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As a COVID-19 expert, Linsey Marr, PhD, was among the first wave of Americans to get one of the two new coronavirus vaccines rolled out in December.
But her husband and two children have yet to receive their shots.
“The vaccine provided a mix of relief and the wish that both of us could have received the vaccine,” says Marr, a Virginia Tech specialist in the airborne transmission of viruses whose recent research centers on COVID-19.
“I am the only one in my household of four who has been vaccinated. My husband might be able to get it in a few months, and the kids…who knows?”
The complicated rollout of the coronavirus vaccines, which remain in limited supply, has created millions of households like the Marr family’s — where one person has been vaccinated but the others have not.
They typically involve a doctor, nurse, public health expert, research scientist, senior citizen, or others who were first in line to receive the vaccines developed by Moderna and Pfizer-BioNTech.
Because research has yet to confirm that vaccinated people are not contagious, experts say even those who’ve gotten the shots need to be careful to keep others in their homes safe.
That’s particularly true for frontline health care workers who are treating COVID-19 patients and may carry the virus — even if they show no symptoms — because they are exposed to it every day.
Marr says, for instance, getting vaccinated hasn’t changed her lifestyle much, or the precautions she’s taking to keep her husband, children, and others safe.
“The only thing that’s changing is that I am now the lucky one who gets to do all the grocery shopping,” she notes.
“Before, my husband and I shared the duty. I’m hoping to travel (very carefully) to see my parents, who have also been vaccinated, but there are concerns that if transmission is still possible in vaccinated people, I could bring the virus home to my household. So, we have discussed some kind of quarantine and testing plan for afterwards.”
Leana Wen, MD, an emergency medicine doctor and public health policy professor at George Washington University, says the situation for “mixed” households is tricky.
By design, most people whose professions make them eligible for vaccination face greater risks of exposure to people with COVID-19.
“Vaccination provides a level of assurance and protection that’s really important, and I think many health care workers have breathed a sigh of relief after receiving our shots,” says Wen. “Just because we have some level of risk at work doesn’t mean we should introduce other risk (i.e., seeing extended family or friends indoors).”
Wen, a former Baltimore health commissioner, is taking part in a clinical trial of an experimental two-shot Johnson & Johnson COVID-19 vaccine. As a result, she does not know whether she received the vaccine as part of the trial or a placebo.
Regardless, she’s following federal health recommendations that even vaccinated people should continue wearing masks, social distancing, and limiting time spent indoors with others — at home, at work, and in social situations — just as she’s been doing (and urging) since the start of the pandemic.
“The best thing to do is follow all safety protocols at work, and to reduce risk in other encounters, too,” says Wen.
How to Cope if Someone at Home Is Infected
While “mixed” households face some challenges, the difficulties are far greater in homes where one member has been infected but the others haven’t.
When Melissa Martin contracted COVID-19 in September, she was as worried about infecting her fiancé, Shane McGeehin, as she was about her own health.
While she recovered, Martin holed up in a separate room in the Atlanta area home the couple shares, and McGeehin spent time in a second home he owns. They communicated only via phone, text, and even video conferencing instead of face-to-face. They wore masks whenever they were together. And Martin kept a portable air cleaner — equipped with a high-efficiency particulate air (HEPA) filter — at her bedside.
“Shane has his own house, so while I was in quarantine, he stayed there,” Martin says. “When he came over to drop off food or take the dog out, he stayed in a separate room, and I did use a mask if he needed to come into my room.”
In addition to receiving the steroid dexamethasone and taking Tylenol, Martin used a neti pot to relieve her congestion. She also turned to peppermint essential oil, healthy foods, and deep breathing exercises to keep her blood oxygen levels and immunity high, which she says “may sound a little new age-y (but) it’s one of the biggest tips I have.”
After 14 days — during which she lost 12 pounds — Martin’s fever broke and she was on the way to recovery.
The upshot: “Shane tested negative the entire time.”
Now, she and McGeehin are eager to get the vaccine.
“After going through COVID once already, I can’t wait to get the vaccine because I never want to suffer with it again!” Martin says.
Lindsay Macheska faced similar challenges when she had COVID-19 last month after getting together with friends, several of whom later tested positive for the virus.
Macheska, a 26-year-old marketing professional, shares a one-bathroom New York City apartment with two other women. And when she learned she had COVID-19, after having a spiking fever and blinding headaches, she was worried she’d infect her housemates.
After considering a hotel stay, she decided to bunk with her parents in their Montville, NJ, home while she recovered.
“They have a basement with a separate entrance, so I decided it would be best to go there and quarantine there for 14 days,” she says, noting the area of the house has a separate ventilation system. “So, we would communicate through FaceTime, and they would periodically leave food for me by the back door.”
