Consider Your Herd
An ode to the yet-to-be-vaccinated:
I see you.
You are following the facts. You are pro-science. You were masked up before masking was cool. You haven’t hugged, high-fived, or team-huddled with anyone since March 2020. Even your dog is wondering if you’ll ever leave the house again.
After a year in purgatory, you’d (practically) kill for the vaccine.
You’re aggravated, of course, by crashing vaccine websites; the look-but-don’t-touch promise of a vaccinated future; the burden of your youth and good health.
I feel your unvaccinated pain. You want the damn shot, but—for the love of God—you can’t get it.
But wait! There’s good news for you, too.
While vaccinated people are nursing sore arms and planning vacations, YOU, TOO, are the beneficiary of their immunity.
I’ll explain here:
There is growing evidence that the vaccine not only protects people from getting COVID-19, it protects people from spreading it. As recently as last week, the Johnson & Johnson vaccine trial data suggested what other studies are seeing (and what makes intuitive sense!): that the vaccines reduce asymptomatic infection and therefore transmission.
Is the vaccine 100% sterilizing such that the risk of transmission after vaccination is ZERO? No! That’s not even biologically possible. In fact, we don’t even NEED the vaccine to be 100% sterilizing to begin to resume normal life. If we waited for perfection—like ridding the planet of influenza for example—we’d never leave our houses again.
The upshot?
Risk is relative. Risk is everywhere. Smart decisions are made when we know the facts, know our values, and understand our own risk tolerance.
We’ve got CLOSE to a silver bullet with these three amazing vaccines without promising the impossible.
The more people in your HERD who’ve been immunized, the less likely YOU ARE to get sick, too.
It means, for example, that your non-immunized kids are safer at school when the teachers have been vaccinated. When we can drastically reduce the teachers’ risk of getting sick with or transmitting COVID-19 (as we can with the Pfizer, Moderna, and Johnson & Johnson vaccines), the risk of your child getting sick or even infected with coronavirus drops significantly, too. And when you layer the risk mitigation elements of masks, distancing, ventilation, and hand hygiene, the teacher-student transmission risk drops even further.
(FYI: my friend Monica Gandhi, MD, MPH, last week cranked out this amazing article for the Atlantic about schools and school safety.)
Similarly, when you’re trying to plan your summer vacation with a mixed household of vaccinated and unvaccinated people, remember that the risk of COVID-19 to unvaccinated people is reduced when the people they are surrounded by have been vaccinated.
Traveling, mixing households, and mingling with people in crowded indoor places will always carry risk, particularly in places where case rates are high. Which is why, in public, masks, distancing, and other measures continue to be critical.
But remember this: the Pfizer, Moderna, and J&J vaccines de-fang and de-claw the coronavirus. After you’ve been vaccinated, you won’t die or need hospital care from COVID-19. It means that if you are in the small percentage of people who do get COVID-19 despite vaccination, you’d have a cold or mild flu—and even that risk is low.
Vaccinated people together in private — one, two, or even a minivan-full of them together — can mingle without restrictions or fear of death, hospitalization, and disease. Even Fauci said it last week: “It’s backed by common sense.” Is the risk zero? No! (But it’s pretty darn close.) Why isn’t it zero? Because nothing in life is risk-free! Should vaccinated people always wear masks, distance, and exercise every precaution if and when even ONE person in that van is unvaccinated—and always in public where most of the “herd” isn’t yet immune? YES!!
Unvaccinated people mixing with other unvaccinated people need to maintain full and aggressive risk mitigation with the expectation that these restrictions will lift gradually once more people are immune.
Unvaccinated people mixing with vaccinated people is where risk and risk tolerance meet. It’s where the question “Can I do X?” should always be reframed as “What are the risks and benefits inherent in doing X?” For example, your choice to mix vaccinated adults with unvaccinated kids should always be informed by facts, like:
Children and adolescents are less likely to get COVID-19, accounting for approximately 2–8% of confirmed COVID-19 cases. (Though these percentages likely underestimate the burden of disease on children given asymptomatic cases, the underreporting of mild symptoms, and the lack of adequate testing over the last year), and.
Severe consequences of COVID-19 like MIS-C in kids is rare, affecting approximately one in 10,000 children.
As we gradually re-enter more risky territory (also known as: LIFE), the short story is this: the more vaccinated people in your group—or in society at large—the fewer chances we have to become infected and the safer we are.
A collective willingness to get vaccinated and to maintain risk mitigation behaviors (masks, distancing, etc) is our GOLDEN TICKET out of this mess.
“We’re in this together” is more than a slogan—it’s epidemiological code for HERD IMMUNITY.
I will see you later this week for more on herd immunity, taking risks, and making hard decisions for our safety and sanity. Until then, be well.