Although almost anyone would agree that COVID-19 vaccines and boosters coupled with the (typically) less-severe omicron variant makes this season safer than the previous two, the corresponding lack of clear public health guidance around precautions feels a little unsettling. Should we be starting text threads or scheduling group chats to figure out the “rules of the game” this year? Can we just go back to the way we used to celebrate, or will that lead to another COVID-19 surge? Seth Cohen, MD, an infectious-disease physician and the medical director of infection prevention and control at UW Medicine in Seattle, suggests a “cautiously optimistic” approach to the holidays. “It is impossible to predict what will happen with COVID, but that does not mean we can’t plan for safe gatherings with friends, family, and loved ones. Barring a new highly contagious variant, we are clearly in a different place now than we were for the last several holiday seasons,” he says. Unfortunately, although being in a “different place” is good, it doesn’t mean you can turn the calendar back and party like it’s 2018. And it’s not just COVID-19 that you need to worry about: Cases of flu and RSV (respiratory syncytial virus) are already increasing and beginning to strain hospitals, says Purvi Parikh, MD, a clinical assistant professor at NYU Grossman School of Medicine and an immunologist at NYU Langone in New York City. Dr. Parikh believes that people can celebrate the holidays safely, provided they use the available resources, such as vaccines, boosters, and COVID-19 tests, and take care not to be around others when experiencing any symptoms. Here’s what experts recommend when it comes to keeping you and yours safe in the coming months. Experts recommend waiting two months after the primary vaccine series or your last booster. If you recently had COVID-19, the Centers for Disease Control and Prevention (CDC) says you can consider waiting 90 days. If you were recently infected, you likely have excellent immunity for the next month or two, though it is difficult to know with new omicron subvariants like BQ.1 and BQ.1.1, which are replacing the once-predominant BA.5, Dr. Cohen says. “For people planning large get-togethers or big trips, it may make sense to get boosted as soon as a month or two after infection, i.e., before you have a significant exposure. For people planning on a quiet holiday season without much travel or large gatherings, it may make sense to wait 90 days after infection to get boosted,” says Cohen.
Stay Home if You Have Symptoms of COVID-19, Flu, or RSV
The guidance is clear on this: If you have any symptoms or COVID-19, flu, or RSV — including runny nose, sore throat, cough, headache, or fever — you should stay at home until you’re feeling much better, even if you test negative for COVID-19, says Nandita Mani, MD, an infectious-disease specialist and hospitalist at UW Medicine. “Viruses like flu and RSV can have serious consequences in small children, pregnant people, and older or otherwise vulnerable individuals,” she says. If you have any symptom of an upper respiratory illness, you should not be at a gathering, whether or not you test negative for COVID-19, says Sajal Tanna, MD, MPH, an infectious-disease doctor at Inova Health System in Falls Church, Virginia. It’s important to recognize that many common symptoms that may seem fairly innocuous might not be, says Dr. Tanna. “A lot of people I’ve seen who have had COVID-19 chalk up their symptoms to allergies or a cold, or say, ‘Oh, I just have a headache because of my period.’ It’s very easy to explain things away, but I think everything should be considered COVID-19 until proven otherwise,” she says.
Use Extra Caution in the Days Leading Up to Your Gathering
It’s a good idea to have people take precautions the best they can in the week leading up to a group event, says Cohen. That includes minimizing contacts from people outside your household. Before gathering, double-check that no one has symptoms or has had a known high-risk exposure, says Cohen.
Take a COVID-19 Test to Add Another Layer of Protection
Testing is a great tool in our COVID-19 safety toolbox, regardless of vaccination status, says Dr. Mani. Whether you’re taking a PCR or a home antigen test, the key is to test as close to the event as possible, she says. Antigen (rapid) home tests are less accurate than PCR tests, but they can provide results in minutes, per the CDC. Home COVID-19 antigen tests are quick and convenient, but if you’re asymptomatic or have an early-stage infection, they’re less likely to be accurate than the PCR. If you have symptoms or you were recently exposed to COVID-19, you should interpret a negative test with caution, says the agency. “Rapid tests should be done 48 hours prior to your gathering, the day of, and 48 hours after arrival and every two to three days thereafter. Do not travel if symptomatic; even if your rapid test is negative, often it will turn positive by day three to five,” says Parikh.
