After I wrote about the strange sensation of being fully vaccinated and out socializing but still feeling vaguely stressed and sad last month, I heard from a lot of people who had been feeling the same way. And one thing that kept coming up was the fact that there aren’t really clear guidelines on how vaccinated people should be handling hangouts now that the Delta variant is widespread in the U.S. Vaxxed people obviously want to keep seeing their vaxxed friends, but are worried about whether it’s truly safe, and the return to this very specific kind of anxiety is making a lot of folks feel particularly low right now. It seems fairly clear to me that no public health expert wants to tell exhausted Americans that we might actually need to change our behavior yet again. Unfortunately, that means there’s a real dearth of practical advice about how to be right now.
But for a lot of fully vaxxed people (those who are high-risk, for example, or who live with unvaccinated kids or immunocompromised folks), simply saying “Breakthrough cases seem to be low so don’t worry about it! But maybe wear a mask in some situations! No, we won’t tell you which situations! But do it if you live somewhere with high case numbers. No, we won’t tell you what ‘high case numbers’ means either!!!” isn’t enough. And it’s especially not enough when there’s a lack of data about the prevalence of breakthrough infections that are seriously unpleasant if not technically serious.
In an effort to get some straight answers, I reached out to Syra Madad, the senior director of system-wide special pathogens for NYC Health + Hospitals and the author of a COVID prevention guide for parents and caregivers of school-age children. Madad and I last spoke in July 2020, when she helped me put together a list of questions to ask friends and family before planning an unmasked hangout. This time around, I was seeking far less granular advice. Basically, I wanted to know what relatively small steps fully vaccinated people hanging out with other fully vaccinated people could take to make their gatherings a little bit safer. Like, should my friends and I be doing indoor hangouts or not?
Madad said that the “Swiss cheese” method of layering safety precautions remains our best bet; vaccines are a truly amazing development, but we’re going to have to combine them with other mitigation measures (like testing, continued masking, etc.) to stop spread and end this pandemic. “Fully vaccinated? Great, your chances of contracting and spreading COVID-19 are reduced,” Madad said. “If you do things outdoors, even better. We can't necessarily get it to zero, but we can get it pretty damn close if you layer on these approaches.”
If you’re fully vaccinated and want to be a little bit safer when hanging with other vaccinated people, there are actually a lot of things you can do—and the good news is that most are fairly small, doable things you likely already have experience with, and that’ll give you a lot of safety bang for your buck. Here are Madad’s suggestions.
Get tested, get tested, get tested.
“Testing is extremely important,” Madad said. “Even though we've been talking about testing from the very beginning of the pandemic, I think it's still a very much underutilized resource.”
“If you're going to go to an event, I think having that added layer of testing is really important,” she continued. “Whether that event is happening outdoors or indoors, whether it's with a few people or a large number of people, testing certainly is one thing you want to continue to include.”
Madad is a big proponent of the newly available at-home rapid testing options, and suggested a combination of in-person PCR testing and at-home rapid testing, depending on what’s accessible to you and what you can afford. For example, if you’re planning to see a friend on Saturday, you might get a PCR test done at a county site on Wednesday and then test yourself at home on Saturday morning. If you can only do one test, Madad said she’d opt for the at-home rapid test the day of the gathering. A PCR test administered by a professional would technically be more accurate, but doing that the morning of would be too late unless the facility you go to offers rapid results. So just know that day-of prophylactic testing won’t necessarily be the end-all, be-all; it’s just another layer of cheese.
Beyond that, it’s a good idea to get tested again a few days after the event. “I don’t think you can overtest,” Madad said. “I would say three days after your gathering, and again five days after—having that two-day interval is usually good.”
Put another way: If you’re seeing friends every weekend, you might want to make getting a PCR test every Wednesday part of your basic routine. (And if you’re organizing a large in-person event, like a conference or the return to work in an office, Madad suggested the When to Test calculator as a useful resource.)
Keep doing things outside, even as the weather gets cooler (and mask up even for quick trips indoors).
We’ve known for a while that outdoor hangouts are vastly safer than indoor ones, so as you plan gatherings with other vaccinated people in the next few months, do what you can to make these hangouts happen outdoors—catch up on the patio instead of the living room, meet earlier in the day while the sun is still out, invest in a fire pit and good gloves for the winter months, etc.
One other important note about doing things outside: While outdoor hangouts are absolutely the safest bet, Madad said it’s a good idea to still wear a mask if you’re hanging with unvaccinated people outdoors—because Delta is that much more transmissible than earlier variants. She said she’d personally wear a mask if she was sitting very close to/talking with an unvaccinated person outdoors for longer than 15 minutes in a city with high case numbers (e.g., sitting next to an unvaccinated parent or buddy at a baseball game).
If you want to hang out unmasked and indoors with your vaccinated pals right now, do what you can to improve ventilation.
