What doctors wish patients knew about life after vaccination

After you have gotten your second dose of the Pfizer-BioNTech or Moderna COVID-19 vaccine, or one dose of Johnson & Johnson’s Janssen vaccine, when will your life get back to normal? While a vaccination against SARS-CoV-2 feels like the light at the end of a long, dark tunnel, the return to normal will be cautious and slow. But physicians want to clear up what to expect after being fully vaccinated.

Two AMA members took time to discuss how physicians can best encourage patients to practice proper physical distancing. They are:

• Sandra Fryhofer, MD, an Atlanta general internist who serves as the AMA’s liaison to the Center for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) and a member of ACIP’s COVID-19 Vaccine Work Group.
• Christopher Garofalo, MD, a family physician in Attleboro, Massachusetts and a member of the  AMA Organized Medical Staff Section and AMA Private Practice Physicians Section. He is also an AMA alternate delegate.

Here is what these physician experts had to say.

“We still need to really continue to do what we're doing, because there's not enough people who are vaccinated,” said Dr. Garofalo. “If you can continue to gather together outdoors, that is always the best,” he said, adding that “as we get into warmer weather, that's going to be easier to do, but maintaining that distance is still a good idea too.”

In April, the CDC updated its advice on mask-wearing. The agency says both fully vaccinated and unvaccinated individuals can safely unmask while:

• Walking, running, hiking or biking outside alone or with members of the same household.
• Attending a small outdoor gathering with fully vaccinated family and friends.

People who are fully vaccinated have additional safe options for outdoor maskless activities. Someone who is fully vaccinated can safely skip the mask while:

• Attending a small outdoor gathering with a mix of fully vaccinated and unvaccinated people.
• Dining at an outdoor restaurant with friends from multiple households.

For these activities, unvaccinated people should continue to wear masks and practice physical distancing, says the CDC. Everyone—vaccinated or not—should also mask up when attending a crowded, outdoor event such as a concert, parade or sporting event. 

The CDC guidance indicates that it is still important for everyone, fully vaccinated or not, to wear a mask while inside a public space. That includes going to the movies, attending church, getting on a plane, riding the bus, taking an exercise class at the gym or getting a haircut.

Learn more from the CDC about choosing safer activities during COVID-19.

It is much easier to travel if you are fully vaccinated. But it is “still recommended that you delay travel until you are fully vaccinated,” said Dr. Fryhofer, a member of the AMA Board of Trustees. “Fully vaccinated people are less likely to get and spread COVID -19  ,” but, “you still  have to wear a mask if you’re on planes, buses, trains or any other forms of public transportation.

“For unvaccinated people, there are more hoops to jump through before and after travel,” she added.  “Unvaccinated people should get viral testing 1–3 days before your trip, and 3–5 days after travel, and should stay home and quarantine for a full seven days after travel.” 

“Unvaccinated people who do not get tested after their trip should quarantine for 10 days,” Dr. Fryhofer said.

Before domestic travel, says the CDC, people who are two weeks past their final shot do not need to have a COVID-19 test before or after trips. These fully vaccinated individuals also do not need to self-quarantine after travel unless required by a state or local jurisdiction.

“The part about flying that makes it somewhat difficult is not everyone is going to be vaccinated and you're in an airport, which is an enclosed situation,” said Dr. Garofalo, adding that “not everyone's going to be wearing masks” in the state of the vacation destination.  

“As we get into the summer and more people are vaccinated, it's going to be easier to” travel, he added. “If you want to get away and you're going to go someplace and it's just your family and you're maybe trying to take a flight that's not as booked up, that's not an unreasonable thing to do—especially if everyone in the family is vaccinated. But just keep in mind, not everybody around you is going to be.”

Read about six things doctors wish patients knew about flying during the pandemic.

“Masks will continue to be our public persona for the immediate future,” echoed Dr. Fryhofer. But “outdoor activities are safer than indoor activities. The CDC is clear that masks are still necessary even outdoors in  crowded settings and venues.

“They’re also necessary for indoor public activities where you don’t know who has been vaccinated and who has not and where you don’t know if they could be more likely to have variants of concern,” she added. “Vaccinated people can gather indoors with people from one other household, without masks or staying 6 feet apart, unless any of those people or anyone they live with has an increased risk for severe disease from COVID–19. ”

“Normal has been redefined by the pandemic for now and for the future,” she said. “Some things can be done just as well virtually, and we have made strides in fine-tuning the art of Zooming.”

Discover what doctors wish patients knew about COVID-19 vaccination.

“The big wild card is the variants of concern circulating because the way we keep variants from causing mischief is to get people vaccinated, so they can’t change as they infect people,” Dr. Fryhofer said.

More research is being conducted to determine if “you can still carry COVID-19 asymptomatically and therefore spread it to other people,” said Dr. Garofalo. For that reason, “you do have to be very careful and once we get more data on this, we’ll know better exactly” what to tell vaccinated patients about their risk of acquiring and spreading the virus.

Read about what doctors wish patients knew about new coronavirus variants.

“To pass go, you have to be two weeks past the full vaccination series. And if you do pass go, you don't have to get tested or quarantine if you happen to be exposed to someone who has COVID unless you live in a group setting,” said Dr. Fryhofer. “If you do live in a group setting, you should get tested, even if you don’t have symptoms.

“Getting vaccinated is like having a Teflon shield—if you're exposed to someone with COVID, you don't have to quarantine, but you do need to watch out for symptoms,” she added. That is because “we still don't know if people are totally bulletproof from getting and transmitting COVID after vaccination.”

“Once you get vaccinated, the big question right now is how long the immunity is going to last,” said Dr. Garofalo, adding that more data is needed on what happens “the further out you get, particularly after six months.”

“Until we get everybody vaccinated and get those numbers down, we may have to still be careful after that six-month mark,” he said.

Dr. Fryhofer said we still don’t know how long protection will last. She says vaccine manufacturers are studying the question and will continue to share more information with time.

“We're not out of the woods yet. The vaccines are one part of this. They are not a magic bullet and we have to get to that herd immunity,” said Dr. Garofalo. “Keep in mind, in this country we have not gone through a situation like this in a long time.”

“Most of us don't remember having to get to what we consider to be herd immunity for any infectious disease, so it really is new territory for most of us and it’s important to keep that in mind,” he said.

The AMA has developed frequently-asked-questions documents on COVID-19 vaccination covering safety, allocation and distribution, administration and more. There are two FAQs, one designed to answer patients’ questions, and another to address physicians’ COVID-19 vaccine questions.

Additionally, the AMA has created two explainer documents for patients covering COVID-19 transmission and wearing face masks.