How Long to Get Back Into Ketosis After Cheat Day
Vaccine Cheat Days Are Adding Up
Vaccinated and unvaccinated people are getting more lax with behavior at a time when vigilance really matters.
A few weeks ago, my partially vaccinated partner and my wholly unvaccinated self got an invitation to a group dinner, held unmasked and indoors. There'd be Thai food for 10, we were promised, and two über-immunized hosts, more than two weeks out from their last Moderna doses. And what about everyone else? I asked. Would they be fully vaccinated, too?
Well, came the response. Not really. Some would be, some wouldn't. But it had been so long—weren't we close enough?
The answer was of course no, and my partner and I ended up staying home. But as the weeks wear on, I'm having more and more of these conversations with people who are struggling to navigate the new social calculus of a partly vaccinated world. Even as infection rates tick up again, people are bending, stretching, and breaking the rules governing how they should act around others: A recent Gallup poll showed that Americans' vigilance about distancing and avoiding public places seems to be slackening, regardless of their immunization status. Slowly but surely, we're losing our grip.
To be clear, we have reason for optimism. Vaccination rates are also rising, and according to the latest estimates, the currently cleared shots are extraordinarily effective at preventing not just symptomatic disease, but asymptomatic infections—key to slowing the virus's often-silent spread. In recent weeks, the CDC has green-lit fully vaccinated people to skip post-exposure quarantines; mingle with one another in small groups, indoors and unmasked; visit unvaccinated, low-risk people under limited circumstances; and, now, travel safely within the United States. With less than 20 percent of the country fully vaccinated, the agency is quite understandably moving with caution, and hasn't yet changed its stance on whether vaccinated people should wear masks in public (yes) or gather in medium- and large-size groups (no).
But across the country, states are rushing to lift mask mandates, tolerance for physical distancing is flagging, and vaccinated people are amending the new guidelines as they see fit. Some, like our would-be dinner-party hosts, are planning mixed-vaccination events, and pushing the boundaries of what makes a gathering "small." Others are holding birthday bashes, or starting to creep back to in-person work. People are also shaving time off the two-week period that the CDC advises waiting after the final shot, so that immunity can mature. "What difference is a few days going to make?" a friend asked me the other day.
Read: The false dilemma of post-vaccination risk
Amid all the fudging, that sentiment is starting to become a constant refrain: Really, what's the harm?
The harm is, frankly, mathematical. Over time, our vaccine cheat days start to add up. It might truly be innocuous for a few people to cut a couple of corners on occasion. But eventually, a series of flubs will allow exposures, which will in turn beget disease. Our shortcuts also signal to others that it's okay to chill out when it is very much not.
Now is not the time to relax—quite the opposite. "We're so close to the end that we should be extra careful right now," Julie Downs, a psychologist and behavioral scientist at Carnegie Mellon University, told me. The problem is, our lapses don't just slow us down. They set us back, in the same way that repeatedly opening an oven door will prolong the time it takes to bake a cake (and, at worst, make your delicious dessert collapse). Having made so much progress, we risk a lot with our impatience. And right now, we're in serious danger of botching our grand pandemic finale.
The CDC can't be expected to lay out every possible social scenario that a vaccinated person might encounter. But public-health officials do have the tough job of tweaking guidance based on new data on vaccine effectiveness. Wobbly rules are harder to communicate and follow; even CDC Director Rochelle Walensky seemed to waffle last week while discussing how effectively inoculations thwart infection and the risks of post-vaccination travel.
Unfortunately, humans have a tendency to spin ambiguity into the most favorable outcome available, says Uma Karmarkar, a behavioral-economics expert who studies decision making at UC San Diego. Any squishiness in wording can provide a loophole for people to pick at, or to massage into a more convenient shape. Saskia Popescu, an infection-prevention expert based in Arizona, told me she's already noticed people deriving false equivalences from the agency's guidelines: "People figure, If I can get together with another household that's unvaccinated, why can't we do large meetings?"
