Throughout the pandemic, we’ve had to make difficult decisions about the level of risk we’re willing to take on in various situations, weighing the pros and cons, potential consequences and benefits. It’s been exhausting.
When the coronavirus vaccines came along, there was finally hope that we could go back to “normal.” But even though the shots do a great job at protecting people from serious illness, plenty of Americans remain unvaccinated. And even if you are vaccinated, there is still some risk you could get a breakthrough infection, particularly as you get further out from your last shot.
Now, COVID-19 booster shots are here, and early evidence suggests they significantly strengthen the level of protection conferred by the initial doses. But the guidance for boosted individuals is murky. Is it OK to resume normal behavior, or is it still best to take it easy until cases in your area are low?
How much does the booster shot protect me?
We don’t have a clear answer to how protected people are after their booster shots, according to Scott Roberts, a Yale Medicine infectious diseases physician.
The first two shots of the Pfizer and Moderna vaccines remain wonderfully effective in preventing hospitalization and death, especially in young, healthy people. But enough studies have found that immunity from symptomatic disease wanes at around the six-month mark. At the same time, we’ve learned that boosting is incredibly effective, especially when it comes to keeping people at increased risk of severe COVID-19 alive and out of the hospital.
We know this from several real-world studies out of Israel that found boosted individuals were significantly less likely to get infected or wind up in a hospital if they got sick with COVID-19. Research has also shown that booster shots significantly increase coronavirus antibody levels. A National Institutes of Health study found that people who initially got the one-dose Johnson & Johnson vaccine had a 35-fold rise in antibodies after they got a Pfizer booster and a 76-fold rise in antibodies if they got a Moderna booster.
“That’s really remarkable,” Roberts said.
The person getting the booster stands to benefit the most — their risk of having a bad outcome from COVID-19 is remarkably reduced. “Yes, you are more protected with a booster. That is undeniable,” Roberts said. But we don’t know exactly how much safer a boosted person is.
You do need to wait a week or two for the booster to kick in, said Celine Gounder, a clinical assistant professor of medicine at NYU Langone Health. At that point, most people will have peak antibody levels again, and it’s fairly unlikely — but not impossible — they’d get a breakthrough infection.
“Getting an additional dose of a vaccine does not make you Superman,” Gounder said.
Can I go back to “normal” activities and behavior?
As doctors have been saying all pandemic, this really depends on your situation. Given the data, which shows that the chances of getting seriously ill with COVID are much lower after getting a booster shot, Roberts said he’d feel a lot more comfortable going out and doing activities after getting a booster.
“The importance of the booster is mostly to protect you, the individual getting the booster shot, from both infection and poor outcomes from that infection,” Roberts said.
Your chances of getting infected post-booster really depend on how much virus is circulating in your area. “When people ask ‘Well, what can I do now that I’m boosted?’ it really all depends on the context — are you still going to be around people who may have COVID, are you going to have a pretty high level of exposure?” Gounder said.
The more virus around you, the more likely you are to get a breakthrough infection. But keep this in mind: The vast majority of people who get a breakthrough infection will have a shorter, milder illness, though a very small subset may get sicker.
“Even boosted people should plan to take extra precautions when they spend time around especially vulnerable individuals — take those gatherings outside, wear a mask, open the windows.”
Roberts said many patients have asked him if a booster will keep them safe and healthy when they gather with friends and family, unmasked, over the holidays.
“That’s a really tough question to answer,” Roberts said. He noted that a booster will definitely help protect the people who got boosted — “the risk of them getting sick is obviously much less” — but he would be more concerned if elderly or immunocompromised people were also present. Very young kids who aren’t eligible for shots should also be a consideration.
A big unanswered question is how much the vaccines reduce our risk of transmitting the virus to others. We know they reduce transmission rates, but that they don’t eliminate transmission entirely.
Roberts said he’d feel a lot safer if he were gathering inside unmasked with other people who were generally healthy. He still recommends using rapid tests if you plan to hang out inside with people who are at risk of developing serious complications if they catch COVID-19.
Even boosted people should plan to take extra precautions when they spend time around especially vulnerable individuals — take those gatherings outside, wear a mask, open the windows. The same should hold true if you plan to be around someone who is unvaccinated.
Lastly, keep in mind that the booster’s power won’t last forever. “Understand that what you may be able to do around that time safely is not necessarily what you’ll be able to do six months later safely — and when I say safely, I mean without getting a breakthrough infection,” Gounder said.
Experts are still learning about COVID-19. The information in this story is what was known or available as of publication, but guidance can change as scientists discover more about the virus. Please check the Centers for Disease Control and Prevention for the most updated recommendations.