Grandparents and vaccines: Now what?

As COVID-19 vaccines roll out across the US, many grandparents — including one co-author of this blog post — are thrilled to hold out their arms for a jab. In some parts of the country, these vaccinations began as early as mid-January. By mid-February, legions of energized and relieved seniors were trading selfie shots of their newly vaccinated arms.

Grandparents, like other seniors, wanted the vaccine to keep themselves safe. However, there was another compelling reason: the desire to hug grandchildren. Ellen Glazer, LICSW, asked fellow grandparents in different states — some of whom live minutes away from grandchildren, and some who are separated by continents — what they look forward to once fully vaccinated.

Below, Amy Sherman, MD, an infectious disease specialist and instructor in medicine at Harvard Medical School, weighs in on a number of hopes and questions — some very specific, and some that can help everyone. Keep in mind that experts may disagree about what is or isn’t safe to do after vaccination. Also, advice is likely to change as we learn more about the vaccines and as a larger number of people get vaccinated, bringing herd immunity closer.

While some of the current messages — stay cautious, practice protective measures — may feel frustrating for grandparents relieved to have gotten the vaccine, they’re necessary. Reflecting on the past year, many realize that practices that seemed so difficult at the start of the pandemic, such as wearing masks and engaging in some degree of social distance, have become part of our lives. These new habits enable us to move forward with small, well-informed, and hopeful steps toward our new normal.

Can I make others sick? Is it safe to see (and hug) grandkids and family who haven’t had the vaccine?

Studies show both mRNA vaccines (Moderna and Pfizer/BioNTech) and the newly authorized Johnson & Johnson vaccine are extremely effective in reducing severe disease, hospitalizations, and deaths. (Click here for more information about these vaccines.)

But we don’t know if these vaccines prevent asymptomatic infection — that is, being sick with the virus without symptoms like fever, cough, and shortness of breath. So it’s possible that you could have the virus without symptoms, and spread the virus to others.

Generally, the more closely people interact and the longer they spend with others, the higher the risk of getting or spreading the virus, according to the Centers for Disease Control and Prevention (CDC).

With those words of caution, it is reasonable to see and hug your family and grandkids if you are fully vaccinated. That means at least 14 days have passed since you had your second dose of the Pfizer/BioNTech or Moderna vaccines, or your single dose of the Johnson & Johnson vaccine.

The new recommendations below are based upon the vaccination status of yourself and your family members. As we learn more, these recommendations may change.

If you are fully vaccinated and visiting fully vaccinated family or friends

• Indoor visits without masks are okay and likely low-risk.

If you are fully vaccinated and visiting healthy, but not yet vaccinated grandchildren and adult children living in a single household

• Indoor visits without masks are okay and likely low-risk. Although spreading the virus is still possible, the risk of healthy and, particularly, young individuals developing severe COVID-19 is low.

If you are fully vaccinated and visiting a single household of family or friends who are not yet vaccinated, and are at risk for severe COVID-19 due to age (65 or older) or health conditions

• All of you should wear well-fitted masks and stay six feet away from each other when indoors. If possible, hold the visit outdoors or in a well-ventilated space to reduce risk.

Mixing two or more households that have people who aren’t yet vaccinated raises the risk for getting the virus that causes COVID-19 for anyone who isn’t vaccinated.

When possible, everyone gathering for a visit can lower risk further by avoiding contact with people outside their household for 14 days before a visit, and/or by getting tested for the virus one to three days before a visit.

What should I do in public settings?

In public settings, everyone should continue to take protective measures to stay healthy, regardless of personal vaccination status:

• Wash hands often.
• Wear masks that fit well.
• Limit time spent with family members who are not yet vaccinated.
• Hold visits outdoors if you can.
• Avoid large in-person gatherings.

Can I still get sick?

I like to think of these vaccines as being a water-resistant jacket, as opposed to a waterproof jacket. With the vaccine, you may still get wet, but not soaked. As explained above, it is still possible to develop asymptomatic or mild illness. A small proportion of people may get more severe illness despite vaccination. Further, it’s important to note that

• vaccines do not always provide robust immune responses in people ages 65 and older, because the immune system normally weakens with age. Therefore, even if vaccinated, you may not have the same high level of protection against moderate to severe disease described in the studies.
• we are still learning about variant strains now circulating. We do not yet know how the vaccines perform in the real world against these variants. Early indications suggest the mRNA vaccines may not be as effective against some variants, but still seem to help avoid hospitalizations and death.

What if I live with someone who hasn’t had the vaccine?

It’s best to continue the safe behaviors you were doing pre-vaccination to help protect your spouse or others that you live with. The vaccine is another layer of protection for you, and also helps protect your spouse or others in your immediate household. However, transmission is still possible.

Can I visit with nearby friends or family who have had the vaccine — for example, have a meal together indoors or have a grandchild stay with us?

If you and your family or friends have been vaccinated, you should consider spending time together. Talk to your family or friends before gathering, to ensure everyone is comfortable socializing in person and with the general precautions others are taking. Also remember that a person is considered fully vaccinated two weeks after receiving the second vaccine dose (for Moderna or Pfizer/BioNTech), or two weeks after receiving the single-dose Johnson & Johnson (Janssen) vaccine.

Can I travel on a plane safely (and is first class any safer than coach)?

Start by checking CDC, state, and local guidelines before you fly. The CDC currently recommends postponing travel because COVID-19 cases are still very high.

Your risk isn’t confined to the plane itself (or potential differences between first class and coach). How will you travel to and from the airport (public transportation, ride shares)? What about check-in lines at the airport, or sitting in the gate area with others in close quarters for an extended period of time? Will you need to use public restrooms, or eat in areas with lots of other travelers? These scenarios carry higher risks of virus transmission.

If it’s possible to drive, this may be a better option in order to limit exposures. In the car, you can limit stops, pack food and eat and drink in the car, and avoid large gatherings of people that occur in airports and public transit.

If you must fly, try to reduce risk and exposures as much as possible. Your vaccine is one layer of protection. Protect yourself in other ways to lower your chances of becoming infected with the virus that causes COVID-19:

• Get a viral test one to three days before you leave. If it’s positive or you develop symptoms, do not fly.
• Some airlines are limiting seating and keeping middle seats open. Try to book a flight that is abiding by these guidelines.
• Drive yourself or have family drive you to the airport.
• Keep your mask on and avoid crowded areas in the airport.
• Avoid eating or drinking in waiting areas.
• On the plane, continue to wear a mask throughout the flight.
• Bring extra hand sanitizer and masks.

What precautions do I still need to take outside my household, and why?

COVID-19 rates remain very high in the community, and variants will continue to circulate. If you are exposed to the virus, you are not 100% protected from illness even if you’ve had the vaccine.

Until a high proportion of the population is vaccinated, the CDC recommends maintaining familiar precautions outside of the home, especially in public settings: wash hands often, wear masks, practice physical distancing. We need herd immunity in the community before we can relax any of these protective measures. Even if you’ve been vaccinated, you should continue to be mindful that you can still potentially spread the virus to others.

As we learn more about how long the vaccines will protect us and the circulating variants of the virus, these guidelines will continue to evolve.