One year into lockdown measures in the U.S., life remains radically altered for most people. There have been 526,000 deaths in the U.S. and 2.6 million deaths in the world due to COVID-19. There are also multiple highly effective vaccines against virus. Rollout is slow, uneven, but steadily continues, and with it, the hope of returning to social interaction.
As of this writing, more than 18% of the U.S. population has received at least one dose of a vaccine. As more people acquire immunity, there are growing questions about what activities are safe for vaccinated people, how they might interact with each other and with the mostly unvaccinated larger public.
On March 9, the CDC released interim guidelines for individuals who are fully vaccinated. The major concern has been that while we know clinical trials have demonstrated that the vaccines are very effective at reducing illness, we did not know whether the vaccines reduce transmission to others.
Preliminary data suggests that the vaccines do indeed reduce the risk of passing the virus onto others. However, there’s still some uncertainty about whether it reduces it enough to prevent meaningful transmission, especially if there are additional surges (likely) with high levels of circulating virus. There is also still some concern that while the vaccines are effective against several new viral variants, that may not be the case for all variants.
So what do the interim guidelines mean for day-to-day life? There have been so many devastating consequences of social isolation: sick patients dying alone, grandparents who have not seen their grandchildren, and the crushing difficulty of raising children without outside support. One of the less-discussed questions I get from patients, friends, and family is about the impact of immunity on sex and dating.
Social animals need touch and companionship, and that includes sex and sexuality. Any sustainable public health measures must account for these needs. Many individuals who do not have partners within their household have had unique difficulties in navigating dating and sexual connection during pandemic social distancing measures.
And while the federal government anticipates having an adequate vaccine supply for all Americans by the end of summer, for the next several months, there will still be a great number who are not yet vaccinated. How do people navigate dating and sex during an ongoing pandemic?
One option has been for people to refrain entirely from any kind of dating or sex. We learned that this is not a sustainable strategy in the last pandemic—HIV/AIDS. Initially, in response to a troubling wave of young gay men dying (soon followed by others), the official government response was to advise abstinence. What we have learned repeatedly is that this is ineffective.
Several public health departments recall the lessons we learned during the HIV/AIDS epidemic, including dusting off the almost 40-year-old pamphlet “How to Have Sex in an Epidemic.” Recognizing sex and sexuality as a fundamental human need, they have issued guidelines on how to have safe sex during a pandemic.
Public health officials in the Netherlands, New York, British Columbia, and others have issued pragmatic guidelines for risk navigation. Whereas in STI prevention, the central tenet was to minimize the exchange of body fluids, with COVID-19, it is to minimize air exchange.
Those who have partners outside their household should get tested regularly for COVID-19 (about five to seven days after a sexual encounter). Quarantining before and after exposure can minimize transmission to others. Harm reduction is fluid—increasing transmission in one area of life (e.g., an outside sexual partner) can pair with decreasing it in other areas (e.g., quarantining, grocery deliveries). Take into account the COVID-19 dynamics in your region, increasing precautions if cases are increasing and hospitals are taxed.
For those who are vaccinated, using current CDC guidelines, here are general guidelines for dating others outside your household:
- You can hang out with another fully vaccinated person indoors without a mask.
- You can hang out with another unvaccinated person indoors without a mask, as long as that person does not have any conditions putting them at higher risk for severe COVID-19 illness.
- You will have to navigate how much trust you have in someone’s stated vaccination status.
- You can still hang outdoors, six feet apart, especially with a mask.
- You should still avoid hanging out with unvaccinated individuals from more than one household and medium- or large-size gatherings. This includes activities like indoor dining.
- When you are in public among people from more than one household, you should continue to mask, stay six feet apart, and avoid poorly ventilated or crowded spaces.
Finally, continue safe sex practices that also prevent unintended pregnancy and infections that are not COVID-19, including chlamydia, gonorrhea, HIV, and syphilis. Even prior to the COVID-19 pandemic, STIs were at a record high in the United States. Infections such as chlamydia and gonorrhea had been increasing 3 to 5%, and syphilis had risen 15%.
“These areas of public health have been underfunded for decades,” notes Dr. Hilary Reno, an associate professor of Medicine at Washington University and also the medical director of the St. Louis County Sexual Health Clinic and CDC Sexually Transmitted Disease Prevention consultant. The COVID-19 pandemic has taxed this further. There were shortages of chlamydia and gonorrhea tests as manufacturers repurposed swabs for COVID-19 tests. Contact tracers who would normally follow up with partners of infected individuals are now pulled into COVID-19 efforts.
Although many of STIs are curable (chlamydia, gonorrhea, and syphilis) or effectively managed (HIV), untreated they can have lasting consequences. “People are still getting STIs, but they aren’t getting tested, so now we have these undetected infections,” Dr. Reno notes. “When are they going to present? How are they going to present?”
It is important to continue to communicate about sexual consent, use barrier protection, and get tested regularly for both COVID-19 (if you are not yet vaccinated) as well as STIs. As more data about transmission emerges and more people get vaccinated, follow updates on recommended guidelines.
Sex, sexuality, and companionship are a critical part of human health and well-being. We already have decades of experience that an abstinence-only approach, stigma, and shame just exacerbate transmission and make risky behavior secretive. Providing people with reliable information and tools for the prevention of both COVID-19 and STIs allows them to sustainably and realistically navigate their lives while also keeping safe.
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