White Coat, Black Art·The Dose

Are you having a 2-dose summer? Expert weighs in on what's safe to do when you're fully vaccinated

More and more Canadians are getting their second dose of COVID vaccine. So what's safe for you to do if you're heading into a two-dose summer? Can you travel? Hug your grandkids? Go to restaurants? Infectious diseases specialist Lynora Saxinger has the answers for what life can look like if you're fully vaccinated.

But you might have to wait for Dose 2 if you got AstraZeneca, as Ontario rejects calls to shorten interval

The U.S. has released detailed guidelines for fully vaccinated Americans, but Canada has yet to do the same. Infectious diseases specialist Dr. Lynora Saxinger says fully vaccinated Canadians should be able to safely resume many pre-pandemic activities, including eating indoors and outdoors, like the diners shown here at The Birds & The Beets restaurant in Vancouver last summer. (Submitted by Matthew Senecal-Junkeer)

"Please hug!" 

That's Dr. Lynora Saxinger's advice to fully vaccinated grandparents who are eager to wrap their arms around their grandchildren who may not be fully vaccinated themselves. 

Still, the infectious diseases specialist at the University of Alberta cautioned it's important to remember that you are not fully vaccinated until two weeks after your second dose.

The Public Health Agency of Canada (PHAC) has released a roadmap for reopening based on vaccination rates and case counts that suggests provinces should begin to lift public health restrictions only once 75 per cent of all adults have had at least one vaccine dose and 20 per cent are fully vaccinated. However, it doesn't provide detailed advice for the fully vaccinated. More than 60 per cent of the population has had at least one dose and more than eight per cent have had two.

Dr. Lynora Saxinger, an infectious diseases specialist at the University of Alberta, says fully vaccinated Canadians need more detailed guidance around what activities they can safely resume. (Martin Weaver/CBC)

"We haven't really seen the evolution of that information in Canada as much," Saxinger told Dr. Brian Goldman, host of CBC Radio's The Dose and White Coat, Black Art, noting that the U.S. Centers for Disease Control and Prevention released detailed guidelines in May for what fully vaccinated people can do safely.

"It leaves people in a position of having to kind of build their own adventure a little bit. And it's creating a little bit of stress."

Meanwhile, many recipients of the AstraZeneca-Oxford vaccine have to contend with the stress of a 12-week wait before getting their second dose of any vaccine — a rule many experts are questioning. 

There's a major quality of life issue with not seeing your own family.- Dr. Lynora Saxinger

But for those who are fully vaccinated, while you need to follow the public health rules where you are, many of the activities you're likely longing to do are reasonably safe, according to Saxinger.

Seeing family and friends 

She had good news for older people eager to see their children and grandchildren: those who are fully vaccinated have a strong immune response and are "largely protected from severe disease." 

"There's a major quality of life issue with not seeing your own family," Saxinger said. Things like sleepovers and hugs should be fine, she said, if some precautions are taken, including staying outdoors when possible, opening windows when indoors, and handwashing.

Experts say grandparents eager to hug their grandchildren and reunite with their family are in luck — if they're fully vaccinated. (Shutterstock)

But, she cautioned, if you're medically fragile or in a region where the seemingly more transmissible delta variant is circulating, it's a good idea to be more cautious and, again, follow the local public health guidance.

Indoor dining and concerts

Saxinger said indoor dining is relatively safe for the fully vaccinated, depending on what region you're in. 

"I think a lot of restaurants have done a really good job with distancing and protocols, and ... if they continue keeping those structures in place, they'll be pretty safe spaces by and large."

A pre-pandemic night at Edmonton's Bodega Highlands restaurant. Infectious diseases specialist Dr. Lynora Saxinger says it's reasonably safe for fully vaccinated people to resume indoor dining. (Photo by Dong Kim)

However, for larger indoor gatherings such as concerts or parties, Saxinger recommends waiting until at least the fall when case counts will hopefully be much lower. 

Being fully vaccinated does not make you "bulletproof," she said. Although it's rare, there are still breakthrough COVID-19 cases in the fully vaccinated.

