With the Omicron variant of the virus that causes COVID-19 rapidly spreading and its implications unclear, how should people approach the coming holiday season? Should plans be altered?
Some experts think it would be prudent to make some adjustments, although many health experts this year are also emphasizing the importance of seeing family and friends after many people spent the last winter holiday season following stay-at-home orders.
“Unfortunately, we’re seeing indications of a winter surge on the heels of the Thanksgiving holiday. Case rates and daily hospitalization admissions are steadily increasing, and we anticipate that they will continue to increase,” Los Angeles County Public Health Director Barbara Ferrer said. “If we fail to take common-sense safety measures right now, we could find ourselves in a dangerous place by the end of the month and into January.”
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“We are obviously going into another surge, and we have to prepare for the possibility of more hospitalizations,” said Dr. Regina Chinsio-Kwong, an Orange County deputy health officer. It’s important to get vaccinated, get boosted if eligible, upgrade masks, get tested, stay home when sick, and improve ventilation.
Health officials urged people to use strategies to avoid infection, noting that the long-term effects from disease from the new strain is unknown. The speed at which Omicron transmits seems formidable; Chinsio-Kwong referred to a recent study out of Hong Kong suggesting that Omicron “infects and multiplies 70 times faster than the Delta variant.”
Here’s what experts say about plans for the holiday season.
The U.S. government’s top infectious diseases expert, Dr. Anthony Fauci, has consistently said in television interviews that holiday gatherings can continue, but advised common-sense measures — it’s safer if everyone is vaccinated and has received a booster shot.
“If you and your family are vaccinated and boosted hopefully, you should feel comfortable about having a holiday situation where you have dinners and gatherings in your own home with family and friends. But that will only be safe if people get vaccinated,” Fauci told ABC.
Fauci told NBC that his children are coming to visit for the holidays, traveling by plane from all parts of the nation.
“They are vaccinated and boostered, so we can feel very comfortable in having our plans to be together as a family in our home with some friends who are also boostered and vaccinated,” Fauci said. “And I feel we can be, we can feel safe,” while adding, “nothing is 100% risk-free.”
But he expressed worry about unvaccinated people. “They are going to be very vulnerable,” Fauci said. Unvaccinated people remain far more likely to transmit the virus and get infected, and more likely to get severe illness and die from COVID-19.
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Large holiday gatherings are riskier than smaller ones.
One concerning outbreak was one in Oslo, where more than 100 people attended a Christmas party at a restaurant in late November.
Most of the 111 attendees who agreed to be interviewed by researchers were in their 30s and 40s, said Dr. Carlos del Rio, an infectious-disease expert at Emory University School of Medicine, at a forum held by UC San Francisco on Thursday.
The vast majority of the party’s attendees were vaccinated with two doses of an mRNA vaccine, according to a study summarizing the incident.
Eighty people — or more than 70% of the party’s attendees — subsequently were diagnosed with a coronavirus infection, mostly with the Omicron variant, Del Rio said. Everyone had to show a negative test taken one to three days before the party, “and yet, there was infection there.”
Symptoms of the guests included cough, lethargy, headache and sore throat. No one was hospitalized.
Coronavirus infection was also reported in more than 60 other people who visited the same restaurant on the same night as the Christmas party.
It’s clear that the coronavirus is airborne, and there are data that suggest that the virus can hang around the air for an hour or two after an infected person leaves a room, Del Rio said.
“That superspreader event in Norway is like a perfect example of how you can disseminate COVID very quickly: You put a bunch of people together in a place that probably has poor ventilation because it’s winter time; you have them talking loudly at each other all night, without a mask — I mean, they’re basically enjoying themselves of course, it’s gonna lead to lots of spread,” said Dr. Paul Sax, an infectious diseases expert at Harvard Medical School, at the UC San Francisco forum.
Airborne viruses can get easily diluted outside, Sax said.
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People who are particularly risk-averse, or who are older or have a weakened immune system, may want to think twice about attending large, crowded indoor gatherings where people aren’t wearing masks.
