Many Americans are looking forward to traveling over the summer months. The CDC has created guidelines for safer travel, and recommends delaying travel until fully vaccinated. Take a look at some of the CDC’s main recommendations to vacation safely this summer.
International travel
Fully vaccinated travelers (i.e., people two weeks out from their final dose) are less likely to get and spread COVID-19. However, the CDC notes even fully vaccinated travelers might be at increased risk for getting and possibly spreading some COVID-19 variants when traveling internationally. Unvaccinated people who must travel internationally have more travel requirements than fully vaccinated people. Before travel, it’s also important to look up requirements related to travel, mask wearing, testing, or quarantine, in your destination, which may differ from U.S. requirements.
Key tips for safer international travel:
Learn more on the CDC’s international travel page.
Domestic travel
Masks are required on planes, buses, trains, and other forms of public transportation traveling into, within, or out of the United States and while indoors at transportation hubs like airports and stations. Masks are not required in outdoor areas of a conveyance (like a ferry or top deck of a bus).
Key tips for safer domestic travel:
Learn more on the CDC’s domestic travel page and use the travel planner tool to get local information on restrictions in specific areas of the U.S.
When not to travel
The CDC recommends not traveling if you or your travel companions:
Are sick with symptoms of COVID-19 (even if fully vaccinated against COVID-19 or have recovered from COVID-19 in the past).
Have suspected or diagnosed COVID-19 (even without symptoms)
Have been around someone with suspected or diagnosed COVID-19 in the past 14 days (even without symptoms).
Get more information on the CDC website for travelers and visit the Baseline COVID-19 Testing Program website to learn if testing is available in your area through Baseline. (Note: always check your destination’s COVID-19 travel rules to confirm when and how to get tested to meet their requirements.)
The Delta variant is becoming a dominant COVID-19 strain worldwide, and is increasing rapidly in the United States. We sat down with immunologist Dr. Charlie Kim, Head of Molecular Sciences at Verily, to learn more about it and the threat it poses to vaccinated and unvaccinated individuals.
What makes the Delta variant so dangerous?
The evolution of the new coronavirus that causes COVID-19 is to be expected, but of course it causes new challenges. What we’re seeing now is an example: because of the difficulty of getting vaccines into arms quickly globally and expanding access to testing, it’s forced an evolution of more severe forms.
What’s concerning about Delta is that it’s more easily transmitted, and it’s spreading to different parts of the world quickly. Based on early data, it also causes more severe health outcomes. Vaccines do offer protection, but not all vaccines are as protective against Delta as they are against the original strain of the virus. We need to keep the pressure on vaccination, and in areas with low vaccination rates, testing, masking and distancing.
What threat does it pose to vaccinated people? Unvaccinated people?
Vaccination is still worthwhile. You should be vaccinated if you want protection against any variant, and vaccination still provides strong protection against severe outcomes like hospitalization and death. Fully vaccinated people are more protected against Delta than those who have only received one shot.
What we’re seeing is that in communities where there’s a lot of infection with Delta, even vaccinated people are more likely to get infected than they were with previous strains. If you’re not vaccinated, you’re definitely at greater risk than you were a year ago with Delta.
If you previously recovered from COVID-19, you likely have some natural immunity, but the recommendation is still to get vaccinated because it offers a different level of protection.
Where does this leave people with children under 12 and those who cannot get vaccinated for medical reasons?
Children under 12 are considered unvaccinated individuals, so the CDC’s guidance is to follow guidelines for unvaccinated people including masking. The same applies to immunocompromised individuals who are not able to get the vaccine.
That said, the more adults who are able to get vaccinated do so, the better. This can bring down the overall infection rates and make things much safer for children and immunocompromised adults.
How does relative risk change based on vaccination rates in your area?
There is a lot of variation in vaccination across the United States. In San Francisco for instance, around 70% of eligible people are vaccinated. Other areas have much lower vaccination rates. Generally, the higher the rate of vaccination in an area, the safer it is. In areas where vaccination is on the low side and there are still infections, it makes sense to continue to be cautious. That said, we live in a global community and we’ve seen that as long as the virus is continuing to spread unchecked in one area of the world, it does create risk for all.
What would you say about those who are hesitant to get vaccinated due to possible side effects?
