The last time we checked in with public health experts on whether it would be a good idea to heed Russell Crowe and Christopher Nolan and head out to the cinema, the answer was an unambiguous no. But that was before COVID-19 vaccines were approved for use, let alone widely available. Now, vaccination rates are slowly going up in the United States, and CDC guidelines are loosening. (Controversially so—more on that later.) And with films like In The Heights and A Quiet Place Part II positioning themselves as summer movie events that simply must be experienced on the big screen, now seemed like a good time to revisit the issue.
So we reconnected with Dr. Anne W. Rimoin, professor of epidemiology and director of the Center For Global And Immigrant Health at the University Of California, Los Angeles, as well as Dr. Abdul El-Sayed, a physician, epidemiologist, former city health commissioner, and host of the podcast America Dissected. Both of our experts agreed that, once you’re fully vaccinated, going to a movie with a mask on carries a very low probability of catching or spreading COVID-19. From there, it’s up to the individual to decide what they’re comfortable with: Taking off your mask in the theater adds another layer of risk, as does eating and drinking during the movie, as do smaller, more crowded rooms.
One point that our experts underlined again and again was that there is individual responsibility and then there is collective responsibility. Sometimes being a good citizen means wearing a mask even if you don’t have to, and depending on your risk factors, you might want to keep wearing a mask for a while even after you’re fully vaccinated. In short, now is the time to sit down and figure out what your personal risk threshold is—Dr. Rimoin has some advice on how to do that—pair it with your local mandates, and act accordingly.
The A.V. Club: In our interview last August, we discussed certain indicators that would signal when it’s safe to go back to activities like going to a movie theater. How is the U.S. doing on those metrics as a country?
Dr. Anne W. Rimoin: We have places where the rate of infection is extremely low, and we have some places where we we have a lot of transmission. It really does depend. The bottom line is that fully vaccinated people are at much lower risk, but unvaccinated people are still at risk. Movie theaters are closed environments, which involve being in crowds. Many of them are poorly ventilated. And so therefore, if you are unvaccinated, being in a theater really puts you at a greater risk for infection. People who aren’t vaccinated still need to wear masks and social distance and be much more cautious. But at this point, in places where there is low community transmission, if you are vaccinated, going to a theater is a very-low-risk situation.
At this point, people are going to really have to think about their own threshold for risk tolerance. Everybody has to remember there’s no zero-risk scenario, but the probability of a serious infection if you are vaccinated is extremely low. So to me, the issue here is really understanding what you consider low-risk, and the risk of transmission in the community. But for vaccinated people, it is really low.
Dr. Abdul El-Sayed: We’re doing well. We’ve got a growing vaccination rate, although it’s not growing at the rate that any of us might want. But it’s growing, and cases are falling. Hospitalizations are falling. That’s good news. And we’ve got really good science now that shows us that vaccinated people are protected against symptomatic and serious COVID-19, meaning that they are substantially less likely to pass the virus on. And those two things mean that a lot of the protections that we have been relying on to protect people from COVID-19 production and people are not necessary anymore—thus the CDC guidance in that respect. I think there’s a lot more justification for going back to the movies, although I just want to make sure that people understand that this is still a place that, considering all of the circumstances that lead to the spread, it is still, on its face, one of the riskier places to go.
For vaccinated people, I think it’s justified to go without a mask. That being said, when it comes to the policy [for theaters], I would recommend that if you’re going to have [patrons taking their] masks off, there needs to be vaccine verification. Because the risk comes when you have people who are unvaccinated taking their masks off and spreading the virus amongst each other. And that’s particularly important when you talk about more vulnerable people—people who can’t get a vaccine yet, like kids, or people for whom vaccines are just less effective, like folks who are immunocompromised. And that’s where I think it is on theaters to say, “We’re going to reopen, but when it comes to masking, we’re going to have to verify that you’ve been vaccinated if you want to take it off.”
AVC: So, for vaccinated people, going to the movies is risky, but not an unreasonable risk. Would you agree with that?