Travel in Canada

Many people are eager to travel to see friends and family in Canada, but Saxinger advised holding off another six weeks or so to see what the delta variant does to case counts.

"If you're going from low to high risk [areas], you might be bringing something home," she said. "If you're going from high to low risk [areas], you might be bringing something with you."

Fully vaccinated Canadians eager to travel should consider holding off until mid- to late summer to avoid transporting the delta variant to or from their destination, say experts. (Vince Warburton/The Associated Press)

She said if we're not seeing flare-ups of delta and vaccination rates continue to climb, "mid- to late summer travel starts looking a lot more reasonable."

What about AstraZeneca recipients? 

But as many Canadians get their second dose, so-called Team AstraZeneca is mostly waiting.

"I've received thousands and thousands of irate messages from people saying, 'I did as I was told. I took the first dose available to me. I chose AstraZeneca so I could give Pfizer to someone else who is in a hot spot. And now everyone around me is able to get their second doses, but I have to wait for 12 weeks and I feel like I'm being penalized,'" said Sabina Vohra-Miller, co-founder of the South Asian Health Network, a Toronto-based advocacy and education group that provides vaccine information to communities. 

Data from the original AstraZeneca-Oxford clinical trial showed increased robust immune response if the second dose is given at the 12-week mark. However, last week, PHAC released new guidance on mixing vaccines, saying it was safe for someone who received a shot of AstraZeneca to get Pfizer-BioNTech or Moderna for their second dose at a four- to 12-week interval.

In Ontario, though, if you had AstraZeneca first, you can't book your second appointment until 12 weeks after your first dose, which is longer than in other provinces.

Sabina Vohra-Miller, the co-founder of the South Asian Health Network, who has her master of science in pharmacology, is calling on the Ontario government to shorten the 12-week interval between doses for those who received an initial shot of AstraZeneca. (Submitted by Sabina Vohra-Miller )

But Vohra-Miller is part of a growing chorus of experts calling on the Ontario government to reduce this interval. 

Vohra-Miller, who has her master of science in pharmacology, said we don't have the "luxury of time" to wait for the optimal immune response because "we are in a race" against the delta variant, especially in regions such as Peel in Ontario, where she lives.

WATCH | Infectious disease specialist Dr. Isaac Bogoch discusses shrinking the 12-week interval between doses for AstraZeneca: 

Ontario reopening on Friday 'clearly the right move,' expert says

Canada

13 days ago
8:40
Moving into the first phase of its reopening plan on Friday is the right move for Ontario, says infectious diseases specialist Dr. Isaac Bogoch. Restaurant patios and outdoor exercise facilities are among the businesses that will be allowed to open and they are not drivers of the COVID-19 pandemic, he says. 8:40

According to a preprint study looking at vaccine efficacy to the delta variant from Public Health England, which has not yet been peer reviewed, AstraZeneca is only 33 per cent effective against symptomatic disease three weeks after the first dose.

Vohra-Miller pointed out that other provinces, including Quebec, Manitoba and Saskatchewan, have shrunk the interval for AstraZeneca doses to between four and eight weeks, depending on the province.

In a statement to CBC Radio, Ontario's Ministry of Health says it continues to recommend the 12-week interval "to get the best immune response possible for all Ontarians." It says "two doses of AstraZeneca at a 12-week interval provides a better immune response than over a shorter interval," which refers to data from the original AstraZeneca-Oxford clinical trial.

The ministry also says it is continuing to review the evidence around dose intervals and mixed-dosing schedules.

Vohra-Miller said new science is emerging to support shorter intervals. A preprint study out of Germany that has yet to be peer reviewed looked at mixing vaccines, with AstraZeneca as the first dose and Pfizer as the second. The results suggest a strong immune response with an eight-week interval. 

A woman gets a dose of the AstraZeneca COVID-19 vaccine at the Guardian Snowdon Pharmacy in Toronto on March 17. (Sam Nar/CBC)

Once you're fully vaccinated, regardless of the vaccine, Saxinger said making decisions about what risks you're prepared to take is still an "odds game," and while the risks are getting lower as more people are vaccinated, "we can't promise zero [risk]."

Still, she's "optimistic for a good summer."


Written and produced by Willow Smith.

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