What's safe after COVID-19 vaccination? Don't shed masks yet

In Miami, 81-year-old Noemi Caraballo got her second dose on Tuesday and is looking forward to seeing friends, resuming fitness classes and running errands after nearly a year of being extremely cautious, even ordering groceries online.

"Her line is, `I'm tired of talking to the cats and the parrots,"' said her daughter Susan Caraballo. "She wants to do things and talk to people."

But the Centers for Disease Control and Prevention hasn't yet changed its guidelines: At least for now, people should follow the same rules as everybody else about wearing a mask, keeping a 6-foot distance and avoiding crowds - even after they've gotten their second vaccine dose.

Vaccines in use so far require two doses, and experts say especially don't let your guard down after the first dose.

"You're asking a very logical question," Dr. Anthony Fauci, the top U.S. infectious disease expert, responded when a 91-year-old California woman recently asked if she and her vaccinated friends could resume their mah-jongg games.

In that webcast exchange, Fauci only could point to the CDC's recommendations, which so far are mum about exceptions for vaccinated people getting together. "Hang on," he told the woman, saying he expected updates to the guidelines as more people get the coveted shots.

What experts also need to learn: The vaccines are highly effective at preventing symptomatic COVID-19, especially severe illness and death - but no one yet knows how well they block spread of the coronavirus.

It's great if the vaccine means someone who otherwise would have been hospitalized instead just has the sniffles, or even no symptoms. But "the looming question," Fauci said during a White House coronavirus response briefing last week, is whether a person infected despite vaccination can still, unwittingly, infect someone else.

Studies are underway to find out, and hints are starting to emerge. Fauci pointed to recent research from Spain showing the more coronavirus an infected person harbors - what's called the viral load - the more infectious they are. That's not surprising, as it's true with other illnesses.

Some preliminary findings from Israel have suggested people infected after the first vaccine dose, when they're only partially protected, had smaller viral loads than unvaccinated people who got infected. That's encouraging if the findings hold up. Israel has vaccinated a large fraction of its population and scientists worldwide are watching how the outbreak responds as those inoculations increase.

Also critical is tracking whether the vaccines protect against new, mutated versions of the virus that are spreading rapidly in some countries, added Dr. Walter Orenstein, an infectious disease expert at Emory University. He's been vaccinated and is scrupulously following the CDC guidelines.

There are practical reasons. "It's hard to tell who got vaccinated and who didn't if you're just walking around the grocery store," noted University of Pennsylvania immunologist E. John Wherry.

And experts like Wherry get asked, repeatedly: Yes, there are rules for being in public, but what's safe for Grandma to do at home, with family or close friends, after she's vaccinated?

Not everyone's immune system is boosted equally from vaccines - so someone with cancer or the frail elderly may not get as much protection as a robust 70-something.

But most people should feel "more confident about going shopping, for example, or going to see your grandkids, or giving your daughter a hug," Wherry said.

That's because the chances of a fully vaccinated person getting seriously ill, while not zero, are low.

"Friends coming over for dinner, we should still try to follow the guidelines," Wherry added. "You never know who is compromised, where the vaccine may not work as well."

What if the fully vaccinated are exposed to someone who's infected? The CDC did recently ease those rules: No quarantine as long as the vaccinated person shows no symptoms and it's been at least two weeks but not longer than three months since their second dose.

Getting on an airplane? Vaccinated or not, the CDC still urges essential travel only.

International travel is an even tougher prospect. Expect countries that already have different quarantine and test requirements to come up with varying post-vaccination guidelines _ especially since multiple types of vaccines, some better proven than others, are used around the world. There's also the concern about carrying those worrisome mutations from one country to another.

Stay tuned for updates to the advice as more people get vaccinated. Meanwhile, don't underestimate how important it is for the vaccinated to feel less anxiety as they run errands or go to work while still following the public health measures, said Dr. Luciana Borio, a former Food and Drug Administration scientist.

Even with a trip to the grocery store, "there was always this anxiety about, 'Was that the contact that's going to make me infected?"' Borio said. "That is a very powerful change in one's living situation."