The CDC has new guidelines for people who have been vaccinated against Covid-19. They’re incredibly conservative. And while the federal government is telling vaccinated people they can spend time indoors and unmasked with small groups of other vaccinated people, or with relatives from a single household who haven’t been vaccinated, they’re still telling vaccinated people not to travel. But the reasons why make no sense.
The harm in ‘erring on the side of caution’ by the way is the opportunities foregone, the lives not lived in the meantime, as well as the message it sends about how little vaccination actually gives back to you. Soon we’re going to move from Vaccine Thunderdome where we fight to get a shot to where we’ll be begging vaccine hesitant people to get one. Telling those people it doesn’t actually restore much of their freedom – when the science supports otherwise – is a mistake.
I’ve argued that once fully vaccinated, most people can feel comfortable traveling again. The CDC says I’m wrong. Let’s have a look.
Travel By Vaccinated People Isn’t Driving The Virus
CDC Director Dr. Rochelle Walensky said on Monday, “Every time there’s a surge in travel, we have a surge in cases in this country.” But this isn’t actually true, and it misses the point completely.
First, travel isn’t driving the pandemic. There was no Labor Day spike in cases. Cases were already rising before July 4th and Thanksgiving, and simply continued along trend.
Moreover travel peaks have corresponded with holidays. It’s not the travel driving infection at those times, it’s indoor congregant activities over the holidays – families and friends gathering together indoors.
And in any case, Dr. Walensky is describing what she thinks happened with unvaccinated people, not vaccinated people.
Now, if you want to disagree with this, that’s fine, but show your work. An appeal to authority (‘but the CDC says so!’) simply begs the question here. An appeal to authority should be your last resort, not your first one, in any case.
Vaccines Protect People Enough That Most Can Travel
A vaccinated person is highly protected against bad outcomes. Protection from vaccines may vary with respect to symptoms but that’s not what we care about. All of the vaccines are incredibly protective against hospitalization (so we don’t overwhelm hospitals) and death. They may not be 100% protective, but they’re sure close. Widespread vaccination in Israel means the Pfizer-BioNTech shot is the most studied under real world conditions:
Once vaccine had a chance to work (7 days after 2nd dose),
there were 2 hospitalizations in the vaccinated group
Much of the benefit of preventing hospitalizations and deaths was clear even before the 2nd dose
Reminding us that one dose is still quite potent
— Ashish K. Jha, MD, MPH (@ashishkjha) February 25, 2021
You’re protected when you’re vaccinated, not perfectly, but enough that most people would make a calculation that they can engage in more activities than the CDC advises. For instance they’ll eat in restaurants again.
And it’s the activities you engage in when you travel, rather than the travel itself, that was riskiest to begin with. Airports aren’t super-protective settings, but planes are safer than other crowded indoor environments. If you fly to a beach resort and stay in your room or down at the pool, you’re engaging in less risky behavior than people going to bars that were supposed to be at 50% capacity.
An older person with comorbidities will have a different calculation than a younger healthy person, perhaps, but vaccines are a significant input into the decision-making.
Vaccination Protects Other People – Not Just You
Could you be spreading the virus to other people? Again, less so while traveling if you keep a limited engagement footprint than if you stay home and do not. But we’re beginning to see just how protective vaccines are against spread, not just symptomatic infection.
We know that vaccines do not eliminate transmission risk, and that effectiveness against asymptomatic transmission varies by vaccine, but that all of the ones approved so far in the U.S. reduce asymptomatic infection and transmission substantially.
- We knew this was highly likely from the start since vaccines “eliminate[d] asymptomatic infection” in primate studies and because monoclonal antibody therapies “reduce the viral load throughout the respiratory tract, including the nose.”
- Israeli studies have found reduced asymptomatic infection, not just reduced symptomatic disease.
During a follow-up period beginning seven days after the second dose, vaccinated subjects were 92 percent less likely to test positive for the coronavirus, 94 percent less likely to develop COVID-19 symptoms, and 92 percent less likely to suffer serious disease.
- The CDC itself says Israeli studies show those who do develop Covid-19 post-vaccination “have a four-fold lower viral load than unvaccinated persons” so are much less likely to spread the disease (and if they do, it’s far more likely to be mild).
- A Lancet study found infections (including asymptomatic infections) were reduced 85% seven days after a second vaccine dose where the U.K. B.1.1.7 variant was dominant as it is becoming in the U.S.
- A Mayo Clinic study of 60,000 people found 88.7% effectiveness in preventing infection, not just symptoms.
There is no absolute guarantee that a vaccinated person cannot be carrying the virus and spread it, but the risk is substantially reduced compared to an unvaccinated person.
So What Are We Left With?
There’s a potential but low likelihood that someone could become sick while traveling, when they would have just stayed home and not ventured into a restaurant if they hadn’t traveled.
There’s a potential but low likelihood that someone could pick up an asymptomatic infection while traveling, and spread the virus, and that they wouldn’t have done so at home eating in a restaurant.
And there’s a potential but low likelihood they’ll pick up a variant of the virus with the E484K mutation found in the Brazilian and South African strains, even though they’re vaccinated, and spread those strains, though of course it’s B.1.1.7 that appears to be becoming dominant and vaccines are highly protective against those.
These risks by the way aren’t going to end this year or even next year, which is why airlines are asking the CDC “to publicly release the criteria it will use to adjust travel guidance.” The exceptionally low risk faced by and posed by vaccinated individuals hasn’t been enough for the CDC to lift its recommendation against travel. So what would it take? They won’t say.
Update: After writing this I came across a new piece in the Washington Post from Dr. Leana Wen,
This fails the common-sense test. The CDC said nearly a month ago that vaccinated individuals, if asymptomatic, do not need to quarantine or get tested if exposed to someone with covid-19. If risk of infection is so low that even exposure to the virus doesn’t require quarantine, why can’t we say that vaccinated people can resume activities around people who probably don’t have covid-19?
Take flying on an airplane. The risk of infection during air travel is already very low when all passengers are masked. Surely, that risk is even lower for vaccinated people. Why can’t the CDC say that vaccinated people can travel without having to quarantine or get tested?
In fact, I think it could go further and encourage those fully vaccinated to travel. The CDC can specify that they should still be careful once they get to their destination. Don’t go to parties with people of unknown vaccination status, for example, but it’s fine to visit extended family, go to beaches and parks and tour cultural sites (while wearing masks in public places).
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