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Weddings in 2020 did not look like weddings of years past. Some were held in backyards, attended by only immediate (masked) family members. Others were held virtually, allowing loved ones from near and far to partake in the big day. Many were postponed to a to-be-determined date. But as the world reopens and all those postponed ceremonies are officially rescheduled, you may be wondering how safe it is to attend a wedding if you’re fully vaccinated but immunocompromised.
The U.S. Centers for Disease Control & Prevention (CDC) has updated its guidance and loosened most restrictions for fully vaccinated individuals, but says you should talk to your doctor if you’re immunocompromised. That’s because there isn’t enough data yet on how well protected immunocompromised, vaccinated individuals are from COVID-19.
Experts still recommend that most people who take immunosuppressant medications, such as those for inflammatory or autoimmune conditions, get the vaccine. But people may need to be more cautious about continuing to reduce their exposure to COVID-19 — such as by wearing face masks — even after they’re vaccinated.
For instance, some immunosuppressive medications may affect your immune response to the vaccine. One small study in the Annals of the Rheumatic Diseases found that only 62 percent of patients with immune-mediated inflammatory diseases (IMID) on methotrexate achieved an adequate response to the second dose of the Pfizer COVID-19 vaccine, compared to more than 90 percent of healthy individuals or IMID patients on other medications like TNF inhibitors. Researchers are currently studying how various medications and medical conditions affect the body’s response to the vaccine.
Here’s what the CDC says: “If you have a condition or are taking medications that weaken your immune system, you may NOT be fully protected even if you are fully vaccinated. Talk to your health care provider. Even after vaccination, you may need to continue taking all precautions.”
Until precise lab tests that can determine correlative protection are available, people who are immunocompromised need to be cautious even though they are fully vaccinated, says infectious disease specialist John Swartzberg, MD, Clinical Professor Emeritus at the UC Berkeley School of Public Health in the Infectious Diseases & Vaccinology Division. Correlative protection means a simple blood test measuring antibodies could tell you how protected you are.
“The most important thing to recognize is that if you’re immunocompromised, we’re not as secure in our knowledge about how protected you are from being vaccinated,” says Dr. Swartzberg. “We know that for a lot of people who are immunocompromised, they are well-protected by being vaccinated — but for others, they may not be.”
That may make it difficult to decide when to celebrate special events with your loved ones, especially since more weddings are expected to take place this year and next, per the New York Times. In a recent interview with Time, Lauren Kay, Executive Editor of the Knot Worldwide, said they “expect a 20 percent to 25 percent increase in weddings this year  and into 2022. We believe it’s going to be the biggest wedding year ever.”
The CDC doesn’t provide guidance for how fully vaccinated individuals should approach weddings or other gatherings (though it still states that unvaccinated individuals should avoid large gatherings). It does note, however, that fully vaccinated people can generally resume activities that they did before the pandemic and without wearing masks, unless it’s required by local or business laws and regulations.
Weddings are tricky because they’re such a milestone event. Of course, you want to celebrate your loved ones and are looking forward to reuniting with family and friends. But you’re right to be concerned about spending time in a large crowd, especially if the wedding will be held indoors.
If you’re immunocompromised, here are four questions to ask yourself if you receive a wedding invitation this year and are debating whether or not it’s safe for you to attend, or how to best protect yourself if you want to go.
1. How Large Will the Wedding Be?
There’s no “right” number or threshold that will determine if an event like a wedding is safe or not — but naturally, the larger the wedding, the greater the risk will be.
“If you’re going to have 500 people in a closed space, that’s asking for trouble,” says Stuart D. Kaplan, MD, Chief of Rheumatology at Mount Sinai South Nassau in Oceanside, New York and a partner in practice at Rheumatology Consultants, LLP. “If you’re talking about 50 people spread outside in a backyard, it’s probably less risky.”
In addition to asking the hosts how large the wedding will be, ask if guests will be expected to be vaccinated (or otherwise wear masks). Some venues may even require guests to show proof of vaccination or a negative COVID-19 test.
“If the other people attending are vaccinated and asymptomatic, the chances of those people transmitting the virus to anyone are extremely small,” says Dr. Swartzberg. “If you’re attending a wedding and you’re immunocompromised, you’re going to want to do everything you can to protect yourself. That includes finding out if everybody going to that wedding is vaccinated.”
The CDC notes that unvaccinated people should still avoid large gatherings that bring together many people from various households in a private or public space. Talk to your doctor for their opinion on how much of an immune response you may have garnered from the vaccine, and if they recommend you avoid gatherings for the time being. Keep in mind there’s no way to know for sure what kind of response you had to the vaccine (antibody testing is not recommended), but your doctor may be able to provide some guidance based on the medications you take and your overall risk factors for COVID-19.
2. Will I Be Able to Follow Standard Mitigation Efforts?
If you do attend a wedding, continue to follow the standard mitigation efforts that are known to lower the risk of COVID-19 transmission: Wear a mask (consider double-masking), stay at least six feet away from people who don’t live with you, and avoid crowds and indoor spaces that are poorly ventilated.
