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A photo of a Black woman grocery shopping while wearing a face mask.
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As more people get vaccinated for COVID-19 and pandemic precautions like mask wearing and social distancing continue to loosen, you may wonder what the risk level is for everyday activities like grocery shopping if you’re fully vaccinated but immunocompromised.

Although the U.S. Centers for Disease Control & Prevention (CDC) has updated its guidance and loosened most restrictions for fully vaccinated individuals, 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.

Because of this, many experts recommend that immunocompromised patients, including those who are fully vaccinated, continue to follow standard mitigation efforts until more is known about how the vaccine works in these patients. This includes people who take certain immunosuppressive medications, like methotrexate and rituximab, as these drugs may decrease your immune response to the vaccine, leaving you less protected than a fully vaccinated person who is not taking such medication.

For those who have not been vaccinated or may not have had a full immune response to the vaccine, it’s important to limit exposure to potential COVID-19 infection. The means wearing a mask (or even double-masking), staying at least six feet away from people who don’t live with you, and avoiding crowds and indoor spaces that are poorly ventilated — in some cases, that may mean your local grocery store.

“Odds are, in crowded indoor settings, people are going to be exposed to unvaccinated individuals who could be transmitting SARS-CoV-2 virus unwittingly,” says David Aronoff, MD, Director of the Division of Infectious Diseases at Vanderbilt University School of Medicine in Nashville, Tennessee. “So it’s still really prudent to avoid crowded, indoor areas, particularly those that are not well-ventilated, and act accordingly.”

But avoiding the grocery store is easier said than done, since food is a necessity. Although use online grocery shopping grew significantly over the past year (a November 2020 report from eMarketer and Business Insider Intelligence reports that online grocery sales in the U.S. increased by 53 percent in 2020), not everyone lives in an area where online grocery shopping and delivery is available. The same is true for curbside pick-up, which also became more widely used during the pandemic.

If going into the grocery store is your only way to get food, you may be nervous about shopping in person if you’re immunocompromised and others around you are not wearing masks. Here are four ways you can continue to protect yourself when you stock up on groceries if you’re fully vaccinated but your doctor says you may not have had a full immune response to the vaccine.

1. Shop During Off-Peak Hours

Select stores still offer designated shopping times for those at higher risk. For instance, Target has dedicated shopping time for vulnerable guests — including those over 65 years old, pregnant women and those defined by the CDC as vulnerable or at-risk for COVID-19 — during the first hour stores are open on Tuesdays. (Check with your local store for opening times.)

Walmart will also continue to hold a dedicated shopping time for those 60 and older and those most vulnerable to COVID-19 from 6 a.m. to 7 a.m. on Tuesdays, reports USA Today.

Call your local grocery store to find out if its offers designated shopping times for those at high risk.

“I think it’s great that stores are still offering these options and patients should take advantage of them,” says rheumatologist Jiha Lee, MD, a Clinical Assistant Professor at Michigan Medicine. “Based on your community, you might also know when the store may be less crowded, like during school or work hours.”

Even if your local grocery store doesn’t offer designated hours for high-risk people, it’s still worth going when there will be fewer crowds, especially if the store doesn’t require masks. This can make your trip safer and quicker. Although most large grocery stores have adequate ventilation to prevent infectious particles from building up in the air, crowds raise the risk of COVID-19 transmission.

“It’s hard to know what air filtration or ventilation is like without studying each individual location, but many grocery stores benefit from the fact that they are big buildings with high ceilings, pretty good airflow, and doors that are opening and closing a lot,” says Dr. Aronoff. “I’m not particularly concerned with dead air in big, open grocery stores — but the most important factor is probably how crowded the store is when you’re in there.”

2. Continue to Wear a Mask

The CDC has updated its guidance to say that fully vaccinated people can return to normal activities without masks (except when required by local or state laws), but notes that it’s important to speak to your doctor if you’re immunocompromised.

In fact, the CDC says: “At this time, there are limited data on vaccine protection in people who are immunocompromised. People with immunocompromising conditions, including those taking immunosuppressive medications (for instance drugs, such as mycophenolate and rituximab, to suppress rejection of transplanted organs or to treat rheumatologic conditions), should discuss the need for personal protective measures with their health care provider after vaccination.”

Your doctor may recommend what many other experts are urging immunocompromised patients to do if they may not have had a regular immune response to the vaccine: Continue wearing a mask. It’s even better if you double up with a cloth mask over a medical mask, which a February 2021 study in the CDC’s Morbidity and Mortality Weekly Report found can reduce exposure to potentially infectious aerosols from an unmasked person by 83 percent.

