Every day on my day to work, at the entry gate, the security guard always asks me the same question- ‘Doctor, where is your mask?’ and every time I reply: ‘It’s in my bag’ and zoom off. The other day when the old man asked me again, I purposely parked the car and asked him why I should wear a mask when I was the only one in my car with the windows wound up. He looked at me blankly and replied that he was just obeying orders from above. I realised then that they needed orientation.
People often ask me this popular question: After receiving the COVID vaccination, now what? Do we go back to life as we knew it before? Can we stop wearing masks? What about us that have had the disease? Is it safe to converge in large crowds?
I have had COVID-19 and Alhamdulillah, my symptoms were mild. A serological test done afterwards showed that I had developed antibodies to the virus. Still, I went ahead and got my 2 doses of the vaccine just to be on the safe side. I don’t want to hear stories that touch the heart. The Centre for Disease Control and Prevention (CDC) announced that people who are fully vaccinated against COVID-19 don’t need to wear a mask or physically distance in most settings, except where required by federal, state, local, tribal or territorial laws, rules and regulations. This also includes local business and workplace guidance. And so, I throw my mask in my handbag and put it on only when required.
In April, the CDC updated its advice on mask-wearing. The agency says both fully vaccinated and unvaccinated individuals can safely unmask while walking, running, hiking or biking outside alone or with members of the same household and attending a small outdoor gathering with fully vaccinated family and friends. Whereas, people who are fully vaccinated have additional safe options for outdoor mask-less activities. This means that someone who is fully vaccinated can safely skip the mask while attending a small outdoor gathering with a mix of fully vaccinated and unvaccinated people and dining at an outdoor restaurant with friends from multiple households.
Furthermore, as COVID-19 vaccination rates pick up around the world, people have reasonably begun to ask: how much longer will this pandemic last? It’s an issue surrounded with uncertainties. But the once-popular idea that enough people will eventually gain immunity to SARS-CoV-2 to block most transmission — a ‘herd-immunity threshold’ — is starting to look unlikely.
That threshold is generally achievable only with high vaccination rates, and many scientists had thought that once people started being immunized en masse, herd immunity would permit society to return to normal. Most estimates had placed the threshold at 60–70% of the population gaining immunity, either through vaccinations or past exposure to the virus. But as the pandemic enters its second year, the thinking has begun to shift. Hesitation about the vaccines and the fact that a vaccine is yet to be available to children are some of the factors contributing to the unlikeliness of herd immunity. Additionally, as new variants arise and immunity from infections potentially wanes, we may find ourselves months or a year down the road still battling the threat, and having to deal with future surges.
I know, it sounds scary, all gloom and doom. Nigerians, in fact, have already thrown all caution to the wind as everyone now wears their masks on their chin and weddings and parties have continued as normal. Truth is, social distancing with our population in this country, and our penchant for gatherings will forever remain a farce.
Epidemiologists believe that the long-term prospects for the pandemic probably include COVID-19 becoming an endemic disease, much like influenza in the west. One of the reasons is that the key to herd immunity is that, even if a person becomes infected, there are too few susceptible hosts around to maintain transmission — those who have been vaccinated or have already had the infection cannot contract and spread the virus. The COVID-19 vaccines developed by Moderna and Pfizer–BioNTech, for example, are extremely effective at preventing symptomatic disease, but it is still unclear whether they protect people from becoming infected, or from spreading the virus to others. That poses a problem for herd immunity.
Furthermore, the worldwide COVID-19 vaccine roll-out is uneven. In most countries, vaccine distribution is stratified by age, with priority given to older people, who are at the highest risk of dying from COVID-19. When and whether there will be a vaccine approved for children, however, remains to be seen. In Nigeria, as expected, some centres even ask: Do you want the vaccine or just the card i.e without receiving the vaccine? How then do we expect to ever attain herd immunity?
And even as vaccine roll-out plans face distribution and allocation hurdles, new variants of SARS-CoV-2 are sprouting up that might be more transmissible and resistant to vaccines. “We’re in a race with the new variants,” says Sara Del Valle, a mathematical and computational epidemiologist at Los Alamos National Laboratory in New Mexico. The longer it takes to stem transmission of the virus, the more time these variants have to emerge and spread, she says.
Calculations for herd immunity usually consider two sources of individual immunity — vaccines and natural infection. People who have been infected with SARS-CoV-2 seem to develop some immunity to the virus, but how long that lasts remains a question, hence my rush to get the vaccine. Given what’s known about other coronaviruses and the preliminary evidence for SARS-CoV-2, it seems that infection-associated immunity wanes over time, so that needs to be factored in to calculations. Truth is, scientists are still lacking conclusive data on waning immunity, but what we do know is that it’s not zero and not yet 100.
The reality is that we are not out of the woods yet. The vaccines are one part of this. They are not a magic bullet and we have to get to that herd immunity. How and when we will get there is the million-dollar question. But it’s going to be hard to stop people reverting to pre-pandemic behaviour. Some countries are already lifting mask mandates, even though substantial proportions of their populations remain unprotected.
So, for now, we should get our vaccinated and keep our masks close-by. Maybe someday, life as we know it, may return to normal. Until then, we can only pray and hope.
