It's been more than a year since I've seen my mother. Like many families, we live a fair distance apart and the pandemic has put a stop to our visits. I was supposed to go last April to help celebrate her 90th birthday, instead we shared a toast over the phone and tightly crossed our fingers that by summer things would be better. They weren't.
Then a few weeks ago my mother called to say that she'd been vaccinated. She's now more than two weeks out from her second dose of the Pfizer BioNTech COVID-19 vaccine and the thing I want to do most, is go and give her a long and belated birthday hug. But is that really a good idea, as I haven't been vaccinated yet? I called several infectious disease specialists to get their advice on visiting vaccinated older friends and relatives. And the answer is not a simple yes or no.
First things first
The vaccines available in the U.S. are extremely effective, but the protection is not perfect. And given that the virus is still circulating widely around the country, and more infectious new variants are starting to spread, it's still better to be cautious.
People 65 years and older account for 80% of COVID-19 deaths in the U.S., according to the Centers for Disease Control and Prevention, which is why they have been prioritized for the vaccines. But elderly people with weakened immune systems may not respond to them as well and the FDA has found the Moderna and Pfizer vaccines are somewhat less effective in people 65 and older.
The only thing that will finally cut the risk of infection will be when the U.S. reaches herd immunity, meaning that the virus is brought down to extremely low levels and we can get back to normal.
Until then, "You still pose a clear and present danger to your parents," says Dr. June McKoy, associate professor of medicine at Northwestern University Feinberg School of Medicine.
A visit may depend on where your loved-one lives
"Everybody got excited when the vaccines came out," says McKoy, a geriatrician who works with nursing homes in Chicago. "Families were hoping this would liberate their parents, but unfortunately, we are telling them, not yet."
For nursing homes and assisted living facilities, extra caution is warranted. That's because people who live there can be frail and have underlying conditions that make them even more vulnerable to severe illness and death. And in a communal living situation, one infection can put everyone at risk.
In these settings, meeting virtually or outside with masks is still safer, McKoy advises. "To come inside and really spend time, visitors should be vaccinated."
Inside the building, residents who have had their two doses should be allowed to get together in small groups and socialize, McKoy says. As long as any staff members who haven't been vaccinated wear masks.
If your relative lives independently, visit carefully
"Isolation itself is a pretty high risk factor for the elderly," says Dr. Saad Omer, Director of The Yale Institute for Global Health. "So reasonable people can have different perspectives on this because it's nuanced and we're making judgements."
Omer says if his parents were alive they would have been really distressed to be away from their grandchildren for such a long time, so he thinks some loosening up after getting the second dose is reasonable, especially for people who live independently.
Before the visit, double check to make sure the person you are visiting has had two shots, and it's been two weeks since the second dose. In that case it's OK to visit, agrees McKoy. "You should still wear your mask, make sure your hands are sanitized and you should still socially distance," she says.
The vaccine doesn't switch our normal lives back on, Omer cautions. It's more like a dimmer switch. After two doses "It's OK to socialize a little bit more, but it's not time for bingo night. It's not time for square dancing."
And be cautious about hugging and kissing, says Dr. William Schaffner, professor of infectious diseases at Vanderbilt University Medical Center. "Wear that mask, give them a quick hug around the waist, then back off. Don't kiss them extensively, and maintain your distance," Schaffner advises.
Take precautions so you don't get infected
Even if your loved-one has been vaccinated they could still become mildly infected — remember the clinical trials only looked at whether the vaccines prevent severe disease not infection, so a vaccinated person could unknowingly pass the virus on to you and others. That's why it's so important for people who've been vaccinated to keep wearing their masks, avoid crowded indoor places and socially distance.
"Many people are seeing this as the door opening out of the locked room," says Schaffner. "If only we can get vaccinated, we will be free. It's not that easy."
Until about 80% of people have been vaccinated and we get closer to herd immunity, he urges people to be satisfied with "half a loaf." Limit yourself to a quick visit, take a walk, sit on a park bench, wear your mask.
"Even if your own parents or grandparents are protected, they wouldn't want to contribute to spreading the virus to you or others," Omer says. So, "don't overdo it. Prioritize things that you want to do and slowly ease up. It's not a license for large gatherings."
Especially with the spread of new more contagious variants and variants that make the vaccines less effective.
Don't travel too far
One thing to consider before deciding to visit is how far you have to travel.
If your relative lives close by, or is reachable by car, a visit is more reasonable, Omer says. You can pack food, eat in the car, limit stops along the way to reduce your chances of infection.
"But if you are flying there that's a different risk," says Omer. Getting to and from the airport, waiting in check-in lines, put you at risk for infection.
"I just don't think it's safe quite yet," says Dr. Ravina Kullar, an epidemiologist and spokesperson for the Infectious Disease Society of America.
Kullar lives in Los Angeles and her mother lives in North Carolina. But she's not planning to visit just yet. "I would consider it safer once we achieve that herd immunity level and we are far from that point," Kullar says. "So I would say still wait."
The risk of travel is not just for you or your relative, it's for the entire community.
The three coronavirus variants that have scientists so worried have already been detected in the U.S. The variant that emerged in the U.K. is about 50% more contagious and is already spreading in at least 33 states. The variant from Brazil has been reported in Minnesota and the one from South Africa has been found in South Carolina and Maryland - the vaccines may be less effective against both.
And one of the best ways to slow the spread of these variants is for people not to travel.
Sadly, for me it's 'don't go'
And that's how my decision was made. My mother is a 90-year-old dynamo, who lives independently — in the northwest of England. If she were closer I would put on a mask, give her a quick squeeze and relish her company from across the room. But at this point in the pandemic, travelling from the U.S. to the U.K. and back again doesn't seem like a good idea for anyone. So we'll hunker down and continue our wonderful conversations over the phone. I feel lucky my mother was able to get the vaccine, as so many people around the world are still waiting. And I'm lucky my brother lives close by. But sadly, the birthday hug will have to wait.