EEH: What COVID-19 vaccines mean for the summer of 2021

The summer of 2021 is looking quite different from the summer of 2020.

In 2020, without a COVID-19 vaccine, the only way to protect the community was by staying away from others and covering noses and mouths with a face covering. Now, immunity from vaccines gives people the opportunity safely gather again.

There are now three highly effective COVID-19 vaccines available in the United States. As of May 2021, 92% of DuPage County residents over age 65 (the most vulnerable) have received at least one vaccine dose and 85% are fully immunized. Of eligible residents, 62% have received at least one dose and 53% are fully immunized, representing 45% of all residents.

In April 2021 COVID-19 vaccines became widely available to those 16 years and older, and in May 2021 Pfizer-BioNTech was approved for children as young as 12. There is still a long way to go before everyone is protected, but there has already been a huge impact on the number of new infections, hospitalizations and death.

Many people still have questions about how well the COVID-19 vaccine protects us. Consider these facts:

What is “fully immunized?"

It takes two weeks to develop the initial protection from the Pfizer or Moderna vaccine. But it’s not until two weeks after the second dose that someone has full immunity. For the single-dose Janssen (J&J), full immunity begins two weeks after the dose. The level of immunity after vaccination is several times higher than after natural infection, high enough to neutralize resistant variants.

Can someone who is fully immunized still get COVID-19?

Yes, but not as often and it is rarely severe. This is called a "breakthrough infection." The clinical trials in the United States showed a 94-95% efficacy for Moderna and Pfizer, and a 72% efficacy for Janssen (J&J), in preventing symptomatic COVID-19 infection.

For children ages 12-15, the Pfizer vaccine was 100% efficacious. Hospitalizations or death due to COVID-19 did not occur in vaccine recipients in the clinical trials.

Real world effectiveness was demonstrated in Israel: among 1.2 million, there was a 94% effectiveness against symptomatic infection, 87% protection against hospitalization among those infected, and 100% protection against COVID-19 death.

In the U.S., an analysis of 189 COVID-19 hospitalizations revealed that only 1 (0.5%) was fully immunized. Breakthrough infections that lead to hospitalizations are extremely rare and are thought to predominantly occur in those with immunodeficiencies or those on medications that severely impair immune function.

The Centers for Disease Control and Prevention (CDC) reported that as of May 17, 2021 out of 123 million vaccinated, there were 1,368 COVID-19 hospitalizations and 290 COVID-19 deaths.

COVID-19 vaccines protect against symptomatic and severe infection, but do they protect against asymptomatic infection and transmission?

Yes. Studies of healthcare workers in the U.S. who underwent weekly screenings have shown 90% effectiveness against testing positive for the virus regardless of symptoms. In Israel, healthcare workers tested weekly showed a 97% protection against symptomatic infection and 84% protection against asymptomatic infection.

In another study, fully immunized individuals who tested positive for the virus had lower levels of RNA, suggesting that they are less able to transmit the virus. This all fits in with the idea that immunity from vaccines leads to low viral burden, fewer testing positive, fewer progressing to develop symptoms, and fewer infectious to others.

Does this mean if I am fully immunized, I don’t need to wear a mask?

The CDC recently updated its guidance for fully immunized individuals. Fully immunized individuals can gather with other fully immunized individuals un-masked and without observing social distancing. The latest guidance also allows fully immunized individuals to gather unmasked with other non-fully immunized individuals who are masked and physically distant.

Exceptions are hospitals, trains, buses, airlines, airports and in crowds where physical distance is not possible. Masks may still need to be used for immunocompromised patients and in certain communities that have higher levels of transmission and lower levels of vaccination.

I am not fully immunized, but the cases are going down. Do I still need to mask?

Yes. The best way to protect yourself and others is to get vaccinated. Until you are fully vaccinated, wear a mask. It is expected there will be more surges in communities that have lower vaccination rates.

My child is not old enough to get vaccinated. What does that mean?

Children who are not fully immunized should continue to wear face coverings and physically distance until they can be fully immunized. As fewer adults will be susceptible to infection, there will be increased burden of infection on children. While COVID-19 is not often severe in children, the chances rise as there are more cases. COVID-19 vaccination virtually eliminates any chance of a severe infection and will allow children to safely play together again.

The summer of 2021 is shaping up to be very different than the summer of 2020, thanks to vaccines that provide immune protection. With more people vaccinated, there will be fewer people for the virus to infect and lower risk of exposure.

For more information, visit www.eehealth.org/coronavirus.