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Answers to readers’ questions on the coronavirus vaccine, masks and the delta variant in Colorado

Yes, your vaccine is still effective, but you need to take precautions for unvaccinated children

A masked installation by artists Darrell E. Ansted and Cynthia Allen outside of Molly's Spirits in Lakeside on May 2, 2021. (Eric Lubbers, The Colorado Sun)
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Ever since the U.S. Centers for Disease Control and Prevention changed direction so fast on its latest coronavirus guidance that it practically made cartoon tire-screeching noises, we at The Colorado Sun have been getting a lot of questions from readers.

Like, a lot of questions.

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You want to know about what this means for back-to-school and for mask-wearing in stores and for visiting relatives and friends. You want to know about the authority for getting more people vaccinated. You want to know about the now-dominant delta variant.

And we have answers. Well, we have the best answers anyone can get right now.

“It’s a challenge,” said Dr. Lisa Miller, a professor at the Colorado School of Public Health and formerly the state government’s top epidemiologist. “I don’t think answers are easy for anyone.”

Here’s what we learned when we asked Colorado health experts your questions.

I’m fully vaccinated. So when do I need to wear a mask?

With some exceptions, it’s up to your best judgment and sense of safety. But the recommendation is to wear a mask in indoor public places where you don’t know who is vaccinated and who is not.

The backstory, here, is that the CDC pulled a 180 and declared that it appears possible for vaccinated people who are infected with the highly contagious delta variant to spread it to others. That caused the agency to recommend that people who are in areas of high viral transmission to wear masks again in indoor public spaces, regardless of their vaccination status.

Where in Colorado are the areas of high viral transmission?

Right now, it’s pretty much everywhere. In the map below, places that are darker orange or really dark orange have high viral transmission rates.

This map, produced by the Colorado Department of Public Health and Environment, shows the one-week cumulative incidence rates of COVID-19 in the state’s counties. In counties with high or very high incidence rates (those counties in dark orange or very dark orange on this map), the Centers for Disease Control and Prevention has recommended that people wear masks in indoor public spaces. This map is current as of Aug. 5, 2021. (Screenshot by John Ingold, The Colorado Sun)

Those areas that have lower transmission rates right now also tend to have smaller populations. This means they could toggle in and out of high-transmission status quickly based on a handful of new cases.

“We know these are the best measures we have to go by for these policy-level decisions,” Miller said. “But they’re not perfect. So I think trying to take into account your own knowledge about your community and your own comfort level, you may decide to be more cautious.”

“It’s a really challenging situation,” she added. “But I think for many people, wearing a mask is not a huge commitment.”

There are some places in Colorado where you must wear a mask now, regardless of vaccination status. They are:

  • Nursing homes and other residential care facilities
  • Public transportation such as Regional Transportation District buses or trains
  • On commercial flights

There are also more restrictive local policies as well as mask requirements at individual businesses and facilities, so it’s a good idea to carry a mask just in case.

The state also requires unvaccinated people to wear masks in:

  • Prisons and jails
  • Shelters for people experiencing homelessness
  • Hospitals, doctors’ offices and other health care settings

Should I postpone visits with friends or relatives?

If they are vaccinated, you don’t have to.

Miller said the CDC’s new mask guidance reflects the uncertainty of the world you encounter when you head outside your door. In places where it’s practically impossible to control the vaccination status of everyone, the safest thing to do from an overarching policy view is to play it safe and recommend everyone mask up.

But visits to family or friends are a different matter.

“If you’re talking about your individual interactions with people and you’re interacting with vaccinated people, I think the risk is quite low,” she said. “The vaccine — and I think this might be getting lost a little bit — the vaccine is still very effective. Most effective at preventing you from getting significantly ill, but still pretty effective at preventing just infection.”

Restaurants like TommyKnocker in Idaho Springs moved diners to the streets after facing limited seating indoors due to state coronavirus safety measures. There are currently no capacity limitations for indoor dining. (Tamara Chuang, The Colorado Sun)

Can I eat inside restaurants?

Ehh, it depends on your risk tolerance.

Restaurants are often seen as some of the riskiest places for coronavirus transmission. People from a bunch of different households sit in relative proximity for an extended period of time, and, because you’re eating and drinking, you can’t wear a mask much of the time.

But, if you’re vaccinated, you’d have a good layer of protection working to your advantage.