AWR: Absolutely. That’s exactly what I’m saying. For vaccinated people, there is an extremely low risk of infection—and, if you do get infected, transmitting it to other people. That’s a developing scenario. We’re still learning about this. But the things that we all have to think about are, for example, even if you are vaccinated, if you’re immunocompromised, you still may wish to be more cautious, and possibly avoid certain activities that carry any risk. It’s all about the individual’s risk threshold.
AE-S: It’s not an unreasonable risk. Vaccines are extremely effective, but they’re not perfect, right? And in those circumstances, there is still an added risk for the SARS-CoV-2 virus to be in the air in theaters. That being said, it’s not a risk that I think is overwhelming or should take people away from enjoying something they want to do. I’m just saying that it’s not the safest possible thing. But it’s not unwarranted to go and enjoy some time at the movie theater—and to do so without a mask, if you so please.
AVC: What about concessions?
AE-S: There’s the broader policy guidelines I would offer, and then there’s the individual guidance. In terms of the broader policy, I would say that if you want to have concessions that you should have vaccine verification. If they’re vaccine-verified, they can be opening their mouth and laughing and chewing and doing all those things as much as they want. The risk of passing on the virus and having the virus is really quite low. Whereas for people who are unvaccinated, the risk is real. For theaters that want to do this, I would just say to verify vaccines. And for people who are not vaccinated, there may be a different theater where masks are required. Maybe taking face masks off in the theater is not allowed for people who are unvaccinated. From an individual standpoint, I would say that if you’re vaccinated, enjoy your concessions. If you’re not vaccinated or are worried about illness, keep your mask on—if you’re going to go to the theater in the first place.
AVC: Does it matter how big the theater is?
AWR: It matters how big the theater is, how many people are in that theater, and what the ventilation is in the theater. Are they practicing social distancing? You want to look at the capacity and the space. If you’re in a small, teeny little theater, that’s very different from a big one with high ceilings and state of the art ventilation. But you should also be thinking about [whether] you can stay 6 feet away from others.
AE-S: I would say it’s more about the ratio, the number of people per square foot of space. One person in a small theater—whatever. It’s basically no risk. Now, a hundred people in that same theater? That’s another thing. As for a lot of people in a large theater—it’s certainly less risky, just because you’re thinking about the concentration of virus [in the air]. A) The probability that someone has a virus that they’re putting out in the theater is a function of how many people are there. B) How much of a concentration of that virus gets in the air is a function of how big the space is. And so, a bigger space with fewer people is always better.
AVC: What if you’re only partially vaccinated?
AWC: The benefits of vaccination really kick in when you are fully vaccinated. You should only consider yourself fully vaccinated when you have had two doses of Pfizer or Moderna and then waited another two weeks, or two weeks after a single Johnson & Johnson shot.
AE-S: You should behave as if you’re unvaccinated. The guideline is that you should act as if you’re unvaccinated up until about two weeks—or, more specifically, 10 days—from the date of the first vaccine. After you’ve gotten past two weeks from the first vaccine, our evidence suggests that you’re 84% less likely to get symptomatic illness, as compared to 94% two weeks after the second vaccine. So there is a level of protection [after the first shot]. But the recommendation is still to wait until you’ve gotten the second vaccine, and you’re two weeks out from that. Then you are as protected as you are going to be.
AVC: This question is a bit more complicated—even though the CDC has said that vaccinated people can go maskless in most situations, many are still hesitant. “How do I know that the people around me are also vaccinated?” That kind of thing. They’re not quite ready to just go about their daily business as before. Do you have any thoughts or ideas for those people?
AWC: First of all, the CDC guidance is just that. It’s guidance. The recommendations are just recommendations, and they are for fully vaccinated individuals. But that doesn’t necessarily correlate with what the rules are in your area where you live. And you need to follow local guidance in terms of whether or not you can take your mask off if you’re fully vaccinated. For example, here in Los Angeles, mask mandates are still in place. So that’s number one. But number two is that, even if the mask mandates are lifted, if you feel more comfortable wearing a mask, it’s always safer to wear a mask. It’s not a problem! In fact, I think that being more cautious is better, personally. Whether or not there were mask mandates in my area, in many situations, I would wear a mask. There is no reason for people who are more comfortable wearing a mask not to wear a mask. And in particular, some people who have underlying conditions, who are immunocompromised—they have real reasons [to wear a mask]. There may be many circumstances in which wearing a mask is a smarter decision.
