What the CDC recommends for fully vaccinated, pregnant, and immune compromised persons

Like weather updates about tornados, hurricanes, and blizzards, the warnings and recommendations from the CDC about COVID-19 change to reflect current findings and predictions.

This information is current as of the publication date; it is general medical information that helps doctors and patients make decisions about what is right for them. Medical recommendations and practice changes as we learn new things. If you deal with any of these issues , please discuss with your doctor before taking any action.

When I wrote the first version of this post I did not anticipate a need to update it, but have now done so 4 times. Like weather updates about tornados, hurricanes, and blizzards, the warnings and recommendations from the CDC about COVID-19 change to reflect new data about the current status of the coronavirus and its activity among the population. Now I suspect this will not be the final post in this series.

The arrival of the Delta virus variant into the United State caused a new surge of infections, mostly among the unvaccinated. Those of us vaccinated can become infected with it, but likely will not become seriously ill, need hospitalization, or die.

Breaking news – Vaccination in pregnancy

August 11, 2021
  • COVID-19 vaccination is recommended for all people 12 years and older, including people who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future.
  • Evidence about the safety and effectiveness of COVID-19 vaccination during pregnancy has been growing. These data suggest that the benefits of receiving a COVID-19 vaccine outweigh any known or potential risks of vaccination during pregnancy.
  • There is currently no evidence that any vaccines, including COVID-19 vaccines, cause fertility problems in women or men.

Breaking news-COVID-19 Vaccines for Moderately to Severely Immunocompromised People

August 13, 2021

CDC now recommends that people whose immune systems are compromised moderately to severely should receive an additional dose of mRNA COVID-19 vaccine after the initial 2 doses. Widespread vaccination is a critical tool to help stop the pandemic. Read CDC’s statement.

CDC updates July 27, 2021

The CDC recommends fully vaccinated people wear a mask in public indoor settings , in areas of substantial or high transmission. (find transmission rates at this link.)

Fully vaccinated people might choose to wear a mask regardless of the level of transmission, particularly if they are immunocompromised or at increased risk for severe disease from COVID-19, or if they have someone in their household who is immunocompromised, at increased risk of severe disease or not fully vaccinated.

Fully vaccinated people who have come into close contact with someone with suspected or confirmed COVID-19 to be tested 3-5 days after exposure, and to wear a mask in public indoor settings for 14 days or until they receive a negative test result.

CDC recommends universal indoor masking for all teachers, staff, students, and visitors to schools, regardless of vaccination status.

electron microscope image of a 2019-nCoV isolate
Transmission electron microscopic image of an isolate from the first U.S. case of COVID-19, formerly known as 2019-nCoV. The spherical viral particles, colorized blue, contain cross-sections through the viral genome, seen as black dots. credit Hannah A Bullock; Azaibi Tamin, public domain
Here is what the CDC, Centers for Disease Control and Prevention, posted on their web site as of July 28, 2021.

Interim Public Health Recommendations for Fully Vaccinated People

For the purposes of this guidance, people are considered fully vaccinated for COVID-19

  • ≥2 weeks after they have received the second dose in a 2-dose series (Pfizer-BioNTech or Moderna), or We
  • ≥2 weeks after they have received a single-dose vaccine (Johnson and Johnson (J&J)/Janssen ).
Dr. Aletha inspecting her arm after a COVID-19 shot
Three days after my first vaccination the soreness in my arm was almost gone, and I had no redness or swelling. After the second shot, minimal soreness. No other side effects to report. I feel fortunate. I am now fully vaccinated.

Fully vaccinated people can:

  • Resume activities without wearing masks or physically distancing, except where required by federal, state, local, tribal, or territorial laws, rules and regulations, including local business and workplace guidance
  • Resume domestic travel and refrain from testing before or after travel or self-quarantine after travel
  • Refrain from testing before leaving the United States for international travel (unless required by the destination) and refrain from self-quarantine after arriving back in the United States
  • If you came into close contact with someone with COVID-19 get tested 3-5 days after the date of your exposure and wear a mask in public indoor settings for 14 days after exposure or until a negative test result.
  • Refrain from routine screening testing if feasible
  • Get tested if experiencing COVID-19 symptoms and isolate for 10 days if positive.
  • Follow CDC and health department travel requirements and recommendations

Travel

For now, masks are still required for everyone on public transportation, until those policies are updated. (June 10, 2021 update)

Healthcare facilities

For now, you will likely be required to wear a mask in hospitals, clinics, medical offices, nursing homes, and other facilities that provide direct healthcare.

