After Toronto family physician Dr. Tali Bogler received her final dose of a COVID-19 vaccine in January, she felt a newfound sense of relief — but also knew her daily life wasn’t going to suddenly change.
On an afternoon in late February, while still dressed in her bright blue scrubs after a shift at St. Michael’s Hospital, she was cuddling one of her twin daughters while catching up with her parents on a video chat.
It’s the same kind of virtual family time Bogler has experienced throughout the pandemic. Being vaccinated doesn’t mean she’ll start seeing them in person without precautions any time soon, she said, since her parents won’t get their shots for months.
“It’s really hard,” she said, though acknowledging there’s also a sense of excitement for what’s to come. “This period of time, from now until September, I guess, when everyone else is vaccinated, is a transition period.”
More and more Canadians will be grappling with that sense of limbo in the weeks and months ahead after getting vaccinated and protected against COVID-19 while millions of others are still waiting for their turn.
“What does that normalcy look like?” asked Dr. Donald Vinh, an infectious disease specialist and medical microbiologist at the McGill University Health Centre.
“That’s a question that we are collectively struggling with.”
Experts who spoke with CBC News stressed that people still need to err on the side of caution and keep their guard up awhile longer, whether vaccinated or not, to protect those around them.
But after a year of lockdowns and restrictions, there’s also bound to be plenty of friends and families hoping to spend time together once more Canadians start getting their shots — a reality that requires taking stock of everyone’s comfort level when it comes to risk.
“I do think we’re entering into a phase where people are more and more tired of having to deal with public health restrictions, and so we’re probably more likely to encounter that,” said infectious disease specialist Dr. Susy Hota, an associate professor at the University of Toronto.
“I think the important message to give people is that in the short term, nothing changes. So they have to live their lives the same way as they were before they were vaccinated, because it will take some time to get enough people vaccinated.”
Risk ‘quite low’ among vaccinated people
Of course, as time passes, more vaccinated people will know more vaccinated people, be it friends, family members or co-workers.
So, at what point can those groups of COVID-protected people start spending time together without the usual pandemic safety concerns?
“If your parents are older, and they’ve gotten vaccinated — and you’re vaccinated — the risk is quite low, especially if you are continuing publicly to maintain all the other public health measures,” Hota said.
But those situations won’t be common for a while, forcing friends and families to navigate a stark, two-tier world of protection levels.
That means even while vaccinations scale up, public health measures such as mask-wearing and distancing from others are expected to stay in place.
“We often talk about herd immunity,” said Dr. Vinita Dubey, Toronto’s associate medical officer of health. “And that’s often what we really need to have before we can be confident that having so many people vaccinated is acting like that wall to keep COVID from coming back into our community.”
While the vaccines in use so far are proving highly effective at stopping serious illness and death, they aren’t 100 per cent protective and don’t offer instant immunity. Researchers also still aren’t sure how much they might curb transmission of the virus.
“If it interrupts infection, then it’s kind of stopping that chain of transmission from happening, just by virtue of having fewer people who are going to get infected,” Hota said. “But there may still be some asymptomatic infections and some ability to shed virus.”
In Israel, where mass vaccinations are already taking place, the country’s largest health-care system has so far reported a 94 per cent drop in symptomatic COVID-19 infections — and early study findings suggest at least one vaccine may curb transmission, too.
Those results bode well, but it’s still going to take time to confirm them more broadly, Vinh said.
In the meantime, plenty of people waiting to get vaccinated will remain highly vulnerable to the impacts of a COVID-19 infection, be it lingering, long-lasting symptoms or a gruelling recovery following an ICU stay.
“People who have had cancer, people who had transplants, people who have genetic conditions,” he said.
Find ways to lower risk
At first blush, it’s probably not the news most people want to hear. Finally, at long last, vaccine shipments are ramping up and more residents will be rolling up their sleeves in the months ahead, yet nothing changes?
Hota said while it might feel that way at first, there’s likely going to be a slow and steady reduction in restrictions as vaccination campaigns roll out from high-risk age groups to younger populations.
“If you rush it,” she said, “you can jeopardize the whole approach.”
Dr. Dominik Mertz, an infectious disease specialist and associate professor at McMaster University in Hamilton, said it will become even more crucial in the months ahead to assess your comfort level around risk, and the comfort level of those with whom you’re considering spending time.
“Policy decisions aside, it’ll be a discussion,” he said.
“Some families may decide, OK, my grandparents or parents are vaccinated — they’re high risk, but highly protected — and we as a family decide it’s OK meeting in their house.”
But you can also make those efforts to start seeing each other without fully scrapping precautions, he said. Instead of meeting indoors post-vaccination, you could spend time outside where the transmission risk is lower.
“Maybe don’t take the full risk,” Mertz said. “Find something in between, where your personal needs are met but you don’t take the highest possible risk.”
And, he said, it’s important to pay attention to what’s happening in your broader community, not just your own social circle.
High levels of community transmission would mean the chance of people you know being infected goes up as well. It’s a trend public health officials are watching closely given the cases of highly contagious variants already circulating, which could lead to another surge in cases.
WATCH | Pfizer-BioNTech vaccine may curb transmission, early research suggests:
New research conducted in Israel shows that if a person is infected with COVID-19 after receiving a single dose of the Pfizer-BioNtech vaccine there’s less coronavirus in the system, and that could mean the vaccine may help prevention transmission. 1:55
‘Normalcy is on the horizon’
With so much to consider, Canadians could face some frustration and ethical dilemmas over the next year.
Toronto resident Mary Ellen Abrams, who is currently living in a retirement community in Palm Springs, Calif., said she was surprised to get access to a local vaccination program during her stay in the U.S. — but then found herself stumped on what to do next.
“We’re all kind of saying, by mid-March, two weeks after the second dose, we should all be able to hang around each other, to go for dinner together,” said the 65-year-old. “They’ve opened up indoor dining here in California and we thought, ‘Gosh, can we do that?'”
She also wondered whether it would be safe to see her grandchildren in Toronto after she gets back and completes the mandatory hotel quarantine, since she hasn’t spent time with them in-person since last March, beyond saying hello on a front porch or during drive-by greetings.
But finding answers to her questions hasn’t been easy, Abrams said, with little information available on any government websites about what you can or can’t do in your daily life post-vaccination.
“Everyone will want to be vaccinated if they know they can get their life back to somewhat normal,” she said.
Vinh said that scenario requires a little more patience to avoid giving the virus more chances to spread during what has the potential to mark a turning point in the pandemic.
“We don’t want to say, ‘Well, we have a vaccine coming and they say it is almost 100 per cent effective, and once I get my first shot I can go out and do my thing, my regular thing,'” he said. “Not yet, not yet.”
The payoff of getting your shot, for now, remains the personal protection it provides, not a sudden end to the pandemic for everyone in your life — even though that’s the ultimate hope for mass vaccination efforts.
Bogler, the mother to twins who is both a family physician and chair of family medicine obstetrics at St. Michael’s Hospital in Toronto, can certainly relate to that feeling.
Memories of her COVID-19 exposures at work are still fresh, including a stretch where she had to isolate from her daughters and partner for two weeks last year. But those close calls likely won’t be the norm for her anymore, taking a weight off her shoulders even as she continues masking, distancing, and staying apart from her parents awhile longer.
“Normalcy is on the horizon,” she said.