The vaccines authorized in the U.S. are first-in-class vaccines with a truly remarkable track record in efficacy and safety. We now have data from hundreds of millions of people, and it is remarkable how well the vaccines are working and how safe they are. While there have been some cases of side effects, the numbers are very low, the incidents have been investigated by regulators, and it’s been determined that the risk of complications from COVID-19 are much higher than any risk from the vaccines.
The vaccines, particularly the mRNA vaccines from Pfizer and Moderna, are working well for now. What is the end game if the virus mutates to become fully vaccine resistant?
Let’s start with an example for comparison here. The flu virus evolves very quickly, and it’s a constant struggle every year to keep up with vaccines. Coronaviruses usually evolve more slowly. Right now, the reason why we’re seeing quicker evolution is because it is so widespread.
If we can create enough immunity in the global population and reduce the number of infections, that will decrease its ability to evolve quickly, which means fewer severe variants. That is, if we can be aggressive about vaccinations in the U.S. and worldwide
What do you think the future priority research areas are for COVID-19?
At the start of the pandemic, around 10-20% of Americans in the hospital were dying, which is a huge number. In late 2020 to early 2021, an evolution in care pushed that down to around five percent. Part of that was new medical treatments, and part of it was changes in care. For example, we found that a process called pronation, or rolling a person on their side to oxygenate their blood, was effective. Going forward, I expect to see more research done in the area of treatments.
To learn more about the Baseline COVID-19 Research Project and how you can get involved, visit our website.
Verily Head of Clinical Policy and former FDA Commissioner, Dr. Rob Califf, sat down with us to break down recent CDC guidance for vaccinated individuals. Learn more about the science behind the shift in guidelines.
Fully vaccinated people no longer need to wear a mask indoors or outdoors. This has been controversial, with some feeling it’s early to make that call. What have we learned about how the virus is transmitted that makes the CDC confident about this recommendation?
One of the most difficult things about public policy is that you need to make a strict yes-or-no, binary recommendation. Scientific evidence is not binary, it grows over time and speaks to probabilities and likelihood of risk. We now have many studies that show people who have received vaccines approved in the U.S. are at very low risk of becoming infected. If they do become infected, they are at very low risk of serious illness. Some vaccines approved globally are less effective than the ones available in the U.S.
From the original vaccine clinical trials, it was clear that the vaccines were very effective against serious illness or death, and now we know there’s a low risk of getting infected at all. If you’re vaccinated and in an environment with unvaccinated people or in a big crowd, or riding public transit — the guidance is still to wear a mask to protect the unvaccinated. I would do that as a courtesy to others.
Some states opted to leave mask mandates in place a while longer. What goes into the calculus of a locality or region when deciding its masking guidance?
The CDC actually doesn’t have authority over states or local public health agencies. We’re seeing that different localities have different risk tolerance. In California, for example, health authorities kept the mask mandate in place until mid-June, while many states with lower vaccination rates have decided to remove mask mandates and reopen.
One concern is people who don’t want to get vaccinated generally don’t want to mask. What risk do the unvaccinated pose to the vaccinated?
People who received an approved vaccine in the U.S., almost no matter what, have low risk of getting infected. Unvaccinated people with a high viral load pose some risk to the vaccinated, but not much. Currently, we’re thinking that being in an enclosed space and the viral load a person has are the biggest factors that go into being a risk to others.
Viral load refers to the amount of virus in the upper respiratory tract. The more virus you have in your system, the more of it you expel when you sneeze or speak. The vaccines create an immune response to suppress the virus, so even if you do happen to get it, you have a lower level of viral load. So we’re seeing asymptomatic infections or scenarios where you don’t get that sick.
Where does this leave parents of unvaccinated children or the immunocompromised? Are they at greater risk if adults stop wearing masks?
Children age 12 and older can now get vaccinated, so we strongly recommend parents of older children help them get vaccinated. For kids under age 12, it’s a dilemma. The recommendation for younger children is to continue to wear masks and social distance, but this can be a challenge with summer activities. I expect we’ll learn more over the summer about how to best manage risk for younger children, with more safety data.
Similarly, for the immunocompromised, the recommendation is to continue to mask and stay distanced. The best thing people can do to protect the immunocompromised is to get vaccinated.
