As the delta variant surges across the U.S. and the rest of the world, it can be difficult even for those who are fully vaccinated against COVID-19 to figure out how to keep themselves and their communities safe; should we be masking? Getting tested? And what’s going on with the FDA approval for vaccines? For answers to these questions and more, Vogue spoke to Dharushana Muthulingam, M.D., M.S., a specialist in infectious disease and faculty member at Washington University School of Medicine in St. Louis; read her answers below.
When and where should fully vaccinated people be wearing masks?
What a timely question, like the CDC, updated its mask recommendations pretty recently. If you are in an area of high or substantial transmission (which is nearly all of the U.S.), you should wear a mask while indoors with people from other households. You should also wear masks in crowded outdoor spaces. All vaccinated people in high-transmission risk areas should follow the two-of-three rule, meaning at least two of the following should be true: outdoors, distancing, and masking. If you are vaccinated and immunocompromised, you should also follow these recommendations, probably in all regions. You are still required to mask in certain settings, like health care and airplanes, no matter the region or vaccination status. At this time, the CDC also recommends universal masking in schools for students and staff.
If you are a vaccinated person who closely interacts with unvaccinated or immunocompromised individuals of any vaccination status, you should definitely be masking in all indoor settings. Whereas with previous variants there was a minimal transmission from vaccinated people, that no longer is the case with the Delta variant.
How often should a fully vaccinated person be getting tested for COVID-19?
The CDC has recommended against routine screening for vaccinated people. They have also advised against routinely testing before flights. When my family recently visited just as it became clear that the delta variant was surging, I did ask them to test prior because they would be interacting with unvaccinated children. You will need to assess the context. If you have been vaccinated but are having symptoms consistent with COVID-19, you should get tested and self-isolate. Vaccinated people are much less likely to get infected, but when they do they seem to transmit the virus as effectively as unvaccinated people. You should get tested three to five days after you come in close contact with someone who is infected. The data on whether you can transmit the virus while vaccinated and have no symptoms is still evolving.
As of now vaccinated individuals still have a much lower risk of infection and transmission and an even lower risk of serious infection, hospitalization, and death. At the end of the day, the vaccine affords significant protection from illness and significantly reduces transmission compared to being unvaccinated.
Is there anything that fully vaccinated people can do (beyond masking and testing) to protect children, the immunocompromised, and others who may not yet have been able to get the vaccine?
It’s going to depend on context. Getting vaccinated is the number one thing you can do to protect yourself, your loved ones, and your community. Masking, distancing, and appropriately testing is an important second piece of that. At this time, I would recommend cutting back on exposure—minimizing large gatherings and decreasing unnecessary outings and travel. I think for a lot of people this is painful to hear after almost 18 months of this pandemic in the U.S., especially when, for the briefest time, we were hopeful about turning a corner. I wish I had less painful recommendations. Just this week, I have cared for multiple vaccinated patients hospitalized with breakthrough infections who are very elderly or immunocompromised. My pediatrician colleagues have been sounding the alarm of increasing numbers of hospitalizations of children, who cannot get vaccinated, and the numbers support their observations. Several regions are experiencing hospital-bed and ICU shortages again. Several regions of the country are in a flatten-the-curve mode again. It’s disappointing to face another wave, but we protect the immunocompromised and unvaccinated in our lives with our own bodies by getting the vaccine ourselves, masking, and distancing.
What would an FDA approval for the COVID-19 vaccine mean in terms of getting more people vaccinated?
I think we need to still appreciate the distinction between those who are anti-vaccine versus vaccine-hesitant versus those who are experiencing logistical barriers to vaccination. We probably will not change the minds of the first group, but the second and third groups are likely a large and meaningfully large number of people who can make a big difference. I can’t predict if the approval will make a significant shift, but we do know that vaccination has increased dramatically in all 50 states. I wish it weren’t because people are responding to a wave of death and illness, but we need to maximize resources in addressing the concerns of the hesitant and building access and not individualize what is still a societal and institutional public-health issue.
Is it reasonable to expect an FDA approval relatively soon?
I honestly don’t know, and I am not sure how much it matters. Maybe it does, but I think we need to be thinking through and providing resources to overcome the material barriers that people have to getting vaccinated. We should be sending fleets of mobile vans to people’s jobs where they can’t get time off; going door to door for people who can’t leave their children or don’t have rides; and offering a vaccine to every single consenting adult that walks through a clinic, emergency department, school, or house of worship.