Madad repeatedly stressed that COVID safety measures aren’t all-or-nothing—so if you decide to plan some unmasked indoor hangouts with vaccinated friends, you should still take other precautions. Madad said that ventilation remains highly important to stopping the spread of COVID, and that it’s our best bet for making indoor hangs with friends safer (assuming you don’t want to mask up at home). If you’re going to have people over, here are some relatively doable things to implement, via Craig Mod at The Atlantic:
- Open all of the windows (even if you’re running the A/C or the heat)
- Turn fans on and place them so they’re pointed toward open windows (versus pointing toward walls)
- If you have the A/C or heat running, place fans perpendicular to your air vents to improve circulation further
- Open the doors between rooms that only have a single window to help improve airflow even more
And you may want to consider buying a HEPA air purifier if you don’t already own one—they make a real difference, especially if you can’t open windows or doors. (I’ve had this $99 one for a year or so, and it’s been great.) According to previous VICE reporting, you should place the air purifier in the middle of the room, unobstructed by furniture, ideally up on a chair or table so it’s closer to the level of people’s mouths/noses. And one expert told VICE that, contrary to popular belief, you can definitely keep the windows open while running the air purifier—and doing so actually improves air quality.
A friend of mine recently asked me if, once you have unmasked friends in your home, it’s worth taking other precautions, like avoiding hugs, not sharing drinks, or having visitors use their own designated towels to dry their hands… or if it’s more of a “once you’re in my space unmasked, we might as well just make out” kind of situation. So, I posed this question to Madad during our conversation. “Certainly you wouldn't want to share utensils and things like that—plates, cups, spoons. You wouldn't want to do that generally,” she said, adding that that simply isn’t a good hygiene practice because it can spread plenty of non-COVID illnesses too. But, she said, swapping out hand towels in the bathroom is probably overkill; focus on ventilation instead.
Utilize case data to inform your plans and additional precautions.
Experts often talk about being more careful if case numbers are especially high, but that’s not helpful if you don’t know how “high” is being defined. Madad offered some ways to interpret the data in your city or county when making plans.
Here are some signs you should be playing it safer, even with your fully vaccinated friends:
- Cases where you are are going up, not down. Madad said a two-week drop in cases is generally a good sign—but make sure it’s a true steady decline, and that there aren’t any days with reporting anomalies or missing data. If cases are on a two-week rise, or are swinging up and down over the course of 14 days, proceed with caution when planning hangouts.
- There are more than five cases per 100,000. Cases per 100,000, combined with test positivity rate (more on that below), will give you a sense of how active the virus is where you are, and Madad said she’d personally like to see a daily average of five per 100K to feel pretty OK about gatherings. (Some other numbers to know: 50–100 cases per 100,000 is considered a “substantial” transmission rate, while 100+ cases per 100,000 is considered “high.”)
- The test positivity rate is above 3 percent. When this number starts to climb—and especially once it gets above 8 percent—it means that a city is likely only testing people who are very sick/symptomatic… meaning case numbers are probably even higher than the raw numbers indicate.
- More than 40 percent of ICU beds are currently occupied. If beds at your local hospitals are filling up, Madad said, that’s reason to be more cautious—because that means there’s likely still a lot of virus circulating. She also said this is an especially important bit of data to look into if you’re planning to travel or planning to have out-of-town visitors staying with you; you don’t want to head somewhere where it would be difficult to get a hospital bed if you got sick. And keep in mind that when ERs are slammed and ICUs are full, it’ll be that much harder to get vital care in non-COVID emergency situations.
Avoid hanging out with people outside of your household if anyone has cold or flu-like symptoms… even if their COVID test came back negative.
A nasty strain of respiratory syncytial virus has been making the rounds recently, as has the common cold. You should definitely get a COVID test ASAP if you’re experiencing cold, flu, or COVID symptoms… but even if you’ve tested negative for COVID, Madad said you should still cancel any upcoming hangouts as long as your symptoms persist. This is, in part, because false negatives are absolutely possible with COVID tests… but also because we should all be trying to reduce the spread of other illnesses in These Times. “If you’re sick, regardless of what symptoms you may have, it’s just best not to interact with other people,” Madad said. “You don’t want to give them what you may have.”
Think about bringing back the pod.
Throughout this pandemic, people have continued to think of strangers/public places as inherently unsafe, and gatherings with family and friends as relatively safe. And, of course, it’s true that strangers may not all be vaccinated, and you’re likely to cross paths with a lot more people if you’re out in public. But it’s also a mistake to treat the vaccinated people you know as though they couldn’t possibly have the virus or pass it to you. Forming a pod—which a lot of folks did at various points last year—with a small group of vaccinated buddies is a way to stay social in the coming months without giving everyone in your life an automatic pass.
“Just because somebody is your partner, your spouse, your close friend, your neighbor doesn't mean you're going to be shielded from getting COVID if you're interacting with them,” Madad said.
Even if you don’t go the pod route, be sure you’re still having open and honest conversations before hangouts, and letting friends know it’s OK to cancel at the last minute if they’re feeling extra stressed about COVID or wake up with a sore throat. Also make sure people are fully vaccinated before getting together, Madad said, and maybe even ask when their last COVID test was. “If you're planning on getting together, that gives you just another added layer of insurance,” she said. “I think vaccination, testing, and then masking are really important. We know vaccines are not a panacea, they’re not 100 percent. So adding on some of these additional layers now makes sense.”
Rachel Miller is the author of The Art of Showing Up: How to Be There for Yourself and Your People. Follow her on Twitter.