Vaccinated? It’s best to keep behaving like you’re not
Families will have to navigate what it means when only one person has been immunized
Exhausted after 10 months of caring for the elderly and sick, Veleta Davis will never forget the moment the needle filled with COVID-19 vaccine pricked her arm: “I felt ready to conquer the world.”
Davis, 51, received her first dose of Pfizer’s vaccine on Dec. 15 as a personal support worker at Castleview Wychwood Towers Long-Term Care residence. “I felt I was part of a movement to make a difference,” she said.
But when she returned to her family, nothing changed.
She didn’t kiss her children, hug her sister or hold her two nieces. She didn’t visit her parents. As she had done throughout the pandemic to protect her family from the risks of her work, she sanitized her hands and put on her mask. Then she braced herself for a difficult conversation.
Her family “thought that since I got the vaccine, I’m OK, which means they’re OK,” Davis said.
“I had to explain that’s not how it works … and the more I explained, the more questions they had.”
Until Ontario’s three-phased vaccine rollout is completed, the province will likely experience a tiered society in which some people will have received both doses of a COVID-19 vaccine, some just one, and others will still be waiting. Currently, with the province in Phase 1 and vaccines prioritized for longterm-care staff and residents and some health-care workers, the idea of a home where one family member is vaccinated well before the others is something many will have to navigate.
Davis lives with her 23-yearold son; one of her three daughters, 29; her 41-year-old sister; and two nieces, ages 16 and 22. Her family members will unlikely be vaccinated until the late phases of the vaccine rollout.
“It’s one thing to go to work, be diligent about PPE and care for the elderly who are sick, some of them with COVID-19,” Davis said. “But then we come and have to maintain distance from the very people that we really truly love ... the vaccine didn’t change that.”
Ontario’s Health Ministry says vaccinated people should continue to physically distance, wear masks, practise hand hygiene and limit non-essential travel until further research is done and experts say it’s safe to stop.
The province will distribute different types of vaccines offering varying levels of protection. People who receive the Pfizer-BioNTech or Moderna vaccines will require two shots; after two doses, Pfizer showed an efficacy of 95 per cent at preventing symptomatic COVID-19 infection, and Moderna showed 94.1 per cent.
Reports on the efficacy of AstraZeneca’s vaccine — which is in its final stages of being reviewed by Health Canada — are inconsistent and range from 62.1 per cent to 90 per cent. It can be administered in single or double doses. Johnson & Johnson’s one-dose vaccine is 66 per cent effective against severe to moderate illness.
However, efficacy can depend on factors, including age and health, and there is no evidence that any of the current COVID-19 vaccines on the market can completely stop all people from being infected and transmitting the virus.
Because of this, people who have been vaccinated should continue to act as if they haven’t been vaccinated, said Dr. Abdu Sharkawy, internal medicine and infectious-diseases specialist at the University Health Network. It can take weeks, even months before the vaccine creates a maximum degree of immunity — and by extension, to make a person no longer capable of transmitting the virus to others. That’s why someone like Davis, fully vaccinated in January, can’t return to “pre-pandemic business as usual” in February.
“Within the time frame of having that immunity become firmly established, there are chinks in our armour,” Sharkawy said. “Those chinks are absolutely susceptible to being breached by a virus.”
Like Davis, Sharkawy has also received both doses of the vaccine and lives in a multi-generational household, which includes his 72-year-old motherin-law. Many of Sharkawy’s decisions are to avoid compromising her health.
“That hasn’t changed a single bit since I’ve been vaccinated ... there’s nothing worth taking a chance over, especially with the emergence of the variants,” he said. “That’s a big X-factor.”
There were at least 275 cases of the B.1.1.7 variant, which originated in the U.K., and three cases of the variant first reported in South Africa in Ontario as of Friday. Since reporting of B.1.1.7 began, cases in the province have grown at an average daily rate of 16 per cent.
Currently, there is no strong data that suggests someone who’s vaccinated can’t get the South African variant, Sharkawy added.
