Dear Tripped Up,
I’ve had my first vaccination shot and plan to book a flight to California two weeks after my second one. Like so many others, I have not seen my grandchildren for more than 15 months, during which time the baby became a toddler and the preschooler became a young boy. Now that some of us are getting successfully vaccinated and are planning on flying to see our families, I have a few questions that I’m hoping you can clear up. Margot
1. Is it safe to travel by subway, train, bus or plane after I have been vaccinated? What are the proper protocols for protecting others?
Even before the vaccines arrived, mass transit was rarely labeled by health officials with blanket terms like “safe” or “unsafe.” Studies conducted over the summer suggested that when certain criteria are met, subways are safer, from a viral-transmission standpoint, than one might assume. A trove of new research indicates that the chance of contracting the coronavirus while flying is low. For trains and planes alike, the focus is — and will continue to be — concrete, actionable measures that mitigate risk, like high-efficiency air filtration, enhanced disinfection, mask requirements, social distancing and capacity limits.
With that in mind, let’s rephrase your first question:
“It is safer for her, as the individual, to travel that way, and not herself get sick,” said Keri N. Althoff, an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health, deliberately emphasizing those italicized words.
“We know that vaccines protect the person who has been vaccinated from getting really, really sick to the point of hospitalization or death,” Dr. Althoff said. “But we don’t know whether or not a vaccinated person can still become infected and transmit either asymptomatic infection or very mild unnoticed infection. We’re still waiting for the data.”
Only about 8 percent of the United States population has gotten at least one shot, according to the latest numbers, which means you’re in the minority right now; if you’re in line to board a plane, there’s a good chance the person behind you won’t have been jabbed yet.
That’s why the second part of your question is so important, and why the basic protocols for protecting others (masks, distancing, hand-washing) haven’t changed. It’s also why airlines and other transportation companies are nowhere close to getting rid of them. In fact, those protocols have only been strengthened in recent weeks by the Centers for Disease Control and Prevention, which has issued a mask mandate for all domestic transportation.
“I know it’s frustrating, especially for grandparents, because it almost feels like the goal posts have been moved again,” Dr. Althoff said. “But we’ve always said that you cannot just rip your mask off and run around like it’s 2019 once you’re vaccinated. We’ve all learned not only how important our individual health is, but also how interconnected we are.”
2. Do I need a negative virus test to fly if I have a vaccination card?
For the time being, vaccination cards don’t supersede — well, much of anything.
Last week, the C.D.C. enacted an order requiring a negative coronavirus test (or documentation of recovery) for all incoming international travelers (ages 2 and older), including United States citizens. The test must be completed within three days of departure and submitted to the airline before boarding, and there are no exceptions for antibody or vaccination status.
“It’s directly related to the fact that we don’t know if people who are vaccinated are also protected from infection and cannot transmit,” Dr. Althoff said. “So those guidelines are going to stay in place until the science says differently.”
There is currently no federal testing mandate for domestic flights like the one you’re hoping to take, but C.D.C. officials have said they’re “actively looking at it.” (On earnings calls last week, executives from several domestic airlines expressed the concern that such a requirement would further stymie the faltering industry.)
Currently more than 150 million people — almost half the population — are eligible to be vaccinated. But each state makes the final decision about who goes first. The nation’s 21 million health care workers and three million residents of long-term care facilities were the first to qualify. In mid-January, federal officials urged all states to open up eligibility to everyone 65 and older and to adults of any age with medical conditions that put them at high risk of becoming seriously ill or dying from Covid-19. Adults in the general population are at the back of the line. If federal and state health officials can clear up bottlenecks in vaccine distribution, everyone 16 and older will become eligible as early as this spring or early summer. The vaccine hasn’t been approved in children, although studies are underway. It may be months before a vaccine is available for anyone under the age of 16. Go to your state health website for up-to-date information on vaccination policies in your area
You should not have to pay anything out of pocket to get the vaccine, although you will be asked for insurance information. If you don’t have insurance, you should still be given the vaccine at no charge. Congress passed legislation this spring that bars insurers from applying any cost sharing, such as a co-payment or deductible. It layered on additional protections barring pharmacies, doctors and hospitals from billing patients, including those who are uninsured. Even so, health experts do worry that patients might stumble into loopholes that leave them vulnerable to surprise bills. This could happen to those who are charged a doctor visit fee along with their vaccine, or Americans who have certain types of health coverage that do not fall under the new rules. If you get your vaccine from a doctor’s office or urgent care clinic, talk to them about potential hidden charges. To be sure you won’t get a surprise bill, the best bet is to get your vaccine at a health department vaccination site or a local pharmacy once the shots become more widely available.
That is to be determined. It’s possible that Covid-19 vaccinations will become an annual event, just like the flu shot. Or it may be that the benefits of the vaccine last longer than a year. We have to wait to see how durable the protection from the vaccines is. To determine this, researchers are going to be tracking vaccinated people to look for “breakthrough cases” — those people who get sick with Covid-19 despite vaccination. That is a sign of weakening protection and will give researchers clues about how long the vaccine lasts. They will also be monitoring levels of antibodies and T cells in the blood of vaccinated people to determine whether and when a booster shot might be needed. It’s conceivable that people may need boosters every few months, once a year or only every few years. It’s just a matter of waiting for the data.
As for what those vaccination cards might mean in the future, experts are predicting a surge in third-party “health passports” that store test results, vaccination records and travel guidelines. Some, like CommonPass and the IATA Travel Pass, have already been tested on different routes and airlines and will be further assessed, to eventually be rolled out to the public in the coming months. But for now these apps are information guardians only: Travelers shouldn’t expect them to override testing mandates and other guidelines.
3. Do I need to follow each specific state’s quarantine regulations if I have been fully vaccinated? Such a requirement would make it very difficult to travel.
With the exception of New Hampshire, which now allows people who are 14 days past their second shot to skip quarantine, most states are still requiring fully vaccinated people to adhere to quarantine requirements.
“States are being conservative and waiting for that data,” Dr. Althoff said. “That’s why the C.D.C. and most public health leaders are not recommending any travel until things calm down. Vaccine or not, there are no silver bullets here.”
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