Top 8 Reasons Why You Still Need to Wear a Mask and Take Precautions After Getting COVID-19 Vaccine

Vaccines may give you the false sense of security that mask-wearing, hand-washing, and social distancing are no longer needed. Unfortunately, that is not the case for COVID-19. One day we can, and we will get back to normalcy, but we need to continue to patiently mask-up and follow the public health measures for a little while longer, just until enough people are vaccinated. To effectively contain this coronavirus pandemic, we need to leverage both vaccination and reducing our exposure to the corona beast. While vaccination will teach the body to successfully fight off the virus without getting sick, public health measures will decrease our exposure to the COVID-19 coronavirus. Both measures remain mission-critical to tame the pandemic successfully.

Here, we have outlined 8 reasons with context behind why you need to continue wearing a mask even after vaccination:

Vaccination won’t grant you instant immunity to the coronavirus

Pfizer/BioNTech, Moderna, and AstraZeneca-Oxford's vaccines require two doses that are administered 3 to 4 weeks apart. It takes time to build immune protection. Depending on the vaccine, it can take four to six weeks from initial dosing to achieve immune protection against a subsequent infection from the coronavirus. Until sufficient immunity is built, it is still possible to contract an infection and become sick. There have been several cases where people have contracted COVID-19 within a few days of receiving the first dose of the vaccine. After all, the first dose of the Pfizer-BioNTech vaccines gives you about 52% effectiveness in preventing COVID-19. It is only after the 2nd dose you increase that level of protection to 95%.

The herd immunity or community level protection threshold for COVID-19 coronavirus is unknown

Herd immunity occurs when enough people in the community are exposed to the virus, usually through vaccination, and thereby limits the ability of the virus to spread. Herd immunity can be better understood as herd protection. When a high percentage of the population is vaccinated, the infection cannot spread as easily, mainly because there aren’t that many people left who are unexposed or unvaccinated and can succumb to the infection—therefore, the disease can potentially disappear. But, the key to making herd immunity work is by vaccinating most of the population. The percentage of the population who needs to be vaccinated to achieve herd immunity can vary by disease. For example, in the case of measles, 19 out of 20 people (95%) need to be vaccinated to protect the remaining 1 out of 20 who are not vaccinated.

We currently do not know the threshold level of herd immunity needed to curb the spread of the coronavirus pandemic. According to the Centers for Disease Control and Prevention (CDC), the herd immunity threshold for COVID-19 has yet to be established.

We still do not know about the duration of COVID-19 vaccine immunity

The length of protection from the COVID-19 vaccines is yet to be determined. This is something the vaccine manufacturers and FDA will continue to monitor as vaccination campaigns are rolled out. We now have limited optimistic data that immune protection against the coronavirus persisted beyond six months in certain patients infected with COVID-19.

How things pan out in the real world setting typically vary to some extent from the outcomes seen in a controlled clinical study

Clinical studies are typically strictly controlled with specific set criteria and they investigate carefully defined patient populations. However, in a real-world setting, vaccine effectiveness, safety, treatment pattern, and patient behavior vary since they are reflective of the everyday clinical practice rather than a controlled environment of a conventional clinical trial. Factors such as how the vaccine is stored, transported, administered and the health condition of an individual can alter the real-world effectiveness and safety of the vaccine. In the real-world setting, we will likely have more people with diseases that weren’t necessarily evaluated in the clinical trials. In the coming days, we will find out how operational logistics along with an individual's unique medical conditions may affect overall immunity levels from these vaccines.

We still do not fully understand about COVID-19 coronavirus reinfection and natural immunity

Though seemingly rare, reinfection or catching COVID-19 a second time is possible. In a recent study, experts tried to look for insights from infections with four similar human coronaviruses that are seasonal so that they may reveal commonalities applicable to the coronavirus that causes COVID-19 (SARS-CoV-2). Healthy individuals who were monitored for 35 years were found to be reinfected with the same seasonal coronavirus frequently at 12 months after infection with the same virus.

