A Doctor's advice on holiday gatherings

"We gather together to ask the Lord's blessings. . .."

How should the COVID-conscientious handle the holidays?

There are people who have had COVID and now feel immune, and people who feel the whole thing is overblown, and people who just aren't worried much about COVID. This post is not for them. This post is, in part, because of them.

This post is for the "COVID-conscientious," people who worry about getting a breakthrough case, which may make themselves sick and a contagion risk. That would include me. I am 72 now. Many people my age have compromised immune systems. 

But maybe it is time to declare victory over COVID. The vaccines are very effective. That is the sentiment of New York Times columnist David Leonhardt, who noted that COVID risk for the fully vaccinated is now at the baseline for hospitalization and death from the annual flu, and we don't mask and social distance for the flu. The people who aren't vaccinated are willingly taking their risks, so quit trying to protect them. Let's move on, he said. 

Is that sound thinking? Most of us will have opportunities this holiday season to gather with family and friends. Should we join in?

I asked the question of college classmate Eliot Nierman, M.D. He responded, telling me he shared a draft of this post with infectious disease specialists and that he considers it consistent with generally accepted medical opinion. He is a Professor of Clinical Medicine at the University of Pennsylvania Medical School. 

Guest Post by Eliot Nierman, M.D.

Do you drive fast, do you ski, do you rock climb, do you sky dive? What is your risk tolerance?

Eliot Nierman, hiking

Nothing is 100% safe whether it be driving in your car or walking down the street. Even staying home confers the risks to health of inactivity and isolation. If you are a young child, if you are under 50 and vaccinated, covid is a small risk. If you are elderly, especially over 80, if you are immune suppressed, if you have underlying diseases, COVID is a large risk even if you are vaccinated. Your behaviors and exposures impact your risk, as does that of those you are in contact with. 

There is also the issue of local amounts of disease. Are you lucky enough to be in a place with under 10 cases per 100,000, which is considered low risk? Is there a local surge in cases? You can check out your community on the NY Times or elsewhere. 

Very important is the other side of the equation. What is the benefit/importance to you of seeing family, friends, grandchildren, of partying?

How do we put this together? Everyone has their own personal calculus. Here is mine. It corresponds to that of other main-stream medical professionals I have talked with. I am vaccinated and boosted and not immunosuppressed. My vulnerability is being 71. For the purposes of this discussion, I am assuming no one is wearing masks and we are indoors. Family Thanksgiving with everyone vaccinated except young kids is a reasonable risk with a big benefit. I’m going. What if some are not vaccinated? If the numbers of unvaccinated are small, and they are willing to do rapid covid tests, perhaps the risk is reasonable if it means a lot to you. The rapid tests aren’t great, especially in those without symptoms, but are better than nothing. 

Holiday parties with unknown vaccination status, drinks, close contact--no way I’m going. I would, however, go to a party with a close small group of friends (under 10) who are all vaccinated. Maybe if you are young, healthy, vaccinated and don’t have vulnerable close contacts, especially people you live with, who are elderly or immunosuppressed, the benefits may outweigh the holiday party risks for you especially if you are not in a COVID hot spot.  Not for me.

 
How about travel? In general, that is a reasonable risk. Planes are well ventilated, and the vast majority of passengers do wear their masks. The risks are limited to infection from those in your immediate vicinity, especially if they spent a lot of time with masks off eating and drinking. Short flights without meals are safest. Airports are probably a bigger risk than the planes, but you can largely avoid the crowded areas and people not good about their masks.  I will fly to Boston for Thanksgiving.

What if you are immunocompromised or are in close contact/live with someone who is and can’t realistically isolate from them for a while? The answer is no.