The slow road back to normal starts with a first step

It’s hard to believe that the one-year anniversary of the declaration of a pandemic is this week. It has been a long, brutal year that has felt like a decade. One thing is clear: Everyone has been stressed in ways they could not have ever imagined.

One of the biggest sources of stress — other than the very real fear of having someone we love get sick with Covid-19, or coming down with it ourselves — is keeping our distance from friends and loved ones. It’s becoming increasingly clear that the isolation we have all endured has taken a remarkable toll.

It’s a theme I hear from CNN readers, viewers and listeners all the time: When am I going to be able to see my grandchildren, my elderly father, my sister and her family? Most everybody has somebody they long to hug, to hold close and see in person.

My family, too, counts itself in that category: We haven’t seen my parents — my children’s grandparents — for more than a year. And, like so many other families around the country, we can’t wait to have a family reunion. So, as I have done so many times this past year, I pulled out pencil and paper and started to map out the possibilities.

I had first begun to think about when it would be safe to see my parents a short while ago, after my parents and I, separately, got vaccinated. One of the sticking points was that my wife and daughters weren’t vaccinated. Even after talking to the brightest epidemiologists, virologists, infectious disease experts all over the world, I wasn’t 100% sure on where the line in the sand for acceptable level of risk was drawn. And so we held off — but still, I daydreamed of the day.

I wasn’t alone in wondering when that time would come. With an increasing number of Americans getting vaccinated, the question of “When can I visit with fill-in-the-blank?” was growing louder and more insistent.

And on Monday, the US Centers for Disease Control and Prevention brought that moment into clearer focus. The agency came out with its first set of guidance about what fully vaccinated people can now do.

My parents had a significant emotional burden lifted after they were vaccinated, because they are now approximately 95% protected against getting severely ill from Covid-19. But like the rest of the country, they are restless and want to do something with their newly vaccinated status. That is why they called me right after they saw the news report about new recommendations from the CDC to ask me what it all meant. I laid out the good news for them, and the caveats as well.

In a major step, the CDC said people who are fully vaccinated against Covid-19 can safely visit with other fully vaccinated people in private settings without masks, without social distancing and without having to be outdoors. The CDC defines people who are “fully vaccinated” as those who are two weeks past their second dose of the Moderna or Pfizer/BioNTech vaccine or two weeks past the single dose of the Johnson & Johnson vaccine. I think this recommendation was an obvious one, and probably should’ve happened when the vaccines first started rolling out.

Additionally, however, the CDC guidance now allows for fully vaccinated people to visit indoors with unvaccinated people from a single household without masks or physical distancing, if the unvaccinated people are at low risk for severe disease. That last part is important.

“This means that none of the unvaccinated people or any unvaccinated members of their households, for example, are an adult over age 65 or have an underlying condition such as cancer, heart disease or diabetes that could increase their risk of Covid-19 related hospitalization or death,” explained Dr. Rochelle Walensky, director of the CDC, at a virtual White House briefing, Monday, announcing the new guidance.

Bingo.

This was starting to sound like it was going to work, and that my parents should be able to safely visit, even though my kids or wife haven’t been vaccinated. They meet the age requirements and would be considered low risk, both in terms of health and their very limited exposures.

It’s important to remember that the risk to my parents isn’t the primary issue. They are well protected by the vaccine. The concern is for anyone else my parents might encounter after visiting with us. Remember, there is a risk, albeit a small one, that vaccinated people could become infected with mild or asymptomatic disease and potentially transmit the virus to others who are not vaccinated.

No free pass

As I kept digging into the guidelines and speaking with members of the Biden administration’s Covid-19 task force, it became increasingly clear that a visit was looking possible, but with a few strings attached. For starters people like my parents, who are fully vaccinated, still need to take precautions in other situations, including wearing masks and physically distancing when visiting with unvaccinated people who are from multiple households. That means, for example, my parents should not have a reunion with my family and my brother’s family (who are unvaccinated) at the same time.

And, perhaps most notably, fully vaccinated people are also still being discouraged from traveling, something that throws a monkey wrench into my fantasy of an imminent family reunion. Non-essential travel is still not recommended for anyone, vaccinated or not. The concern is that you are likely to encounter someone in the airport who may be vulnerable and at risk of being infected. Remember, while it is remarkable that nearly 10% of the country is now fully vaccinated, that also means about 90% is not.

