As more El Pasoans receive their COVID-19 vaccines, questions remain about what activities are safe to participate in following the two-week waiting period after the second doses.

El Paso Matters asked local infectious disease experts a series of questions to help the community navigate the post-vaccination landscape.

More than 360,000 El Pasoans have received at least one dose of the COVID-19 vaccine as of Monday, which is 56% of the population age 16 and older who are eligible to be vaccinated. More than 230,000 El Pasoans are now fully vaccinated, which is about 35% of the eligible population.

City of El Paso health officials said at least 750 El Pasoans have tested positive for COVID-19 after receiving at least one dose of the vaccine. City officials did not specify whether those who have tested positive after receiving the vaccine were infected after their first or second dosage.

Dr. Armando Meza, chief of infectious diseases at Texas Tech Physicians of El Paso, and Dr. Ogechika Alozie, an infectious disease specialist and CEO of Sunset ID CARE, answered common questions about what is and is not safe to do following full vaccination.

While Meza and Alozie offered differing views at times, their overall consensus is that there is more flexibility for activities than there were in the first year of the COVID-19 pandemic if individuals have been fully vaccinated.

Question: Can you transmit COVID-19 to someone who is not yet vaccinated? If, so why?

Dr. Ogechika Alozie

Alozie: Is it likely? I think it’s highly, highly unlikely and we have a number of studies now that showed this. At a point in time, those that keep saying that the likelihood has to be zero, I think they’re really doing the public and public confidence a disservice. I’ll say that because whether we look at the health care worker study in England that reduced it by 86%, the health care worker study in Israel reduced it by 75%, there’s patients in the Mayo Health Care Clinic. There is a host of data that now clearly points to the fact that if you’re fully vaccinated, you reduce your risk of transmission. But I think that has to be a conversation that we tell people — that is it possible? Potentially. Is it likely? Highly unlikely. I think that’s the key.

Meza: Yes you may. Once you have received the vaccine you have protection against severe illness but you are still susceptible to become infected and may have mild or no symptoms. This means that you could still pass the infection to someone else, especially if they are more susceptible than the average individual such as people with low immune systems. 

Read more: CDC guidance on what you can do once fully vaccinated

Q: Once fully vaccinated, should people still wear N-95 masks, or are cloth masks acceptable?

Meza: The use of N-95 masks is most appropriate for health care providers and other individuals in a higher than usual risk for exposure to COVID-19 virus.

Alozie: I think that out in public, very few people were wearing N-95s to begin with. Cloth masks have always been acceptable in public. I think in hospitals and health care settings, the N-95 will be key, but I also think this starts to become a multi-pronged question. The question is not just the mask type, but the location you’re wearing it in. Is it in public? Are people that haven’t been vaccinated? I think it’s fair as a societal norm to wear a mask, whatever type you have access to. In airports and airplanes, this should hold true as well. Again, whatever mask you have access to. Some people want to double mask, some people don’t because they have a higher quality mask and that’s the key. In hospital and health care facilities, however, the burden of disease and sickness are potentially higher and so a hospital-grade mask is acceptable. I think, however, we are going to get to a point where a predominant percentage of people in health care are vaccinated, we’re going to have to rethink that whole conversation about mask type. It may be a little bit early, but outside, people and with people that are also vaccinated, there’s truly no reason to wear a mask. I think we have adequate data to signal that.

Q: How many people can safely gather outdoors if not everyone is fully vaccinated?

Alozie: I think the key takeaway here is that outdoor gatherings, even prior to vaccination, were the best place to gather. And there was no recommendation for mask wearing outdoors and outdoor activities, even prior to vaccines. So this is not a new point and dependent on vaccines. Outdoors is safe. And again, then the question becomes safety, safety of home to whom? I think that’s also important, but fully vaccinated outside absolutely no reason to wear a mask.

Meza: Outdoors is safer than indoors when people are gathering. As a general rule, gathering should not be of more than a few people at any given time, provided that social distancing and wearing a mask as well as proper hand hygiene is maintained. Keep in mind that you are not eliminating the risk, you are only reducing it by these interventions. The specific number is not stated by the CDC (Centers for Disease Control and Prevention) but it would be reasonable to assume that no more than nine individuals is adequate. 

Q: Can you have a get-together indoors, and if so, how many people is it safe to have inside if everyone is fully vaccinated?

Dr. Armando Meza

Meza: The CDC has not specifically established a number here either because it may be misleading. However if everyone is vaccinated and two weeks have gone by, a small gathering can take place. In the scenario of a meeting in a single household environment, a mask may not be required.

Alozie: If everyone is fully vaccinated, gather away. I mean, if you’re vaccinated, two weeks post your last shot, you’re safe and your chance or risk of having a severe event or hospitalization is as close to zero as anything can be close to zero. I don’t have any concerns about fully vaccinated people engaging whether indoor or outdoor. Now you may say what about if we have 10 people or 20 people or 100 people? It’s unlikely that anybody’s planning to have a 100-person indoor gathering at the moment. But I think again, if you are really clear about the fact that everybody is vaccinated, the risk is probably very minimal. We can multiply that out using Professor Emily Ulster’s calculator at a later point as well. But then the key is your friends and family indoors fully vaccinated is pretty safe.

