Coronavirus FAQs: What Should I Do With My Vaccine Card? Is Choir Practice OK Now?

Each week, we answer "frequently asked questions" about life during the coronavirus crisis. If you have a question you'd like us to consider for a future post, email us at goatsandsoda@npr.org with the subject line: "Weekly Coronavirus Questions."

I've just had my second dose of the vaccine and now I have a "vaccine card." Um, what do I do with it?

That's a good question. The U.S. version bears this instruction: "Bring this vaccine record to every vaccination or medical visit."

In essence, it's proof that you've gotten the jab (or jabs for the two-dose options).

Beyond that? Yes, there are questions about what purposes it can serve — and how to safeguard it.

In the U.S., the card is a 3 inch by 4 inch document. It'll have your name, birth date and a bunch of key information about your vaccine regimen: which brand you got; when you received your dose or doses; where you were inoculated.

The idea of giving out cards to document a vaccination has been around since the 1930s, explains Maureen Miller, an adjunct associate professor of epidemiology at Columbia Mailman's School of Public Health.

"As people colonized the world, there were illnesses that were endemic to certain areas," she says. "Using cards saw to it that those diseases could be monitored as individuals crossed borders, like the now internationally-recognized Yellow Fever vaccine cards."

Indeed, the COVID-19 Vaccination Record Card is a valuable document. Dr. Amesh Adjala, a senior scholar at the Johns Hopkins University Center for Health Security, "urges people to keep [vaccine cards] safe." Vaccine passports will likely soon be needed for some international travel, he said — though the concept of the "vaccine passport" is still very much in the development stage. One idea is to digitize immunization records into easy-to-trace systems like scannable barcodes. Until those systems get set up, though, you'll likely need to carry your physical card for international travel ... even though its size in the U.S., for example, isn't the most wallet-friendly.

The use of the vaccine card may stretch far past air travel, says Miller. You made need it to enter cinemas, board trains, even sometimes as a condition of employment. In the U.K., for instance, government officials are considering asking individuals to present proof of vaccination to get access to public spaces like pubs and sporting events — a provision that 70 lawmakers have announced they'll stand against.

As societies begin to reintegrate and have similar conversations, having a vaccine card will likely determine access to certain services. To this end, "people should be guarding vaccine cards very carefully," Miller says.

So what does that mean for you once you receive your vaccine card?

First things first. Miller says it's prudent to take pictures of both sides of your document as soon as you receive it or find a way to scan it, just so that you have a personal record. That's what people often do with a driver's license or passport, she notes. While it wouldn't fly to present a phone scan as proof of vaccination, it's good to capture all the data just in case you, say, lose your card.

(A quick tip for iPhone users is to use the built-in Notes app for a close-to-Xerox-looking clean photocopy.)

Miller also suggests laminating your card, as she did. That way, the card feels a bit less like a random scrap of paper and more like the real, official and important document it is. Though some worry that lamination might preclude the ability to update your card with potential immunity "boosters" in the future. Adjala said thinking about "boosters" is a bit premature and urged individuals to do what works for them. And if you opt for lamination, you shouldn't have difficulty fulfiling that goal. Office supply stores like Staples, Office Depot and OfficeMax have agreed to laminate, for free, your vaccine card if you visit one of their stores. Check to make sure the offer is still on before stopping by.

As to where you'd keep the card at home, Miller says she has hers in the folder she uses for medical insurance and health documents. A safe bet would be anywhere you store important records like passports. Miller emphasizes that it's probably better to keep it at home and not in a security deposit box in a bank!

And in the worst case scenario, what if you lose your card?

"The physical document isn't the only record," Adjala said.

When you get vaccinated, that information enters your state's immunization registry, Adjala said – so no need to call up your primary care doctor or do any other logistical legwork to make it be part of your permanent health record. That process should happen automatically (although it couldn't hurt to call your primary care doc just to make sure it did!).

In the case of losing your card, your best bet is to hit up the pharmacy or clinic or site where you got your vaccine at and ask for a duplicate copy. This will be problematic if you were vaccinated at a local pop-up effort; in that case, Miller suggests contacting your state board of health. You should be able to get a duplicate ... but perhaps not without a fair share of moving through bureaucracy, Adjala said.

Eventually, Adjala predicts, more "durable forms of vaccination status" — AKA, records that don't just exist on a flimsy piece of cardstock — will emerge. But until then, it's just a matter of being extra careful.

My choir director says the pandemic is ending soon and that face-to-face, in-person practice is expected to begin in May. Is it true that vaccinated people can safely sing together? Should people still be wearing masks?