As Walensky explained, “Importantly, our guidance… must balance the risk to people who have been fully vaccinated, the risks to those who have not yet received the vaccine and the impact on the larger community transmission of Covid-19 with … what we all recognize to be the overall benefits of resuming everyday activities and getting back to something to some of the things we love in life.”

It’s a fine line, and an extremely cautious one, between encouraging vaccination and over-relaxing restrictions.

Dr. William Schaffner, an infectious disease expert and a professor at the Vanderbilt University School of Medicine in Nashville, thinks the new guidance is a “great” first step.

“These are excellent, thoughtful guidelines. And people are going to try to apply them to their specific circumstances,” he said. “They have been eagerly awaited by many people who, having been vaccinated, would like to expand what it is that they’ve been doing.”

Schaffner however adds that he would encourage people “to think about who the unvaccinated people are and what’s been their behavior, day in and day out, before they visit the grandparents.” He is concerned that even though the vaccines are very effective, older people who often have comorbidities may still be vulnerable to infection by a particularly social relative.

Tara Kirk Sell, a senior scholar at the Johns Hopkins Center for Health Security, said the guidance strikes the right note.

“I think the guidelines are in a good middle ground,” she said. “We’re starting to go back to normal now, but it’s not going to be flipping a switch… We will make that journey towards normalcy, or at least a new normal, as more people get vaccinated.”

Expect changes

Walensky said this guidance isn’t set in stone. “It’s important to note that this is initial guidance. The science of Covid-19 is complex and our understanding of the virus continues to rapidly evolve. The recommendations issued today are just a first step as more people get vaccinated and the science and evidence expands. And as the disease dynamics of this country change, we will continue to update this guidance,” she said.

Andy Slavitt, a senior adviser on the Biden administration’s Covid-19 team, told me that the guidance on what vaccinated people can and cannot do is tied directly to vaccination rates. “The rate at which new guidance will develop is directly related to how quickly we vaccinate the country. This is the key point. At 10% vaccinations we have this guidance. At 20-30%, we will have new guidance,” he said, noting that there’s going to be a distinct shift in the messaging of what people can and cannot do — moving away from more binary messaging to one that describes activities as a range of low, medium and high risk.

Dark clouds on the horizon?

Even as Walensky delivered the hopeful new guidance, she also noted the country still stands at a seven-day average of about 59,000 new cases of Covid-19 per day — a rate that has leveled off somewhat, instead of continuing to steadily decline. And there are close to 2,000 deaths per day. So, she and other experts warn, any easing of restrictions is going to have to be gradual.

During a virtual speech at the National League of Cities Conference — an event that immediately followed the White House briefing to announce the new CDC guidance — Walensky warned, “There is so much that’s critical riding on the next two months; how quickly we will vaccinate, versus whether we will have another surge, really relies on what happens in March and April.”

She said she hopes local leaders will do what they can to encourage people to wear masks and keep good physical distance from each other, as well as encourage people to get vaccinated.

But Walensky’s remarks came at a time when several states are expanding business capacity and lifting or preparing to lift mandates for people to wear masks, including Texas and Mississippi this week.

Dr. Anthony Fauci, the chief medical adviser to President Joe Biden, added that the country urgently needs to get ahead of the variants, some of which are more easily transmissible and encouraged people “not to pull back on public health measures prematurely.”

“In other words, listen to the recommendations of the CDC regarding mitigation methods, wearing of masks, physical distancing,” Fauci said, during the same National League of Cities event Walensky spoke at. “Listen to what their recommendations are.”

Schaffner also thinks the country is at a “dicey point” now. “While we’re vaccinating … there is a desire to immediately throw off [restrictions], but we are not at ‘mission accomplished’ yet. So we have to hang in there a little longer,” he said.

Despite the potential of dark clouds gathering on the horizon, I can’t help but feel hopeful about the new CDC guidance and the direction our country is moving in with our vaccination efforts. I believe we can get to a place of “back to normal” sooner rather than later, especially if we can stay the course and make sure we’re all as safe as can be — not just those who’ve gotten their shots.

So where does that leave my family reunion plan? Unless my parents make the long drive to see us, we are going to hold off on a visit for now. With more than 2 million people getting vaccinated a day, however, another 20% of the country could be vaccinated by the end of the month. And, that will probably lead to a further relaxing of CDC guidelines and maybe allow my parents a plane ride instead, which means a possible visit to celebrate their wedding anniversary this spring!