Q: Is it safe to exercise in a gym?

Alozie: The follow up question is are you vaccinated? Yes. If you’re not, wear masks and try to get vaccinated as soon as possible.

Meza: Generally speaking yes. However, make sure that these facilities are in compliance with providing the required mitigation measures, such as requiring wearing a mask, proper ventilation, physical distancing, and regular surface disinfection. Outdoors is preferable for some physical activities such as running.

A summary from the Centers for Disease Control and Prevention on activities after being fully vaccinated for COVID-19.

Q: Is it safe to dine inside a restaurant?

Meza: In general, restaurants are places where the risk of infection is higher than with other activities of daily life. Therefore it would be best to take out food instead of eating inside a restaurant. However if you are going to eat inside a restaurant you should wear a mask, maintain social distancing, and frequently clean your hands. You should only remove your mask when eating or drinking and avoid crowded times of the day. Limiting alcohol consumption will help you with compliance of the precautions.

Alozie: People were eating inside a restaurant before we had vaccines in the middle of COVID. So it would be hypocritical and really ridiculous of me to say don’t dine when people were doing it prior to and not everybody that dined inside got COVID. Now, if you’re vaccinated, fully support our community and eat out when you’re so inclined with other vaccinated people. I think if you’re unvaccinated you need to consider the pros and cons. Is it an important dinner? Do you potentially trust or not trust the person that you’re with? Are they at high risk? There’s a host of risk and harm reduction there and variables that go into this. I think where we have failed as a community and spokespeople is creating these black and white, dichotomous choices. Nothing is dichotomous, there’s always a spectrum and we have to continue to remind people of that.

Q: Please rank from safest to least safe other activities for individuals who have been fully vaccinated.

Alozie: I want to make this really, really clear — fully vaccinated — I don’t truly believe there are any activities that you can’t engage in. Now, again, societal norms come into play and you may want to wear masks when you’re with other people. Travel, you’re going to be mandated to wear a mask anyway. But apart from that, the whole point of vaccination is to get back to normal and so we can’t tell people, hey, it’s really important to get vaccinated, but it’s really important to do everything that you did in June of 2020. That’s a ridiculous conversation. So I think we have to do better than that. You have to give people more hope and the science supports that. This is not just hyperbole, so I think that’s important as well.

Meza: Even though fully vaccinated people are better protected against infection, the risk is not zero. Consequently the same activities for unvaccinated people will carry this risk the same way as vaccinated people. Ventilation, social distancing and hygiene of the area are the factors involved in risk stratification. The highest risk is going to be inside bars or participating in large gatherings. Inside restaurants, indoor events especially with high respiratory droplets production such as speaking loud, singing or exercising. Less risk is going to be with outdoor activities such as walking, getting fuel for your car or playing tennis.

Q: What sort of activities have you personally participated in since being fully vaccinated that you avoided at the beginning of the pandemic?

Meza: Meeting with extended family members. I’m still wearing a mask and don’t handshake, especially when I am meeting with family members that I don’t frequently interact with.

Alozie: I think at the beginning of the pandemic, I was scared and so my last flight was probably March 10 of 2020. I didn’t fly again, until the end of 2020. I created a bubble of friends on average, and they were all in health care. So we were all wearing masks and everything. Outside of the hospital, I wanted to go and see my mom, my mom lives in Nigeria, and I deliberately put that on hold for all of 2020. So I completely reduced that and all the business travel and sort of philanthropic health care travel I would have typically done, I put that on hold, because of the role that I played previously. In that little lull that we had between our first spike and our second spike, we took some doctors out to dinner, we engaged in recruiting. But again, we only did that in places that were on average, outdoor, and other things like that. So that changed. My kid that plays sports stopped playing sports for a long period of time, until we got more comfortable and looked at the data around kids and started to do that. Now that I’m vaccinated I plan to go on vacation this summer. I traveled, I’m in a foreign country right now and I plan to go to Nigeria to see my mom. So that has changed again.

Q: What sorts of activities have you personally avoided regardless of being fully vaccinated?

Alozie: Being fully vaccinated, there are no activities that I plan to avoid and I think that’s the whole point. I’m vaccinated now, and I feel very comfortable engaging in all other activities that I need to.

Meza: I have not eaten inside a restaurant since the pandemic began. I have not gone to any large gatherings such as conferences.

Q: How will things change over time as more El Pasoans are vaccinated, versus where we’re at right now in terms of safety?

Meza: Once herd immunity is reached and the majority of people have been vaccinated, the number of individuals at higher risk of severe illness will significantly drop. There will most likely continue to be some general measures enforced, including wearing a mask and social distancing. I also anticipate a greater consideration to provide virtual options to individuals who prefer to do so.

Alozie: I always say this. I’m not trying to be Nostradamus. But if expectations hold up and supply outstrips demand by this summer, sometime in June, I truly anticipate mask wearing to reduce drastically this summer. We’re in a state where there are no more mask mandates that are state driven, or are federally driven. So I truly believe that in terms of that, we could have a very Woodstockean, and I’ve used this term before, Woodstockean summer and early fall and I think that’s a good thing.