As you mentioned previously, there is still some risk of “breakthrough” COVID infection when vaccinated. Doesn’t this run counter to the idea of removing masks before herd immunity?
Herd immunity is a concept — we don’t know exactly what level of vaccination is needed to achieve it and completely eliminate the virus. Most experts don’t think we can fully eliminate this virus and that it will be endemic, or present in the population at some basic level, similar to the flu and other viruses. Vaccines approved in the U.S. do work against the variants that are emerging. That said, they are less effective, which is why it’s important to vaccinate as many people as we can, as quickly as we can, to get the virus to a manageable level.
What’s the risk of someone who gets COVID-19 when vaccinated sustaining “long COVID”?
So far, it looks like the risk of long COVID in vaccinated individuals is very, very low based on the data we have from thousands to millions of people. It is still possible, and in the few people where that happens, it may be due to immune system differences that we’re still learning about.
For people who get COVID-19, develop long COVID, and then get vaccinated, we’re seeing some evidence that getting the vaccine can help. We’re not sure why that is yet, but one theory is that individuals with long COVID may continue to harbor the virus in the body after the initial infection, and the vaccine helps fight it.
Do we know any more about how long immunity lasts? Is it possible that we’ll need booster shots in a number of months?
We are collecting data that shows a strong immune system response that goes out pretty far from the original vaccination, but we’re only a year or so into this pandemic and can’t be sure of exactly how long immunity lasts yet. However, mRNA vaccine platforms lend well to making boosters, so we are set up to produce them.
Personally, when would you feel comfortable not wearing a mask in a crowded indoor function?
I’ll continue to wear a mask until we see the follow-up from summer holiday weekends, where people will likely wear fewer masks but many more will be vaccinated. In the fall, we should consider masking as it’s a good way to prevent the flu and other seasonal viruses. Our immune systems will be tested more during fall and winter by spending increased time indoors and coughing from other viruses. We’ve seen in Asia that masking has helped stop pandemics earlier, so I am hopeful that we may adapt to wearing masks during higher-risk time periods and situations.
Forty percent of adults in the United States struggled with a mental health disorder during COVID-19, according to the CDC. Along with this increase in need, utilization of mental healthcare like digital apps and telehealth for accessing talk therapy has risen tremendously. We sat down with Verily Mental Health Lead, Dr. Danielle Schlosser to understand how people are coping in the current phase of the pandemic, and tips for managing stress.
How has COVID-19 impacted mental health in the U.S.?
It’s important to note that the mental health impact of the pandemic has not been one-size-fits-all. On the one hand, we’ve seen huge increases in mental health needs as well as really high adoption of mental health services. Many people nationwide are dealing with grief from losing loved ones during the pandemic. There’s also evidence to suggest that many people who recover from COVID-19 have long-term struggles with mental health, with one study showing that one in five COVID survivors has a mental health disorder. We’re also seeing a lot more openness around talking candidly about mental health struggles.
Interestingly, on the flip side, we’re also seeing some people experience “post-traumatic growth.” Some are reporting positive experiences around feeling more connected to family and friends, or benefiting from reduced time spent commuting among those who are able to work from home. The mental health impact of the pandemic is nuanced, and we’ll continue to see this as we hopefully shift into a new normal.
Currently in the U.S., the approach to managing the pandemic and public health guidance is changing. As vaccinations increase and many communities loosen restrictions, what can happen with people’s mental health?
In the U.S., there is a sense of seeing a light at the end of the tunnel and many people are feeling excited about a return to normal in sight. By the same token, however, many people have also adapted to the pandemic over the course of the past year and we’ve settled into certain habits and routines. Some feel anxiety around socializing, even if they crave it. Humans are predisposed to feel stress around major life changes, and our brains like predictability. For example, getting married, having children, and graduating high school are all seen as positive events, but it takes time to adjust to the new normal.
The best way to manage this stress is to be gentle with yourself and validate your experience, realizing it’s one shared by many. One technique from talk therapy is identifying and naming an experience. When you’re in the midst of swirling thoughts that seem very chaotic, you may not recognize it as anxiety. In psychology, we refer to these thought patterns as “rumination.” Naming these experiences isn’t meant to stigmatize, but actually to gain a sense of control.
