Think now about preventing infection during the holidays

An outdoor Thanksgiving (Photo by Spencer Davis on Unsplash)

By Katelyn Jetelina

About 2,600 Americans are still dying each week from Covid-19. The vast majority are older and vaccinated but not up to date on their boosters. As an epidemiologist, I refuse to accept this as the “new normal.” So my professional bias influences my priorities.

Goal 1: Protect the vulnerable. Ensure that the vulnerable around us (like grandparents) do not end up in the hospital with Covid-19, flu or respiratory syncytial virus (RSV). This means we are going to do everything in our power to break transmission chains before gathering for the holidays. This includes:

At least three weeks before the event, ensure that everyone is up-to-date on their flu shot and fall booster (especially the older adults). The fall booster rate is currently 7.3% (20% for those aged 65+).

One week prior to the event:

• Wear an N95 mask. In public. Everywhere I go. This will help ensure we don’t bring Covid-19 (or flu) to Thanksgiving dinner. It will also help make sure I don’t miss the event because I’m sick. 
• Don’t rely on case levels to influence masking decisions; at this point, they don’t accurately reflect transmission.
• Cadence testing: Use Covid-19 at-home antigen tests two days before seeing grandparents and the morning of. Test everyone. Including my toddlers who scream when I approach their nose. For people who have the virus and are asymptomatic, the average antigen test will catch 44% to 70% of cases. This isn’t perfect, so we don’t rely solely on this layer. But it sometimes works.
• If I’m positive a few days before the event: We see strong evidence (here, here) that an Omicron infection lasts, on average, 8-10 days. Some people will be infectious for less, and some will be infectious for more. You won’t know unless you test. Antigen tests are very good at telling us when we’re not infectious anymore (very few false positives). If I get a negative after a positive, then I would trust that I’m not contagious anymore and go to the event. With Paxlovid, we are seeing rebounding. So for anyone who tests negative after Paxlovid, I would continue to test for another couple of days. If you turn positive again, assume you’re infectious until you turn negative again.

Day of the event: Ventilation and filtration are powerful tools. This is especially important in the middle of winter when people head indoors. You can use a CO2 monitor if you want to take safety at your family event to the next level.

 
If we have symptoms, stay home. This is lonely during the holidays, but the best thing to do. When symptoms are present, Covid-19 antigen tests are great at detecting highly infectious people: the average antigen test will catch 78% to 97% of cases in the first week of symptoms. False negatives are more common at the beginning of infection, especially with Omicron. If you have symptoms and test negative, it’s a good idea to re-test in 24-48 hours. But, because flu and RSV levels are high right now, there’s a good chance it could be something other than Covid-19, too. Just stay home.

After the event: If an older adult gets infected, make sure they know about Paxlovid and get it within 5 days of symptoms, even just the sniffles.

Goal 2: Limit disruptions. We are trying as much as possible to prevent disruptions in our lives due to sickness. We want to go on our trip. We want to go to holiday parties. We want to help the crowded and broken healthcare systems right now.

This means we are all up to date on vaccines. This also means wearing masks. (Yes, still.) I wear one probably 40% of the time when I go to Target, but if there’s an event we’re really looking forward to, I wear it religiously (I usually dial up about four days before the event). This also means wearing a mask while traveling for work so I can come home, not get sick, and spend time with my girls.

Having two little ones and avoiding sickness gets harder and harder because they are in childcare. This is just a reality that I have to accept: they may bring something home. I’m going to do all I can to not bring it home. I know parents of older kids struggle what to do because there are competing realities: masks help reduce the odds of disruption (including missed school). But peer pressure is real, and they probably don’t wear them when you’re not around, anyways.

We are booking our holiday travel. With boosters, there is very little SARS-CoV-2 could do in the next couple months to cancel our trip. (A severe mutation may be an exception.) I know people travel with Covid-19 and sickness. Staying home is the least I can do to help someone else’s grandparents. We are prepared to cancel flights if we get sick. Make this an expectation with travel this winter.

Other considerations: I’m a healthy young adult who has been incredibly lucky. I recognize not everyone has similar situations. If you . . .

• Are the vulnerable person, like an older grandparent: The pandemic is not over for you. And I’m sorry. I would consider wearing a mask throughout winter. This will help with COVID, the flu, and (we think) RSV. If everyone who attends Thanksgiving dinner embraces Goal #1 above, the risk to you is very low.
• Have a child under 6 months: The pandemic is not over for you either. And RSV and flu should be concerning, too. The biggest advice I have for you is not to let people kiss or hold your baby. They’ll live.
• Have limited means: One tragic reality is that tools are being stripped away from people who can’t afford to pay for them. Free antigen tests are gone. Free masks are gone. Vaccines are still free, but many places are asking for proof of insurance. Cancelling flights can be super expensive. I recognize taking all of the steps above involves privilege. Instead, choose one or two precautions. It will help.

Bottom line: Yes, we are still in a pandemic. Yes, the “normal viruses” are back. We can enjoy the holidays this year while staying healthy: get vaccinated, mask (at least leading up to the event), ventilate, test and stay home when you’re sick. This seems like a lot— especially when it looks like the greater public isn’t doing anything— but it really isn’t. It’s still worth navigating this petri dish to ensure our loved ones are protected.

Katelyn Jetelina, a California epidemiologist, writes a column called Your Local Epidemiologist.