“You can’t be assured of protection from other people who are infected, but you can still protect yourself,” says Dr. Swartzberg. “Probably the most important things would be masking and social distancing, but at gatherings that may not work very well.”
Ask the hosts how practical it will be to follow standard mitigation efforts. For example, an outdoor wedding in an orchard with tables and chairs that can easily be moved to allow for social distancing will be better suited for reducing your risk of exposure to COVID-19 than a wedding in a crowded ballroom with no flexibility to move furniture.
And, as difficult as it may be, remember that standard mitigation efforts include holding off on embracing loved ones at the wedding, even if it’s been a long time since you last saw them.
If you’re immunocompromised, “avoid close contact with people outside of your household, including kissing and hugging,” says Dr. Kaplan. “Try to maintain social distancing whenever possible.”
3. Should I Skip the Reception?
If you don’t know if everyone at the wedding will be vaccinated, consider attending only the ceremony.
“You can take multiple steps to chip away at your risk,” says Dr. Swartzberg. “The first big one would be making sure everyone there is vaccinated — in that case, if you’re at the table with someone without a mask on, the risk of transmission is very small. But you may want to chip away even further at your risk by not attending the reception at all.”
Consider other factors that may increase your risk at the reception: For instance, if dinner will be served buffet style, it may lead to crowding around certain dishes (making it difficult to social distance). Otherwise, you likely don’t need to worry too much about the items you touch or the food you eat.
“I’m not very worried about inanimate objects or the food you eat,” says Dr. Swartzberg. “I don’t think there’s any good evidence that’s going to transmit the virus. But still, if you’re going to be at a buffet and handling the same serving utensils as other people, perhaps carry hand alcohol with you and use that to reduce any theoretical possibility of transmission.”
You may also want to refrain from lingering around the dance floor if you attend the reception.
“Close dancing is something to be careful about — when the dance floor is packed with people, that’s going to be a high-risk situation,” says Dr. Kaplan. “Also, if there’s a lot of singing, shouting, or loud talking, that’s going to be a risk since COVID-19 is spread through droplets in the air.”
Finally, when considering whether to attend the reception or not, think about if it will be indoors or outdoors. “If it’s outside, you tremendously reduce your risk as opposed to being inside,” says Dr. Swartzberg.
4. Is There a Virtual Attendance Option?
If the wedding takes place in (or many of its guests are traveling from) a location with a high COVID-19 caseload, your best option may be to ask the hosts if a streaming option is available through services like LoveStream or Wedfuly.
This may also be the right choice for you if you have to travel a long distance to attend the wedding and are not yet comfortable flying or using other forms of public transportation.
“Even though the United States is doing incredibly well right now, there are selective counties and cities that have rates of 50 to over 100 new positive COVID-19 cases per 100,000 people daily,” says Dr. Swartzberg. “So if you’re going to a community where there’s a high rate, that may influence your decision.”
Ideally, the rate would be five or fewer daily new cases per 100,000 people. As of the end of May, the United States had an average of seven daily new reported cases per 100,000 people, per The Washington Post.
“If the current trajectory in the United States continues, you can see where, as a country, it’s going to be very improbable that you’ll encounter somebody who’s contagious,” says Dr. Swartzberg. “That said, the virus does better in cold months, so we could still see an uptick in cases during the winter and vigilance remains important.”
The bottom line is that the decision to attend a wedding if you’re immunocompromised is very personal. As with much COVID-19 decision-making these days, there aren’t necessarily right or wrong answers, but rather making choices based on your own risk-benefit analysis. If you’re fully vaccinated and the wedding has elements that make it a lower-risk gathering (it’s outside, you know guests will be vaccinated), it will be safer to attend than one with higher-risk elements (it’s indoors, you know many guests will not vaccinated).
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Dockterman E. 2021 Could Be the Biggest Wedding Year Ever. But Are Guests Ready to Gather?. Time. May 29, 2021. https://time.com/6051959/weddings-covid-19/.
Haberman RH, et al. Methotrexate hampers immunogenicity to BNT162b2 mRNA COVID-19 vaccine in immune-mediated inflammatory disease. Annals of the Rheumatic Diseases. May 25, 2021. doi: http://doi.org/10.1136/annrheumdis-2021-220597.
Interim Public Health Recommendations for Fully Vaccinated People. COVID-19. U.S. Centers for Disease Control and Prevention. May 28, 2021. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html.
Interview with John Swartzberg, MD, Clinical Professor Emeritus at the UC Berkeley School of Public Health in the Infectious Diseases & Vaccinology Division
Safronova V. The Wedding Boom is Coming. The New York Times. February 19, 2021. https://www.nytimes.com/2021/02/19/style/weddings-2021-coronavirus.html.
Marriage in the ‘New’ America: A Pandemic, Equality, and an Industry Ready for Change. American Wedding Study. Brides. October 6, 2020. https://www.brides.com/american-wedding-study-5079338.
More than 593,000 people have died from coronavirus in the U.S. The Washington Post. June 1, 2021. https://www.washingtonpost.com/graphics/2020/national/coronavirus-us-cases-deaths/.