(CNN) With Covid-19 infections at their highest levels since January and hospitalizations at a level not seen since the winter surge, the US Centers for Disease Control and Prevention is recommending indoor masking even for vaccinated people. While new studies show that the Covid-19 vaccines continue to provide excellent protection against severe disease, the data suggest there may be decreased protection against the Delta variant.
There are many people who are fully vaccinated and want to be responsible members of society. They are wondering, what can and should they continue to do? What about getting together with friends, dining indoors, and going to the gym? Can vaccinated grandparents still get together with their unvaccinated grandchildren?
To help answer these questions, we spoke with CNN Medical Analyst Dr. Leana Wen. Wen is an emergency physician and visiting professor of health policy and management at the George Washington University Milken Institute School of Public Health. She's also author of a new book, "Lifelines: A Doctor's Journey in the Fight for Public Health."
CNN: How should people be thinking differently about risk given the rise in infections and new research?
Dr. Leana Wen: In terms of processing where we are right now, I think people should keep two things in mind. First, most parts of the United States have substantial or high Covid-19 transmission, as defined by the CDC. We need to think about the vaccine as a very good raincoat. If it's drizzling outside — if the level of infection isn't very high — the vaccines will protect very well. But if it's a constant thunderstorm, then there's a higher chance of getting wet. A vaccinated person is at higher risk when surrounded by a lot of people who could be infected with Covid-19, and that's what occurring throughout the US right now.
Second, we are entering a phase in the pandemic where nearly all activities will have some level of risk. People need to decide for themselves what risk they are comfortable with by considering their household's medical circumstances and the value of the activity to them.
If everyone in your household is fully vaccinated and generally healthy, you might be willing to take on more risk. You might conclude that even if a breakthrough infection were to happen, it would probably be mild, and you are OK with taking on that risk in order to continue your pre-pandemic activities. Someone else could decide that, because they live at home with unvaccinated younger children or immunocompromised family members, they want to be more cautious.
I think that both options are equally reasonable. The vast majority of the spread of Covid-19 is by people who are unvaccinated. Vaccinated people are not a threat to public health, and they should be able to exercise their own judgment about what activities are safe enough for them.
CNN: Let's go through the risk of specific activities. What's the risk of indoor dining?
Wen: Indoor dining in a restaurant definitely has more risk than dining outdoors. What that risk is depends on several factors. For starters, what's the space configuration in the restaurant? A very crowded, poorly ventilated setting will have higher risk than a venue in which you could spread out from other diners.
Also, who are you dining with? If everyone in your party is known to be fully vaccinated, and these are the only people who will be near you, that is a safer scenario than if members of your own party are unvaccinated. I'd also look at the rate of virus transmission in your community. The lower the rate, the potentially safer it is.
CNN: How about going to the gym?
Wen: Again, that depends on the circumstances. If you're using the elliptical or weight machines, and no one is close to you, then it's pretty safe. If you're attending outdoor gym classes, the risk is also low. But if you're going to, say, a high intensity exercise class where a lot of people are breathing heavily, near one another, and you don't know whether they are vaccinated, the risk is substantially higher.
CNN: Would you travel?
Wen: The risk of air travel is pretty low and can be reduced further if you are wearing a high-quality mask like an N95 or KN95. The bigger concern is what happens once you get to your destination, as I addressed in this CNN Q&A.
CNN: What about a private gathering with friends where everyone is vaccinated? Would it be OK to continue dinner parties and other indoor get-togethers?
Wen: That will certainly be a lot lower risk than if the same people were together, but they were unvaccinated. A CDC study this week found that those who are unvaccinated have five times the rate of getting Covid-19 than the vaccinated (and a 29-times higher likelihood of being hospitalized or dying from coronavirus).
A lot of vaccinated people would feel comfortable with the level of risk in this situation. Again, it's not zero, but it's fairly low. That's particularly true if the other people at the gathering have a similar level of risk tolerance to you and are otherwise not engaging in high-risk activities — for example, if they always wear masks when in indoor public spaces and if they avoid higher-risk exposures such as crowded bars and restaurants.
CNN: Last fall and winter, people formed pandemic pods. Would you recommend doing this again?
Wen: For some people, yes, I would. There are many people who really want to minimize the chance of having a breakthrough infection. That includes individuals who have underlying medical conditions, where a breakthrough infection that's mild for someone else could land them in the hospital. Others might be pretty healthy themselves, but don't want to be asymptomatic carriers who could transmit Covid-19 to their vulnerable family members. People in similar situations, who have a similar approach when it comes to caution in their lives, could decide to form a pandemic pod with one another. They could decide to socialize only others in the same pod indoors.
My family has done this with another family that has young, unvaccinated children. That makes childcare, carpooling and playdates easier. I'd also advise others to consider the level of caution other households have before deciding to get together indoors with them. When in doubt, get together outdoors only.
CNN: Can vaccinated grandparents still be getting together with their unvaccinated grandchildren?
Wen: Yes. I'd advise grandparents who are concerned about transmitting Covid-19 to their unvaccinated grandchildren can choose to reduce their own risk in the three to five days prior to seeing their grandkids. They could refrain from indoor get-togethers with others during this period, and, if they want to be extra safe, I'd suggest that they get tested just before seeing their grandkids.
My advice is the same the other way around, for the grandkids, if grandparents are particularly vulnerable. The grandkids can always make sure to wear masks indoors around others in the three to five days prior to getting together and then getting tested before the reunion.
If all of this is too much, consider seeing one another outdoors only. Outdoors remains much safer than indoors. And, of course, if there are any individuals age 12 and above who are not yet vaccinated, they should do so as soon as possible, to protect them and others around them.