‘I’m fully vaccinated. Now what?’

From outdoor dining to visiting loved ones, we heard from experts about how people should navigate their newfound immunity.

Itzel Diaz celebrates getting her second dose of vaccine with a selfie.
Itzel Diaz celebrates getting her second dose with a selfie. Credit: Amir Aziz

Kristian Ruggieri got her Johnson & Johnson shot at the Oakland Coliseum on April 2. Two weeks later, she met two other fully vaccinated friends for a walk, followed by a meal indoors, which she says felt “both wonderful and made me slightly anxious.”

Ruggieri is one of the more than half a million Alameda County residents now considered fully vaccinated. But after more than a year of “internalizing good pandemic citizenship,” she and others are wondering how to safely ease back to “normal,” like eating in restaurants and gathering with friends. 

This story was originally published on The Oaklandside.

“Going back to activities like indoor dining and socializing inside without a mask feel wrong,” Ruggieri said. “Still wrapping my mind around the fact that these things are both allowed and not as risky as they were.”

California’s tiered reopening system has relied heavily on key pandemic metrics, such as hospitalization and positive test rates, and since those are down statewide, many pandemic restrictions have been lifted.

State leaders are expecting California’s continued vaccine rollout—the largest in the nation—to keep those key metrics down far enough to meet the state’s tentative goal of ditching its tier system come June 15. 

President Joe Biden announced Wednesday that, by the end of the day, more than 200 million doses of the COVID-19 vaccine would be administered in the United States. That comes as California has the second-lowest COVID-19 case rate in the United States, just slightly behind Hawaii.

As of Thursday, 851,000 Alameda County residents have received at least one shot, including more than 70,000 Berkeleyans, according to the latest figures on Alameda County’s COVID-19 dashboard.  

The U.S. Centers for Disease Control and Prevention recently updated its guidelines for vaccinated people, but what they should or shouldn’t do at this point in the pandemic remains tricky with virus variants becoming dominant spreaders in the United States and the impact of “vaccine breakthrough” infections. 

Kimi Watkins-Tartt, director of Alameda County’s public health department, says everyone isn’t vaccinated just yet, so people need to be reminded to wear their masks and maintain social distancing from people they don’t live with. 

“We still need to protect ourselves and others and do all the things we’ve been doing this whole year in the workplace and in other places we go,” Watkins-Tartt said during the most recent meeting of the Alameda County Community Advisory Group, or CAG. “We don’t know who has been vaccinated and who hasn’t, so we need to act like no one is, quite frankly.”

What does ‘fully vaccinated’ mean? 

Oakland Coliseum is the newest location hosting COVID-19 vaccinations in the parking lot.
The Oakland Coliseum has a mass COVID-19 vaccination site in its parking lot. Credit: Amir Aziz

For the Pfizer and Moderna shots, the CDC considers a person to be fully vaccinated two weeks after their second shot. 

Being fully vaccinated means people have a 90% smaller chance of developing a COVID-19 infection after significant exposure to the coronavirus, according to the CDC’s “real world” study of frontline medical workers who received either the Pfizer or Moderna shots. 

For those who received the Johnson & Johnson “one and done” vaccine before it was “paused” earlier this month, the company’s data shows there’s an immune response after 15 days, but protection reaches its full potential after 29 days. But the CDC says full immunity is reached after two weeks.

That’s the amount of time the shots were tested before the U.S. Food and Drug Administration gave them its Emergency Use Authorization, or the federal government’s streamlined process to approve drugs and products in emergencies.

Since then, researchers in Israel and the United States published a study in the New England Journal of Medicine in February that suggested the Moderna and Pfizer vaccines have shown high effectiveness in preventing hospitalization, severe illness, and death.

So what, exactly, can fully vaccinated people do?

Alameda County is following the California Department of Public Health’s guidelines, which mimic CDC guidelines, when it comes to advising the public about what to do and not do. 

All of these guidelines say vaccinated people should avoid medium to large gatherings indoor or outdoors, and avoid all unmasked indoor visits with people who are especially vulnerable to the virus, such as older people or people with compromised immune systems.

Under the current state guidelines, fully vaccinated Californians can spend time indoors and unmasked with other fully vaccinated people without social distancing. Those guidelines also work for a single household of unvaccinated people, so long as they’re at lower risk of developing severe COVID symptoms, such as a vaccinated grandparent and an unvaccinated young grandchild.

But the guidelines don’t detail best practices for homes with mixed vaccination statuses, such as those with children under the age of 16 that aren’t yet eligible for the vaccine.

Shoshana Gould helps set up Curative’s vaccination sites across the Bay Area, so she qualified early to get her shots. After being fully vaccinated, she says she feels comfortable eating outside at restaurants and being able to be more socially spontaneous with vaccinated friends.  

