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Dr. Peter Hotez Gives COVID Etiquette Tips For A Semi-Vaccinated World

Dr. Peter Hotez admits there's not always an easy way to talk about touchy topics like vaccines and pandemic safety.EXPAND
Dr. Peter Hotez admits there's not always an easy way to talk about touchy topics like vaccines and pandemic safety.
Photo by Agapito Sanchez
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It can be tough to know exactly how to act in this strange new period of the coronavirus pandemic we find ourselves in, with vaccine supply outpacing demand, confusing local threat levels and recommendations from the U.S. Centers for Disease Control on mask-wearing that shift from week to week.

COVID-conscious people who want to “follow the science” while still venturing out of isolation are increasingly having to deal with navigating the etiquette of how to stay safe and not risk offending the people they care about. It's especially tricky in a state like Texas where there’s plenty of coronavirus misinformation floating around and a large number of residents either didn’t believe the pandemic was a real threat to begin with, or just aren’t totally informed about how to safely go about their lives despite their best intentions.

That’s why the Houston Press reached out to Dr. Peter Hotez — the Baylor College of Medicine professor and Texas Children’s hospital vaccine researcher who’s become a trusted source of infectious disease expertise during the coronavirus crisis — for a few tips on how to balance safety and politeness in the unique social situations that pop up a year-plus into a global pandemic.

Hotez said Houston area residents should know “There’s still a moderate level of transmission” of COVID-19 in the region when they’re deciding whether to mask-up or not, which is why Hotez said he still typically keeps his mask on when indoors at work and takes it off when he’s outside.

When people think about whether to wear masks when out and about, Hotez said the three most important factors they should keep in mind are whether they’re fully vaccinated, whether they have compromised immune systems and just how much the coronavirus is spreading where they live, “because the vaccines are not perfect.”

“You can still have breakthrough infections,” Hotez said, describing the extremely rare but still possible chance that people could come down with COVID-19 after vaccination, even though research shows those “breakthrough” cases would likely be on the milder side of coronavirus cases.

The virus is spreading more rapidly in other parts of the country, and vaccination rates are starting to dip particularly in the South, which is why Hotez thinks the CDC should have held off on its latest round of masking recommendations that gave fully-vaccinated people the green light to ditch masks in most settings.

“There’s still a ways to go, so I think some of the CDC guidelines, the new ones, would have been better to happen over the summer when we can get close to fully vaccinating the American people. We still have a significant level of transmission [in the United States as a whole],” he said.

Unvaccinated and immunocompromised folks should definitely keep wearing their masks wherever they live, Hotez said, and even the vaccinated should realize it’s safest to mask-up if they’re in close contact with a person who isn’t vaccinated.

But making that call would depend on knowing the other person’s vaccination status, which Hotez admitted can be a tricky subject to broach, especially in southern states like Texas where vaccination rates are lagging behind other parts of the country.

“What you have now in Texas is unfortunately, some people are tying their political allegiance to conservatism by demonstrably saying they’re not getting vaccinated. That’s a problem,” he said.

If Hotez has to meet with someone face-to-face in close quarters, he’s found it easiest to deduce the vaccination status of the other person by first bringing up that he himself has been vaccinated.

“I kind of offer it. I don’t ask, I just say that I’m vaccinated, and that takes some of the pressure off too, and so people don’t feel like they’re just being in an inquisition,” Hotez said. If his counterpart says they’re also fully vaccinated, he said they’ll both drop the masks while they chat. If the other person isn’t vaccinated, the masks stay on.

“It’s a bigger problem here in Texas and in the south than up in the northeast,” Hotez said of possibly offending someone by bringing up vaccines. “Almost everyone in the northeast, most people want to get vaccinated, and they’re getting vaccinated.”

If people want to push back against anti-science and anti-vaccine views held by their friends and family but still want to stay on speaking terms, Hotez said he’s found a softer, non-combative approach works best.

“I try to understand what they’re basing their information on, why do they think that, and sort of take it from there. But you know, you have to sort of ease into the conversation,” he said. “I don’t go to war with people. I try to understand. I try to learn what their concerns are, and then have an open, honest conversation.”

Then there’s the issue of all those people who fall somewhere between the coronavirus safety sticklers and the hardcore anti-vaxxer crowd, like a person who posts a celebratory selfie after getting the first shot of a two-dose vaccine, but does it without a mask on, indoors, in a crowded restaurant weeks before shot number two and the waiting period it takes for the highest level of protection to kick in.

When dealing with folks who seem to be trying to act safely but might have missed a few important details along the way, Hotez believes that “You have to recognize that it’s most likely not deliberate defiance, as most likely, people are trying to find the guidelines, but the guidelines are confusing, and they’re inundated with outright information or disinformation [at the same time].”

“So the way I usually start those conversations,” he continued, “is I talk about myself and what I’m doing and why I’m doing it, and then you kind of see where it goes from there.”

Given the highly rare but still possible chance of breakthrough infections in people who are vaccinated, Hotez said there’s nothing rude or improper about fully-vaccinated people telling their friends and family that they’d still rather stick to outdoor gatherings versus getting together inside.

If Hotez was in that person’s shoes, “I would say ‘I’d feel a lot more comfortable if we go out to a bar or restaurant if there’s outdoor seating.’ And say ‘Look, once transmission really declines towards containment mode, then I think we can go back to pre-pandemic [ways of doing things].’”

“Right now, I’m still a little skittish about it,” Hotez said of his own comfort level hanging out with others indoors. “I’ve went to an indoor restaurant only a couple of times where I’m actually sitting indoors and eating. My son had a birthday for instance, and there wasn’t any outdoor seating, so we did it.”

“It was okay, [but] I can’t say I felt entirely comfortable,” he admitted. “But by the summer, assuming we can get vaccination rates up, transmission will really slow or halt, and then absolutely that’d be fun.”

“But the point is, it’s not a light switch. It’s an evolving situation,” Hotez said, meaning we’ll still have to deal with plenty of potentially uncomfortable pandemic-induced social situations for many months to come.

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