New CDC Recommendations, Vaccines and Variants

vaccine being drawn for shot

Michael S. Calderwood, MD, MPH, chief quality officer at Dartmouth-Hitchcock Medical Center (DHMC), answers questions about the new Centers for Disease Control and Prevention (CDC) guidelines for when a fully vaccinated individual can visit with other people who are fully vaccinated—as well as with other people who are not vaccinated. He also answers some questions about the different vaccines that are available and the COVID-19 variants.

Can you provide more detail on these new recommendations?

Calderwood: First, the goal in releasing these new recommendations was to provide evidence-based guidance (you can learn more about the science behind this guidance here) on what you can do in your personal life outside of work, if you are vaccinated. These include:

  • Fully-vaccinated individuals can have indoor visits if everyone is fully vaccinated. Masks do not have to be worn, nor do you have to physically distance from one another, with a likely low risk of COVID-19 transmission. As a reminder, though, children are not yet eligible for vaccination, so they need to follow prevention practices under the guidance for unvaccinated individuals.
  • Unvaccinated individuals from a single household that does not have individuals at risk for severe COVID-19, can visit with fully vaccinated people indoors without wearing masks, with a very low risk of COVID-19 transmission. The goal here is to allow parents and grandparents to visit with family once fully vaccinated. It’s okay to hug someone in this situation, depending on their comfort level. You may still consider wearing a mask, again, depending on the comfort level of others. Please note that travel is still discouraged, although we expect new guidance on travel to come out soon based on where individuals are traveling from and traveling to.
  • If individuals or household members are at increased risk of severe COVID-19, visits should include wearing a well-fitted mask, staying at least six feet apart and visiting outdoors or in a well-ventilated space.
  • Unvaccinated people from multiple households have a higher risk of transmission, and everyone should take precautions, including wearing a well-fitted mask, staying at least six feet away from others and visiting outdoors in a well-ventilated space.

I have found this graphic from the CDC very helpful in illustrating the new recommendations.

Is there a recommended number of how many people can safely gather together?

Calderwood: Everyone, whether they are vaccinated or not, should follow the current guidance to avoid medium or large-sized in-person gatherings and to follow any local guidance restricting the size of gatherings. If fully vaccinated people choose to participate in a gathering, they should continue to adhere to prevention measures that reduce the spread of the virus.

Unfortunately, the CDC doesn’t define what a “medium or large-sized in-person gathering” is, but instead leaves that to each state for guidance. At this time, I would recommend gatherings with 10 or fewer people.

What about other activities like indoor dining at restaurants and going to the gym?

Calderwood: Masks and social distancing are still recommended for indoor dining at restaurants and going to the gym. Fully vaccinated people engaging in social activities in public settings should continue to follow all guidance for these settings, including wearing a well-fitted mask, maintaining a physical distance of at least six feet, avoiding crowds, avoiding poorly ventilated spaces, covering coughs and sneezes and frequently washing hands.

There are still many questions about the three vaccines that are currently approved. Can you tell us more about them?

Calderwood: The three currently available are the two-dose vaccines from Pfizer and Moderna and the single-dose Johnson & Johnson vaccine. With vaccine production ramping up, the hope is that enough adults (16 years and older) may be vaccinated by July to achieve herd immunity, but this is dependent on not pulling back current mitigation strategies too soon.

For children (ages six to 16), trials are currently taking place, and if these trials provide evidence that the vaccines are safe and effective, COVID-19 vaccines could be available for children by the start of the next school year.

We’ve heard about the possible need for boosters? Why would that be necessary, and just how long is the vaccine effective?

Calderwood: There still are a lot of unknowns, including the duration of immunity to COVID-19 following vaccination. While there is some encouraging data about the development of immune memory at least out to six months, there is evidence that other respiratory virus vaccines like the influenza (flu) vaccine may lose some effectiveness starting somewhere six and nine months after vaccination. So, we’re waiting on the data to see if the same thing happens with the COVID-19 vaccines, and the manufacturers are working on a booster to be ready to be administered in the fall if needed.

There’s also been many reports of new variants of the virus, especially the B.1.1.7 variant (identified first in the United Kingdom) and the B.1.351 variant (identified first in South Africa). Are the vaccines that are currently available able to protect against these variants?

Calderwood: The B.1.1.7 variant is expected to become the most commonly circulating COVID-19 virus in the U.S. this spring. The current vaccines are effective against the variants, particularly when talking about protection against severe disease. Still, the concern with some of these variants is that they are more transmissible and are spreading—because folks aren’t adhering to physical distancing and wearing masks prior to getting their vaccinations.