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2) It’s hard to avoid respiratory viruses. Doing so requires a lot of proactive work.
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Max from Indiana is in his 70s, as is his wife. He is on dialysis and just recovered from a lung infection. His wife has two cancers and is receiving chemotherapy. “Our son and his family are coming to visit us. What, if anything, can they do to avoid spreading infections to us?” he asks.
Max and his wife are both very susceptible to severe outcomes because of covid-19 and other illnesses. Their visitors are presumably out and about and constantly exposed to pathogens. They need to take steps now to minimize their chance of contracting and spreading infections to Max and his wife.
I’d advise Max to ask visitors to refrain from engaging in higher-exposure activities for about a week before their arrival. Specifically, they should not attend indoor gatherings, including dinner at other people’s homes, and should mask in crowded public places. They should also take a rapid coronavirus test just before the visit.
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These steps might not be practical for some families and might not be necessary for those who aren’t as high-risk as Max and his wife. Remember that risk is additive. Taking some steps, such as masking at airports or forgoing large parties ahead of family gatherings, can help reduce the chance of contracting viruses.
3) Vulnerable people need to be vaccinated. But getting the shot matters less for people around them.
I’ve written before about the importance of the updated coronavirus shot, the flu shot and the new RSV vaccine for vulnerable individuals. Those who have not had them should get them as soon as possible. If you get the vaccines today, there will be some additional immunity by Thanksgiving.
But what if those attending aren’t vaccinated? That will be the case for Carol from D.C., whose 84-year-old husband has a daughter who doesn’t “believe in vaccines” for herself or for her kids. “Do we still have to avoid get-togethers with them for Thanksgiving and for Christmas?” she asked.
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No. While the coronavirus vaccine offers essential protection for individuals by reducing hospitalization and death, it is not a tool that substantially reduces transmission to others.
This is different from earlier in the pandemic, when the vaccine dramatically cut the likelihood of infection and therefore transmission. Recent research has shown that this is no longer the case. For instance, one study found that the bivalent vaccine reduced the chance of infection by just 4 to 29 percent. Another found that two months after their last shot, vaccinated children had only a 16 to 24 percent reduction in urgent-care visits compared with unvaccinated kids. Yet another recent JAMA Pediatrics paper concluded there was no difference in the infectivity of vaccinated vs. unvaccinated children.
If avoiding infection is important for Carol and her husband, they can take other steps to protect themselves, including keeping doors and windows open and asking guests to try to reduce their risk in the days before their visit.
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4) Have a plan for illness before and after the gathering.
Ellen from Michigan has two kids: one in day care and one in kindergarten. “I can’t remember a day where one or the other doesn’t have a sniffle or a cough,” she wrote. “Can I bring them to Thanksgiving dinner at my aunt’s house? There will be some elderly people there and a newborn.”
This one is tricky. It’s one thing to bring young kids who constantly have colds to a gathering where everyone is generally healthy; it’s quite another if there are people who probably need to avoid viruses.
Ellen could contact her aunt and ask for guidance. Perhaps the sniffly kids could primarily stay outdoors to play and eat in a separate room. Alternatively, her aunt might wish to be extra careful and ask that those with symptoms not attend. But that latter approach deserves nuance. People can have coughs long after they are contagious, and some people could be asymptomatic and unknowingly transmit viruses to others.
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As a result, those attending gatherings should be aware that they might be exposed to respiratory viruses. As I have written many times, vulnerable people should have a plan to access Paxlovid or other covid antiviral treatments if they’re infected. And don’t forget about Tamiflu or other antiviral flu pills if they contract the influenza. If they are traveling, they should also look into where they would go if they needed further medical care.
Hopefully, none of these contingencies will come to pass. But good planning can aid in peace of mind to enjoy the holidays.
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You’re reading The Checkup With Dr. Wen, a newsletter on how to navigate covid-19 and other public health challenges. Click here to get the full newsletter in your inbox, including answers to reader questions and a summary of new scientific research.
This Thanksgiving will be the fourth since the start of the covid-19 pandemic. While the coronavirus is little more than an afterthought for many Americans, plenty of people are still concerned about exposure to it and other respiratory viruses during holiday gatherings.
In this week’s newsletter, I’d like to answer reader questions and offer four concepts to consider as folks prepare for Thanksgiving get-togethers.
1) These are not pre-covid times. Some people will want more precautions.
Meaghan from Virginia is among those who want to know how things are different this year compared with pre-covid times. “Before the pandemic, there were lots of viruses around, but we didn’t cancel gatherings,” she wrote. “Will things always be different due to covid?”