A big problem that has become more noticeable, especially with the newest variants, is how there seems to be an increased chance that vaccinated, boosted asymptomatic people can still be unknowingly infected and be contagious.
That’s why wearing masks in indoor public settings still remains an essential strategy at this particular moment in the pandemic, even if you’re already vaccinated and have received a booster shot, local health officials say.
“Vaccinated people — as we have seen every single week for the last few months — are catching and spreading COVID. And masks protect both you and the people with whom you’ve had contact,” Ferrer said. “While vaccines are an extraordinarily powerful tool for preventing infection and severe illness or death in the people who receive them, their protection is not 100%.
“People who have been vaccinated can still get infected. And while more severe illness is rare among people that have been vaccinated, even a moderate illness can make you feel pretty lousy,” Ferrer added.
Vaccinations and booster shots provide good protection, but it’s not perfect, Ferrer said at a town hall meeting. And it’s riskier while coronavirus transmission is high, which it is in much of Southern California.
“When we go out and about we have to make some good choices,” Ferrer said. “You may want to avoid that big holiday party that’s indoors at a hotel, or that huge wedding that’s going to have 500 people, all eating and drinking together for hours on end.”
Although California has a mask requirement for indoor public settings, people don’t wear masks while eating and drinking.
For some people, based on their age or particular underlying health condition, they may decide they may not want to take a risk of attending such a gathering.
“Because we know for some of us, those risks are going to be too significant for us to take right now with all of the transmission we have in our county,” Ferrer said.
“If we have a variant that’s evading our vaccines more than the variants we’ve experienced to date, then those of us who are fully vaccinated, we’ve done our part, we’ve gotten boosted. [But] we still have risk, and we need to be very careful,” Ferrer said.
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“The risk really is when you’re in close contact with poor ventilation,” said Chinsio-Kwong. “The transmission occurs when people are not being careful about the preventive measures.”
Gatherings outdoors will be safer. “We do not encourage large gatherings indoors at all. We still think you’ll be much, much safer — if you need to have a large gathering — to take that gathering outdoors,” Ferrer said.
If indoors, smaller gatherings are safer than larger ones, and Ferrer urged people to adhere to the order to wear masks in indoor public settings. She suggested that the time for eating and drinking be limited, so there’s not a situation where people are doing so for hours at a time, not wearing masks, which raises the risk of transmission.
“The more people that you’re around — and particularly if you’re in close contact with lots and lots of different people — the greater your chances is going to be of getting infected. That’s going to apply whether you’re vaccinated or you’re unvaccinated,” Ferrer said.
If the chances are high that people aren’t going to be wearing masks at large events, if an event has a lot of people, “the chances that there are people there who are infected are pretty high,” Ferrer said.
People should also think about the risks to people in their family should they get infected. Those who live with people at high risk for severe complications should they get COVID-19 “may want to delay for a while the kinds of activities you do that put you in a lot of contact with potentially other people who could be infected,” Ferrer said.
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Theme parks can still be attended in a relatively safer way, Chinsio-Kwong said, since the experience is largely outdoors. She advised that people wear a well-fitted mask and take it off only when there’s good ventilation around.
It’s less risky to attend theaters if you keep a fitted upgraded mask on at all times and don’t eat or drink in the theater, according to Chinsio-Kwong.
While cloth masks are good, surgical masks or higher-grade masks offer better protection, Chinsio-Kwong said, and people at higher risk because they are immune compromised should consider upgrading to an N95-style mask.
Chinsio-Kwong said with Omicron, officials do expect higher numbers of breakthrough infections for vaccinated people, which can lead to symptomatic illness. Nonetheless, it’s expected that the chances of getting hospitalized — even due to Omicron — for vaccinated people will be lower than for unvaccinated people.
“If you’re going to be indoors, you all should be testing before you show up at that gathering,” Ferrer said. There are hundreds of testing sites across L.A. County; and rapid test kits can be bought at pharmacies or ordered online.
