Giving Thanks and Keeping Safe During The Holidays

We all want to celebrate the holidays normally, with our families and friends. But COVID-19 cases are rising, and gatherings of different households, especially indoors, are proven spreaders of the virus. According to the CDC, the lowest risk holiday activities are small dinners limited to household members only, and virtual gatherings with others. As COVID pandemic fatigue sets in, the temptation to push boundaries and take chances can be strong. However, as NYU epidemiologist Celine Gouder warns, “it’s really important to understand that the coronavirus hitches a ride on our trust and our love for our family and friends. It’s actually the people we trust most whom we’re most likely to infect and who are most likely to infect us, because we’re not going to take those same precautions.”

 So let us be thankful that unlike at the beginning of the COVID-19 pandemic, we now have nearly two years of data about how it spreads, and plenty of practical knowledge about how to reduce our risks and keep ourselves and our families safer from this airborne virus.

Let us be thankful that vaccines are now available in the U.S. for ages 5 and up, with boosters now available as well, and that we have the data informing us that while vaccines are very effective at preventing hospitalization and death, they are not 100%, and that vaccinated people can transmit COVID and can develop long COVID. Let us be thankful that we have been alerted that additional layers of protection, such as good quality, well-fitting masks and effective ventilation and filtration of indoor air can keep us safer.

Let us be thankful for Georgia Institute of Technology professors Joshua Weitz and Clio Andris, who developed a risk assessment tool for gauging the odds, by county and by gathering size, of a COVID-infected person being present at a given event. For example, in Boston, there is currently an approximately 20% chance of at least one person having COVID at a gathering of 25 people.

Let us be thankful that COVID testing has the potential for helping to reduce the risk of disease transmission over the holidays, if used correctly, though this can be challenging to accomplish, particularly for students returning home from college or others who travel to visit family. The incubation period for COVID is up to 14 days, with an average of 4 – 5 days between exposure to the virus and the development of symptoms, and infected people are contagious before symptoms begin. The  probability of a false negative test the day after exposure is 100%, and there are many factors which affect the variable but significant false negative rates for both at-home antigen tests and laboratory RT-PCR tests, even several days after exposure in both symptomatic and asymptomatic people. It is important to understand that any given test is just a snapshot of the day that it was taken and doesn’t exclude an exposure that is too early to show up on a test, nor does it exclude exposure to infection after the test was taken. Exposure can happen during travel, or at the destination if precautions are not maintained.

To get the most out of testing, the potential for exposure should be minimized for two weeks before attending a family holiday gathering. Consider planning to wear good quality, well-fitting masks consistently indoors with others, to avoid eating indoors with others, and to limit contact with others as much as possible – minimize shopping and errands, and forego get-togethers, sports events and entertainment venues – followed by a series of home tests five days and three days before as well as the day of the holiday gathering, or a PCR test three days before and a home test the day of. And even if the tests are negative, anyone feeling unwell the day of the event should still stay home.

Even with multiple layers of protection in place, it is still possible that an infected person may be present, and precautions may still need to be taken during the visit, especially in the presence of medically vulnerable household members. If celebrating outdoors is not an option, limiting the number of guests and the length of the celebration, maintaining social distance as much as possible, having good quality air purifiers running, and keeping the windows cracked open will reduce the concentration of any viral particles that may be in the air.

At the end of the day, we need to keep current and informed, and communicate openly and frankly with our loved ones. We can mindfully decide together what level of risk is acceptable, and fully comply with the agreed-upon plans. We can also choose to play it as safe as possible, acknowledge the difficult reality that health, life, death are at stake, avoid the risk of making this holiday a loved one’s last, and skip the trip this time to help get us all closer to the time when we don’t have to do this anymore. And while we’re at it, let’s be thankful for platforms that provide a way to celebrate virtually together.

Happy, healthy, safe holidays!