With COVID-19 infections at their highest levels since January and hospitalizations at a level not seen since the winter surge, the 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."Q: 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 U.S. 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.Q: 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 depends on several factors. For starters, what's the space configuration in the restaurant? A very crowded, poorly ventilated setting will have a 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.Q: 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.Q: 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.Q: 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.Q: 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.Q: 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.

With COVID-19 cases and hospitalizations increasing in communities with low vaccination rates, an expert says Americans face a choice: get vaccinated or continue dealing with the impacts of the pandemic."We can't have it both ways; we can't be both unmasked and non-socially distant and unvaccinated. That won't work," Dr. Jonathan Reiner, a CNN medical analyst and professor of medicine and surgery at George Washington University, said Monday.COVID-19 cases rose a sharp 47% over the past week as the more transmissible delta variant spread, but not all communities were impacted equally.About a third of the nation's cases came out of five states, Florida, Louisiana, Arkansas, Missouri and Nevada, Reiner said. And impacts were felt most among the unvaccinated. Of all the deaths from the virus in June, more 99% were among unvaccinated people, Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, said."We have to pick sides and the side is we need to be vaccinated," Reiner said. "We have the tools to put this down — we can put it down this summer — but the way to do that is vaccination."To get more Americans vaccinated, officials will need to address the reasons behind some of the population's hesitancy.For some, it is that the vaccines have not been fully approved, which Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told CNN is only a matter of time. And for some, political divide has inhibited vaccinations, but Reiner emphasized that with more than 600,000 Americans dead, it is the virus that should be seen as the enemy, not vaccines.In Arkansas, which has one of the lowest vaccination rates in the U.S. at 35% according to CDC data, Little Rock Mayor Frank Scott Jr. said he, as a Black man, was skeptical of getting a vaccine, but now wants to lead the way to ensure all residents get the shot."It's serious and we should not have to allow someone to die for us to really believe the research and science. What we continue to do is go by data-driven policies and research and all that we do in our administration, and this is just another way to continue to do that because, again, this saves lives," said Scott.'Nothing changed' after Pfizer booster meetingFederal health officials met with vaccine maker Pfizer/BioNTech Monday to discuss if and when a booster shot for its COVID-19 vaccine might be needed.Pfizer presented data to federal health officials for about an hour, suggesting boosters may soon be needed to sustain COVID-19 protection, but Fauci told CNN after the meeting, "Nothing has really changed."He said based on the present data, federal health agencies, like the CDC and U.S. Food and Drug Administration, are not ready to recommend a booster."We made it very clear that their data is part of a much larger puzzle," Fauci told CNN.The meeting came after Pfizer said last week it is seeing waning immunity from its coronavirus vaccine and is picking up its efforts to develop a booster shot to protect people from variants.Pfizer emphasized in a statement Monday that it will be publishing "more definitive data in a peer-reviewed journal and continuing to work with regulatory authorities to ensure that our vaccine continues to offer the highest degree of protection possible."The message Fauci hopes the public will take away from the meeting, he said, is that discussion of boosters does not mean current vaccines are not offering sufficient protection against the virus."What we are talking about is not necessarily how good they are, because they are unquestionably terrific," he said. "It's the durability of the response that's in question, which is a perfectly reasonable thing when you are dealing with a vaccine."We don't know how long that extraordinarily high degree of protection is going to last and that's what we're talking about."Boosters aren't recommended now, but that doesn't mean they will not at some point be advised for the entire population or for specific, vulnerable groups, he said.For example, Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, said Monday it was surprising that there was no discussion during the briefing about boosters for immunocompromised people.A 'tidal wave' coming toward unvaccinated AmericansThe rate of infection among unvaccinated Americans is so much higher, CNN Medical Analyst Sanjay Gupta said Monday, that America will soon more from a divide between vaccinated and unvaccinated populations to vaccinated and infected.Dr. Howard Jarvis, an emergency medicine physician in Springfield, Missouri, told CNN on Monday that his sick patients are all unvaccinated."If they're sick enough to be admitted to the hospital, they are unvaccinated. That is the absolute common denominator amongst those patients," he said. "I can see the regret on their face. You know, we ask them, because we want to know, are you vaccinated? And it's very clear that a lot of them regret (not being vaccinated)."In St. Louis County, Missouri, officials said new cases have increased by 63% over the past two weeks, and County Executive Sam Page said, "a tidal wave is coming towards our unvaccinated populations."COVID-19 related hospital admissions rates increased by 36% over the past two weeks in the St. Louis metro area, according to a report from the St. Louis County Public Health Department."This variant is spreading quickly, and this variant has the ability to devastate those in its wake, and that is why it is so critical to get vaccinated now," Page said.

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