Eventually, one of her two housemates also caught the virus, so she joined Macheska in her parents’ basement for about a week of her quarantine.
“I recovered, with no treatment — just fluids and Advil,” she notes. “And my parents never got sick.”
Looking back, she “definitely” regrets attending the get-together with friends that led to her infection (“not my best decision”). But she says she learned a valuable lesson.
“It shows that it’s so easy to be exposed and you have to be careful. I let my guard down,” she says “Now, I am just hoping we can get the vaccine soon. But we have to take all the proper precautions because it’s still very prevalent.”
Scientific evidence indicates the Pfizer and Moderna vaccines are about 95% effective at preventing people from getting sick with COVID-19 symptoms. But the evidence has yet to show for certain whether the vaccines can prevent you from carrying, shedding, and spreading the virus — even if you don’t have any symptoms.
But the CDC on Wednesday said there is now enough evidence to say that people who have been vaccinated against COVID-19 do not need to quarantine for 14 days after they’ve been exposed to someone else who is infected. The caveat: This applies only if it’s been 14 days since the person vaccinated received their second dose, as it takes about 2 weeks after the second of the two-dose Pfizer and Moderna vaccines before they offer full protection, according to the CDC.
Vaccinated people have a 5% chance of falling ill if they’re exposed to the virus.
For now, the vaccine isn’t a medical license to throw away your mask and stop keeping your distance from others.
Experts say such precautions will likely be necessary until the country gets closer to what’s called “herd immunity,” where enough people are immune to a disease to make its spread unlikely.
Studies have estimated at least 70% of the U.S. population needs to be immune to COVID-19 to reach herd immunity, but that number is a moving target and could rise as new variants emerge.
Since the vaccine distribution began Dec. 14, about 44.8 million doses have been put into the arms of more than 33.7 million Americans — just over 10% of the total U.S. population — according to latest federal data collected by the CDC.
Amesh Adalja, MD, an emerging infectious diseases specialist with the Johns Hopkins University Center for Health Security, says some evidence is emerging that suggests vaccinated people may pose a lower risk of spreading the virus.
Moderna found, for instance, that those who received the shot and were tested for COVID between their first and second doses were less likely — by about two-thirds — to test positive for the virus. That suggests the vaccine may prevent some asymptomatic infections.
Although the findings are preliminary, and more results are needed, Adalja is optimistic about the possibility the vaccine may reduce both infection and transmission risk.
“In general, a vaccinated person is very unlikely to contract symptomatic COVID-19,” notes Adalja, who has received the vaccine but does not share a household with others.
“It is also becoming clear that they are less likely a transmission risk. It will take some time for public health guidance to change, as data accumulates, but being vaccinated does provide a path to normalcy.”
Marr says other vaccines in the pipeline, including one now being tested by AstraZeneca, may lower transmission risk.
“But until we know whether the same is true for the ones approved in the U.S., vaccinated people should still follow the same precautions as before to protect others,” she says
John R. Mascola, MD, director of the National Institute of Allergy and Infectious Diseases Vaccine Research Center, says questions about post-vaccine transmission could become minor concerns, if enough Americans choose to get the shot.
“Until we have broad-based vaccination and herd immunity, we should appreciate that it’s possible to still get exposed to the virus really from anybody whether they’re vaccinated or not,” he told The Wall Street Journal . But if most people get the vaccine, “some asymptomatic transmission is not going to have much of a public health implication.”
For now, experts say, vaccinated people should take the same precautions as those who have not received one of the COVID-19 shots. According to the CDC, that means:
Wear a mask over your nose and mouth.
Stay at least 6 feet away from others.
Avoid crowds and poorly ventilated indoor spaces.
Wash your hands often.
For more information, check out the CDC’s Act Now! website on how to protect yourself and others from getting and spreading COVID-19.
Linsey Marr, PhD, professor, Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA.
Leana Wen, MD, emergency medicine doctor; public health policy professor, George Washington University, Washington, D.C.
Amesh Adalja, MD, emerging infectious diseases specialist, Johns Hopkins University Center for Health Security, Baltimore.
Melissa Martin, Atlanta area.
Lindsay Macheska, New York City.
Kaiser Health News: “COVID Vaccines Appear Safe and Effective, but Key Questions Remain.”
CDC: “Frequently Asked Questions about vaccination,” “Covid Data Tracker,” “How to Protect Yourself & Others.”
The Wall Street Journal: “FDA Finds Moderna Covid-19 Vaccine Highly Effective.”
The Associated Press: “Study finds COVID-19 vaccine may reduce virus transmission.”
Mayo Clinic: “Herd immunity and COVID-19 (coronavirus): What you need to know.”