“The one thing that has not changed throughout this pandemic is the way in which the virus is transmitted and the ways in which we can protect ourselves from getting infected,” says Dr. Aronoff. “Wearing a well-fitted mask when shopping is prudent when there are potentially unvaccinated people in the store.”

Naturally, you’ll also be more protected if you go to a grocery store that still requires all shoppers to wear masks. Stores that say only fully vaccinated shoppers can go without masks rely on the honor system, which may pose a greater risk than you’re willing to take, depending on your personal level of risk, how widespread COVID is in your area, and local vaccination rates.

“Stores that require masks present a lower risk of a transmission event occurring than stores that don’t require masks,” says Dr. Aronoff. “That’s particularly true if we assume that shoppers going into stores that don’t require masks may be unvaccinated and not wearing masks. That’s less safe than going to a store where people may be unvaccinated, but everyone is wearing a mask.”

Wearing a mask may help protect you from getting other infections, too — particularly in the winter months.

“We’ve seen a drop in the rate of flu during the pandemic, which is mostly thought to be because of all the mitigation efforts we took with masking, hand hygiene, and social distancing,” says Dr. Lee. “Patients may wish to continue exercising these precautions so they can avoid other potential infections.”

3. Maintain Social Distancing and Use Hand Hygiene

For those who are unvaccinated, the CDC considers visiting an indoor shopping center as “less safe” — and recommends staying six feet apart from others and washing or sanitizing your hands in addition to wearing a mask.

If you’re vaccinated but may not have garnered a full response to the vaccine, you may want to follow these guidelines as well.

An April 2021 report from the CDC found that the risk of getting infected with SARS-CoV-2 infection by touching a surface is less than one in 10,000, but it’s still a general best practice to keep your hands clean as an easy way to avoid COVID-19 and other infections.

That said, many shopping centers may engage in what’s known as “hygiene theater.” It’s the act of showing how clean a space is through constant sanitations and showy wipe-downs. Of course, sanitary surfaces are important for overall cleanliness and may help protect you if you’re immunocompromised, but keep in mind that your greatest risk will likely be from standing next to unvaccinated and unmasked people — not touching the grocery cart handle.

Because of that, try to maintain space between yourself and other shoppers as you wait in line at checkout or at the deli counter.

4. Limit Trips to the Grocery Store — and Time Spent There

 It stands to reason that the less often you visit a public space and the less time you spend in it, the less likely you are to contract the coronavirus.

To limit your visits, plan out your meals for the week (or two weeks if you have the pantry and refrigerator space) and create a detailed list of items you need. This, as well as knowing the general layout of your grocery store, will help make your trip at the store go a lot quicker.

The good news: The pandemic in the United States is easing, and with every additional person who is vaccinated, your likelihood of getting infected in a public space decreases. Talk to your doctor about your risk of contracting COVID-19 or faring poorly if you get infected, and use that to inform your personal level of mitigation efforts.

“Right now we all benefit from the fact that a sizable fraction of our population has been vaccinated and disease activity is relatively low — in fact, it’s about as low as it’s been in over a year,” says Dr. Aronoff. “Those two things make the random occurrence of getting infected when you’re out in public much lower than, say, December 2020 when disease activity was very high and we weren’t yet vaccinating people.”

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Brooks J, et al. Maximizing Fit for Cloth and Medical Procedure Masks to Improve Performance and Reduce SARS-CoV-2 Transmission and Exposure, 2021. Morbidity and Mortality Weekly Report. February 10, 2021. doi: http://doi.org/10.15585/mmwr.mm7007e1.

Choosing Safer Activities. COVID-19. U.S. Centers for Disease Control and Prevention. May 28, 2021. https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/participate-in-activities.html.

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 David Aronoff, MD, Director of the Division of Infectious Diseases at Vanderbilt University School of Medicine in Nashville, Tennessee

Interview with Jiha Lee, MD, a Clinical Assistant Professor at Michigan Medicine

Kats R. Online grocery sales will increase by nearly 53% this year. eMarketer. November 17, 2020. https://www.emarketer.com/content/online-grocery-sales-will-increase-by-nearly-53-this-year.

Science Brief: SARS-CoV-2 and Surface (Fomite) Transmission for Indoor Community Environments. COVID-19. U.S. Centers for Disease Control and Prevention. April 5, 2021. https://www.cdc.gov/coronavirus/2019-ncov/more/science-and-research/surface-transmission.html.

Tyko K. Walmart to increase hours Saturday with stores opening at 6 a.m.; senior hours to continue. USA TODAY. June 1, 2021. https://www.usatoday.com/story/money/shopping/2021/06/01/walmart-hours-2021-change-covid-senior-hours-continue-masks-update/5284374001/.

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