One of my best friends is a kidney transplant recipient. Her immune system must be suppressed so that she doesn’t reject the kidney donated by her brother. Early on in the pandemic, her doctor warned her about the high death rate for people from COVID-19 for kidney transplant recipients and cautioned her to stay in isolation as much as possible until a vaccine became available. So for over a year, she didn’t spend any time with anyone besides her husband and son. She only left the house for medical appointments and early morning walks with her dog. And she worried about how long she might have to wait for a vaccine.

Now the vaccine is here, and in King County, over 70% of our residents are fully vaccinated and the number of vaccinated people continues to rise. That dramatically increases the protection from COVID for those who are vaccinated. It also means that the directive to wear a mask in indoor public places is lifted.

We are proud of reaching this mark, but at the same time, we can’t lose sight that some people aren’t able to have that protection. So as the state and King County continue to open up, we’ll need to be thoughtful towards those who still depend on others to help protect them.

Not everyone is protected, even if they want to be

While the COVID-19 vaccines are incredibly effective for most people, they may not offer the same level of protection for people who have immune systems that are weakened or suppressed from diseases like cancer, chemotherapy and other treatments, or medications.

For example, my friend is participating in a study of organ transplant recipients who have been vaccinated. Of the 436 transplant recipients in the study, only 17% had detectable antibodies to fight the coronavirus after the first dose of vaccine.

Also, not everyone is vaccinated yet, for numerous reasons. Children under the age of 12, for example, are not yet able to get vaccinated. There are over 300,000 children in King County in this age range, so this continues to be a large group that doesn’t have this protection from possible infection from COVID-19.

Some people have not yet been vaccinated because they still have barriers that make it difficult. We continue to hear about working people who don’t have paid time-off, so their concerns about missing work if they have side effects prevent them from getting vaccinated. Challenges with transportation, childcare, and mobility can also make vaccination less accessible.  

And people still have questions about the vaccine, especially given the misinformation that continues to swirl. For those who have experienced racism, discrimination, and harm within the healthcare system or from government, mistrust is understandably higher. We’re working with trusted partners in communities to try to listen and answer questions, but addressing mistrust is a process that takes time.

Public Health and our many partners have been working to reduce these barriers by shifting hours at vaccination sites to include more weekends and evenings, identifying free or low-cost options for transportation, and coordinating mobile vaccination teams that can do vaccination at work sites or in-home. We’re partnering with employers and community-based organizations to hold vaccination events and assist with outreach.

What to do if you’re not fully protected by vaccine

If you or anyone in your household are unvaccinated or not able to get the full level of protection from vaccination, it’s important to follow Washington state guidance, including wearing masks when around other people who may be unvaccinated, indoors and at crowded outdoor events. The Washington State Department of Health’s order remains in effect even after the King County mask directive ends.

Unvaccinated people should also take other precautions, especially with the delta variant on the rise. Limit indoor activities with others who are unvaccinated, make sure there’s good indoor air ventilation, wash hands, and continue to physically distance.

What we can do to create community protection

Cases of COVID-19 have declined since more people have been vaccinated, but the virus hasn’t gone away. Ninety-seven percent of all COVID-19 cases in King County are in unvaccinated people. We need to depend on one another for community protection and to help protect those who cannot be vaccinated.

• Vaccination is the best way to protect yourself and others if you are able to get vaccinated. When more people are vaccinated, each community is better protected. Vaccination is free and available at many locations: kingcounty.gov/vaccine
• Choose outside as a location for activities that involve people who are unvaccinated. The risk of spreading COVID-19 is much lower outside than inside.

• Improve indoor air ventilation and filtration. The virus easily spreads indoors, especially in crowded spaces. Businesses and all organizations with indoor facilities should ensure good air ventilation and filtration. More information available at Improving Indoor Air.
• Support people’s decision to protect themselves if they choose to wear masks, physically distance, and avoid indoor gatherings.

Masks won’t go away entirely

• Vaccinated people in King County may choose to continue wearing masks in public places, even after the mask directive is lifted. Some may choose to continue wearing a mask if they:
  •  Are at increased risk for severe infection, have an underlying health condition, or are in close contact with someone at increased risk.
  • Want to show support for mask-wearing by unvaccinated people or because they feel more comfortable doing so.
  • Are setting an example for their children who must still wear masks.
  • To protect themselves from other respiratory illnesses or allergens. Have you also noticed how few people got the flu or even the common cold in the past year?

• Masks will continue to be required in higher risk group settings like healthcare facilities and shelters, and places where many people are not yet able to be vaccinated, like childcare and schools. Businesses will still have the option of requiring customers to wear face masks.

Easing back into re-opening

I’m looking forward to social activities resuming and businesses and restaurants getting busier—and I’ll also be thinking about people like my best friend. She’s one of the lucky 17% of organ transplant recipients who is building antibodies after her first vaccine dose. But she’s probably not going to have the same level of protection as me.

I got vaccinated, and it feels good to be able to protect people like her, and my co-worker who has been undergoing treatment for cancer, and the young children who live next door to me, and the grocery worker who serves so many people every day. But they can’t tell who has been vaccinated and who hasn’t, and they may be feeling anxious. So even though I know my vaccination protects them, I’m keeping a mask handy for wearing at the store or at businesses that still request them. When people can’t tell who is vaccinated and who isn’t, I hope wearing a mask in some situations can help those like my friend have some peace of mind.

Read more about reopening on the Public Health Insider, or visit our Safe Reopening web page.

Originally posted on June 30, 2021.