Reinfection can occur only when our body’s protective immunity, meaning that protection acquired from a previous infection with the same virus, is insufficient. The fact that natural infection occurs for all four seasonal coronaviruses, suggests that it is maybe a common feature for all human coronaviruses, including SARS-CoV-2. And reinfection frequency after 12 months indicate that protective immunity may be short-lived.

Many experts believe that a second infection may be milder than the first infection, and therefore could even be not symptomatic. These asymptomatic individuals are perfectly capable of spreading or transmitting the virus to others. Hence, the right thing to do is to mask up, continue observing the public health measures and social distancing until we achieve sufficient herd immunity or community protection via vaccination.

It is unclear whether you could be contagious and infect others even after getting vaccinated

You may be baffled as to how it is possible to be contagious and transmit the virus to others when the vaccines proved to be more than 94% efficacious? Let’s focus on the mRNA vaccines for now. Well, first, it is important to understand what we know versus what we don't know about the extent of protection we get from these vaccines.

In theory, a vaccine should stop both the infection and the transmission. However, we don’t have sufficient information to say for sure that is true of the COVID-19 vaccines. Due to time constraints, the focus of the clinical trials had to be somewhat narrow, such that researchers had only prioritized to know whether the vaccines prevented illness and whether they were safe. And that is totally fine given the urgent circumstances. This of course, however, means that we had to compromise on information such as whether vaccinated people can still spread the virus. With other vaccines, we have years of data to evaluate that question, but not for COVID-19.

What we do know is that the Pfizer-BioNTech and Moderna vaccines are very effective at preventing symptomatic illness and the severity of the disease. Meaning, these vaccines seem to prevent people from (1) getting so sick that they develop symptoms, and (2) becoming severely ill that they have to end up in the hospital. While it is great and a fantastic achievement, Pfizer/BioNTech, and Moderna did not track cases of asymptomatic infections with COVID-19 in their clinical trials. The studies never showed whether the vaccine prevents someone from carrying COVID-19 and spreading it to others. This means that they didn’t evaluate the ability of the vaccine to decrease virus transmission.

Actually, from a biological standpoint, it wouldn’t be surprising at all if someone was protected from symptoms of COVID-19 through vaccination but was still capable of spreading the virus. For instance, someone could be an asymptomatic carrier of the coronavirus in this case. One mechanism that will allow this to happen is virus transmission through boogers and phlegm.

In the case of the COVID-19 coronavirus, and in most respiratory infections for that matter, the nose is the main port of entry. The virus can also enter through the throat. Together the nose and the throat are part of the upper respiratory tracts that are protected by a mucous layer. This layer acts as a barrier to infectious agents and slows down the virus before it takes hold elsewhere in the body. The virus can however rapidly multiply in the mucosal tissue in your nose and throat.

The coronavirus vaccines are injected deep into the muscles to stimulate the immune system and produce antibodies--which showed to have generated enough protection to keep the vaccinated person from getting sick. But the mucosal tissue harboring mucus in your nose and throat also acts as a barrier for things like antibodies and immune cells from getting out and blocking the virus as it enters the upper respiratory tracts.

Some of the antibodies generated from vaccines will circulate in the blood supplied to the nasal passage and provide guard, but it is not known how much of those antibodies can be militarized, or how quickly. Even if the COVID-19 vaccine has trained your immune cells to recognize and block viruses they detect, it might not be able to neutralize the ones resting in your nose and throat.

While these COVID-19 viruses wouldn’t be able to make you sick, they still might be able to replicate in your nasal/throat passageway and spread when you speak, breath, sneeze, and so on. Hence, you can transmit the virus to others when you cough it back out of your nose and mouth, where the virus could encounter your unvaccinated friends, family, and the vulnerable ones who can’t have the vaccine.

Some studies have suggested that even people with no symptoms can have high quantities of coronavirus in their nose. The first person to be reinfected with the coronavirus was a 33-year-old man from Hong Kong who lacked symptoms but carried enough coronavirus to infect others.

