Dr. Robin’s Covid-19 Updates

Living in a Post-Vax World

What Happens After Aunt Petunia Gets Her Shots?

Artist Tiziana Barbaranelli; used with permission

Hi, I’m back as Robin-Schoenthaler-the-Boston-cancer-doctor-who-writes-about-Covid.

Every day there’s more science about the likelihood of post-vaccination transmission. And every day the science looks more reassuring.

And that’s so important; that’s the everything, right? Post-vax ransmission is the trump card.

Let’s say Aunt Petunia at last gets both her vaccines; her niece from the bridal shower loves her to pieces and helped her with the techie part.

So now Aunt Petunia knows her chances of getting sick with symptomatic Covid is super low, and her chances of getting a serious or deadly case of Covid is now exceedingly vanishingly low.

As she puts it, “The doctor told me the shots are going to keep me out of the hospital, out of the ICU, and out of the morgue.”

These are all fantastic things — a miracle of science has happened right in front of our eyes.

Because Aunt Petunia can now walk around Marshall’s and legitimately feel safe. She can go back to not feeling like every person with whom she comes in prolonged contact at bridal showers or Total Wine or her sister’s nursing home might be harboring a horrible bullet aimed right at her nose. Aunt Petunia is getting that feeling more and more: people are no longer the threat they once were. It is quite the mind-switch.

But the more she pictures getting together with her friends and family for dinner or bridge or Mah Jong or cribbage, the more she wonders:

Could *she* still be a threat to others? Could she catch an asymptomatic or super mild case of Covid and accidentally give it to someone during a bridge game? Could she get enough virus inside her nose to transmit the disease to somebody else?

Simple answer: we don’t know for sure yet. But it’s looking good, it’s looking lower and lower risk.

It’s a hard question to study. I think we would all agree: you can’t do a study where you ask somebody with Covid to go sneeze on a newly vaccinated person — that would be bad science and bad morals.

But there’s some encouraging basic science. They did some early vaccine safety data on macaques and they saw very little virus in their noses after vaccination. Other scientists found the kind of antibodies we get from vaccines are very good at going into the nasal passages.

In addition, there’s real world data from several sources implying transmission will not be a huge issue after vaccination.

Asymptomatic people in the Moderna trial got swabbed at their second dose and a lot fewer were positive (numbers very small) if they’d gotten vaccinated than if they had received the placebo. In Israel, asymptomatic cases have gone way down. In a new Pfizer analysis, they found four times fewer viruses in the nose after vaccination. Another study has done regular nose swabs on health care workers and they also found very little asymptomatic disease. A study showed the viral load after vaccination in the unfortunate few who get Covid may well be lower.

So bit by bit, data accumulates. No data about transmission has been frightening. All the bits and fragments of imperfect data have been encouraging. The trends are good.

One local ID guy even said, “At this point, it takes a special kind of pessimism to think vaccines will not reduce transmission.”

Some of us do have that special kind of pessimism. Some of us have our “Risk Thermostats” dialed all the way up to “Red Alert, Danger Ahead” all the time.

But I think it’s quite possible we will be moving towards being able to dial down our “Risk Thermostats.” I think pretty soon the CDC will tell us we can go back to our regularly scheduled lives with our vaccinated friends and family with minimal fear. I’m anticipating we’ll be able to hang out without masks and with hugs being pretty sure we’re in a Low Risk situation. Not No Risk, but not Red Alert Risk either.

Emily Oster, the-economist-I-adore, is I think an optimistic realist. She did some back-of-the-envelope calculations about what low transmission rates would mean at her blog site Emilyoster.substack dot com.

She uses what I consider to be really low estimates for several variables like chance of household transmission in general, way lower transmission rate after vaccine, cases per day, how likely any one person is infected on any one day. When she puts them together she paints a rosy picture indeed.

With her optimistic estimates, she calculates very VERY low risk in getting vaccinated and safe people together, like 1 in 16,000 risk of ensuing symptomatic disease.

You can go play with her numbers but even the most pessimistic estimates still produce a low risk situation — definitely higher than 1 in 16,000, but still not in my Red Alert Zone. No matter what numbers you use, getting vaccinated people together is not looking unsafe.

The CDC hasn’t changed any recommendations about family/friend gatherings, but my bet is it will happen soon. Dr Fauci, who is usually ahead of the CDC ball, has said you can be “more liberal” when together with vaccinated friends and family, and that makes sense to me.

I think we will soon get to the point where vaccinated people can get together with vaccinated people without masks. Of course the rest of the time — when vaccinated people are with unvaccinated people, or the unvaccinated are with other unvaccinated people — we will be using the same old precautions of masks, distance, etc.

But I will wait for more data, just a little bit longer, before I unmask with vaccinated friends and family. Just to be sure it really is as safe as the limited early data implies and as safe as Emily Oster calculates. I will tell Aunt Petunia the same — just wait a tiny bit longer.

And then, back to hanging with vaccinated friends! And then maybe eventually, when most of us are vaccinated, we’ll be able to take Aunt Petunia to another Michael Buble concert at the Garden. Or maybe Barry Manilow. A Red Alert moment indeed.

{Robin Schoenthaler, MD is a Boston-based cancer doctor who has been writing straightforward fact-based no-blame-no-rumors-all-science-all-the-time essays about Covid-19 since March 2020.}

Covid-Translator. Cancer doc: ~Three decades at MGH. Writer and storyteller: Moth Grand Slam Champion. Mom. www.DrRobin.org, @robinshome, robinshome2@gmail.com

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