Testing at L.A. County-run sites are free regardless of immigration status. Orange County residents can request free self-collection test kits that will be sent to them, and residents can then submit specimens to the lab in an envelope with prepaid shipping.
“Even if you’re fully vaccinated, getting tested before or after gatherings or parties … can make a difference in whether you expose someone you love to the virus,” said Dr. Dawn Terashita, associate director of L.A. County’s acute communicable disease control program, at the town hall.
If you have symptoms, get tested. A negative rapid test result may seem promising, but Terashita suggested that a symptomatic person follow that test with a PCR test, in which a sample must be sent to a lab for analysis, with results coming back in one to two days.
Anyone who is symptomatic — even with a negative rapid test — should stay home and stay away from others, Terashita said. Rapid tests can result in a small number of people getting a negative test result when they’re actually positive.
If a rapid test turns up positive, “you must consider yourself infected and isolate immediately,” Terashita said. You can consider following up the rapid test with a PCR test to confirm the infection.
It’s irresponsible for people who test positive to continue going out and leaving the home without adhering to isolation requirements, Ferrer said. Those who test positive must stay home for at least 10 days since symptoms first started, or, if there are no symptoms, then at least 10 days after the test was taken.
They’re making slightly different decisions — but all say it’s essential to be vaccinated and boosted.
Dr. Rachel Bystritsky, a UC San Francisco infectious diseases doctor, said at the UC San Francisco forum she’d get tested before seeing her vaccinated 97-year-old grandmother and would have them both wear masks during the visit.
Sax said he visits elderly parents and takes a rapid test right before he sees them. He said it’s important that people do the test as close as possible to the actual visit itself, and not the morning of the visit, nor the day before.
Sax said he wouldn’t go visit them if he had any signs of a respiratory illness, such as a scratchy throat, even if the rapid test results showed a negative result.
“People should not use rapid tests, when they have a respiratory tract infection, as a way of reassuring themselves falsely that they may not have COVID. I’ve heard that mistake made numerous times,” Sax said. A negative rapid test result, while symptomatic for some kind of illness, doesn’t rule out a COVID-19 infection, Sax said.
“I would not go visit grandma with a respiratory tract infection in the COVID-19 era, period,” Sax said.
After the test, Sax said he acts normally around his parents, and doesn’t try to keep distance from them, nor wear a mask. “That’s what I do with our friends when they come over for dinner,” Sax said at the forum.
Del Rio said he plans on getting together with members of his family to see his vaccinated 87-year-old mother.
The rules? If you have any symptoms of illness, you don’t come in, and everyone gets tested just before they go in. “Once everybody’s tested negative, and everybody’s vaccinated and boosted — no masks,” Del Rio said.
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Experts offered different points of view, and noted that people can make different decisions based on their own levels of risk tolerance.
Dr. Peter Chin-Hong, an infectious diseases expert at UC San Francisco, said he would still feel comfortable dining in an indoor restaurant in places like Los Angeles County or the San Francisco Bay Area.
“I still feel comfortable doing indoor dining, personally, being boosted,” Chin-Hong said Friday. ” I would wear a mask until I get to the table, but I don’t feel myself terribly at risk.”
People who might have more reason to be cautious could be those who are older or immune compromised, as well as vaccinated people who haven’t received their booster shot, Chin-Hong said.
Dr. Robert Wachter, chair of the UC San Francisco Department of Medicine, said on Twitter on Friday that, as a fairly healthy 64-year-old who is moderately risk-averse and has received three shots of the Pfizer vaccine, he would not dine in an indoor public setting even in San Francisco, but would outdoors.
He also said, “context matters: what might be safe for a healthy 30-year-old could be way too unsafe for a frail octogenarian.”
“It’s not about you alone. That healthy 30-year-old can spread Covid unwittingly to someone at high risk, including a loved one. So decisions about risk need to account for risk to others,” Wachter wrote.
This story originally appeared in Los Angeles Times.
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