This is the main reason why we can't stop wearing masks even after we get vaccinated, at least not in the short run. Those who get the vaccine should still mask-up and practice physical distancing.

We need to diligently study whether COVID-19 vaccination reduces coronaviral transmission before we can re-evaluate stringency around public health measures. The CDC is sponsoring studies that involve looking at the households of vaccinated people to see the impact of vaccination on close contact spread. Pfizer and Moderna will too continue to monitor virus transmission occurring/not occurring by their respective study participants. But ultimately what we need to know is whether people who are vaccinated can spread the virus in a real-world setting, as opposed to a controlled, clinical study setting.

If others opt out of the COVID-19 vaccine, wearing a mask can help you protect yourself and your community

Despite the COVID-19 vaccines being safe, some people may avoid vaccination. Of course, coronavirus vaccine myths and other misinformation have only provoked this hesitancy further. Others are unnecessarily concerned that the vaccine was developed too rapidly, and hence questioning safety, even though the vaccines have undergone extensive clinical assessments.

While a vaccine won't completely eradicate the coronavirus, it would be the most effective way to reach herd immunity. However, to get there, most of the population will need to get vaccinated. Unfortunately, not everyone can get the vaccine all at once due to limitations with manufacturing. On top of that, if a significant portion of the population refuses to get the vaccine, we won’t likely see numbers of new COVID-19 cases decrease as quickly.

If you stop wearing a mask, those who are NOT vaccinated might think it's okay to stop wearing a mask

There is already so much hesitancy around practicing proper public health measures. According to a Vox survey, 32% of respondents said they don't wear a mask when attending a sit-down gathering. If you stop wearing masks after getting vaccinated, think about how that might tempt others who haven’t been vaccinated to assume masks aren’t needed anymore. And if those unvaccinated individuals contract the coronavirus, they can spread the disease rather faster since they won’t be wearing a mask.

Does that mean we will need to wear masks in public from now on indefinitely?

No, not forever. But we would need to wear masks and practice good measures for a while longer. Experts have estimated that about 70% of the population must be vaccinated before we achieve herd immunity through vaccination. At that point, enough people will have the immune protection so that the virus won't spread so easily. 70% of the population amounts to about 230 million Americans or ~5.5 billion people worldwide who must receive the vaccine to get to herd immunity.

We still have to work through several logistical challenges before the vaccines make it into peoples’ arms. How quickly we reach herd immunity will depend upon vaccine production, distribution, proper storage, and the willingness of the people to take the vaccine. The initial allotment of vaccines will reach only a low single digit percentage of the population. It will take time to scale up production for 70% of the population. Also, recall that the vaccines that are available to date are two-dose shots, so we will need double the number of doses as people. If all goes according to plans, the best scenarios would be late spring or early summer for most Americans to get the vaccine. Soon afterward we could probably see one another without masks - but not before.

Because there are concerns that many people will not take the vaccine even when it is available, we need to roll out thoughtful public education campaigns that are tailored to different communities. We need everyone’s cooperation in this. Take the vaccine when it’s your turn. Convince your family and friends about the importance of vaccination. Spread the truth about vaccines and how they can save lives and end the pandemic.

Public health measures have proven great utility at preventing infection and transmission of the coronavirus. It has been shown that face masks can reduce a person’s risk of infection by 70%. That is not trivial in any sense, particularly when we are faced with staggering death tolls due to COVID-19. Masks have proven to suppress transmission and save lives, as mentioned by the World Health Organization (WHO). One study showed if 95% of the public were to wear a mask, tens of thousands of lives could be saved. Public health measures combined with the vaccines provide an opportunity to significantly reduce the risk of illness while we wait to achieve herd immunity through vaccination. Only then can we relax our mask and social distance mandates to get back to normalcy. If we can get through these difficult months during the first half of 2021, the summer and early fall hold much promise.

VaxTherapy is NOT affiliated with any of the pharma/biotech companies working on COVID-19 vaccines. The purpose of this post is to provide education and awareness from a virologist’s independent perspective based on available facts and data.

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