By The Washington Post · Lena H. Sun, Lenny Bernstein
The Centers for Disease Control and Prevention said people who are two weeks past their final shot may visit indoors with unvaccinated members of a single household at low risk of severe disease, without wearing masks or distancing. That would free many vaccinated grandparents who live near their unvaccinated children and grandchildren to gather for the first time in a year. The guidelines continue to discourage visits involving long-distance travel, however.
The CDC also said fully vaccinated people can gather indoors with those who are also fully vaccinated. And they do not need to quarantine, or be tested after exposure to the coronavirus, as long as they have no symptoms.
Peter Hotez, co-director of the Texas Children's Center for Vaccine Development, applauded the advice, but said it has taken too long for the CDC to tell an exhausted public when their masks could come off.
"The sooner we move to telling people if you're fully vaccinated, you don't have to wear masks, that will be an incentive for people to get vaccinated," Hotez said.
The five-page guidelines offer a road map of sorts to those who have made it through the rocky vaccine rollout to resuming aspects of daily life that have been on hold for more than a year. They come as states have begun reopening, and government and public health officials are racing to vaccinate people as fast as possible to outpace highly transmissible versions of the virus spreading in nearly every state.
After a slow start, the pace of inoculations is accelerating, with 60 million people in the United States having received one shot and more than 31 million people now fully vaccinated as of Monday, or about 9% of the population, according to CDC. On Saturday, 2.9 million doses were administered, a record, while about 2.2 million people on average are getting vaccinated daily. President Joe Biden has vowed to have enough supply for every adult who wants a shot by late May, raising hopes of a return to normal life.
The country is "starting to turn a corner," Andy Slavitt, White House senior adviser on the covid-19 response, said in a briefing Monday, with the guidance highlighting "what a world looks like where we move beyond covid-19."
CDC Director Rochelle Walensky said the recommendations sought to balance potential risk to those who are unvaccinated, and impacts on community transmission, against the benefit of "getting back to some of the things that we love in life" for those who are inoculated. She and others warned that millions more people need to be vaccinated before everyone can stop following covid-19 precautions.
CDC will continue to update this initial guidance, perhaps loosening travel restrictions if new infections continue to decrease as vaccinations increase, Walensky said. But with more than 90% of the population still unvaccinated and levels of virus high, even those who have received the shots "might get breakthrough infections with lesser amounts of virus," she said, referring to a fully vaccinated person getting infected.
For now, officials are continuing to discourage travel because "every time that there is a surge in travel, we have a surge in cases in this country," Walensky said. "We know that many of our variants have emerged from international places, and we know that the travel corridor is a place where people are mixing a lot."
The guidance outlines several ways that fully vaccinated people can return to their old routines, although it is more general than what some might have hoped for. It doesn't explicitly say, for instance, whether vaccinated grandparents can hug and kiss their unvaccinated grandchildren, but appears to endorse such behavior by saying vaccinated people can safely gather indoors with those in one unvaccinated household without masks or physical distancing, as long as no one is at risk of severe disease.
A growing body of evidence suggests that fully vaccinated people are less likely to spread the virus to others. While some prevention measures continue to be necessary, the benefits of reducing social isolation "may outweigh the residual risk of fully vaccinated people becoming ill with covid-19" or transmitting the virus to others, the guidance says.
In addition, relaxing restrictions for vaccinated people "may help improve covid-19 vaccine acceptance and uptake," CDC says. "Therefore, there are several activities that fully vaccinated people can resume now, at low risk to themselves, while being mindful of the potential risk of transmitting the virus to others."
Small gatherings likely represent minimal risk - with the safest situations being for the fully inoculated to get together with one another in private settings, such as a dinner among vaccinated friends in their homes, the CDC says.
But risk increases as gatherings get larger, take place outside the home, or include more unvaccinated people, who may have come from places with high rates of transmission.
The level of caution people need to exercise should be determined by the characteristics of those who are unvaccinated, the CDC says. Unvaccinated people from one household, or people living under one roof who are at low risk for severe covid-19, for instance, can visit with vaccinated people indoors without wearing masks, such as grandchildren visiting their grandparents. But if the unvaccinated neighbors stop by, the visit should move outdoors or to a well-ventilated space, and everyone should don masks because there is a higher risk of virus spread among them.
If a fully vaccinated person visits with an unvaccinated friend who is 70, and therefore at risk of severe disease, the visit should also take place outdoors, with masks and physical distancing, the guidance says.
Vaccinated people should also continue to follow CDC's travel recommendations, which include delaying travel while cases are extremely high. That means vaccinated grandparents are advised against flying to see their grandchildren. Grandparents can visit with their unvaccinated children and grandchildren "who are healthy and who are local," Walensky said.
And vaccinated people must still follow the same requirements before, during and after domestic or international travel, including wearing masks. The CDC requires all international travelers to show proof that they had tested negative for the coronavirus before boarding flights to the United States.
In public settings, vaccinated people should continue to follow all public health precautions, including wearing a well-fitted mask, physical distancing and avoiding poorly ventilated spaces. The virus has been shown to spread in settings such as gyms and bars.
The CDC said fully vaccinated people who have been exposed to someone with suspected or confirmed covid-19 do not have to quarantine or be tested if they remain without symptoms. But if the exposure takes place in certain crowded settings that increase the risk of spread, such as prisons and group homes, they must still quarantine for 14 days and get tested.
Advocates for older people embraced the loosened restrictions on social interaction. Many older people, especially those who live alone, they said, have spent the past year in virtual isolation, hunkered down against a virus that mainly kills people over 65.
"If the CDC is offering new ways for older people to connect more in a way that's safe and healthy, this is really good news," said Katie Smith Sloan, president and chief executive officer of LeadingAge, which represents 5,000 nonprofit organizations that provide services to older people. "I think clarity is so important, and good communication around that. So we welcome this. It takes some of the mystery out of it."
Bill Walsh, vice president for communications for AARP, the interest group that represents 38 million people 50 and older, said that "after nearly a year of the pandemic, we're grateful for any signs of return to life as we know it.
"To the extent this allows people, grandkids, families, loved ones in nursing homes or assisted living [to interact], we welcome that," he added. "We've heard over the past year some heart-wrenching stories of family separation."
But Walsh warned that health officials have a long way to go to eliminate the trepidation many older people feel about safely resuming their old lives. He said many have struggled to apply vague and often conflicting information to their lives.
Those who have already begun resuming their lives said they are elated.
After Helen Boucher, an infectious-diseases doctor at Tufts Medical Center in Boston, was vaccinated in December, she began shopping at the grocery store again, and wearing a mask, visited her in-laws, who are 88 and 90 years old, to bring them kielbasa, macaroni and cheese, and a box of chocolates.
"I felt good that I could bring them stuff," Boucher said. But she kept her visit short since the couple had received their first shot two and a half weeks before. "I had not been willing to put them at risk."
Hotez and his wife are both fully vaccinated and traveled by plane this past weekend to visit with their two oldest grown children, whom they haven't seen in 14 months. One has been vaccinated and the other was recently infected.
"The risk of transmission between us is very low," he said. "It's as good as it's ever going to be. Risk is never going to go down to zero."
Anthony Fauci, Biden's chief medical adviser, who has been vaccinated, said he will finally embrace his daughter once she is also inoculated. "I'm going to have her over to the house, and I'm going to give her a big hug that I haven't been able to do for a year," he told Chris Cuomo recently.