A woman who lives in rural Northwest El Paso County receives a COVID-19 vaccine at The Hospitals of Providence Transmountain Campus. (Photo courtesy of The Hospitals of Providence)

Q: How long will it take for the community to reach herd immunity?

Alozie: Herd immunity is a moving target. People are tagged at anywhere from 60 to 70 to 80% (with immunity). And remember, that’s not just those that have been vaccinated, but also those that have gotten natural immunity through infection. I think that’s important to remember. However, I no longer think in terms of herd immunity as a cut point, but rather when do we start seeing a drastic reduction in new COVID cases and not just COVID positivity — because I think there’s an argument to be had now around what that means in somebody that’s vaccinated, but hospitalization cases and deaths. I think that is going to be our new metric going forward and it should be our new metric going forward.

Meza: It probably will not be at least until the fall of this year that all individuals will have access to the opportunity to become vaccinated. Children will hopefully be able to be eligible for vaccination once the results of the currently undergoing vaccination trials are submitted to the Food and Drug Administration for emergency-use authorization.

Q: How do the number of El Pasoans who have received their first dosage compare in to those who have received their second dosage of the COVID-19 vaccines?

Meza: The recipients of the first dose of Pfizer and Moderna vaccines will achieve a degree of protection by receiving the first immunization. However, the maximum benefit will only be achieved after receiving the second dose mainly because this is when, in addition to short-term benefit, the longer-lasting protection will be developed by their immune system.

Alozie: Looking at the numbers, El Paso is doing great per capita. I think we’re second or third in the state, but there does seem to be a drop off in second dose numbers. Now that may be a supply disruption when we had our electrical grid issues. There may be some people that haven’t gotten the second dose. There’s been a conversation, a controversy about whether we should postpone second doses to certain people. I do worry about those people. That’s why I was really bullish on the (Johnson & Johnson) vaccine, before the present pause, because it was one and done, you didn’t have to worry about the second dose people coming back. I think, however, data is now actually showing that that first dose four weeks out is providing some sort of protection in the range that I’ve seen is anywhere from 60 to 80%. I think that’s a good thing. We just need to get more people their first doses and second doses as well.

A nurse prepares a COVID-19 vaccination dose at the city government’s hub near El Paso International Airport. (Photo courtesy of city of El Paso)

Q: What concerns you about where the community is as far as new cases of COVID-19?

Alozie: I don’t have a concern to date. Obviously, our numbers and our hospitalizations are markedly down from where they were at our peak last year. I think that’s great. November 2020 kept me up at night all the time. We’re in a much better position and the more we vaccinate, the better. I know a majority of our vaccines are MRNA. The unfortunate pause with J&J will push out potentially the available vaccine timeline. I think the White House and CDC are saying that they feel they can ramp up with Moderna and Pfizer and that’s good to hear. I really think the state just needs to get more vaccines into primary care locations. I know that J&J was targeted to go to the pharmacies, the Walgreens and the CVSs, but I think if this is a war, and this is a ground war, it’s the primary care and clinics that know where their patients are and where they can go find them. I think that may be that sort of last-mile phenomenon in vaccines. How do you get it into that group of people?

Meza: We still have a significant number of people that are being admitted to the hospitals for severe disease. The numbers have not increased but they are not going down as you would like to see. In my view this is a reflection of a susceptible population that has not yet received the benefits of vaccination. Whatever the reason may be, it is important that those individuals receive the only proven effective and safe intervention that we have at this time which is vaccination.

Q: What brings you hope about more El Pasoans receiving their vaccines?

Meza: I believe that the benefits of vaccination are becoming obvious to many of the citizens of El Paso. The efforts by the federal, state and local governments are coming to fruition. Access to vaccines has increased tremendously and the interest in getting vaccinated is still very high in the population. I am positive that we will soon achieve the ultimate goal of decreasing the number of cases to a degree compatible with a more normal life.

Alozie: That hope is that we get back to normal. I truly believe that if the city gets their vaccinations percentages up, and the community gets vaccinated by this summer, we’ll have a reassessment and discussion about where we are and what’s next. How do we start to reduce the fear, anxiety and angst that COVID, and a host of responses to it, have driven into our community. Not just ours, but communities across the country, where we do need to engage in a coordinated and targeted, as I said before, sort of ground war for lack of a better term. Just to get that last mile of persons that haven’t been able to get the vaccine. I’m still concerned that in a city that has about three to 4% African American population, they only make up 1% of the vaccine given. That’s a problem. On long-term care facilities we’ve done a great job. We’re going to have to have that conversation that’s going to be controversial, and it’s going to cause a lot of friction, but whether kids require vaccines or not. As of today I don’t think they do, but again, I think it’s a nuanced conversation, and we’ll have to go from there. But all in all, I’m really hopeful and positive about 2021.

Cover illustration courtesy of Rochester Regional Health.

Elida S. Perez is a senior reporter for El Paso Matters. Her experience includes work as city government watchdog reporter for the El Paso Times, investigative reporter for El Paso Newspaper Tree and communities...