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Clubs require COVID-19 vaccination certificate for entry in Philadelphia

How health experts are navigating daily life amid the delta variant surge

With Covid-19 cases and hospitalizations spiking around the country, dreams of a summer like those many us had in mind just a short time ago have faded.

The fully vaccinated have been told to resume wearing masks indoors. Companies and institutions are leveling vaccine mandates. And some municipalities are requiring people to show proof of vaccination to get into restaurants, bars, and gyms.

Confusion abounds about what is safe to do. (For the unvaccinated, there’s no confusion about what’s most important to do: Get immunized.)

To try to cut through the fog, STAT contacted three dozen epidemiologists, immunologists, and other infectious disease experts around the country to see how they are navigating the risk of Covid in these uncertain times. Twenty-eight responded.

STAT didn’t ask these experts to explain how they would advise others. Rather, we asked them to answer 10 questions — saying yes, no or only if masked — about their own willingness to engage in various activities, assuming they were vaccinated.

Their answers suggest that, with the highly transmissible Delta variant spreading, caution prevails. Those who know viruses best aren’t buying many movie tickets, and most aren’t eating indoors in restaurants.

But in other ways, responses diverged. And at least one expert suggested that geography really does matter when it comes to his own comfort level. Naor Bar-Zeev, a statistical epidemiologist at Johns Hopkins Bloomberg School of Public Health, declined to respond to all but one of the questions, saying answers are highly dependent on the circumstances of a place.

“In a place where most people are unvaccinated, or otherwise at high risk, and where there is active transmission, I should act more conservatively and with greater caution, even though I am protected from disease,” he said. “In a place where most people are vaccinated, and there is low transmission, one can be more permissive.”

Let’s unpack their answers.

Of the questions, only one earned a unanimous response: “Would you send your unvaccinated child to school without a mask?”

“Lord, no,” Paul Offit, a pediatric infectious disease specialist at Children’s Hospital of Philadelphia, replied.“NO!!! As a parent and a pediatrician, that is a terrible idea,” wrote Andrew Pavia, chief of pediatric infectious diseases at the University of Utah.

None of 27 people who answered this question expressed a willingness to send an unvaccinated child to school without a mask. Carlos del Rio, a professor of epidemiology and global health at the Rollins School of Public Health at Emory University, said he’d withdraw an unvaccinated child from a school if it didn’t have a mask mandate.

Children under the age of 12 cannot yet be vaccinated as none of the vaccines has been authorized for use in this age group.

The other school-related question — “Would you send your vaccinated teen to school without a mask?” — drew almost as fervent a response, with 24 of 26 saying no.

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Chart by J. Emory Parker/STAT

Ellen Foxman, an immunologist at Yale University, was one of the exceptions. “Yes, if the high school had a high vaccination rate/low Covid transmission rate and my family had no high-risk personal contacts,” she wrote. “If the school required all students and staff to be vaccinated, I would have no problem whatsoever with no masks.”

Pavia gave a nuanced answer for his support for masks for vaccinated teens. “If the vaccinated kids don’t mask, the unvaccinated are unlikely to mask and there is a risk of bullying. Masks for all is much more likely to work,” he wrote.

Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, said he not only wouldn’t allow a vaccinated teen to go to school without a mask, he’d demand the teen wear an N-95 respirator. Cloth face coverings aren’t enough to combat Delta, he insisted.

Shane Crotty, an immunologist at La Jolla Institute of Immunology, said he’d send teenagers to school with masks, but would be okay with them taking them off around friends outside of school or during an outdoor lunch break.

When the experts were asked whether they would eat indoors at a restaurant, responses were slightly more mixed. More than half of respondents said no, but six said they would, or would in off-peak hours, and three more said they would do it but would wear a mask when they weren’t eating.

Saad Omer, director of Yale’s Institute for Global Health, said he would eat indoors in a restaurant that required customers to show proof of vaccination. “I generally feel safe indoors in a restaurant as long as underlying community transmission is low and I’m eating with other vaccinated people,” wrote John Brownstein, an epidemiologist and chief innovation officer at Boston Children’s Hospital. “However, I always prioritize eating outside where possible.”

That approach no longer seems viable to Syra Madad, senior director for the special pathogens program in the NYC Health + Hospitals network. “More than 95% of Americans live in areas of high or substantial community transmission so it’s no longer a matter of ‘Yes, I’ll eat indoors if I’m in an area of low community transmission,’” she wrote.

It seems like we’re over DIY hair — or so the answers to the question of whether the experts would go to a hairdresser or a barber shop would suggest.

All but four respondents said they would go to a hair salon or barber at this point even if they didn’t know the vaccination status of other clients. And even one of the four more cautious respondents allowed that she might consider it. “No, but if we are all far apart and there are few people I might with a mask,” said Krutika Kuppalli, an infectious disease physician at the Medical University of South Carolina.