Protocols for vaccinated and non-vaccinated healthcare workers are detailed on the CDC website.

Immune compromise

People who are immunocompromised should be counseled about the potential for reduced immune responses to COVID-19 vaccines and to follow current prevention measures (including wearing a maskstaying 6 feet apart from others they don’t live with, and avoiding crowds and poorly ventilated indoor spaces) regardless of their vaccination status to protect themselves against COVID-19 until advised otherwise by their healthcare provider.

It has been reported that the CDC may recommend a booster for these people soon.

a scientist in a lab working on covid antibodies
Centers for Disease Control and Prevention (CDC) scientist was preparing patients’ samples for SARS-CoV-2antibody testing. Serological testing is used to detect antibodies, which indicate past infection with the virus that causes COVID-19, and is important to the understanding of disease prevalence within a population. credit James Gathanay, public domain

About the Delta Variant: 

Vaccines are highly effective against severe illness, but the Delta variant causes more infections and spreads faster than earlier forms of the virus that causes COVID-19. Learn more about variants in the US.

Testing, testing, testing

Testing helps us identify cases, trace contacts, and prevent spread. With fewer cases, public health professionals can find contacts easier and sooner. Stopping spread will make the variant viruses less of a threat.

So please don’t stop seeking testing if you have symptoms; it is still important to know how many cases of COVID-19 there are. If we only know about the severe cases that required hospitalization, it will skew the statistics, and be less representative of the true extent of the pandemic.

Masks and Vaccines -“do unto others”

I’m not here to debate the use of masks. If you are not yet vaccinated, masks are an easy and safe way to protect yourself but aren’t anywhere close to vaccine effectiveness. Bottom line, get vaccinated; it’s available and easy to get. You probably won’t have to wait in line for an hour like I did. Just click on this link

VACCINES.GOV

Remember, this is a contagious infectious disease spread by direct person to person contact. It’s not just about you, we’re here for each other.

Information and misinformation

There has been much of both in the past year, some deliberate, some well intentioned, some valuable, some just plain wrong. Whenever possible, get your information directly from the source, not “a friend of a friend’s second cousin”. Here are some tips for finding reliable information

Final comments from the CDC

CDC will continue to evaluate and update public health recommendations for fully vaccinated people as more information, including on new variants, becomes available. Further information on evidence and considerations related to these recommendations is available in the  Science Brief.

CDC website

exploring the HEART of ending the pandemic

Please do your friends a favor by sharing this post on social media and even in real conversations.

I appreciate all of you who are following Watercress Words, and if you aren’t I invite you to join the wonderful people who are. You can meet some of them in the sidebar, where you can click on their image and visit their blogs. Use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me.

Dr. Aletha

from 1776 to 2020-a vision for a “more perfect Union”

The United States’ healthcare system combines public health efforts with mostly private delivery of health care. Usually they coexist side by side with some but infrequent interaction. The public health emergency created by the pandemic forced them into a “union” that quickly became politicized, and unfortunately diminished the effectiveness of the response.

In ophthalmology, visual acuity is measured by the distance one can see compared to “normal”. A person with 20/80 vision can see at 20 feet what a normal vision person can see from 80 feet. Perfect vision is labeled 20/20.

Maybe you expected 2020 to be a perfect year. I doubt that any of us would say it was. The year brought

  • a contentious presidential election and an unexpected serious pandemic
  • peaceful protests and raucous riots
  • racism confrontations and reconciliation pursuits
  • health inequities battles and healthy community pursuits

This next year 2021 has already had its share of problems, but I think most of us feel calmer, more hopeful, and eager to resume many of the activites we put on hold last year. And that includes a 4th of July celebration.

Statue of Liberty
Lady Liberty lifting her torch in New York harbor
Independence Day, July 4

Every year on July 4th the United States celebrates Independence Day- the day in 1776 the original 13 American colonies established an independent country.

A few years later they established a government as specified in the Constitution of the United States, to “form a more perfect Union”.

The United States Constitution

The Constitution does not specifically mention, establish, create, or endorse a healthcare system. Some phrases in the Preamble hint at it though-

  • establish Justice
  • insure domestic Tranquility
  • provide for the common Defense
  • promote the general Welfare

Government sponsored health care programs

The Affordable Care Act, aka Obamacare

The  United States Congress passed the Patient Protection and Affordable Care Act (ACA) in 2010 to guarantee basic health insurance to all citizens.  During his term in office, President Trump vowed to “repeal and replace” this law but although it has been modified, it is still in place.

