Look at the Big Picture Even Though We’re Not Done
The new CDC guidance has created some emotional whiplash. It allows vaccinated people to remove their masks — indoors and outdoors — in most situations. It wonderfully acknowledges scientific evidence and stunning real-world effectiveness of the vaccines. Indeed after vaccination, the risks of getting COVID-19 and transmitting the virus are tiny.
As I said last week (and in the New York Times): this is a watershed moment in the pandemic.
The new guidance is evidence-based and in many ways a relief. This boost in vaccine confidence should also help motivate people on the fence about getting vaccinated to get the shot. Indeed it’s clear that vaccination is our ticket to gradually restoring our health, safety, and sanity.
However the guidance has also created a lot of confusion and anxiety — particularly about kids and other unvaccinated and high-risk people.
Parents and guardians are naturally fearful about their unvaccinated kids. For example, a patient called me Friday very worried that her high-risk 11-year-old son might experience even more risk now that unmasked, unvaccinated people might misinterpret CDC’s guidance as a message that “we’re done” when we are not done at all with the pandemic.
I hear her concerns loud and clear. Unvaccinated people — particularly those with underlying health conditions — are still vulnerable to COVID-19. Kids ages 11 and under won’t be eligible for the vaccine for many months. Not everyone who wants a vaccine has been able to access it. Immunocompromised people don’t necessarily get full protection from the vaccine. People are still getting sick and dying from COVID-19.
And now — with the CDC’s “blessing” — we’re relying on the good old honor system, hoping that unvaccinated adults appropriately mask up in public indoor spaces until we’ve further contained the virus and have equitably distributed more vaccine doses. But how will we know who is vaccinated and who is NOT when we’re in a public space??
So what is my suggestion to parents and guardians of unvaccinated kids and to people at high risk in general from COVID-19? First, I created a short video on Instagram to break down the CDC guidance and issue some general thoughts and advice.
Next, take comfort in knowing:
With each passing day, the risk of COVID-19 to all of us (particularly to unvaccinated people) falls further. As Dr. Eric Topol tweeted yesterday, “In a matter of days, the US covid death rate will drop to the lowest level since the start of the pandemic.” With more and more shots in arms, kids and other unvaccinated or high-risk folks are indirectly protected by vaccinated people who no longer transmit the virus to others.
Immunocompromised patients are still better off having been vaccinated than not — even if they don’t mount the most robust immune response. Our immune systems aren’t binary, and even developing a “whiff” of an antibody and T-cell response to these marvelous vaccines should offer some — if not complete — protection.
Vaccine doses are popping up at schools, malls, and local hot-spots to increase access and ease of administration (though of course we need even MORE efforts to reach the hardest-hit populations.)
The vaccine has been shown to be safe and effective for 12-15 year olds. My 15-year-old daughter got her first dose last week. As this teen crowd gets vaccinated, their immunity further protects the unvaccinated kids in the same camp, school, or social environment.
Kids are generally at very low risk for COVID-19. (Here is my recent newsletter about kids.) The risk of COVID-19 is on par with — or even lower than — the flu depending on the severity of the flu season. This statement always gets a lot of HEAT, so feel free to lob gentle grenades my way. As long as an argument is decently polite, I welcome them!
Kids (and everyone) — vaccinated or unvaccinated — can and should feel comfortable unmasking outside. It’s healthy to get out there. Outside is safe. Are the exceptions? Sure. When kids bunch up are they at risk for transmitting there virus to one another? Sure thing. But with case rates dropping, outdoors generally so safe, and kids generally low risk, I vote to let kids play outside with their friends unmasked unless, of course, your child is at higher risk or lives with an unvaccinated or higher risk adult and taking that small risk isn’t worth it for you. Indeed we all have to make judgments based on our own health.
That’s really the essence of the CDC’s message: that it’s time to take your health into your own hands. While I agree that it’s essential for each of us to understand our unique medical risks and to take responsibility for our own health, I think the CDC should have delivered more nuanced guidance for at-risk people in particular. In the meantime, it’s up to states to decide whether or not to take the CDC’s advice — then it will be up to us as individuals to manage our own risk.
In short, we’re not done. We have to protect ourselves and our neighbors in tandem. We need to respect people who are still on the fence about vaccination and give them some time. We need to appreciate that risk is variable and that not everyone is ready to drop their mask. We need to give people the benefit of the doubt and hope (pray?) that unmasked people in stores, malls, and movie theaters have been vaccinated and therefore can’t sicken unvaccinated people around them.
At this pivotal moment in the pandemic, it’s also appropriate to zoom out and look at the big picture. Let’s remember our broad health goals — for ourselves, our families, and our communities. After all, health is about much more than NOT getting COVID. Particularly after we’ve been vaccinated, it’s time to focus on our overall mental and physical health. Health is about connecting with loved ones, getting outside in nature, moving our bodies, recreating lost routines, laughing with friends, and putting the pieces of our regular lives back together.
Let’s also take stock of what we’ve been through and how far we’ve come. I think back to the hair-on-fire days of spring 2020 and am in awe of what we’ve been through. Think about it for a minute! What has been the hardest part of the pandemic for you, your family, and your community? How did you handle it — and how would you do things differently?
As we emerge from this collective trauma, battered, bruised, and hopefully a little wiser, too, it’s time to imagine life after COVID. Try to realize what matters most to you. What did you miss most? What did you miss the LEAST? What habits, routines, and relationships could use a tune-up now that we’re coming through the end of the tunnel. What have you learned about the kind of friend, partner, parent, worker, and person you are — and want to be?
I will revisit this “big picture” concept later this week. In the meantime, I had the honor of talking about post-traumatic growth and redefining “normal” with NPR’s Ari Shapiro and public theologian Ekemini Uwan on All Things Considered. (Pictured above.) I learned a lot. I hope you take a listen to this 13-minute ditty!
I will see you later this week. Until then, be well.