Take Precautions if You Have to Fly or Use Public Transportation to Reach Your Gathering
Although it’s no longer required, the CDC recommends that everyone age 2 and older wear a mask in indoor areas of public transportation; that includes buses, subways, trains, and airplanes. “I mask when I travel, mostly because I’m always nervous about the potential of spreading COVID-19 to vulnerable family members,” says Cohen. According to Cohen, masking at the airport or when you are in line for the flight (when ventilation is not ideal and there are crowds of people nearby) is just as important as masking in-flight.
Outside Is Always Safer
“A good rule of thumb is that if the outdoors is an option, gather outside. I know that the ability to do this varies depending on where you live and how hot or cold it is,” says Parikh. COVID-19 spreads more easily indoors than outdoors, according to the CDC. Since people can’t wear masks while eating and drinking, bringing the party outside reduces the risk of virus transmission.
Open a Window or Filter the Air to Reduce the Risk of Virus Transmission
If you choose to gather indoors, opening doors and windows (even just an inch or two) brings fresh air in and helps prevent virus particles from accumulating. “Opening windows makes sense to me as a low-cost way to improve ventilation, if weather permits,” Mani says. As far as investing in a fancy air filter, there isn’t much data to show that’s significantly better than less high-tech options, she adds. “There are lots of great DIY suggestions for improving ventilation in rooms that otherwise don’t have access to fresh air, which seem to work quite well.” One DIY option, a Corsi-Rosenthal box, uses a square box fan and 4 MERV-13 filters. Cocreated by the dean of the engineering school at the University of California in Davis and a past president of the National Air Filtration Association, this homemade air cleaning system can reduce indoor exposure to airborne particles that contain the virus that causes COVID-19. If your home or apartment has a central heating, ventilation, and air-conditioning (HVAC) system, you can reduce virus transmission risk by setting the fan to the “on” position rather than “auto” when you have visitors; this will allow the fan to run continuously, even if the heat or AC is not on. You should also use pleated filters, make sure they fit properly, and change them according to the manufacturer’s recommendations.
Take Precautions That Protect the Most Vulnerable People in Your Group
“Staying up-to-date with vaccines (meaning the full primary series plus updated booster) is still the best way to protect people who are immunocompromised or at high risk for complications from infection. More importantly, this means surrounding people who are immunocompromised with others who are also fully vaccinated; we call this the ‘immune cocoon,’” says Cohen. Additionally, since people have different needs when it comes to COVID-19 prevention, it may be worth having an open dialogue about whether somebody at your gathering has specific concerns or wishes that you could help address, Cohen suggests. “Testing, asking others to minimize community contacts ahead of time, improving ventilation, and making sure people stay home if sick are all important complementary strategies to consider,” he says. Parikh agrees that you should tailor your behavior to minimize the risk for the most vulnerable member of the group. “It’s like the saying, ‘A chain is only as strong as the weakest link.’ I would think everyone would want to take those precautions if it’s a family member or friend. Logically, you wouldn’t want that person to get sick,” she says.
Take Steps to Avoid the Flu and RSV
At this time of year and moving into the winter season, even people who are vaccinated against COVID-19 are susceptible to other germs such as those that cause the flu. If you’ve been wondering how to time your flu shot this year, get it now if you haven’t already, says Cohen. And don’t forget, good old-fashioned hand-washing can help prevent the spread of all kinds of germs, including RSV. Wash hands thoroughly (for at least 20 seconds) with soap and water when arriving at and leaving any social gathering, advises the CDC.