It can also be helpful to internalize that thought patterns are just thought patterns, not who you are. One technique of managing a detrimental thought pattern is to catch it, check it, and change it. This process involves being mindful and aware of when you start slipping into rumination, so you can challenge the unhelpful thought and replace it with an alternative thought.
On the preventative side, evidence shows us that physical activity, meditation and being in nature can help reduce stress. Socializing can also help, which can seem counterintuitive if you’re experiencing anxiety around socializing. But this can involve connecting with a partner or family member and just getting out of your own head.
How can people cope with information overload?
Greater exposure to news can induce stress, and digital hygiene can help. If you notice your heart rate goes up when you watch the news, for instance, notice and identify that. You can stop automatic notifications on your phone from news apps in order to create more control over when and how you consume information.
How can people navigate sensitive conversations around masking and vaccination with family and friends?
This is really hard, especially given how divisive the dialogue around public health has become in the U.S. When you’re having a difficult conversation about a really important public health guideline like vaccines, getting curious about the other person’s feelings and what is at the heart of their perspective is a good place to start.
When a decision gets into people’s value system and identity, it will not be productive and constructive to quickly criticize their point of view. One way to navigate these conversations is by sharing information so they can have the best data available to them to consider their choice. We can orient these conversations around helping people feel empowered to make these decisions, rather than controlled.
In one year, Baseline COVID-19 Research Project has made a significant impact on researchers’ understanding of the virus. Learn more about the community and their contributions to science:
One in five U.S. adults experiences mental illness. In honor of Mental Health Month, we sat down with data scientist Stefanie Nickels to learn about how digital tools can unlock better ways of managing mental health.
Why is it important to focus on mental health research, especially now with the impact of COVID-19?
Over the past 30 years, we’ve seen no improvement in mental health outcomes. Mental health disorders are the leading cause of disability in the United States, and anxiety and depression have only increased during the pandemic. Social isolation and worries around getting sick or losing loved ones can exacerbate existing mental health conditions. Not only is there a cost to the healthcare system, mental health issues have a profound impact on the sense of self, emotional and physical well-being, and the professional and personal relationships of the individual.
What are digital therapeutics and why are they interesting in the mental health space?
Digital therapeutics are technology tools used to prevent, treat, or manage a disease. We can deliver many types of therapies digitally. Telehealth allows you to speak to a mental healthcare provider via video chat, removing the barriers of needing to be in the same room if you’re physically distant or experience mobility challenges. There are also apps with built-in cognitive behavioral approaches — a common type of psychological treatment — that can teach valuable skills in a scalable way that’s accessible to many people. You can go at your own pace, using an app that’s always available and private.
What is a digital biomarker and what’s an example in mental health?
A digital biomarker is something you can measure digitally that indicates mental health status. A simple one is how long you sleep. Sleep disturbances are associated with depression so changes in sleep can indicate a shift in mental health.
Smartphones contain sensors that can capture data relevant to health, and figuring out how to translate this information into useful insights is still a young field. One of the data points mental health researchers are interested in is location, because it helps us infer how much time people spent at home. Increased homestay is associated with depression, as is increased social media app usage and decreased physical activity, which are other things we can infer from smartphone use.
Can you describe some notable aspects of mental health research that Baseline has conducted?
Most clinical studies are conducted at a study site like a hospital. For the Baseline Mood Study I and II, we set out to make them completely remote, easy to access, and fun. The studies were self-guided using an app, and one of the notable aspects was the use of an engaging chatbot that led participants through daily activities. We also used a mix of clinically validated electronic questionnaires that are approved by a body of experts to accurately measure something related to health, and more novel research approaches like audio diaries.
What is next with mental health research and care, and what do you hope we can achieve?
On the research side, we have a lot of work to do in finding digital biomarkers and provide evidence that they are valid mental health measurements that can tell healthcare providers something meaningful about mental health outside the clinic. This in turn can enable better care.
Measurement-based care is routine in other fields, but not in mental health. For example, with diabetes we continuously monitor A1C levels to understand if the disease is being controlled. What this might look like for psychology and psychiatry could be completing a questionnaire every one to two weeks in order to quickly identify whether a treatment is working. One reason this isn’t being done today is that it’s burdensome to providers, but through an app, this type of data can be collected very quickly.
As vaccines become widely available, we asked COVID-19 research Project members about their attitudes, questions and perceptions on vaccines. See infographics below:
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