For a substantial group of Americans, I think the answer is yes. Before 2020, there were plenty of highly contagious respiratory viruses that are still around today. But covid changed the equation by making us aware that we could take steps to reduce transmission of these diseases. In particular, it made vulnerable people more cautious; covid still poses a danger to them, and other infections could result in severe illness as well.
Those organizing Thanksgiving events should be sensitive to the fact that people have different levels of comfort with gathering in small, enclosed spaces. Organizers can set expectations and allow guests to choose whether they wish to attend. Those aiming to be more inclusive can ask guests if they would attend if more options existed: Perhaps a portion of the day could be outdoors, for instance, or windows and doors could be open during mealtimes.
2) It’s hard to avoid respiratory viruses. Doing so requires a lot of proactive work.
Max from Indiana is in his 70s, as is his wife. He is on dialysis and just recovered from a lung infection. His wife has two cancers and is receiving chemotherapy. “Our son and his family are coming to visit us. What, if anything, can they do to avoid spreading infections to us?” he asks.
Max and his wife are both very susceptible to severe outcomes because of covid-19 and other illnesses. Their visitors are presumably out and about and constantly exposed to pathogens. They need to take steps now to minimize their chance of contracting and spreading infections to Max and his wife.
I’d advise Max to ask visitors to refrain from engaging in higher-exposure activities for about a week before their arrival. Specifically, they should not attend indoor gatherings, including dinner at other people’s homes, and should mask in crowded public places. They should also take a rapid coronavirus test just before the visit.
These steps might not be practical for some families and might not be necessary for those who aren’t as high-risk as Max and his wife. Remember that risk is additive. Taking some steps, such as masking at airports or forgoing large parties ahead of family gatherings, can help reduce the chance of contracting viruses.
3) Vulnerable people need to be vaccinated. But getting the shot matters less for people around them.
I’ve written before about the importance of the updated coronavirus shot, the flu shot and the new RSV vaccine for vulnerable individuals. Those who have not had them should get them as soon as possible. If you get the vaccines today, there will be some additional immunity by Thanksgiving.
But what if those attending aren’t vaccinated? That will be the case for Carol from D.C., whose 84-year-old husband has a daughter who doesn’t “believe in vaccines” for herself or for her kids. “Do we still have to avoid get-togethers with them for Thanksgiving and for Christmas?” she asked.
No. While the coronavirus vaccine offers essential protection for individuals by reducing hospitalization and death, it is not a tool that substantially reduces transmission to others.
This is different from earlier in the pandemic, when the vaccine dramatically cut the likelihood of infection and therefore transmission. Recent research has shown that this is no longer the case. For instance, one study found that the bivalent vaccine reduced the chance of infection by just 4 to 29 percent. Another found that two months after their last shot, vaccinated children had only a 16 to 24 percent reduction in urgent-care visits compared with unvaccinated kids. Yet another recent JAMA Pediatrics paper concluded there was no difference in the infectivity of vaccinated vs. unvaccinated children.
If avoiding infection is important for Carol and her husband, they can take other steps to protect themselves, including keeping doors and windows open and asking guests to try to reduce their risk in the days before their visit.
4) Have a plan for illness before and after the gathering.
Ellen from Michigan has two kids: one in day care and one in kindergarten. “I can’t remember a day where one or the other doesn’t have a sniffle or a cough,” she wrote. “Can I bring them to Thanksgiving dinner at my aunt’s house? There will be some elderly people there and a newborn.”
This one is tricky. It’s one thing to bring young kids who constantly have colds to a gathering where everyone is generally healthy; it’s quite another if there are people who probably need to avoid viruses.
Ellen could contact her aunt and ask for guidance. Perhaps the sniffly kids could primarily stay outdoors to play and eat in a separate room. Alternatively, her aunt might wish to be extra careful and ask that those with symptoms not attend. But that latter approach deserves nuance. People can have coughs long after they are contagious, and some people could be asymptomatic and unknowingly transmit viruses to others.
As a result, those attending gatherings should be aware that they might be exposed to respiratory viruses. As I have written many times, vulnerable people should have a plan to access Paxlovid or other covid antiviral treatments if they’re infected. And don’t forget about Tamiflu or other antiviral flu pills if they contract the influenza. If they are traveling, they should also look into where they would go if they needed further medical care.
Hopefully, none of these contingencies will come to pass. But good planning can aid in peace of mind to enjoy the holidays.
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