Navigating COVID-19 During the Holiday Season

What a difference a year makes. Vaccines were still on the horizon last December, meaning many people spent the holidays hunkered down apart from loved ones. The numbers are increasing for the fully vaccinated, and with all but the youngest children eligible, the definition of a safer holiday looks different. The availability of vaccines–including booster shots–as well PCR and antigen COVID-19 tests means more people may be ready to travel and get together. A recent press briefing sponsored by the Infectious Diseases Society of America (IDSA) featured expert advice for laying out a holiday plan that takes into account individual and collective needs and risk tolerance.

Joshua Barocas, MD, a visiting associate professor of medicine at the University of Colorado School of Medicine in Aurora and an IDSA public health committee member spoke at an IDSA event. When Barocas spoke last week, the Omicron variant had been found in just 3% of tests nationwide, except for New York and New Jersey, where its prevalence was 13%. However, the latest numbers reported today have shown a significant increase. According to the Centers for Disease Control and Prevention, the variant is now responsible for 73% of all cases in the US.

"What we do know is that this variant does appear to transmit more rapidly," Barocas said. "Its severity is truthfully yet unknown.” This uncertainty does not seem to be stopping the US and other nations from getting on with life, he observed, and now that we have vaccines and other tools in our arsenal, we need to figure out how best to use them, ideally after assessing our own individual risk profile and coming up with a multilayered approach.

If someone is planning to visit unvaccinated family members, Barocas suggested that everyone in the group take extra precautions such as masking when together, meeting outdoors, and using rapid home antigen tests. In a lower-risk scenario such as a gathering in which everyone is not only vaccinated but boosted, perhaps masks no longer need to be part of the calculus. “Ultimately, the higher the risk situation, the more personal protection you need to keep yourself healthy,” Barocas said. “The lower the risk situation, the lower the mitigation you need.”

Travelers should prepare in advance, as the experience has become increasingly complex, said Romney Humphreys, PhD, D(ABMM), M(ASCP), medical director of the clinical microbiology lab at Vanderbilt University Medical Center. “It really does feel like a brand-new process,” she said. “You may need to show proof of vaccinations for some locations, and most countries are requiring some form of testing both upon entry into their country and, in some cases, after entry a couple of days later.” Entry into the US depends on receiving a negative result after testing 1 day prior to travel.

Humphreys feels that home rapid tests can provide value during the coming winter surge, although these tests can be hard to find. She recommends that people test on consecutive days, particularly if they have symptoms, but cautions that a negative result is not a guarantee. “Testing really is not a substitute for public health practice,” she said, urging people to continue getting vaccinated, wearing masks, washing hands, and distancing when necessary.

Asked about the practice of testing in schools, Barocas acknowledged that it is uneven: “Because we don’t necessarily have a national approach to testing in schools, and different jurisdictions have interpreted data differently, school districts have the ability to make their own decisions.” While regular testing is optimal, not all school districts have the resources to put that into place, he said. The supply chain also has been constrained, with Humphreys noting that her laboratory struggles with a shortage of COVID-19 test reagents on a weekly basis.

With an increasing number of fully vaccinated people testing positive for COVID-19, the experts suggested a different way of considering our ultimate aim as a society when it comes to the virus. “I’m not sure right now the goal is to decrease transmission,” Barocas said. “The goal is to decrease the burden of disease, and we have to remember that just because something is transmissible or that someone is infected does not mean that they have disease, or symptom-carrying disease, or substantial disease.”

That said, vaccines are at the top of the list when it comes to our pandemic tools. “Vaccination takes the cake,” Barocas stressed. “It is one of the best mitigation strategies that we have, and while we can’t necessarily say how much more important it is on a quantitative level than, say, standing 6 feet away from someone, we do know that of the interventions that we have proposed, put forth, and approved, vaccination seems to be the highest level of risk reduction.”