Singing indoors is one of the riskiest things you can do during this pandemic — up there with screaming for your March Madness picks in a packed arena. When you sing or scream, you expel air forcefully, which generates lots of respiratory aerosols that can contain the SARS-CoV-2 virus that causes COVID-19.

We all remember that haunting episode from the early days of the pandemic in which 52 of 61 members at a choir rehearsal in Skagit County, Washington, got confirmed or probable cases of COVID-19 after a 2.5-hour practice. Three choir members were hospitalized and two died.

But the vaccines are powerful tools. So, for advice, we tapped one of the co-authors of the International Coalition of Performing Arts Aerosol Study, University of Maryland mechanical engineering professor Jelena Srebic, and Dr. Jill Weatherhead, assistant professor of adult and pediatric infectious diseases at Baylor College of Medicine.

After Srebic had a good chuckle about the choir director's pronouncement that the pandemic is almost over (as much as we may wish it, we're not quite there), she explained that the study's most recent guidelines, released in December will hold true for a while — even with the additional protection from vaccines. Here's a summary:

Masks should be worn by choir members and anyone playing an instrument. (Cutting a slit in your mask with an X-Acto knife allows you to fit it over a wind instrument.)

Practice outdoors if possible. If indoors, the choir director should make sure there's a good air filtration system.

Singers should be at least 6 feet apart. Practice no more than 30 minutes at a time. The idea is to move away from plumes of air created from singing.

As vaccines become more widely available, Srebic suggests asking as many members to get them as soon as they're eligible.

"Vaccination reduces the risk [of infection] dramatically, especially for vaccinated people, but we still don't have a clear picture on what is going to happen with variants," Srebic explains. "So, it's very prudent to continue to be cautious."

That's why she suggests sticking to the above guidelines even once most of your choir is vaccinated. Instead of changing your habits when you get vaccinated, she suggests changing your thinking: "The vaccine gives you peace of mind," she says. "You can keep the same precaution measures but not worry as much as people used to worry."

Choirs could also wait to resume in person practice — and definitely performances with audiences — until more people are vaccinated, Weatherhead points out. "Wait until the community transmission comes down. That is the safest plan."

But don't despair that you will have to follow these rules forever. Real-world studies suggest that vaccines may be efficacious against transmission from asymptomatic cases. "That was one of the biggest unknowns because the clinical trials didn't study that," she says.

And an observational study published in Nature showed that the small percentage of people who got infected after a vaccine tended to have much lower viral loads than unvaccinated people who got infected, providing further evidence that the ability to transmit the disease likely diminishes with vaccination.

As more people get vaccinated, choirs should be able to start gradually shifting their protocols, Srebic notes. For example, choirs could practice longer and shorten the breaks, she says.

And yes, all of this also applies to screaming at big concerts and sporting events. But feel free to cheer as much as you like for the UConn Huskies from the privacy of your couch tonight!

Will taking a CBD product prior to my shot affect its efficacy?

In short, avoiding CBD pre-shot will probably be the safer approach here. CBD, which stands for cannabidiol, is a chemical component of cannabis. It's been known to have a relaxing and therapeutic effect and is sometimes used to manage pain.

According to Maureen Miller, an adjunct associate professor of epidemiology at Columbia Mailman's School of Public Health, there's "absolutely no research" that looks at the effect of CBD oil on COVID-19 vaccine efficacy in humans. So it's important to note upfront there's not much that can be said conclusively on the effects of CBD specifically.

That said, Miller points to updated Centers for Disease Control guidelines that advise against anti-inflammatories, like Ibuprofen and other painkillers, prior to inoculation — unless those medications are already a part of peoples' typical medical regime. Miller notes CBD also happens to act as an anti-inflammation tool — though the CDC advisory did not specifically take note of it.

To gain immunity, she emphasizes, your body needs to build up an inflammatory response. So, she reasons, it might be better to be safe than sorry and stay away from using CBD prior to your shot – just to make sure you're getting your biggest bang-for-your buck with the vaccine. Unless, of course, CBD is already part of your usual medical routine, Miller said — in which case, you should continue business as usual.

Sheila Mulrooney Eldred is a freelance health journalist in Minneapolis. She's written about COVID-19 for many publications including Medscape, Kaiser Health News, Science News for Students and The Washington Post. More at sheilaeldred.pressfolios.com. On Twitter: @milepostmedia

Pranav Baskar is a freelance journalist who regularly answers coronavirus FAQs for NPR. [Copyright 2021 NPR]