To achieve herd immunity against a non-variant strain of COVID-19 — meaning enough people have achieved immunity to prevent the spread — you would require 60 to 70 per cent of the population to be vaccinated, said associate chief medical officer of health Dr. Barbara Yaffe in a January news conference. It’s closer to 70 to 80 per cent with a variant strain, she said.
Until the province is in a late stage of mass vaccination with consistently low case numbers, “we’re in no position whatsoever to think about adjusting our lifestyle practices and dropping public health measures,” Sharkawy said. “There’s just too much at stake.”
The Health Ministry says Phase 2 could begin as early as
March, depending on vaccine supplies. In this phase, adults 80 and older will receive the vaccine first, then that threshold will decrease by five-year age increments, until 8.5 million people have been immunized.
Even though Jenna Lee is only 28, the social worker got vaccinated for her work at Providence Healthcare’s Orthopedic and Amputee in-patient unit, which takes in COVID-19 patients from the facility’s acute care sites and helps them through rehab.
Like Davis and Sharkawy, nothing about her routine has changed since she received both doses of the Pfizer vaccine; the first on Dec. 29 and second on Jan. 19.
At the end of her workday, Lee changes out of her “dirty” clothes, throwing them into a fabric bag. When she gets home, she tosses the bag in the washing machine and steps in the shower, a routine that she’s been repeating for months.
Lee hasn’t seen her parents, who live down the street, or her brother since the province entered lockdown Dec. 26. Her husband, Sam Phan, 33 — they married during the pandemic — is an electrician working on a renovation project at a longterm-care site. Because he’s a contract worker, he’s not eligible for the vaccine. His mother is a community nurse.
Although she feels relieved, safer and “a little lighter” knowing she has the vaccine, Lee recognizes her bubble is exposed to high-risk populations. They are “keeping (their) germs separate” so Lee doesn’t bring anything from the hospital to her mother-in-law’s patients, and vice versa.
The U.S. Centers for Disease Control and Prevention announced Feb. 10 that fully vaccinated people who are within three months of receiving the last dose, and showing no symptoms, will no longer be required to quarantine if they are exposed to someone with COVID-19.
“There’s so many unknowns, but I would rather know I’m protecting myself and the people around me, especially working in a high-risk area of the hospital,” Lee said. “You never know, especially with the new variants ... I didn’t run out and give people hugs.”
Because the majority of Lee’s friends and family work in health-related fields, she didn’t have to explain why she needed to maintain safety protocols.
For Davis, who got her second dose on Jan. 5, conversations with her family were a little trickier.
“Being a health-care worker, I know more than they do,” she said. Her kids have reached for her many times, and although they understand it’s for their own safety, it hurts her to reject them in those moments.
“It’s very hard ... I buy them gifts, tell them I love them and care for them. It’s emotional,” Davis said, adding the difficulty has become part of their reality. “Sometimes I come home, have my shower and go straight to bed. I just can’t deal with it.”
For health-care workers dealing with the burden of unpacking complex science and setting boundaries, acknowledging their distressing emotions and anxiety is the first step, said Dr. Saunia Ahmad, a clinical, health and counselling psychologist and director at the Toronto Psy- chology Clinic.
She has been working with health-care workers since last March when the Canadian Psychological
Association called on registered psychology practitioners to consider donating services and time to help frontline workers. She has helped them cope with burnout, fears of getting COVID-19, loneliness and navigating difficult conversations.
Ahmad tells health-care workers to combat misinformation by explaining concepts in simple language. She reminds them to accept they may not be able to get everyone around them on the same page, even if it’s for the safety of everyone in the family.
“It’s important they accept the degree to which people understand something right now,” Ahmad said. “Validate the sense of disappointment, frustration and resentment over not being able to get that hug or kiss.”
She tells health-care workers to make sure they’re eating and sleeping well, and recommends mindfulness and breathing exercises as a great way to manage anxiety. “I tell them it’s key to accept the uncertainty we’re all facing right now. Accept it’s difficult. Accept that it’s going to be temporary. There is light at the end of the tunnel.”
“There’s nothing worth taking a chance over, especially with the emergence of the variants. That’s a big X-factor.”
DR. ABDU SHARKAWY INFECTIOUS DISEASES SPECIALIST AT UNIVERSITY HEALTH NETWORK