South Africa: Covid-19 - Do I Still Need to Wear a Mask When Vaccinated, and Other Questions

With South Africa's COVID-19 mass vaccination rollout set to start on 17 May, many more people, for now, those older than 60 years, will start receiving their jabs.

What, if anything, will change for those who have been vaccinated in South Africa, and what have other countries done in this regard?

Must I still wear a mask when vaccinated?

For now, it appears that the same rules, such as mask-wearing and social distancing, will remain in place for everyone.

"Presently the South African guidance on public health interventions to prevent SARS-CoV-2 has not been altered to accommodate for any impact that the vaccine may have on transmission," says Dr Kerrigan McCarthy from the National Institute of Communicable Diseases (NICD).

"Mask-wearing in public is still mandatory, and social distancing, sanitising is still advised," McCarthy adds. "The guidance regarding the duration of quarantine following exposure is unchanged at present. In part, this is because vaccination is not widely accessible, but also, there is not yet clarity on the degree to which vaccination protects persons or reduces transmission."

Will I be exempt from COVID-19 regulations?

Public Health Medicine Specialist, Dr Lehlohonolo Majake, confirms that vaccinated individuals are not exempt from any COVID-19 regulations at this point.

"We are nowhere near having 65% of the country vaccinated, and so even those who have had a vaccine should be very cautious and continue to take all non-pharmaceutical precautions," she says.

According to Majake, the SARS-CoV-2 virus is not fully understood at this point and it hasn't yet been confirmed what level of protection the available vaccines provides against different emerging variants. Because of this, people who have been vaccinated should still behave as if they haven't been vaccinated. She adds that it is also important to keep using the preventions that have been proven to work, particularly non-pharmaceutical interventions like social distancing, wearing masks, and good hand hygiene.

Can you get the flu shot if you've been vaccinated?

McCarthy points out that the NICD has provided guidelines about getting both the influenza vaccine, commonly known as the flu vaccine, and the COVID-19 vaccine.

The guidelines say that an individual can get both vaccines, but should not get them on the same day. Instead, it recommends that the flu vaccine and the COVID-19 vaccine be administrated at least 14 days apart. If someone gets both vaccines between 14 and 28 days apart, the injections should be in opposite arms, so it is easier to monitor the local reaction.

It does not matter which order the vaccines are received in, according to the NICD guidelines, but if both are available to someone at the same time, the COVID-19 vaccine should take priority.

It also recommends that people in high-priority groups should get their COVID-19 vaccine as soon as possible, and those in lower priority groups should get their flu vaccine while waiting for their turn to get the COVID-19 vaccine.

What are countries doing that have vaccinated larger percentages of their populations?

While South Africa is still in the early stages of its vaccination rollout, several other countries have already vaccinated a higher percentage of their population and have adjusted their guidelines for what fully vaccinated people can and cannot do.

What is the situation in the United States?

By 8 May, the United States (US) had fully vaccinated 34% of its population, according to the New York Times's vaccination tracker.

The Centers for Disease Control and Prevention (CDC) recently released guidelines for what people who have been fully vaccinated can and cannot do.

The latest recommendations, last updated on 27 April, state that vaccinated people should still take precautions in public, indoor settings like wearing a well-fitting mask. They should also still avoid large, in-person gatherings.

Precautions should also be taken if a vaccinated person meets indoors with someone who is at increased risk for severe COVID-19 disease.

Vaccinated people do however now have the freedom to visit other vaccinated people indoors without needing to wear a mask or practice physical distancing, according to the CDC. They are also allowed to visit unvaccinated people indoors, provided that they are from a single household and at low risk for developing severe COVID-19.

The CDC also makes allowance for vaccinated people to "participate in outdoor activities and recreation without a mask, except in certain crowded settings and venues".

According to the CDC guidelines vaccinated people in the US are allowed to travel. For domestic travel, they do not need to undergo a COVID-19 test before and after travelling and do not need to self-quarantine after travelling. For international travel, they still need to be tested if their destination requires it, but they do not need to self-quarantine when they return to the US.

Vaccinated individuals also don't have to undergo routine screening and testing, as well as testing and quarantine after a known exposure, on the condition that they are asymptomatic.

What is the situation in Israel?

Another country that has made significant progress in its COVID-19 vaccination rollout is Israel.

According to the New York Times's vaccination tracker by 8 May, 56% of Israel's population had been fully vaccinated. This has resulted in the country relaxing some of its restrictions for individuals who have been vaccinated.

According to Israel's Ministry of Health website those who have been fully vaccinated, as well as those who have recovered from COVID-19, can be issued a "Green Pass", which is valid for six months and allows pass holders to enter recreational facilities including gyms, swimming pools, sporting events, theatres, cinemas, and cultural venues.

The Ministry announced on 4 May that "all restrictions, including gathering restrictions, are lifted for establishments that opted to operate subject to the Green Pass requirements. It should be stressed: Only Green Pass holders may enter these establishments".

According to a Reuters article, the Israeli government announced in April the country will from 23 May allow entry to a limited number of fully vaccinated tourist groups.

Could South Africa adopt similar guidelines to other countries?

When asked whether she foresees South Africa adopting guidelines similar to those of countries like the United States in the near future, Majake says that based on the number of people vaccinated so far it would be premature to have a different set of guidelines for such a small number of people.

According to the National Department of Health's vaccination update on 9 May, a total of 382 480 healthcare workers had been vaccinated to date.

She adds that factors that will inform further COVID-19 guidelines would be a bigger uptake of vaccination and study results. For now, having the same guidelines for everyone is better.

"Standardised guidelines reduce any room for misinterpretation which may lead to unintentional default in behaviour," she says.

The World Health Organization's (WHO) recommendations for individuals post-vaccination is to keep taking precautions like practising social distancing, wearing a mask, coughing and sneezing into their elbow, and ensuring there is good ventilation when indoors with other people.

"While a COVID-19 vaccine will prevent serious illness and death, we still don't know the extent to which it keeps you from being infected and passing the virus on to others... Continue to take actions to slow and eventually stop the spread of the virus," the WHO states.

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