Healthcare for military service members, veterans ,and their families

During the American Revolution the fledgling government extended health care benefits to the soldiers and veterans of that war; that system evolved into the current Department of Defense military health care system which covers service members and the Veterans’ Administration system for veterans.

a Veterans Administration clinic
a Veterans Administration clinic (photo by Dr. Aletha)
American soldiers serving in Afghanistan
American soldiers serving in Afghanistan
Medicare and Medicaid

Two other government healthcare programs- Medicare and Medicaid are over 50 years old. 

Medicaid provides insurance coverage for adults and children who are unemployed or low income.  

Medicare covers disabled children and adults  and persons 65 years and older.

a senior adult couple relaxing in lawn chairs
by Brayden Heath from LIGHTSTOCK.COM

Department of Health and Human Services

Most of the health care activities of the federal government fall under the agencies of the Department of Health and Human Services or HHS. The Secretary of HHS serves in the President’s Cabinet.

Due to the COVID-19 pandemic, we’ve heard more about the HHS in the news than usual; maybe you’ve never heard of these agencies. Generally, management of a pandemic or other public health emergency falls within the work of the CDC.

Centers for Disease Control and Prevention

The CDC’s mission is simple but encompasses many facets of health

“to work 24/7 to protect America from health, safety and security threats, both foreign and in the U.S.”

The CDC website devotes an entire section now to information, guidelines, and news about the SARS-CoV-2 virus and COVID-19.

illustration showing the coronavirus which causes COVID-19

The goal of public health is to avoid or prevent health threats from becoming public health emergencies, like the COVID-19 pandemic. If they accomplish the mission, we hardly notice. But when an outbreak occurs, their work suddenly becomes visible, scrutinized, and debated.

The CDC director, Dr. Robert Redfield, spoke to Congress soon after the pandemic started, and his assessment of the response and funding for it were not positive. Lack of funding hampered the federal government’s response to the coronavirus outbreak, he told lawmakers on March 10, 2020.

“The truth is we’ve underinvested in the public health labs,There’s not enough equipment, there’s not enough people, there’s not enough internal capacity, there’s no search capacity”

Dr. Robert Redfield, Director, CDC

The Trump administration subsequently enlisted private companies to help cut the difference. The CDC partnered with Integrated DNA Technologies to manufacture the COVID tests under a CDC contract. IDT partnered with commercial labs for the testing.

2021-the Biden Administration

On December 7, 2020 President Biden’s transition team announced that Rochelle P. Walensky, M.D.  was slated to become the new director of the Centers for Disease Control and Prevention. In a 2021 interview she talked about the “big questions that keep her up at night.”

  • How are we going to ensure that the people who are hardest to reach with COVID vaccines receive it?
  • How are we going to ensure that when everyone else is not thinking about COVID we are still leveraging the infrastructure and connections we’ve made and that we address the collateral damage of this pandemic: the hypertension , the pediatric vaccinations that haven’t happened, HIV control?
  • How are we going to address a resurgent opioid crisis that I thought I’d never see again?
  • How are we going to address gun injury prevention?
  • How do we not only protect this nation, as we realize that we need to protect the world, too. Not just for humanitarian purposes, but because we are so integrally linked, as this virus has taught us.

National Institutes of HealthNIH

The National Institutes of Health, part of the Public Health Service,

  • supports biomedical and behavioral research with the United States and abroad,
  • conducts research in its own laboratories and clinics,
  • trains promising young researchers, and
  • promotes collecting and sharing medical knowledge.

And within the NIH is the NIAID– the National Institutes of Allergy and Infectious Diseases, which has been an invaluable source of guidance as the United States and the world works to understand and manage this new infectious disease.

President Donald Trump Visits NIH
President Donald Trump visited NIH on March 3, 2020 and toured the National Institute of Allergy and Infectious Diseases’ Vaccine Research Center (VRC) to learn about research on a vaccine for the novel coronavirus SARS-CoV-2. From left: VRC Deputy Director Dr. Barney Graham, NIH Director Dr. Francis Collins, VRC Director John Mascola, Department of Health and Human Services Secretary Alex Azar, President Trump, and VRC Research Fellow Dr. Kizzmekia Corbett.
credit NIH, public domain
Novel Coronavirus SARS-CoV-2
This scanning electron microscope image shows SARS-CoV-2 (orange)—also known as 2019-nCoV, the virus that causes COVID-19—isolated from a patient in the U.S., emerging from the surface of cells (green) cultured in the lab.
 
