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Opinion The Checkup With Dr. Wen: Should the unvaccinated be excluded from family gatherings?

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Over the past several months, many readers have asked a version of this question: Should they continue to ask that everyone gathering with them be vaccinated and perhaps even up-to-date with their booster shots?

Some have been more pointed: “I have no time or patience for people who are still (still!) unvaccinated,” Ellen from New York wrote. “My two cousins were excluded from holiday gatherings last year, but other family members are pressing for them to come to this year’s Thanksgiving dinner. Can I safely do this, considering we have quite a few elderly people attending?”

In the early months of the vaccine rollout, the data pointed strongly in favor of requiring vaccines because they were highly effective against infection and therefore against the spread of covid. In September 2021, I wrote a column with my colleague Sam Wang in which we equated the risk of remaining unvaccinated with the risk of driving intoxicated. At that point, vaccination reduced the risk of becoming infected by a factor of five, meaning if you were around an unvaccinated person compared to a vaccinated person, you were five times more likely to be around someone who had covid and could pass it on to you.

That’s why I favored vaccine requirements and advised readers that they could make their holiday gatherings safer by asking all those attending to be vaccinated. When boosters first came out, and initial data showed that they restored vaccine effectiveness against infection, I also thought requiring boosters made sense, because they substantially reduced the chance of someone becoming infected and therefore contagious to others.

Circumstances have changed. We now know that while being up-to-date with boosters continues to protect against severe disease, immunity against infection wanes in a matter of weeks. In addition, the omicron subvariants are partially immune-evasive, and the effectiveness against symptomatic infection is not high even during the period of optimal vaccine protection.

One study, published in JAMA in May, found that during the time of omicron predominance, vaccine effectiveness against symptomatic infection after two months was only 29 percent in children ages 5 to 11. It was just 17 percent in adolescents.

Another study, published in the New England Journal of Medicine (NEJM) in July, reported that there was essentially no difference in protection against infection between unvaccinated adults and people who received two vaccine doses six or more months prior. A third dose restored effectiveness to 52 percent, but, as other studies have demonstrated, this protection is likely short-lived.

It’s important to note that none of these findings should dissuade people from getting vaccinated. Rather, we need to be clear about what the covid vaccines do. They are very good at protecting us from hospitalization and death, which is a remarkable scientific success. But, as we learned from omicron, the vaccines are not so good at protecting us from contracting covid.

There’s another reason the likelihood of infection is no longer so different between the unvaccinated and the vaccinated: A large majority of both groups have had covid. Those who previously contracted covid still benefit from vaccination, as hybrid immunity appears to afford the strongest and most durable protection (indeed, the NEJM study found that prior infection plus three doses of the vaccine was 77 percent effective against infection). But it’s hard to make the case that someone still unvaccinated — who has almost certainly had covid — poses a greater danger to others than a vaccinated person.

My advice to Ellen is that her unvaccinated cousins can attend Thanksgiving this year. To make it safer, she could ask that everyone — vaccinated or not — take a rapid test just before arriving. Other measures, such as improving ventilation by holding some portion of the get-together outdoors and opening doors and windows, will also help.

And people who are feeling unwell should not attend, as they could be infected with something other than covid and sicken guests just the same.

Ask Dr. Wen

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“We would like to have friends who would be traveling from an international city to visit us in our home. How can we remain safe from covid and still welcome them after their long journey? We both are elderly and vaccinated. They’ve had some covid shots but generally don’t wear masks. We do not want covid. We would like to host them in our home. Your suggestions?” Judy from Hawaii

Would your visitors be willing to wear masks during their travels and for a few days before — essentially to have a short quarantine ahead of their trip during which they limit exposure and do not visit others, maskless, in indoor settings? If so (and if they make sure to wear an N95 or equivalent mask during these periods), have them take a rapid test just before seeing you. These steps should reduce the risk of them being asymptomatic covid carriers who could infect your family.

