What the next CDC guidelines for the fully vaccinated could look like


(CNN) -- Some celebrated when the US Centers for Disease Control and Prevention came out with its long-awaited guidelines for the fully vaccinated Monday. Others were hoping for more, especially about travel.

With daily new cases hovering around the 60,000 mark and the threat of variants spreading, navigating the pandemic is admittedly tricky, even for the fully vaccinated. The director of the CDC made clear these guidelines will not be the last word.

"Our understanding of the virus continues to rapidly evolve. The recommendations issued today is just a first step," CDC Director Dr. Rochelle Walensky said at a White House Covid-19 news conference on Monday.

Andy Slavitt, the Biden administration's Covid-19 senior adviser, told CNN that as more people get fully vaccinated -- currently, about 10% of the population has -- the more CDC will add to its advice.

"The rate at which new guidance will develop is directly related to how quickly we vaccinate the country. This is the key point. At 10% vaccinations we have this guidance. At 20-30%, we will have new guidance," Slavitt told CNN Chief Medical Correspondent Dr. Sanjay Gupta.

Slavitt said that there will be a distinct shift in the way the CDC gives advice next time. It will move away from the kind of binary messaging in this first set.

For instance, the guidelines currently advise all people, the fully vaccinated included, to avoid medium- and large-sized crowds. The fully vaccinated, though, the guidelines advise, can now trade in the outdoor picnic table for the dining room table, and meet each other indoors and unmasked.

The next version of the guidelines, Slavitt said, will instead describe activities as being more in a low, medium or high risk category.

Dr. Onyema Ogbuagu, an infectious disease specialist at Yale, thinks with a sliding risk scale, the CDC could be a "little more broad ranging" next time, for example, addressing more specific spots such as gyms and restaurants.

"With a range, the public can better gauge what's a negligible risk or higher risk," Ogbuagu said.

But for now, there are many questions still left unanswered.

More questions about travel

The CDC did not update travel guidelines for the fully vaccinated in new guidance it released on Monday. The guidelines say "follow CDC and health department travel requirements and recommendations," and the CDC travel guidelines page says to "delay travel and stay home."

In a statement to CNN on Tuesday, CDC spokesman Jason McDonald said the agency "may update its travel recommendations for fully vaccinated people as more people are vaccinated and we learn more about how vaccines work in the real world. This is something we will be closely watching in the United States."

McDonald added that "several new virus variants have spread globally and in the U.S. through travel. Because of the increased risk for both fully vaccinated and unvaccinated individuals, everyone, regardless of vaccination status, should still take all CDC-recommended precautions before, during, and after travel."

CDC's Walensky explained Monday that "every time there's a surge in travel, we have a surge in cases in this country. We are really trying to restrain travel at this current period of time, and we're hopeful that our next set of guidance will have more science around what vaccinated people can do."

That did not land well with the travel industry. An airline industry source told CNN it is urging the CDC to publicly release the criteria it will use to adjust travel guidance.

Some public health experts are also pushing back.

Dr. Leana Wen, a former Baltimore health commissioner, told CNN's Brooke Baldwin that the latest advice was too conservative and inconsistent with other recommendations on who vaccinated Americans could see. She hopes for more in the next round.

"I actually would go further and say that people who are fully vaccinated should be able to travel -- should be encouraged to travel, and that's one of those incentives that we can give as a way for restoring freedoms, that you now are able to travel and go visit your loved ones and go to museums and cultural institutions once you're fully vaccinated," Wen said.

"I think the big holes in these first guidelines are around travel, and whether things can loosen up further, or if you need to quarantine after travel," said Dr. George Rutherford, an epidemiologist at the University of California, San Francisco.

It would be helpful if the next guidelines offer a range of risk for who should travel, he said.

For instance, if a person's 65-or-older mother is vaccinated but has 15 underlying conditions, Rutherford said, they may want to think twice about getting on a plane. "I mean, the vaccine effectiveness is an average, and there's a certain failure rate and you may not want to take that chance," Rutherford said.

If, however, the older mother is healthy and has an adult child who is obese and has hypertension -- two conditions that make someone more vulnerable to the severe effects of Covid-19 -- mom may want to book her ticket.

"It's a highly individualized circumstance," Rutherford said.

Adapting to more scenarios

The guidance also didn't address fully vaccinated people at schools. President Joe Biden announced last week that he would direct states to make vaccinating teachers a priority and many states have.

As more teachers get fully vaccinated, Rutherford said, guidelines may want to address, for example, school districts that test people regularly for Covid-19. They may no longer need to screen those teachers.

Future guidelines will also want to look at college campuses that do regular screening.

"Is it good enough to be vaccinated, and are they going to have to have decreased density in the dorms?" Rutherford asks. "I can imagine colleges are looking at vaccination as a way to start to get people back on track and they'll want guidance."

Even as more guidelines come out from the CDC, Ogbuagu reminds people that it is not just your vaccination status that you need to keep in mind while you calculate the activities that can be added to your life.

"Remember, the driver of this is if you're in an area where there's high intensity or transmission, you have to adapt to that," Ogbuagu said. "These guidelines should appropriately have variability in relaxing some of these measures based on the incidence of Covid-19."

Ogbuagu has empathy for the CDC's guideline writers and faith that they will give good advice in the next round, balancing what they know about the science with each.

"There's a little bit of messaging there that I think the CDC had to consider with their guidelines. Many of us think that the guidelines could have gone further, but I'm quite sympathetic, because we're at a very difficult intermediary place in the pandemic," Ogbuagu said. "It may be a little premature to make such broad ranging recommendations, but that will change as more people get these highly effective vaccines."

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