Rochelle P. Walensky, M.D.

The Centers for Disease Control and Prevention has issued long-awaited guidance on what new activities COVID-19 vaccinated people in “non-healthcare settings” can and can’t do regarding masking and social distancing. Further guidance for nursing homes is expected imminently.

While the guidance does not directly address long-term care or other elder care settings, it does state, for example, that grandparents who are fully vaccinated may begin intermixing more with family members who might not be vaccinated but are not at risk for severe reactions to COVID-19.

Industry leaders did not anticipate Monday morning’s guidance would “be connected” to skilled nursing facilities, but believed that further direction about facility visitation practices would soon follow it.

“We … know CMS is working with CDC separate and apart from this work to coordinate on nursing home visitation,” said Ruth Katz, senior vice president of public policy and advocacy for LeadingAge, after Politico broke news of the pending CDC announcement last week. “We actually thought we would have that by now.” 

One of the biggest implications of the new guidance is that it is expected to compel more people to become vaccinated, which in turn will lower the risks for others, including nursing home residents and workers — and potential facility visitors. Numerous academic studies have drawn strong relationships between the rate of community infections with those within long-term care facilities.

The guidance “represents a first step toward returning to everyday activities in our communities,” the CDC said. “There are some activities that fully vaccinated people can begin to resume now in the privacy of their own homes,” said Rochelle P. Walensky, M.D., director of the CDC.

While Monday’s guidance is not legally binding, state health officials usually extend them into their respective jurisdictions. The full guidance is available here.

The White House also announced Monday morning that President Biden will address the nation Thursday night on the one-year anniversary of the start of coronavirus shutdown restrictions.

SNF infections plummet

With nursing homes receiving some of the highest priority in the federal vaccination hierarchy, facility residents are among the most completely inoculated demographic in the country. This has led to an “absolutely astonishing” drop in infections and deaths in nursing homes, association leader Mark Parkinson noted in a recent CNN interview. Nursing homes are expected to have completed their third of three government-run on-site clinics by the end of March, with many already having done so.

There were just more than 1,900 new resident COVID-19 cases reported in nursing homes for the week of Feb. 21, according to the latest federal data — that’s a far drop from its peak in late December when 33,625 weekly cases were reported.

Monday’s guidance pertains to “fully vaccinated” individuals, which means those who are at least two weeks out from receiving the single dose of the Johnson & Johnson vaccine, or the second dose of the Pfizer-BioNTech or Moderna vaccines.

The CDC urged continuing precautions in public and did not rule out that vaccinated individuals still could become infected and spread the virus to others.

Health officials note that the majority of Americans have not been vaccinated yet and that many millions more will have to be inoculated before mitigation measures can be suspended.

Nearly 31 million Americans had been fully vaccinated as of Sunday, with just fewer than double that having at least one of two required doses, the CDC said. About 2.1 million doses per day are being administered, federal health officials said.

Although Monday morning’s guidance hedged in many places, CDC officials said that there is  “a growing body of evidence” intimating that fully vaccinated individuals are less likely to be asymptomatic carriers and are “potentially less likely to transmit the virus that causes COVID-19 to other people.”

Other highlights of the CDC’s five-page “Interim Public Health Recommendations for Fully Vaccinated People” included: 

  • Vaccinated individuals should still continue to avoid anything but small gatherings. The CDC, however, did not define what would qualify as “medium” or “large” gatherings.
  • Fully vaccinated individuals can forego masks and social distancing in their private homes. They also may gather with unmasked, unvaccinated individuals who are deemed not to be at risk of developing a severe case of COVID-19 should they become infected.
  • As long as symptoms of infection do not appear, vaccinated individuals do not have to quarantine or get tested. If symptoms arise, isolation and consultation with a physician should ensue.
  • Masks, maintaining social distancing, washing hands and avoiding poorly ventilated spaces in public, as well as other safety protocols, shall continue to be observed.