“I have been avoiding going into restaurants, but as the pandemic is ongoing, I am realizing that this is probably not feasible long term, especially as the colder months are upon us. Can you please give me some guidance? Is there a safer way to go about this? My husband and I are 61 and 59, and we have been fortunate to have avoided getting covid thus far. We mask at the gym and in crowded places, but socialize unmasked in small group settings. I am also a kindergarten teacher and have continued to mask at work. I would really appreciate some guidance!” Marla from Maryland

A lot of people have come to the conclusion that covid is here to stay and that there is a cost to forgoing activities that carry some infection risk but are otherwise important to us. It seems you’ve already made such a decision when it comes to socializing unmasked with small groups of friends. Such an activity is undoubtedly important for your sense of well-being, but you are still being careful to limit the group size and therefore to try to reduce your exposure.

You could use a similar calculus when it comes to dining at indoor restaurants. Perhaps you could begin with a restaurant with a lot of space between tables. Go with a few close friends — maybe the same small group that you’ve been socializing with already. Bring a mask and use it if you need to wait in a crowded reception area or go to the restroom. These actions won’t eliminate risk, but they will reduce it while allowing you to resume indoor dining.

“I cannot take the Pfizer or Moderna vaccines. I have allergies to PEG. It was suggested that I restart my vaccine protocol with the Novavax vaccine (I had the Johnson & Johnson vaccine and the J&J booster in September and December 2021). Will the Novavax vaccine protect me from the new variants?” Cindy from Indiana

PEG, or polyethylene glycol, is a component of the Pfizer and Moderna vaccines, and you are right to avoid these vaccines because of your known allergy.

At the time you received your vaccines, Johnson & Johnson was the only other vaccine authorized in the United States. You already completed your primary series, which is one dose of the J&J vaccine, and you had one J&J booster. So you don’t need to restart your vaccine series. Rather, you need one booster dose to be up-to-date with your vaccine.

The Novavax vaccine is a reasonable choice for you. The Centers for Disease Control and Prevention allows for this vaccine to be given as a booster in a “mix-and-match” format for adults who completed their primary vaccine series, so anyone who got at least two doses of Pfizer or Moderna, or one dose of J&J, can get Novavax. This vaccine is not reconfigured to target the omicron subvariants, but it should have broad coverage against them. (The company has said its vaccine produced a strong antibody response against BA.1, BA.2 and the dominant BA.5 subvariant.)

The Post has also compiled Q&As from my previous newsletters. You can read them here.

What I’m reading

In a large JAMA Network Open study, researchers compared the severity of disease for people who contracted the BA.2 omicron subvariant with that of the BA.1 and delta variants. They found the mortality rate for delta was 0.7 percent; for the original omicron BA.1 variant, it was 0.4 percent. It dropped to 0.3 percent for BA.2. Patients infected with delta and BA.1 were also more likely to require hospitalization, invasive ventilation and intensive care admission. Hopefully, this is an indication that SARS-CoV-2 is becoming less severe as it evolves.

A clinical trial of Moderna’s coronavirus vaccine in 6-month-old to 5-year-old children found that it is safe and protects just as well against infection as it does in young adults. Two doses of this vaccine elicited a strong antibody response, and the effectiveness against infection is 37 percent among 2- to 5-year-olds and about 50 percent among 6- to 23-month-olds. That’s comparable to the 46 percent effectiveness seen among 18- to 25-year-olds. These results, published in the New England Journal of Medicine, provides additional information to parents still questioning whether to give the vaccine to their younger children.

About 700 American women die every year from pregnancy and its complications. A new CDC report reviewed more than 1,000 pregnancy-related deaths and found that more than 4 in 5 of them were preventable. Nearly a quarter were related to a mental health condition such as suicide or drug overdose. Other common causes were hemorrhage, cardiac conditions and infection. More than half of the deaths occurred after the first week of birth, underscoring the need to provide better postpartum care.

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