Related: The fine print: Understanding the new policy authorizing extra Covid vaccine doses for the immunocompromised

Most people who said yes did so with the caveat that they’d wear a mask. Jesse Goodman, a professor of medicine at Georgetown University, said he would go only if he and everyone else in the place was masked. Akiko Iwasaki, a Yale University immunologist, said she would try to reduce the frequency of visits. But Jeanne Marrazzo, director of the division of infectious diseases at the University of Alabama in Birmingham, was in favor of professional hair care in general.

“I know how careful my hairdresser has been,” Marrazzo wrote. “She also needs financial support; my hair also needs it.”

Would the experts go to the theater to see a film? Seventeen said no.

“Non-essential,” said Shweta Bansal, whose Georgetown University laboratory studies how social behavior affects infectious disease transmission.

Florian Krammer, an immunologist at the Icahn School of Medicine at Mount Sinai, in Manhattan, believes most people who are fully vaccinated are well protected at this point. He would go to see a movie wearing a mask.

Amesh Adalja, an infectious disease physician and a senior scholar at Johns Hopkins Center for Health Security, has a different view on Covid risks than some of the other people STAT polled. He (and others) believe Covid is going to become endemic — we’re going to have to learn to live with it. For fully vaccinated people, Adalja said, the risks even from contracting Covid are pretty low.

“That fact makes me comfortable as a fully vaccinated individual without underlying health problems to resume my pre-pandemic life because I am risk-tolerant and I know that if I am to get a breakthrough infection it is likely to be mild,” he said. Adalja said yes to all but two of STAT’s questions; he would not send an unvaccinated child to school without a mask and would not currently give a second dose of the Johnson & Johnson vaccine.

William Hanage, an epidemiologist in Harvard’s T.H. Chan School of Public Health, said he’d happily skip going to the movies, but his wife enjoys going. So he would go, wearing a mask.

There was almost an even split among the experts to the question of whether they would attend a large outdoor concert or sporting event, with a slight edge going to the “yes” side. Most of the 15 people said they’d do it if masked.

Robert Wachter, the chair of the University of California, San Francisco’s department of medicine, said he’d don a mask “if shouting people [were] at very close range.” Jason Salemi, an epidemiologist at the University of South Florida, said he “would not attend a large outdoor concert right now,” stressing the amount of Covid transmission in his state at the moment.

Move a mass gathering indoors and the answers shift. In response to the question of whether they would go to an indoor wedding or other religious service — one where they did not know the vaccination status of the other attendees — more of the experts said no.

Saskia Popescu, an infectious disease specialist and assistant professor in George Mason University’s biodefense program, for instance, would go to an outdoor concert or sporting event, masked. Even with a mask, she would not attend an indoor wedding or religious ceremony.

Emergency physician Uché Blackstock, founder and CEO of the consulting firm Advancing Health Equity, said she’d forgo indoor and outdoor large gatherings at this point.

We asked two questions about travel: “Would you travel to a part of the United States experiencing a surge in Covid cases?” and “Would you go on a non-essential international trip?” Surprisingly, there was slightly more willingness in the group to travel internationally than to domestic Covid hot spots.

In response to the former, Peter Hotez was succinct. “I’m living it,” said the Hotez, co-director of the Texas Children’s Center for Vaccine Development, based in Houston-swamped Covid-19.

Del Rio, who lives in Atlanta, goes frequently to Miami to visit his son and his son’s family. “I am very careful when I travel,” he said. Since the pandemic began he has twice visited his mother in Mexico, “but at this point I am not going. May go later in the year,” he wrote.

Carl Bergstrom, an evolutionary biologist at the University of Washington, said he wouldn’t travel abroad now. Not because of Covid directly, but because he might get stuck somewhere if travel restrictions were instituted. Hanage and his family vacationed on Cape Cod this year instead of taking a planned trip to Iceland, for the same reason.

Nahid Bhadelia, director of Boston University’s Center for Emerging Infectious Diseases Policy & Research, said she would not travel to an American Covid hot zone if she could avoid it, but would travel internationally, if her destination had a high vaccination rate and a low transmission rate.

Angela Rasmussen, a coronavirus virologist at the University of Saskatchewan’s Vaccine and Infectious Disease Organization, said she would travel to a location in the U.S. having an upswing in Covid transmission, but would do it using precautions. As for international travel, “depends where, but masked,” she said.

Our final question was for the physicians in the group was this: “Would you recommend that patients who received the one-dose J&J vaccine get another dose of vaccine?”

Crotty, the immunologist at La Jolla Institute of Immunology, said yes; he tweeted recently about his support for giving J&J recipients an extra dose of vaccine to cope with the Delta variant. “I have had physicians emailing me thanks about my [Twitter] threads on this,” he said.

Megan Ranney, an emergency physician at Lifespan Health System in Providence, R.I., said she’s waiting for guidance from the Food and Drug Administration. “But in the meantime, I certainly wouldn’t judge anyone who does get another dose.”

And Helen Keipp Talbot, a vaccine researcher at Vanderbilt University, pleaded the Fifth. Talbot is a member of the Advisory Committee on Immunization Practices, which advises the CDC on vaccination policy. “No comment,” was her reply.

This article is reproduced with permission from STAT. It was first published on Aug. 17, 2021. Find the original story here.

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