vaccinated, but the kids (under 16) are each unvaccinated, and they will be playing with other kids who are unvaccinated. It’s a tough one because they are breaking the “no two unvaccinated households together” rule by playing. However, their chances of catching COVID from their friends or having poor outcomes from COVID are significantly lower than adults, because their viral loads are smaller and their immune systems are generally far more resistant to severe COVID even without the vaccines. The number one reason we were keeping kids out of schools this past year was to prevent them from getting it and giving it to the adults. And unlike most things I’m writing about, there are very few guidelines on how to proceed here post-vaccination. So I’m just going to tell you what my family has decided we will do (for now, until official guidance and our primary sources of Lakshmy Menon & Dr. David Agus advise otherwise): we will allow our daughter Natalia to finally play with other kids, but with a mask at all times. Yes, that means we will not be wearing masks, the other parents will not be wearing masks, but the kids will be masked while playing. But they can play indoors, outdoors, and actually sharing things and touching. And this will apply in both scenarios I listed above, whether it is either ONE unvaccinated low risk other household she is playing with, or TWO other fully vaccinated households. That is what we have decided. I can easily see others being more or less strict, and I can understand the justification for either direction, but we needed to pick a lane and this is what we feel makes sense, based on our current information, for our unvaccinated children who clearly miss playing with each other.

  

• I’m fully vaccinated, do I still need to disinfect surfaces? I spent the last year being extra careful, fully aware it was probably unnecessary, and wiping down all groceries, take-out food, and high-touch surfaces. We sprayed our doorknobs after repairmen left. We were spraying the swing in the park before our daughter sat on it. Most of you weren’t, but we were being extra neurotic about the fomites/surfaces. The chances of such a thing transmitting COVID is so incredibly unlikely that most people shouldn’t worry about this, and we certainly will no longer be doing that now that we are vaccinated. As my mother told us today, Lysol is going to lose a lot of money now!

(As a side note, for the same reasons we were also following the strict precautions of only buying prepared food if it was something hot, or something we could reheat at home. Not anymore, we just had our first sushi/poke in a year!)

• Can I finally go to stores safely? Yes, please do! You’ve been vaccinated, so go support local businesses again, they need you after this year of hell! Go get your haircuts, pedicures, and everything that you’ve been avoiding for the past year. Keep your mask on of course, but get it done. My wife Adi was fully vaccinated as of Sunday, and today her first act of celebration was to finally go to Trader Joe’s for the first time in over a year. What a rebel! Go shopping!
• Is it safe to return to the movies and casinos? Here comes another grey area. You have no idea how much I want to say yes to this. I miss going to the movies almost as much as I miss traveling. And I miss going to casinos almost as much as I miss going to the movies! But here’s the thing: gathering with one or two families who are fully vaccinated is great. Going to a store with a mask is fine. But being indoors with a large number of people from several households, who may still be unvaccinated, and who remove their masks frequently to eat and drink? I don’t feel comfortable doing that or advising it yet. I asked Dr. Agus about this and his answer was, “I personally wouldn’t go to a place with a large number of people who are removing their masks.” And when I messaged with Lakshmy Menon, her response expanded on this by saying, “I’d wait two more months. They’re opening up with restrictions now. Just because they’re opening up doesn’t mean it’s safe. The number of people gathered at one time for that long is not safe. If you insist on going though, please stay masked the whole time.”

Trust me, this confuses and frustrates me too. We are confident your risk of catching COVID is low post-vaccine. We are confident your risk of transmission is low post-vaccine. And we know the risk of you being hospitalized or worse is unbelievably low post-vaccine. Maybe we are being too cautious. But given that I’m already easing my life a great deal more than I have in a year, I am going to exercise patience a bit longer for some of these other changes. If a room/business is the perfect storm of unvaccinated people for long periods without masks, I’m going to still avoid it a bit longer. I’m going to return to outdoor prayers at my synagogue, but not return to indoor services yet, since I have the option. I’m going to start eating without wiping down surfaces at outdoor restaurant seating, but I’m not prepared to return to eating inside the restaurants with others unmasked. I’m happy to find a casino that has outdoor poker, but I’m not going to go inside the casino where hundreds of people have their masks off eating and smoking. And I’m not yet going to the movie theaters. (Though if fully vaccinated friends rent out a private screening, I will be excited to join in the fun!)

For what it’s worth, I do believe that they will soon prove that even these activities are safe when you are vaccinated, but until my (apolitical) sources are comfortable with it, I will follow their guidance and avoid these things too.

When fully vaccinated, prioritize your other health conditions again! My wife has Ulcerative Colitis, and gets annual colonoscopies as a result. She missed it last year due to the pandemic, so the first thing she did today was schedule her overdue procedure. Please remember that there are so many health conditions which are dangerous and require routine prevention and checkups. It’s a tragedy that many of them needed to be skipped/delayed over the course of this year, but when fully vaccinated there is no reason to do so anymore, and it would be dangerous to delay further. Get those mammograms/colonoscopies/dental checkups/annual physicals that you are due or late with, and make those appointments right away. Keep in mind that mammograms must be delayed by at least 3 weeks after your vaccines because of the false positives the lymph node effect can create, so always mention your vaccine when scheduling in case it affects things.

Please remember I am not an epidemiologist nor a virologist. But I am a highly informed Registered Nurse who has spent the last year specializing in this topic of journalism. I try to follow the guidance of the CDC and Department of Public Health, and when there are grey areas or even contradictions, I ask my experts what they recommend. Some of this may be stricter than you are ready for, and some of this may not be strict enough for your personal comfort zone. My goal here is to help you navigate the muck of all of the information out there and let you make your own informed decision based on that and on my family’s decisions. No matter what you do, I hope you’re staying safe and, especially if vaccinated, starting to live your life again.

Boaz Hepner grew up in LA in Pico/Robertson and now lives here with his wife and daughter. Thus, the neighborhood is very important to him. He helped clean up the area by adding the dozens of trash cans that can still be seen from Roxbury to La Cienega. When he is not working as a Registered Nurse in Santa Monica, he can be found with his family enjoying his passions: his multitude of friends, movies, poker and traveling.