AVC: One thing I thought was very interesting is that we didn’t have much flu last year because of mask-wearing.
AWC: That’s correct. Masks are very effective at preventing respiratory pathogens from spreading, and so there are many reasons to be wearing a mask in enclosed indoor settings. And if people are more comfortable wearing one, they should.
AE-S: If you’re vaccinated, the evidence shows us that you’re really quite protected. The issue is if you’re immunocompromised and the vaccine may not have been as effective, or are parents of a child who is unvaccinated. Those folks really are at higher risk in situations where people who are unvaccinated are free riding off of policies [designed] for vaccinated people. If you yourself are vaccinated, even if there are people who are unvaccinated around you, it doesn’t really put you at such a great risk. More risk than if they were vaccinated, obviously, but not that great of a risk.
The challenge is when you end up having multiple unvaccinated people who are all not wearing masks in indoor places who then spread it among each other. We still have a responsibility as a society to protect people from some of the situations in which they can get infected, and there is a broader risk here where, if unvaccinated people who are not masking are spreading the virus among each other, that increases the probability of the evolution of a variant that could render all of our immunity moot. So it’s in everybody’s interest to have less virus floating around. And there is a responsibility, I think, for institutions to be thoughtful about making sure that people aren’t spreading COVID in their places. And that’s why I do think it’s problematic when large stores like Walmart go with the honor system, because we know that there are a lot of folks who may choose to go unmasked and who are not vaccinated, who could be passing it among each other. And that’s bad for all of us. I worry when institutions choose to forego that responsibility.
I’m fully vaccinated. I will likely keep putting my mask on in indoor spaces. Outdoors, I won’t be wearing masks, but indoor spaces I will, just because I think it’s important to protect the norm that allows people to wear masks if they feel uncomfortable. I have a 3-year-old daughter, and if we go inside and I tell her to wear a mask, but I’m not wearing one, she doesn’t have the nuance to be able to appreciate what that means. Maintaining that norm is important. There are people for whom a COVID-19 infection could be catastrophic, who are immunocompromised and could still get sick even if they’ve been vaccinated. And so then they do need to wear a mask. I don’t want to create a norm where all of us just take off our masks, even if we haven’t been vaccinated, and people who do choose to keep wearing a mask to protect themselves get bullied.
The thing I want folks to understand is that these vaccines work. They’re effective. If you are vaccinated and choose to take the mask off, you’re perfectly reasonable in doing that. It’s not that the science isn’t clear about this. The challenge is a public policy one. How do we make sure that people who have been denying the pandemic and choosing not to wear masks and choosing not to get their vaccines don’t ruin it for everybody? There are a lot of people who can’t get vaccinated right now or for whom vaccines are not as effective, who rely on public policy to keep them safe.
AVC: Do you have any advice for people to try to calculate what their risk tolerance is?
AWC: I think that the [question to] answer is, “What would be the consequence if I did get COVID?” You have a low probability of getting it [if you’re vaccinated], but what are the consequences if you do? The consequences if you’re immunocompromised are much greater than somebody who has a robust immune system. And so you have to think carefully about that. If you’re bringing your 90-year-old parent to a movie, vaccines may not be as effective in older individuals, and there’s the immune system issue, so you’d want to be more careful in that situation. The bottom line here is people have to think about what the consequences would be for them as an individual, as a part of a family, or as a part of the community were they to become infected, and looking at what the risk is of that happening.
AVC: It sounds like it’s really just a matter of taking some time to sit and think through what your risk factors are, and what you’re comfortable with.
AWC: Exactly. It’s being thoughtful, thinking about your risk, the risk to your family, the risks in your community, and their consequences. And then weighing them.