The country is inching closer to a level of protective immunity as highlighted by drastically declining new COVID-19 cases, hospitalizations and deaths, yet the lack of clear guidance and statements from health experts and policymakers are leaving people frustrated with many questions. If our transmission levels are down and our level of protective immunity is rising every day, why aren’t we able to loosen the restrictions on gathering and mask-wearing? Is there an endpoint to this crisis?

During a television interview on February 11th, Savannah Guthrie on NBC’s “Today” posed the question if grandparents could see their grandchildren after being fully vaccinated to Dr. Anthony Fauci, Chief Medical Adviser on COVID-19 for President Biden. While he refused to give official recommendations, he responded, “Ultimately, yes,” stressing that if all members of a family are vaccinated, getting together poses much less risk.

But vaccine research hasn’t even begun in young children so are we still telling grandparents that despite their vaccination they cannot see their grandchildren until they are vaccinated as well? 

I believe it is dangerous for Dr. Fauci and others to say people are not able to increase their social activities after vaccination when low levels of transmission because it actually may prohibit people from getting the vaccine.

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A year’s worth of experience and research have solidified that people 65 years and older are affected the most severely from COVID-19 with the highest associated infection fatality rate (IFR). In the United States, patient and staff members in long-term care facilities (LCF) account for 40% of all COVID-related deaths — exceeding 100,000 deaths to date, a number likely underestimated as policymakers are still trying to obtain accurate data.  An international meta-analysis evaluating over 611,000 COVID-19 patients over 80 years adds to the growing body of evidence demonstrating age to be an independent risk factor for COVID-19.

The age-dependent mortality can be partially attributed to something called immunosenescence, which is essentially the immune system weakening the older a person gets. This decrease in immune function can lead to increased vulnerability to infections and the development of additional medical issues, both contributing to the vulnerability to SARS-CoV-2.  

Of such, vaccine campaigns have focused on vaccinating the elderly population. 

However, immunosenescence also raises the concern as to whether the elderly can mount an effective immune response to the vaccine because, as seen with some other vaccines, they produce inferior immune responses. Data from the CDC showed that the effectiveness of the flu vaccine in adults over 60 years some seasons can be as low as 14% for influenza A. Yet, despite its low efficacy, it still reduces hospitalizations and deaths from the flu by 40-60%, which not only saves lives, but also lessens the burden on health care systems.

Fortunately, Pfizer and Moderna COVID-19 mRNA vaccines have been tested in adults 65 and older, both showing data confirming a strong immune response against moderate to severe disease, 94% and 87% respectively and both are nearly 100% effective in preventing Covid death. 

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By February 6, 2021, the country of Israel had vaccinated close to 90% of people aged 60 and older.  Data soon after released from Israel’s Health Ministry, showed the mRNA vaccines to be 98.9% effective at preventing death caused by COVID-19.

In the United States, the COVID-19 vaccination campaign also focused on prioritizing millions of patients and staff in nursing homes and other long-term care facilities, now has led to over 5.5 million vaccine doses being administered in the last two months in these high risk individuals. Early results show the increased protection of the residents and staff is a key reason why there has been a steep decline in recent deaths in this vulnerable population. Data from the  Center for Disease Control and Prevention (CDC) reported less than 10,000 new cases and COVID-related deaths during the last few weeks, much lower than the more than 30,000 cases and deaths in each of the last weeks of December.

Yet, despite the mounting evidence Dr. Anthony Fauci and other experts are wary to give formal recommendations because of the lingering questions regarding immunity. No one can blame him for not providing an absolute answer when even the CDC has yet to even weigh in on the topic and he is scrutinized constantly for his words. However, following a year of isolation to protect the vulnerable, hasn’t the goal been for our most vulnerable to resume living the life we worked so hard to save? 

People are living in solitude and getting vaccinated to save lives, but if they are not allowed to see friends and family even after the fact, some may question if that life is worth living. Reports of increased levels of depression and suicide are up across the world because of the restrictions placed on society. For the first time in 11 years, suicide rates in Japan ROSE by 15% with an 80% increase in a single month.

The negative emotional and cognitive impact from social isolation may be even stronger on the elderly population, with a mountain of data suggesting social interaction is essential for preventing cognitive and physical decline. 

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The solution moving forward can no longer be seclusion as a means of protection. Instead an acceptable solution needs to be maintaining necessary social interactions while also protecting the most vulnerable from possible infection with measures such as vaccination and mask wearing of visitors in hospitals and LCFs. 

This pandemic has already put a microscope on long-term care facilities as a breeding ground for infectious disease and hopefully it will result in improved practices including increased staffing and sticking with already implemented hygiene measures, including continued mask-wearing by employees.

The risk of transmission will remain low as the amount of virus in the community continues to go down and immunity further rises. Going forward COVID safety recommendations for the public should be modified based on local transmission levels, rather than universally.

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Young children will not be vaccinated any time soon so for those who are around children for their profession or social reasons, mask-wearing is always an option as children are able to transmit the virus and no form of immunity is 100% effective at preventing illness. Even if vaccinated, if a person is considered a high risk individual, mask-wearing can add a layer of protection in addition to the strong immunity but this should not prohibit family members from gathering or enjoying other social activities.

Of course, the more people in the family who are immune to the virus, the stronger the protective wall will become surrounding the family (and community) from illness. 

The restrictions and recommendations to “stay home” will soon be anti-science as the country nears a level of protective “herd” immunity by late spring. 

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In the fall, circulating viral variants may result in a small wave of infections, and just like we see each year with other pathogens, an additional vaccine or booster may be recommended. The coronavirus will become endemic and will circulate for years so the goal is to balance living life while making adjustments when necessary.

Americans were not culturally ready for mask mandates at the start of this pandemic, and while many still may not be, if mask-wearing is self-selective amongst a population where the majority of individuals have some level of immunity, it may be an acceptable path forward while balancing the devastating risks of further isolation.

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