San Francisco Chronicle - (Sunday)
Vaccinations create tricky social distancing landscape
For Passover last month, Melissa Bondy invited eight people to her home in Menlo Park, and they sat at a table outside for seder, everyone in good spirits and happy to be together.
For the first time in more than a year, “I felt like there’s a life after COVID,” said Bondy, an epidemiologist with Stanford.
But it wasn’t quite back to normal. This was a mixed group: the fully vaccinated like Bondy, a few people who’d had one dose of coronavirus vaccine, and one or two who hadn’t yet gotten a shot. One guest, an unvaccinated pregnant woman who had a baby with her, asked everyone to wear masks and sat a bit apart from the others.
“We were really careful,” said Bondy, who
Approval: Johnson & Johnson vaccine can be administered in California and three neighboring states after an 11-day pause. Inequities: Comparisons of health and wealth by ZIP codes show vaccination gaps throughout California, including the Bay Area.
Coronavirus cases have dropped sharply. A majority of California adults are at least partially vaccinated. And the risk outside is low. So why do we still need a pandemic restriction that everyone seems to hate — the outdoor mask mandate?
Many experts and advocates are asking just that.
“The emerging consensus seems to be that we should end outdoor mask mandates in the next few weeks,” contends Dr. Monica Gandhi, an infectious disease expert with UCSF and one of the earliest and most vocal proponents for using masks to curb the spread of COVID19.
She’s become among the most vocal critics
happily obliged with her guest’s requests. “These behaviors have been so indoctrinated in us over the past year. I feel like we need to gradually ease into this next phase of the pandemic.”
California is in a sort of twilight period of the pandemic, public health experts like Bondy say, as more people who are fully vaccinated start dropping their guard and resuming old social habits, while a significant portion of the population has yet to get a single shot.
As of Friday, about 28% of all Californians were fully vaccinated, according to state data. About 16% were partially vaccinated, meaning they’ve had one dose of a twoshot regimen. More than half the population, including all children 15 and under who aren’t yet authorized to get the shots, is unvaccinated.
That’s creating some tricky social situations, reminiscent of the start of the pandemic, when everyone was figuring out how to politely dodge hugs and handshakes or ask friends to put on a face covering. The fully vaccinated are throwing house parties and letting their masks slip down to their chins in public. They’re inviting unvaccinated friends to dine inside restaurants and go to movie theaters — activities that are allowed now, but still pose risks.
And as more public health restrictions are lifted, the burden of responsibility increasingly is resting on individuals’ shoulders. People must decide for themselves what feels safe, after more than a year of relying on health officers and other experts to tell them what to do — and that goes for the vaccinated and unvaccinated alike.
“It’s something to celebrate. But this liminal period is very challenging,” said Dr. Susan Philip, the San Francisco health officer. “It’s hopeful, but it’s so weird. It feels very fraught.”
This phase of the pandemic in some ways presents new risks for the unvaccinated, who may be feeling impatient, or pressured by peers, to put themselves in situations that could expose them to the virus. And the virus itself may be more threatening than ever, with variants that are more infectious and potentially able to cause more serious illness now dominating.
“I’m not going to argue that for an unvaccinated person they’re in more danger today than they were in January” in the middle of the winter surge, said Dr. Robert Wachter, head of the Department of Medicine at UCSF. But he worries that people are relaxing their behaviors in ways that could expose them to the virus, without fully appreciating the risk they’re taking, to their own health or those around them.
“It’s a lot of psychological chess to be playing,” Wachter said. “I just want to be sure that their eyes are open to the fact that the risk is still very real, and that certain people die even at a young age. And there is still the social obligation: It’s not just about you.”
State and federal guidelines allow people who are fully vaccinated to gather together, indoors and without masks. They can also gather maskfree with people who are not vaccinated, as long as everyone is considered low risk for serious illness and death. For example, that means grandparents can hug their unvaccinated grandchildren and young people with mixed vaccination status can hang out in small groups.
But the guidance doesn’t always match individuals’ comfort levels. Even people who are fully vaccinated may not be ready to fully engage in social activities. Communication is key right now, public health experts say. Ask before hugging a friend for the first time in a year. Don’t judge family members for wanting to keep on their masks even after they’re vaccinated.
“People should be permitted to do what they’re comfortable with,” said Dr. Bela Matyas, the Solano County health officer. “I’m not telling people they shouldn’t embrace opportunities now. But do it in a manner that respects everybody’s concerns.”
Stephen Shortell, former dean of the UC Berkeley School of Public Health, said that as someone who was among the earliest to be fully vaccinated, he’s encountered many situations where he’s had to politely gauge people’s comfort levels. His own risk analysis, and how that translates into his daily routines, is still shifting too.
“A couple days ago, somebody came in to shake my hand, and I said, ‘No, no, let’s do the public health handshake,’ and we bumped elbows,” Shortell said with a laugh. “We’re all kind of stumbling around a bit, trying to figure out what is right, what is appropriate behavior in this interlude period.”
The mingling of vaccinated and unvaccinated isn’t just happening in social circles but in other public spaces, from grocery stores and coffee shops to airplanes and hiking trails. Some of the vaccinated already are discarding their masks and social distancing protocols in public, which is creating dilemmas separate from the private ones between friends and family.
On a recent afternoon at Berkeley’s Fourth Street shopping district, several retail workers said they’ve seen more people with masks around their chins, both inside stores and on the street. Timothy Brown, a partially vaccinated assistant manager at Five Little Monkeys toy store, said he occasionally has to tell customers to pull their masks up.
“I’ve had a couple people say, ‘No, no I’m vaccinated,’ and I have to correct them,” Brown said. “That’s great, but for now these rules are still intact and you have to follow them.”
Down the block at home and garden store the Gardener, operations director Cindy Pugh said she hasn’t had any issues with customers. But as someone who’s also partially vaccinated, she said she’s determined to remain vigilant with her own behaviors.
When friends who are fully vaccinated invite her to hang out, “we sit outside and I wear a mask and they don’t,” Pugh said. “We’ve had a year of being careful, and as much as I really want to get back to it, I’ve been trying very hard to protect the people I work with. Until we’re all vaccinated, that’s not my place to act differently yet.”