Many of these decisions, while well intentioned, will create a patchwork of post-vaccination behaviors, a lot of which will be risk miscalculations. "If I'm the one left to generalize, I'm going to use intuition," Downs said. "So if I can do this, surely I can do this—maybe I don't see it as a step toward the risky, but as a step toward the side." Some people who believe that they've behaved responsibly this past year might feel more impervious to the virus, and cut themselves more slack, Karmarkar told me. A sense of exceptionalism, she said, makes it easy to say, "Well, an intimate gathering might be eight to 10 for most people, but we're extra careful, so 12 or 14 is probably fine." Even people who say they plan to get vaccinated but haven't yet appear to be loosening up ahead of schedule, according to the Gallup survey—perhaps because, for some people, the wait is becoming too much to take.
The post-vaccination cohort might also be subtly signaling to others that behavioral change is expected, and good. Having a ton of vaccinated friends who are starting to hang out and shed their masks might be renormalizing old habits for those who expect their shots soon.
The rash of rule-breaking and early restriction-lifting can't be helping either, Karmarkar told me. "People are out doing stuff," she said. "Instagram is starting to look like it used to." That's probably sapping the motivation of people who have been white-knuckling it all year. "They think, It's not fair," she said. "If no one else is being good, why am I at home?"
There are, of course, some people who have decided to double down on their vigilance in recent months, even after getting their vaccines. Popescu grimly describes people's post-inoculation behavior as almost bimodal—super strict or loose, with practically no in-between.
Read: Vaccinated people are going to hug each other.
Gravitating toward extremes might be our way of grappling with new ambiguities that the vaccines have introduced. Just as infection can be asymptomatic, vaccination protection, too, is invisible. There's no way to tell if the maskless people strolling together in the park are letting their guard down because they're vaccinated, or if they're just sick of wearing cloth on their face. (Popescu, who is fully vaccinated, told me that's why she's been keeping her mask on in public: "If I take it off, they just see a person normalizing less safe behavior.")
Risk is easier to calculate when it's visible and self-contained—taking a recreational drug, bungee jumping off a cliff. This past year, we've been grappling with a far more unwieldy threat, Kenneth Carter, a psychologist at Emory University, told me. "It would be easier if it were zombies," he said. Our frame of reference is also shifting all the time, Downs told me. At the beginning of the pandemic, the situation was growing riskier, shifting us down from our baseline of "normal." Now we're getting signals that things are improving. The vaccines have injected hope into the conversation; they're a tool that is raising the amount of safety we're working with day to day. This new direction is creating a small illusion: Simply hearing "It's getting safer" can inadvertently punt people into what Downs calls a quantum shift, into "It's safe," she said. The mindset of "better" is easy to conflate with "okay" or even "good."
The point of this is not to underestimate the vaccines. They're excellent, extraordinary, expectation-shattering, and already protecting millions of people from many of the most serious consequences of COVID-19. But we can't afford to overestimate them, either, and we're still defining their limits when it comes to blocking disease and infection in real-world circumstances, as the virus they defend against continues to change. As good as these shots are, they can only dial down risk, not eliminate it—more like coats of flame retardant than an impenetrable firewall. Exposure and risk, which occur on a spectrum, also go hand in hand; even the best inoculations will be of little use to people who choose to stroll straight into a viral conflagration.
Experts told me it's worth keeping a few key things in mind if we intend to truly make this next chapter of the crisis our last. For starters, we can't take the pandemic's endgame for granted. Surging cases threaten a vicious cycle: More infections mean more opportunities for the virus to move between hosts and mutate, and potentially further elude our defenses. To forestall that possibility, we still have to consider our collective risk, not just our risk as individuals. Carter stressed the importance of acknowledging how far we've come—not just how far we have left to go. "My message right now is 'I'm so proud of all the sacrifices you've made already,'" he told me. "'Just hold on a little longer.'"
How Long to Get Back Into Ketosis After Cheat Day
Source: https://www.theatlantic.com/science/archive/2021/04/post-vaccination-risk/618500/
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