Test Negative, Stay Positive, and Enjoy Good News When it’s Real
I have to admit I’m frustrated this week.
Probably like you, I’m tired of dreary, cold days. I long for in-person time with friends and family. I’m trying to find joy in everyday activities, but there’s only so much glee to extract from another trip to the kitchen.
Meanwhile I’m seeing a major uptick in patients’ anxiety. People are weary from worrying, waiting, and “what if” thinking: the endless loop of worst-case scenarios.
But I’m mostly upset by the massive amounts of misinformation, the negative slant to positive news, and the incessant media buzz about all of the things we CANNOT do once we are vaccinated.
Let me be clear. Worry and fear are justified. I feel it, too. We’re in a terrible situation. Over 400,000 Americans have died. We’ve hit over 2.1 million deaths from coronavirus worldwide. More contagious variants are circulating. The vaccine roll-out has been abysmal. And no, we haven’t yet officially proven that the vaccine prevents transmission.
But we're feeding an epidemic of anxiety with rampant misinformation and relentless negative spin on real scientific information. And it's making us sick.
So let’s first get the facts straight. And then let’s focus on what we can control, abandon worry about the things we can’t control, and allow ourselves to enjoy good news when it’s real.
First, the variants.
As expected (and as I explained HERE), the virus has mutated toward more contagious variants. This is what viruses do when they have time to fester in large populations. Of course I’m quite concerned about the variants. They are driving spikes in case rates around the globe. But to help mitigate the unbridled fear that is generated by the variants, it’s important to understand the facts:
The current vaccines work against the new variants. Full stop.
Whether the vaccines will work forever against an ever-evolving virus remains to be seen. (Worst case scenario: the virus outsmarts the vaccine down the road, renders it less effective, and we adjust the vaccine and boost people like we do the flu shot annually.) My advice? Follow MOSHPIT and worry about this later. And enjoy knowing that our current vaccines work AND are the most effective vaccines in history.
The same risk mitigation elements we’ve been using still work against the new strains; we just need to recommit to doing them—and do them better.
In other words, if you got away with taking off your mask, standing closer than six feet from someone for more than 15 minutes, or dining indoors in the past, you might not be so lucky this time around. The new variants are contagious enough that we need full compliance with all layers of risk mitigation to stay safe.
You don’t necessarily need to upgrade your mask (though it certainly can’t hurt to do so). You simply need to remember that masks alone aren’t enough. Masks have always been necessary but not sufficient to ward off the virus. And particularly with more contagious variants, wearing a mask MUST be combined with distancing from others, washing hands, and avoiding indoor spaces.
I do recommend upgrading your mask or wearing two masks if you’re in a higher-risk situation (indoors, closer than six feet to other people, etc). For example, in a taxi or plane or grocery store where distancing is more difficult and ventilation is not optimal, you can double up on your cloth mask, swap your cloth mask for a KN95 or KF94 mask, or put a cloth mask over your surgical mask. When you add risk, you add more protection. This is good common sense!
And last, I will say it again: if you are following the MOSHPIT rules—avoiding indoor spaces, distancing from others, washing hands, and masking with your regular mask—you SHOULD NOT GET COVID-19, even from the more contagious variants.
Next, the vaccine. HOOBOY do I have a lot to say about the messaging around the vaccine.
In my humble opinion, we are underselling the vaccine. We are focusing too much on what we can’t prove yet (whether the vaccine prevents transmission) instead of enjoying the known truths about the vaccine and, more importantly, life after vaccination.
Hope—when based in fact and science—is sustaining! Hope can be an elixir for winter blues and anticipatory anxiety! We need a dose of both, STAT.
So let’s talk about vaccine facts, why it’s so promising, and how you might behave after you’ve been vaccinated.
The vaccine is 95% effective at preventing COVID-19. It is 100% effective at preventing severe disease. Pause for a minute to take in that incredible data.
This means that two weeks after your second shot, you are essentially immune to COVID-19. And if you are very unlucky and you do get COVID-19, you’d probably have what amounts to a cold. In short, the current vaccines are phenomenally effective and are our golden ticket to a better future.
Does this mean we can all take our masks off? NO.
Until we have full proof that the vaccine also prevents transmission of the virus to other people—and until we have achieved herd immunity whereby the virus can’t infect most of the population—we need to adhere to the standard risk mitigation protocols.
But let’s also be honest: the risk of getting sick with COVID when vaccinated people hang out together, even indoors, even unmasked is basically ZERO.
Is it possible for one vaccinated person to sicken another vaccinated person with COVID? Sure. Do people get pregnant despite using birth control pills and condoms together? Sure.
But it is extremely unlikely that vaccinated people can silently carry the virus and sicken one other. Could that change with new variants over time? Yes. But does worrying now about future unknowns help us in any meaningful way? No! Science has our back, and we’ll cross that bridge together when needed.
My main take-away is this: we need to recognize our anxiety and stop rationing joy. We can and should allow ourselves the pleasure of looking forward to the days when we and our loved ones are vaccinated, because our risks of being together will be so very low, and the benefit to our mental health high. The science is there. Why not celebrate it?
So what about in the meantime, before we’re all vaccinated? For those of you not yet able to access the vaccine, I feel your pain! Please know that your day will come. More doses are coming, and more vaccines should be approved soon.
What about mixing un-vaccinated with vaccinated folks? For example, can my non-immune kids, for example, hug their grandparents once Nana and Boom (my parents’ nicknames) have had both doses of the vaccine?
The answer is this: it depends. For our family, the answer is YES. You may decide differently based on your particular situation. Again, my job isn’t to tell patients what to do; it’s to help them make smart decisions using facts plus an appreciation for risk tolerance and emotional wellbeing. (You also should consult with your own doctor on any medical decision.)
The chances of my non-immune teen silently carrying coronavirus, transmitting it to his or her immunized grandparent, and sickening them in any dangerous way is very, very low. It is possible? Of course. But it’s a risk we as a family are willing to take given the emotional burdens of isolation and benefits of family togetherness.
Is it possible that my parents, even once immune, could silently carry coronavirus, transmit it to my kids, and sicken them? Yes, but again this is very unlikely. As most of us in medicine agree, it would be surprising if the vaccine prevented COVID-19 and did not also prevent transmission—though of course we need full proof of this before we can abandon our masks. In the words of my idol Dr. Paul Sax at Harvard: “If there is an example of a vaccine in widespread clinical use that has this selective effect—prevents disease but not infection—I can’t think of one!”
Amen, Paul.
The upshot?
The vaccine is incredibly safe and effective. Being vaccinated is our ticket to a better future. Understanding science and protecting one another is critical—now and always—but so is knowing there’s gold at the end of the rainbow.
P.S. Join me and my friend Dr. Amanda Williams tomorrow at 4:30 pm ET on Facebook live to discuss more on the vaccine, variants, and equity issues in the pandemic. Bring your questions!
I will see you next week. Until then, be well.