A year ago, many health experts cautioned against traveling and gathering indoors as the coronavirus spread, straining hospitals across the country. January went on to be the deadliest month of the pandemic in the United States so far.
Today, the pandemic looks much different. More than 200 million people in the United States have been fully vaccinated and millions — both vaccinated and unvaccinated — have recovered from infections, making much of the population far less susceptible to the worst outcomes of a COVID-19 infection than they were a year ago.
However, even with highly effective vaccines, health experts are urging people to continue exercising caution as the delta variant is once again pushing infection rates, hospitalizations, and deaths up in communities across the country, particularly in the Northeast and Midwest. The discovery of a potentially even more contagious variant, omicron, has put many people on higher alert as the world’s scientific community has yet to learn what its impact might be.
With these complicated factors, individuals, families, and friends will have to make nuanced decisions depending on the risk factors and tolerance levels of the people they intend to gather with this holiday season. AAMCNews spoke with physicians and scientists for their tips on how people might consider adapting their holiday plans this year in light of the ongoing pandemic.
Vaccines are key — including the booster
On one point, the experts were unanimous: the best way to limit the risk of COVID-19 is to get vaccinated. Adults who are unvaccinated are about eight times more likely to be hospitalized for COVID-19 than vaccinated adults and 14 times more likely to die from COVID-19, according to the latest data from the Centers for Disease Control and Prevention (CDC).
“Being vaccinated is what makes this a much easier risk calculation,” says Amesh Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security and an adjunct assistant professor at the Johns Hopkins Bloomberg School of Public Health in Baltimore. “If you are vaccinated, you are going to be protected from severe disease. In the end, that’s what matters.”
George Rutherford, MD, head of the Division of Infectious Disease and Global Epidemiology at the University of California, San Francisco, School of Medicine, says that anyone who is eligible should also get a booster shot to be considered fully vaccinated.
Because studies show that immunity wanes in the months after receiving one of the vaccines, the CDC now recommends that all adults over the age of 16 receive a booster shot at least two months after a Johnson & Johnson vaccine or at least six months after their last dose of an mRNA vaccine by Pfizer or Moderna.
The boosters could also be an important tool against the omicron variant, which scientists worry might be able to evade some of the immune response the vaccines induce, says Eric Topol, MD, the founder and director of the Scripps Research Translational Institute in La Jolla, California.
“Delta is a hyper-contagious virus. Omicron adds another dimension to it. People should not be glib. Anybody who thinks the pandemic is over is really completely out of touch with reality.”
Eric Topol, MD, founder and director of the Scripps Research Translational Institute in La Jolla, California
Although he does not think the omicron variant will be dominant in the United States by the holidays, Topol believes there will be an omicron surge next year.
“Our problem [now] is delta,” Topol says. “Omicron will be a big issue as we get into January. … Once omicron starts to get going, we will have serious issues with vaccination breakthroughs unless people are boosted.”
There are still many unknowns about the omicron variant, though the World Health Organization has said that preliminary data suggest that it might be more transmissible and cause milder disease than the delta variant and a preliminary, real-world study conducted by Discovery Health — South Africa’s largest private insurer — found that two doses of the Pfizer vaccine were 70% effective against hospitalization.
But Topol cautions that it’s too soon to draw any conclusions.
“It’s better to assume it’s like the other variant,” he says. “Delta is a hyper-contagious virus. Omicron adds another dimension to it. People should not be glib. Anybody who thinks the pandemic is over is really completely out of touch with reality.”
Both Topol and Rutherford recommend against gathering indoors with anyone who is not fully vaccinated.
“We’re going to have to start differentiating for family gatherings who is vaccinated versus unvaccinated,” Rutherford notes. “We need to be cognizant of the risk.”
Assess your risk and risk tolerance
With many complicating factors surrounding socializing during a pandemic, experts agree that there is no one-size-fits-all approach to gatherings.
“Everything comes down to risk tolerance,” Adalja says. “There are ways to get the risk as low as possible — all vaccinated, outdoors, masks, rapid tests — but that might defeat the purpose of the gathering.”
James McDeavitt, MD, executive vice president and dean of clinical affairs at Baylor College of Medicine in Houston, created a risk assessment tool to help people determine the precautions they should take.
“I don’t think it’s reasonable to think that everyone is going to stick their heads in the sand and not celebrate,” McDeavitt says.
“Everything comes down to risk tolerance. There are ways to get the risk as low as possible — all vaccinated, outdoors, masks, rapid tests — but that might defeat the purpose of the gathering.”
Amesh Adalja, MD
Senior scholar at the Johns Hopkins Center for Health Security in Baltimore
He made a similar tool last year that was far more restrictive, including quarantining and getting a laboratory PCR test before any indoor gathering. This year, because of the vaccines, he has adapted the tool to allow more freedom for those who are vaccinated.
The tool asks the user to assign a point value to different factors, including whether anyone at the gathering is at high risk for severe COVID-19, the rate of community spread in the place where the gathering is taking place and where visitors are traveling from, and the personal risk tolerance of each of the people gathering (whether they are highly concerned or not very concerned about catching or spreading COVID-19).
For example, if the gathering is only among young, healthy, vaccinated people, they don’t need to take many precautions, McDeavitt says. Safety becomes more complicated if people at the gathering have medical conditions or are unvaccinated. He recommends moving gatherings outdoors or using masks indoors in those cases.
Testing and ventilation
For those who are willing to accept some level of risk to celebrate with family and friends, there are some precautions that can help reduce risk, even if it can’t be eliminated.
One option is to have people who will be gathering get tested for COVID-19. This is particularly important for anyone who is unvaccinated or anyone experiencing symptoms of COVID-19.
Adalja says that unvaccinated people — or vaccinated people who are worried about infecting a higher-risk person — can get a rapid test done as close to the gathering as possible. The Food and Drug Administration has approved 14 self-testing kits that are available at pharmacies and give results within 15 minutes. While at-home rapid tests are not as accurate as PCR tests, which are performed in a lab and can take days to get results, they can help to screen people who are most likely to be infectious. Those who have been exposed to COVID-19 or have symptoms of COVID-19 should get a PCR test five to seven days after the first exposure, even if a rapid test comes back negative, according to the CDC.
“Last year was about avoiding the virus. This year is learning to live with the virus.”
James McDeavitt, MD,
Executive vice president and dean of clinical affairs at Baylor College of Medicine in Houston
To further protect people at indoor gatherings, Krystal Pollitt, PhD, an assistant professor of epidemiology and chemical and environmental engineering at Yale School of Engineering and Applied Science in New Haven, Connecticut, recommends improving the ventilation by opening windows and using a portable air cleaner with a HEPA filter.
Pollitt added that all the same precautions that have been recommended to protect against delta and other variants can also be used to protect against the omicron variant and any other respiratory illness.
“It just reinforces our need to continue to take precautions,” she says.
Although the pandemic is still a major global threat, particularly for the unvaccinated, McDeavitt is hopeful that this will be the last pandemic holiday. In the meantime, it’s up to individuals to weigh the risks and benefits of their holiday plans.
“Last year was about avoiding the virus,” McDeavitt says. “This year is learning to live with the virus.”