Credit: National Institute of Allergy and Infectious Diseases-Rocky Mountain Laboratories, NIH
President Biden Visits NIH Vaccine Research Center
NIH immunologist Dr. Kizzmekia Corbett speaks to President Joe Biden about the fundamental research that contributed to the development of the Moderna and Pfizer COVID-19 vaccines when the President visited NIH’s Vaccine Research Center on February 11, 2021. Credit: NIH/Chiachi Chang

Food and Drug Administration– FDA

The FDA joins the pandemic response by

  • reviewing and approving diagnostic tests for the coronavirus
  • protecting consumers from fraudulent products for COVID-19.
  • issuing Emergency Use Authorizations (EUAs) for ventilators
  • sampling and testing of respirators for importation

Late in 2020 the FDA gave Emergency Use Authorization to 2 vaccines against COVID-19. By December Americans began receiving “shots in arms”, a welcome step in returning to normal.

COVID-19 Diagnostic Test Attire
FDA Commissioned Corps officer RADM Estella Jones, DVM, OCET Deputy Director and Co-Chair of the FDA Animal Welfare Council, oversees Commissioned Corps officers as they practice proper fitting of protective items. Healthcare workers testing patients for COVID-19 novel coronavirus infection must wear specific protective gowns, gloves, ventilation masks, and full facial shields as shown, and must replace these items after each patient is tested. credit FDA, public domain

Occupational Safety and Health administration-OSHA

OSHA is part of the United States Department of Labor. OSHA’s administrator answers to the Secretary of Labor, who is a member of the cabinet of the President of the United States.

Congress created the Occupational Safety and Health Administration (OSHA) in 1970 to

ensure safe and healthful working conditions for working men and women by setting and enforcing standards and by providing training, outreach, education and assistance.

For the pandemic response, OSHA offers guidance on

  • returning to work
  • preparing workplaces for COVID-19
  • worker exposure risk to COVID-19
  • for specific industries including airlines, farms, retail, corrections
  • use of respiratory protection equipment

important laws that administer and regulate both private and public healthcare.

The Affordable Care Act- ACA
Health Insurance Portability and Accountability Act-HIPPA
Emergency Medical Treatment and Labor Act- EMTALA
Americans with Disabilities Act-ADA
Family Medical Leave Act-FMLA
replica of the Liberty Bell at Disney World, Florida, photo by Dr. Aletha

Let Freedom Ring

In the Declaration of Independence, the founders of the United States created a nation based on the “self-evident truths”  of  “Life ,Liberty, and the pursuit of Happiness” and to promote “Safety and Happiness” . 

They didn’t mention “healthcare” either, maybe because in the late 1700s medical practice was more superstition than science.

Surgery was rudimentary due to no anesthesia and infections frequently proved deadly due to no antibiotics.

No one had even imagined, much less identified the human genome, and viral DNA-what was that??

I wonder if they intended their new government to spend so much time and money providing and regulating health care –most of which was not available or even imagined at that time? 

Public vs Private-not a perfect Union

The United States’ healthcare system combines public health efforts with mostly private delivery of health care. Usually they coexist side by side with some but infrequent interaction.

The public health emergency created by the pandemic forced them into a “union” that quickly became politicized, and unfortunately diminished the effectiveness of the response.

But despite the lack of coordination and cooperation between all levels of government and private citizens, our health care professionals, in both public health and private medical practice stayed true to their calling. Many risked their own lives to care for COVID-19 victims. Others sacrificed time and finances to lead the pandemic response in their communities and on social media- maybe not perfectly, but definitely UNITED in resolve to lead, help, and heal their fellow citizens through this unprecedented health emergency.

Let’s celebrate!

woman holding a sprakler
Let’s celebrate ! This photo and featured image from stock photo site- Lightstock.com (affiliate)

Sharing and celebrating the HEART of life, liberty, and the pursuit of HEALTH and happiness

I appreciate all of you who are following Watercress Words, and if you aren’t I invite you to join the wonderful people who are. You can meet some of them in the sidebar, where you can click on their image and visit their blogs. Use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me.

I appreciate all of you who are following Watercress Words, and if you aren’t I invite you to join the wonderful people who are. You can meet some of them in the sidebar, where you can click on their image and visit their blogs. Use the form to get an email notification of new posts. Don’t worry, you won’t get anything else from me.

Dr. Aletha 

a woman in a red, white, and blue shirt
Me, a few years ago, showing my patriotic spirit by posing in red, white, and blue