“In many cases, it comes down to your personal choices and how much you value one activity over another,” she said. “It’s a complex weighing of risks.”

She said more caution is probably needed if you’re thinking about taking your unvaccinated kids into restaurants.

“I certainly would be less likely to take a child into a restaurant now than I would have been a month or six weeks ago,” she said. “I’d be more likely to eat outside. But I don’t think there is one ‘correct’ answer here.”

When do I need to get tested for COVID?

Whenever you have symptoms of COVID-19 or you have been in close contact with someone with COVID-19.

This is a recent change in CDC guidance, which previously said vaccinated people did not need to get tested after close contact with an infected person. (“Close contact” means within 6 feet for a cumulative total of 15 minutes over a period of 24 hours.)

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Dr. Reggie Washington, the chief medical officer at Presbyterian/St. Luke’s Medical Center and Rocky Mountain Hospital for Children, emphasized, though, that the first thing people who have cold symptoms should do — regardless of what’s causing them — is stay home.

“I would hate for your readers to try to be physicians and diagnose based on symptoms,” he said.

Even if what you have isn’t COVID, you still don’t want to be spreading it around the community, Washington said. And many of the most common symptoms for COVID-19 — cough, fever, headache, congestion — are symptoms of a lot of other things, too.

“I would recommend that they stay home, first of all,” Washington said. “And if their symptoms progress, they should go to their health care provider. Then the provider can determine if a test is reasonable.”

What does it mean that the delta variant is more contagious?

Essentially, it’s better at making copies of itself.

You’ve probably heard that the delta variant of the SARS-CoV-2 coronavirus is possibly as contagious as chickenpox. What that means is that its basic reproduction number, which is known as its R0 value, pronounced R-naught, is similar to that of chickenpox.

R0 is an estimate of how many people on average a person infected with the virus will pass that infection onto. For the common cold, R0 is around 2. For something like polio, the R0 is about 6. Chickenpox is higher than that, around 9 or 10. Measles is an R0 champion, with a value as high as 18.

The original form of SARS-CoV-2, which is the name for the virus that causes COVID-19, had an R0  around 3. According to an internal CDC presentation that was leaked to the media this month, the delta variant of SARS-CoV-2 has an R0 that could be as high as 9.

This scanning electron microscope image shows particles of the virus SARS-CoV-2 (round magenta objects) emerging from the surface of cells cultured in the lab. SARS-CoV-2 is the scientific name of the virus that causes COVID-19. The virus shown was isolated from a patient in the United States. (Provided by the National Institute of Allergy and Infectious Diseases’s Rocky Mountain Laboratories in Montana)

On a more practical level, Miller said the contagiousness of the delta variant appears to involve how quickly it can grow inside the body. Miller said studies have shown people infected with the delta variant carry higher viral loads, which means there are more virus particles in them to shed out into the world.

And people infected by the delta variant appear to carry those viral levels for a longer time, potentially increasing the number of days they are infectious.

“There is just more virus there,” she said. “When there’s more virus particles, it means the likelihood of one of those virus particles getting to you is greater.”

Is my vaccination still good against the delta variant?

Yes.

Both Miller and Washington emphasized this. Miller called it the “primacy of the vaccine.” It’s the best protective measure we’ve got, against delta or any other variant.

Dr. Rachel Herlihy, the state epidemiologist, this week presented data suggesting that vaccine effectiveness against the delta variant might be slightly diminished. But the vaccines still appear to be at least 80% effective at preventing people from being infected. And they do an even better job at preventing severe illness.

Between July 1 and July 24, 80% of cases, 87% of hospitalizations and 92% of deaths involved people who were unvaccinated or only partially vaccinated.

“If you are eligible to get a vaccine,” Washington said, “please do because it’s the most effective tool we have to date for preventing you from getting really sick from COVID.”

Jhalak Chauhan, a Nepali refugee, receives a COVID-19 vaccine dose from volunteer nurse Lorin Pahlau during a vaccination clinic for residents of zip code 80010 and existing refugee patients at Ardas Family Medicine in The Mango House in Aurora on Thursday, March 4, 2021. (Eli Imadali, Special to The Colorado Sun)

Should I get a booster shot?

It’s too early to tell, and you would probably have to lie a little bit to get one.

