Vaccination stickers
The Centers for Disease Control and Prevention’s V-Safe tracks health status after a COVID-19 vaccination. (GeekWire Photo)

On April 15, anyone in Washington state who is 16 or older can roll up their sleeve and get a shot of COVID-19 vaccine. And once two weeks have passed after either one dose of the Johnson & Johnson vaccine, or a second dose of the Moderna or Pfizer vaccine, that person is now considered fully vaccinated.

And then what?

Vaccinated people can savor the fact that they are now almost certainly protected against getting seriously sick from COVID, let alone needing hospitalization or worse. They’re also contributing to herd immunity, a sought-after, community-wide resilience against the virus that will help shield people who cannot be vaccinated because they’re too young or have health conditions.

But is it a green light for attending that year-delayed gala wedding, hopping a plane to Maui, or raising a glass at a favorite watering hole?

As with all things COVID, the answers are not absolute and are subject to change. And we’re in a tricky spot, racing to deliver shots as the number of positive cases is rapidly growing, with some epidemiologists saying we’re clearly already being swept up in a fourth wave of COVID infections. For his part, Dr. Anthony Fauci, America’s leading infectious disease scientist, hasn’t changed his behavior much post vaccination, and local experts say the same.

With all of that in mind, here’s what we’ve learned about responsible post-vaccine behavior and our path to a more normal existence.

Can I chuck my mask?

(Bigstock Image)

The Centers for Disease Control and Prevention advises vaccinated people to keep wearing masks, avoid crowds and poorly ventilated indoor spaces, and stay six feet apart from others.

But there are exceptions. People can skip the mask when in a home or a private setting with a small group in which everyone is fully vaccinated. Vaccinated people can forgo masks when in a private space with members of one other household that is not vaccinated.

Why mask when vaccinated? While the science is encouraging, there is still a chance that someone who is vaccinated can contract COVID, be asymptomatic and pass it to others.

But the mask habit is starting to slip for some. University of Washington epidemiologist Brandon Guthrie is part of a study that has returned repeatedly to the same mall and store entrances in King County to tally those with and without masks. The researchers have recently noticed a dip in usage among those 65 and older — which is also the population with the highest rates of vaccination.

“It’s absolutely understandable,” he said. “But we really need to keep doing the things that work [in stopping COVID], especially the things that are not that big of a deal, like wearing masks.”

When do we reach herd immunity?

Earlier in the pandemic, experts tossed out vaccination goals that would deliver us to the blissful, mask-free state of herd immunity, often hovering around 75 to 85% of the public. That was then.

“Our ability to understand what that number is went out the window a while ago,” said Dr. Joshua Schiffer, an infectious disease modeler at the Fred Hutchinson Cancer Research Center.

A lot of the blame falls on variants, which are mutations of the original COVID virus. There are five so-called variants of concern in the U.S., each with varying degrees of superpowers that make them more deadly, more infectious, and/or more resistant to vaccines. Those last two traits in particular, in combination with the potential that immunity could decline over time among vaccinated people, make it challenging to set a hard and fast herd immunity target. (There is promising new data showing vaccine protection lasts for a minimum of six months.)

As some countries reach high rates of immunization, researchers will be closely watching to see how variants do or don’t spread, which will give some indication of where herd immunity lies. Israel, for example, is a global leader in vaccination: 60% of the population has received at least one shot, and 55% are fully vaccinated.

A mass vaccination site hosted at Amazon earlier this year. (GeekWire Photo / Taylor Soper)

What’s up with the variants?

It’s in a virus’ nature to keep mutating and evolving, and the versions that have a reproductive advantage will start winning out over other variants. That’s certainly what we’ve seen during the pandemic.

The UK variant, B.1.1.7, has become the dominant form of COVID in the U.S. It’s roughly 50% more infectious, causes more severe infections, but luckily appears to be minimally resistant to current vaccines.

If not for the new variants, we likely could have avoided the fourth wave of infections, said Schiffer. And now state officials are warning that more restrictive rules for businesses in some counties could be implemented soon to try and tamp down the surge.

“It’s frustrating that we have tended to open up the things first that are the highest risk level,” said Guthrie, such as restaurants, bars and gyms, “and open the things that have the most benefit and lowest risk, like schools, last.”

So how do we fight the variants?

Vaccinations are making a difference already, experts said. More than 44% of King County residents age 16 and older  have had at least one COVID vaccine shot, which is more than one-third of the entire population in the county that includes Seattle, Bellevue and Redmond.

“Had we not had 40% of our population vaccinated, we would be completely underwater right now,” Schiffer said. “That is having a very strong effect in terms of protecting people.”

And new vaccines are in the works. UW Medicine announced this week that it’s recruiting volunteers for a clinical trial evaluating a “second-generation” COVID-19 vaccine. The second stage of the study will include vaccines made with multiple viral proteins in the hope of boosting protection against variants.

Moderna said this week that it will supply booster shots against the variants by the end of this year.

What about our kids?

As many folks are giddy with visions of life when fully vaccinated, one might forget an important population who can’t yet get their shots: kids 15 and under. Pfizer has the only vaccine approved for 16 and 17 year olds in the U.S., and there are promising early results for the Pfizer and Moderna vaccines for kids as young as 12. The hope is they’ll be able to get the shots before school starts next year. Tests are underway in even younger children, with Moderna running trials in kids 6 months old and up.

In the meantime, while parents might start feeling easier about the risks they face, their younger kids are still vulnerable.

“Psychologically, people can really transfer their own level of concerns or feeling that you are safe onto other people around them, especially when there is this difference in vaccination status,” Guthrie said.

When and how do we get to ‘normal’?

The hope now is that a new, even more problematic variant doesn’t emerge as we race toward widespread vaccination. Research by Schiffer and his team shows that super-spreader events play a key role in launching variants, which argues for keeping crowd sizes to a minimum.

It’s also going to be important to overcome vaccination hesitancy. While we could reach high vaccination rates in some areas, there will likely be population pockets with less protective numbers that could become hotbeds for infections, Guthrie cautioned. Researchers are already noticing lower vaccination rates in parts of Eastern Washington, as reported in the Seattle Times, particularly in more politically conservative areas.

Worldwide vaccination is also essential. As many of the variants have shown, the virus doesn’t respect national borders.

While the risk of infection drops for those who are vaccinated, all of these factors mean that “normal” will return slowly.

“When this pandemic ends, it’s not going to be a sudden end,” Schiffer said. “It’s going to be in fits and starts and a gradual return to normal life.”

Bottom line: Do I book a flight to the Yucatán or Yosemite?

On a more upbeat note, the federal government has eased some travel-related restrictions for those who are vaccinated.

Fully vaccinated people can travel domestically without doing a COVID test before or after a trip, though Hawaii has its own restrictions. For international travel, vaccinated people still need a negative test before returning to the U.S., and the CDC says they “should” get tested 3-to-5 days after returning. Some countries their own testing rules before entering. In the U.S., neither domestic nor foreign journeys require a post-travel quarantine period.