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Fully vaccinated but worried about a return to normal life? You may have ‘cave syndrome’


For much of the Covid-19 pandemic, Laura G. Bustamante longed for the weekend nights when she drove into Manhattan to meet friends, often at karaoke bars in the Koreatown neighborhood.

She is now fully vaccinated and many bars and restaurants in New York City have reopened. But Ms. Bustamante says she doesn’t feel ready to return to her pre-pandemic forays into the city, and she only feels comfortable meeting friends there one-on-one, preferably outdoors.

“If you look at social media, you see that some people are having all that fun,” says the 49-year-old product management consultant in suburban Rockland County, NY. “I can’t see myself in that photo.”

Since the Centers for Disease Control and Prevention made clear to all vaccinated people to gather indoors without masks and resume pre-pandemic activities, many have eagerly returned to dining at restaurants, attending parties and flying to see friends and family. (And many people have done so before.) But for others, it proves difficult to return to their past lives — and much of the outside world — after more than a year of relative isolation.

Instead of feeling freedom, many say they are afraid to socialize again – awkwardly turning down invitations, avoiding crowds and fearing or even delaying returning to the workplace.


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The phenomenon is so common that it has been dubbed the “cave syndrome” on social media and in some psychiatric circles. “Cave syndrome really means people are just nervous about going outside because they’re going to get infected,” says Coral Gables, Florida psychiatrist Arthur Bregman. He coined the non-medical term earlier this year after some of his patients expressed sometimes crippling fears of going into society even though they are fully vaccinated.

dr. Bregman says cave syndrome varies in grade, from vaccinated individuals who are cautious but participate in limited social interaction to those who choose not to go outside at all. He distinguishes between immunocompromised people who are unable to utilize the full protective effects of the vaccine and remain vulnerable to Covid-19 and those who, data show, enjoy significant protection from the vaccine.

The growing spread of the Delta variant in recent weeks has been substantial enough for places like Los Angeles and Israel to reintroduce indoor mask requirements, sparking more unease among those already apprehensive about re-entering society. . And contrary to the CDC’s guidelines, the World Health Organization also recently reiterated its global guideline that everyone should wear a mask indoors.

Constantly changing information about Covid-19 and fluctuating and sometimes conflicting guidance from government health officials have likely exacerbated fears, says Dr. Bregman. While data shows that vaccinated individuals who receive the Delta variant most likely will not require hospitalization, “there is still the tremendous fear and mistrust that people have that they will get sick, so they stay indoors,” he says.

Meanwhile, Covid-19 restrictions are still being dismantled in many places, adding to the confusion many feel about what constitutes safe social practices. This week, England officially dropped nearly all coronavirus restrictions, including mask requirements and gathering size limits, in a government bet that mass vaccination will stop another deadly Covid-19 wave. Canada said Monday it would allow fully vaccinated Americans to enter the country for tourism activities from Aug. 9, more than a year after the border was closed to most travelers.


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Studies suggest that many people will need time to adjust to the newly reopened society. In a June survey by Ipsos and the World Economic Forum, the majority of 12,497 adults in nine countries — including the US, France, Japan, Mexico and the UK — said they were likely to continue social distancing and wearing masks. in public after vaccination.

In a March survey by the American Psychological Association, nearly half of 3,013 adult Americans surveyed by Harris Poll said they would feel uneasy about adjusting to face-to-face interaction once the pandemic is over. Vaccinated adults were just as likely as those who had not been vaccinated to say they were uncomfortable.

Andrew Ruiz, a 32-year-old technology analyst living in Fort Myers, Florida, has been fully vaccinated since April. He says he remains socially cautious and plans to skip New York Comic Con in October, where he’s been attending since 2014.

“The known feels safe, and the unknown always brings a bit of fear with it.”

— Paul S. Appelbaum, professor of psychiatry, medicine, and law at Columbia University

“It’s just knowing what it’s like in an enclosed space,” he says. “I want to play it safe and not be in a big crowd.” Plus, he’s not ready to board the plane yet, he says, especially with news about the spread of the Delta variant. “It’s probably best for me to just wait another year and see if things slow down then,” he says.

Fear of the virus alone does not stop some from re-entering society. Some wretches have become accustomed to living in their bubble and are reluctant to give up some of the positive aspects of spending more time at home, says Paul S. Appelbaum, a professor of psychiatry, medicine and law at Columbia University.

“That has become a comfortable pattern that is reinforced by the fear of the unknown,” he says. “Won’t it feel weird if I get on the subway again? Won’t it feel strange when I walk into the office?’ The known feels safe, and the unknown always brings a little bit of fear.”

Eoin Hamilton says he “had a knot in my stomach the whole time” when he celebrated his 43rd birthday with family at a Dublin hotel in early July. It was the first time Mr Hamilton, a graphic designer, had been in a crowd after spending the past 18 months of the pandemic mostly at home with his wife and children in Ballivor, a small village about an hour from the capital of Ireland.

“Everything else seemed fine, but inside I was just losing it,” said Mr Hamilton, who has been vaccinated for months. “I had a feeling it might be a little weird, but I didn’t expect it to be this bad.”

More than the virus itself, “it’s the fear of being around people again because you’ve been conditioned to stay away from people,” he says, adding that the experience made him swear to continue. social distancing. “I used to love being in a huge group of people, drinking a few pints, but now I don’t want to be around people anymore.”

Eileen Ybarra, a 44-year-old librarian in Los Angeles, received her second vaccination in April and began shopping in person again and seeing some family members. But she still doesn’t like going to the movies or dining indoors.

“It’s a mix of I don’t want to get sick in general, and maybe I feel more than a little traumatized from the past year,” she says. “I give myself time to return to a more or less normal life.”

She’s recently been “in the slow re-entry phase,” she says, eating indoors for a family birthday party for the first time earlier this month. But Los Angeles’ recent orders to re-mask in most indoor spaces have once again undermined its confidence to go outside.

“Now I kind of, well, guess?” she says. “It’s a bit strange.”

Indoor dining, training classes, concerts. These once mundane events recur in everyday life. But because of Covid-19, everyone now has a different comfort level. What happens in the brain when we decide what is risky or not? Photo illustration: Laura Kammermann

Write to Ray A. Smith at [email protected]

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