There’s no scientific consensus yet around whether booster shots will be needed. The vaccine manufacturers are running tests — and also releasing data touting boosters’ benefits. But the federal government has not yet given the green light to booster shots. And the World Health Organization has asked wealthy nations — such as the United States — to hold off on boosters so there’s enough supply to get initial vaccinations around the globe. (Some countries, such as Israel, have gone ahead with boosters for especially vulnerable people.)

At a news conference this week, Gov. Jared Polis said he has heard of Coloradans signing themselves up to receive a third shot of the Pfizer or Moderna vaccine. But he said they’re probably doing it using a different name or address, since otherwise vaccine providers can check the state’s immunization registry and see that the person is already fully vaccinated.

If a provider does administer a third dose, they have to report it to the state immunization registry and they also have to report it to a federal database as an administration error, said Jessica Bralish, the director of communications for the Colorado Department of Public Health and Environment.

Around the country, governments are getting headaches trying to track whether people are receiving unauthorized jabs. But Bralish said Colorado is also planning for how it would handle any go-ahead from the federal government for booster shots.

Can health insurance companies require people to get vaccinated or charge them more if they don’t?

No.

Vince Plymell, a spokesman for the Colorado Division of Insurance, said federal and state law do not allow insurance companies to mandate the COVID vaccine for their members or to charge people more if they are unvaccinated.

Under the Affordable Care Act, insurers can’t charge people more based on their underlying health status. The only things they can consider in setting prices are a person’s age, where they live and whether they are a tobacco user.

When will vaccines be available for kids under 12?

Not as soon as once hoped.

Pfizer and Moderna, two coronavirus vaccine makers, are running clinical trials for their vaccines in kids younger than 12. They had originally hoped to have approval for the vaccine in kids as young as 5 by the early fall.

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But the federal government recently asked the companies to expand their clinical trials. The request came following reports that the vaccines from Pfizer and Moderna might, in extremely rare instances, cause heart inflammation in teens. The government wanted to make sure the study size was big enough to detect if this would be an issue with younger kids.

That means approval for shots in kids as young as 5 might not come until late-October or early-November, with approval for vaccines for younger kids coming later than that.

Washington emphasized that heart inflammation possibly related to the vaccines is believed to be relatively mild. A coronavirus infection can also cause heart inflammation in kids, and a CDC committee ultimately concluded that the benefits of vaccination for kids far outweigh the risks.

Should my kids wear masks in school?

Possibly.

For some families, this won’t be a choice. Denver Public Schools, for instance, has said it will require universal mask-wearing indoors in school, regardless of vaccination status.

Other districts have adopted less-prescriptive approaches, leaving parents and kids to make the call.

Miller said this can be a simple analysis for families.

“If you fall into one of the places where, according to the CDC guidelines, masks should be worn — then I think they should be worn,” she said. That includes for kids at school.

But she said it’s unclear how well that guidance will be followed. Parents and school districts should keep an eye on the trends and adjust as needed.

Washington encouraged parents whose kids are old enough to be vaccinated to do that. As for kids who aren’t old enough to be vaccinated: “I would strongly encourage everyone to wear a mask and remain as socially distanced as possible.”

Harrison School District 2 students, left to right, Kyla Randle, Parker Layman and Laila Randle wear masks as they wait to enter Centennial Elementary School in Colorado Springs on Wednesday, July 15, 2020. (Mark Reis, Special to The Colorado Sun)

Does the delta variant cause more severe illness in kids?

Maybe.

Washington, who is a pediatrician by training, said the hospital admission rate for kids seen at Rocky Mountain Hospital for Children with COVID-19 has increased a little bit since the delta variant emerged in the state. But the numbers are ultimately pretty small, so it’s not clear whether that increase is statistically significant. 

As of Thursday, there were no kids admitted to the hospital for COVID-19 at Rocky Mountain Hospital for Children, nor were there any kids hospitalized for MIS-C, an inflammatory condition caused by the coronavirus.

So Washington said cases of severe COVID-19 in kids remain rare, though it is possible that the delta variant causes a little bit more severe illness.

A spokeswoman for Children’s Hospital Colorado said the hospital continues to admit kids with COVID-19 — sometimes in combination with other respiratory illnesses — and that the numbers are “steadily ticking up.” Throughout the pandemic, the hospital has treated about 100 kids with MIS-C, with trend lines following those for overall COVID-19 rates.


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