Prep For The Holidays
I’ll be honest: I’m ready for COVID-19 to take a permanent hike. I long for the days when the word “Corona” evokes a cold beer on a hot summer night—and not 10 days of isolation and fear.
You?
After 21 months of grief, loss, and life interrupted, I suspect most of us would love coronavirus to take a vacation.
But until the virus packs its bags, we need to take our own holiday—literal and metaphorical—from worry, fear, and the deluge of COVID-19 news.
So as I pack my bags for upcoming family travel, here are my tips for staying safe and sane:
Get vaccinated and boosted if eligible.
As I wrote about I wrote about last week week, so far Omicron seems to be milder but significantly more contagious than Delta. This means that we can expect more infections overall—including in vaccinated people (aka “breakthrough” infections) but largely in unvaccinated people.
The good news is this: the vaccine continues to do a great job taking the claws and fangs away from the virus. Indeed the vast majority of patients in the hospital for Omicron infections in South Africa and the UK are unvaccinated. But the variant also seems to evade some protection from the vaccine which means that we need that booster shot to be optimally protected.
Getting a booster shot seems to restore our antibody levels to a place where older and more vulnerable people are well protected against death and severe disease—and where younger people are even better protected against all varieties of infection (even mild-to-moderate illness).
Note: we cannot boost our way out of susceptibility to the virus, and we never will be able to. In other words, even people with three shots aren’t completely insulated from the risk of infection; the booster simply helps drop the risk. This is exactly where the acceptance of risk—lessened dramatically by vaccination—comes into play.
Also note: the FDA recently approved boosters for teens ages 16-17. I’m still on the fence about giving a third dose to my 17-year-old son. Why? Because his risk of severe outcomes from COVID-19 is tiny given his young age and vaccine-induced immunity, and because there’s a non-zero risk of vaccine-induced myocarditis in teen and young adult males. I might change my mind if we learn that a) Omicron is intrinsically more virulent in young people (which, so far, seems highly unlikely) or b) the risk of asymptomatic transmission is greatly reduced by a third dose.
Upshot: I’m strongly recommending boosters for the vast majority of my adult patients and have been triple vaccinated myself. I don’t spend any time worrying about getting COVID because I trust the vaccine to protect me from bad outcomes, and because I know I can never reduce the risk to zero.
Upshot of the upshot: once you’ve been vaccinated and boosted, you have taken the best step toward protecting yourself, your family, and your community from infection—even against Omicron.
Don’t travel or socialize if you have symptoms.
Remember that COVID-19 can present as sniffles, a sore throat, and other mild symptoms that people often ignore, especially after we’ve been vaccinated, thinking “This can’t possibly be COVID!” Symptomatic people can infect others with any respiratory infection.
If you’re sick, call your doctor and/or get tested. A negative rapid antigen test (like Abbott’s BinaxNow) means that it’s unlikely you have COVID-19. However in symptomatic people I usually recommend taking a second rapid test to be sure. Two negative rapid antigen tests makes a diagnosis of COVID-19 extremely unlikely.
What about PCR testing? A single negative PCR test in a symptomatic person means it’s highly unlikely that you have COVID-19. Get a flu test, too! We’re seeing outbreaks of influenza now, so also be sure to get your flu shot.
Isolate if you test positive.
People who test positive for COVID-19 need to isolate for 10 days. They do not need to test themselves during the course of the 10 days—or to release themselves from isolation—because people with COVID-19 are no longer contagious after 10 days.
Vaccinated close contacts should exercise caution and get tested.
Close contacts should be tested (by PCR) 5 days after the last exposure and can use rapid tests on days 3-14 post-exposure to prove the absence of contagious levels of virus in the nose. (On my wish list for 2022: that the CDC shortens the duration of isolation for breakthrough infections in vaccinated people given the abundance of evidence that vaccinated people clear the virus much faster than unvaccinated people.)
Unvaccinated close contacts still need to quarantine for 14 days, though some schools are appropriately using daily rapid antigen tests to allow kids who’ve been in contact with a person with COVID-19 to stay in school if they’re symptom-free.
Maximize ventilation.
Recall that poorly ventilated and crowded indoor spaces (i.e. holiday parties—boo!) are where coronavirus loves to spread. But also remember that if you’re double-vaccinated and young—or triple-vaccinated at any age—your risk of transmitting the virus, and for getting severely ill if you do get infected, is very, very low.
The outdoors is safe. Numerous studies find that <1% of cases are attributable to outdoor transmission. Is it possible to inhale the virus-laden breath-plume of someone who’s in the unlucky small percentage of people who are vaccinated and asymptomatically infected with coronavirus—and then to get infected while you’re close-talking by the fire pit? Sure! It’s just highly unlikely.
So if you’re socializing inside, crack windows and doors. The more you increase ventilation, the better chance of dispersing this aerosolized virus.
Limit the number of people in a room. Spread out if you can! There’s no perfect number here—it’s just that the fewer the number of people in a space, the smaller the chance of coronavirus’ invisible presence and potential spread.
Wear a mask inside if you’re unvaccinated. Consider wearing one indoors if you’re vaccinated.
Masks can certainly help reduce transmission of the virus, but their relative utility drops after we’ve been vaccinated. In other words, masks only work if there’s coronavirus in the noses of people in the room. Particularly if you’re unvaccinated, it’s important to wear a well-fitting surgical, KN95, or N95 mask indoors to protect other people.
Asymptomatic, vaccinated people are less likely to be infected in the first place and are less likely to transmit the virus to others if they’re infected. That said, vaccinated people can certainly carry the virus asymptomatically and infect others; it’s just not that likely.
So, should a fully vaccinated person wear a mask indoors at a holiday event? It’s really up to our personal risk tolerance of the (tiny) chance of getting a mild illness but also should factor in the vulnerabilities of the people around us. I, for one, will go maskless with my extended family this holiday because I have faith in my three shots and because my family are at low risk and/or are fully vaccinated, too. Plus, connecting with loved ones includes seeing faces!
Consider rapid antigen testing before a social gathering.
Think of the Abbott BinaxNow as a “day pass.” A negative rapid test tells you that, at that moment, you’re not carrying enough virus in your nose to infect other people. They’re not cheap, but they offer an added layer of protection for other people in your midst.
Particularly before large gatherings of people with unknown immune status, negative rapid antigen tests in all parties help ensure the absence of meaningful amounts of coronavirus in the room.
What’s the upshot?
Get vaccinated, get boosted if eligible, blanket your holiday group with rapid antigen tests if desired (and in your budget), and wear a well-fitting mask if you’re both indoors and unvaccinated.
MOST importantly, try to enjoy this holiday if you’re lucky enough to have time off work! After 21 months of unpredictability and uncertainty, political and social unrest, and a ubiquitous virus in our midst, we all need a break. We need time to rest and restore. We need time to connect with loved ones.
We need to think about each other not as vectors of disease but rather as vessels of love and compassion.
Want to know what I’m doing to celebrate Christmas? I’ll be far away with my husband and three kids, in nature and off WiFi. We will celebrate family togetherness. We will pray for people we have lost and for people who are suffering. We will give thanks for the gift of family, the blessings of modern science, and the promise of a brighter tomorrow.
Pandemics do end. This one will, too.
By the way! I’m taking a three-week break, including from writing this newsletter, but I look forward to seeing you in 2022. Until then, happy holidays! And be well.