“I live close to my parents and grandparents and feel really grateful that I can spend quality time with them safely now,” Gould told The Oaklandside.

The federal, state, and county guidelines recommend that vaccinated people still continue to wear masks and social distance in public or at gatherings with unvaccinated people from more than one other household.

Should I still get tested if I’m vaccinated and was exposed to the virus?

Man getting a dose of vaccine in Berkeley
Marvin Reed, a third-grade teacher at Thousand Oaks Elementary, gets his second vaccine dose. Photo: Kelly Sullivan

CDC guidelines say fully vaccinated people no longer have to get tested or quarantine if they come in contact with someone who has tested positive for the coronavirus. That is, unless your employer requires it. 

“If you’re working, especially as a healthcare worker, in a place where people are really vulnerable, then we are still asking you to follow those protocols,” said Dr. Kathleen Clanon, M.D., medical director of Alameda County Health Care Services Agency. 

Alameda County, however, recommends that fully vaccinated people get tested after coming into contact with someone with COVID, especially if they themselves start showing symptoms. 

As for would-be and current travelers, CDC guidelines say fully vaccinated people can now travel domestically without testing before or after their trip and don’t have to quarantine when they get home. International travelers have to abide by their destination nation’s guidelines about pre-travel testing, but the U.S. won’t require any quarantine when they get home, according to the CDC.

But some Alameda County officials don’t want to see testing dwindle. 

Taunu’u “Tau” Ve’e, co-founder of the Regional Pacific Islander Task Force, told CAG that they want both testing and vaccination services at the San Lorenzo Community Church, where services are targeted at the Pacific Islander community, because public health messaging has shifted away from testing to vaccination, but fully vaccinated people need to be reminded to be tested. 

“There’s a misunderstanding sometimes, in some of our community, that once you’re vaccinated, you’re good,” Ve’e said. 

Watkins-Tartt says Alameda County peaked at around 10,000 COVID tests a day but is currently processing about 7,800 daily. That follows a decline in testing generally around the U.S., but it’s a level she doesn’t want to see go any lower. 

“We don’t want to replace our vaccine work with our testing work,” Watkins-Tartt said. “We need them both.”

Testing can also help spot and track “vaccine breakthrough,” or when a fully vaccinated person contracts COVID, which is typically discovered during routine testing. 

According to the CDC, more than 75 million people in the U.S. are considered fully vaccinated. As of April 13, the centers have received 5,814 reports of breakthrough infections. Only 7% of those cases involved someone being hospitalized, but the CDC notes more than a third of those 396 hospitalized patients were “reported as asymptomatic or hospitalized for a reason not related to COVID-19.”

Since April 14, there have been 93 reported breakthrough cases in Alameda County, Clanon told CAG, adding that they were discovered during routine testing and none of the cases required hospitalization. 

To give those 93 cases some perspective, nearly 38% of county residents over the age of 16—or more than 495,000 people—have been fully vaccinated. So far, there have been more than 85,000 confirmed cases of COVID-19 and nearly 1,500 deaths in Alameda County. 

Testing can also help researchers track variants of the coronavirus. But, as Alameda County Health Officer Dr. Nicholas Moss told CAG, the county doesn’t have the capacity to test each sample for variants, which he and others would like to see improve. 

The first coronavirus variant was detected in Alameda County in February. 

How do I prove I’m vaccinated? Will I have to?

Right now, the best proof of vaccination is the 3×4-inch “COVID-19 Vaccination Record Card” given out during your first shot. Some recommend laminating or otherwise protecting the card. 

Most institutions are still hashing out whether to require vaccinations. But Thursday, the University of California and the California State University systems published a joint statement that they’re considering policies that would mandate COVID-19 vaccines for all students, faculty, and staff in the fall. Stanford also announced all incoming students this fall will be required to be vaccinated against COVID-19, with some medical and religious exemptions.

Some employers, venues, airlines, and other private businesses are looking at using digital vaccination records, often referred to as “vaccination passports,” to allow more people to gather, especially indoors. That’s something the state is encouraging private businesses to leverage, according to the Los Angeles Times

But Alameda County doesn’t seem to be jumping on something like that just yet. 

“It’s pretty controversial,” Clanon said. “And we have not had conversations, I’m aware of, in this county about endorsing that idea.”

While Clanon says there are “practical” reasons for some kind of easily accessible way to declare your vaccination status, the county doesn’t want people to feel “coerced” into getting a vaccine. 

“That’s what’s made us a little hesitant about that idea,” Clanon said.  

The White House said earlier this month it “is not now, nor will we be supporting a system that requires Americans to carry a credential.” That also includes a federal vaccine mandate or database of people who have or have not been vaccinated.