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Vaccinated! Now what? An expert offers answers for Israel’s dosed and confused

So you’re vaccinated, or about to be. What now? And what does it mean that the vaccine appears, based on the latest data, to be 92 percent effective?

With both vaccination and infection rates up, Israelis have some questions.
Almost 2 million Israelis have received both coronavirus shots, and around 3.5 million have received their first shot. But with the virus still raging and the country still under lockdown, it has not been the panacea that many hoped for.

While many dreamed that a week after their second shot they would celebrate vaccine protection with a glass of wine in a restaurant, or a night out in a city center that has sprung back to life, vaccinees are marking the onset of immunity at home, the same place they have been stuck for the past 11 months.

The transmission rate, meaning the average number of people that each verified patient infects, has risen back to around 1 after previously falling below the crucial threshold. (Any rate above 1 means the virus is spreading exponentially.) And things aren’t easing off in hospitals:

There are 1,074 patients hospitalized in serious condition, which is 300 more than what was previously regarded as the red line for healthcare to operate smoothly.

All of this leaves Israelis facing “very confusing and frustrating times,” said leading epidemiologist Nadav Davidovitch, a member of the coronavirus czar’s advisory committee, in a Q&A session with The Times of Israel that addressed questions that many who have been vaccinated are currently asking.

He said the fast vaccine rollout, and high effectiveness of the drug, definitely constitutes good news. But due to fast-spreading variants, immunized Israelis can’t enjoy anything close to a return to carefree, mask-free and social-distance-free life.

Davidovitch, a Ben Gurion University professor and leader of Israel’s doctors’ union, said that while the vaccines have been effective against the variants so far, it may make it harder to treat vaccinated people as virus-proof.

Davidovitch also echoed the claim of Prof. Gili Regev-Yochay, the director of Sheba Medical Center’s Infectious Disease Epidemiology Unit, that in view of the variants, Israel won’t reach herd immunity until vaccines are approved for kids.

Currently, shots are only being given to teens 16 and over, though there is talk about offering it to those ages 12 and up starting in the spring or summer.

“Without vaccinating children we won’t get to herd immunity,” said Davidovitch.

“We were thinking of 60 to 70 percent as the target for herd immunity. But new variants bring more transmissibility, increasing the threshold needed for herd immunity, which may now be 80% or even higher.”

“As around 30% of Israelis are children, we won’t get there without vaccinating them,” he added.

But even herd immunity wouldn’t lead to the end of all coronavirus restrictions, and Davidovitch thinks that with the variants complicating the picture, even vaccinated people will need to remain vigilant.

The government is expected to soon issue rules for post-lockdown conduct, with the closure due to end on Friday. It’s unclear whether these will give immune people privileges that others don’t enjoy.

But as people wait to find out, Davidovitch offered answers to some other common questions that immunized Israelis are asking.

TOI: The first Israeli data suggests that vaccines are highly effective, around 92%. People are confused regarding what this means. Does it mean that every vaccinated person should expect that their immunity will be ineffective part of the time. Or does it mean that for a few unlucky percent of the population, the vaccine fails to deliver significant protection?

Davidovitch: The latter.

Among such people, is any protection afforded by the vaccine? Even if it doesn’t stop them from getting infected, does it reduce impact of the virus?

Yes, it looks like protection from severe cases and death is very, very high. There are also probably some for whom the vaccine probably does not work at all for a variety of reasons, but this is a very small number.

The nation is desperate to return to normal, but this prospect seems to be receding. Where do we stand?

We are in very confusing and frustrating times. We have been saying that vaccines will be a game-changer, and they are, but we’re still learning about their effects. It’s clear that they are very effective on a personal level. They are very successful in preventing severe disease and death. Only a few percent aren’t protected, and adverse events after vaccination are relatively low — it’s well tolerated by the body.

It seems to be effective on variants, perhaps less effective but still effective, though maybe there will be a variant in the future for which this may be less true.

But the vaccine is not the answer to everything.

Immunity from vaccines isn’t 100%. And we don’t know yet whether vaccinated people can still transmit the virus even if they don’t get sick. This has become a bigger concern in light of the variants we are seeing, which spread very fast.

So what does this mean in practical terms?

We should still be cautious. On the other hand, we need a way to return to a kind of new normal.

The decision not to require quarantine by vaccinated people who have been exposed to the coronavirus is correct.

The Health Ministry regulations as they currently stand are too harsh for vaccinated people and I’d be more permissive and allow some encounters while asking where to draw the line. I would think that grandparents meeting with grandchildren would be acceptable now, especially when done outdoors, as well as some other scenarios.

What about family gatherings?

We need to avoid mass gatherings as much as we can, especially in closed places. Outdoor meetings for family are still best, though if all people are vaccinated and can meet together in a house with windows open, that could be okay.

Any thoughts on travel, and the idea of ”green passports”?

International travel will be very problematic for months because of the difference in vaccination rates between countries and because of variants. This is what stands behind hesitation in the issue of a “green passport” [that would exempt vaccinated people and those recovered from the virus from quarantine].

But if such a benefit is an incentive to vaccination, this may be a risk worth taking, while introducing vaccines to low- and middle-income countries.

What other changes can we look forward to?

Life is going to change, and people who have been vaccinated twice will start going to small cultural events, like small concerts that are controlled at the entrance, with access for vaccinated people, those who have recovered from COVID-19, and others after taking a rapid test. While in terms of prayer, outdoor is still best, this may also work for synagogues, though people may not want to undergo testing on Shabbat.

In one sentence, how would you sum up how vaccinated people should think of themselves, regarding the risk of contracting or transmitting COVID-19?

We need to treat them as safer but still with some caution.

Header: The departure hall at the almost empty Ben Gurion International Airport near Tel Aviv on January 25, 2021. (Yossi Aloni/Flash90)

Source: Nathan Jeffay – TOI