Passengers arrive at the international terminal of Tokyo's Haneda Airport on Oct 11, 2022, as Japan reopened to foreign travellers after two-and-a-half years of Covid restrictions.

Published October 29, 2022
Updated October 29, 2022
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NEW YORK — At this stage in the long slog of the pandemic, many of us are forgoing masks in places we previously wore them and getting together indoors when we had formerly avoided it.

But the holidays throw new variables at everyone’s risk calculus.

People trek across the country to see each other. Families crowd around dinner tables, with older, more vulnerable people sitting beside their younger relatives.

As we enter our third pandemic holiday season, some doctors are fearing a seasonal surge in Covid. In Europe — which many experts consider a bellwether for Covid cases in the United States (US) — cases are starting to mount, prompting the European Centre for Disease Prevention and Control and the World Health Organisation to warn that a new wave of infections could be starting.

“This is the holiday that everyone’s going to come back together again,” said Dr Peter Chin-Hong, an infectious disease specialist at the University of California, San Francisco.

With a bit of advanced planning, he said, family gatherings can be safe this year and resemble something like pre-pandemic times. “We have the tools for a normal life,” he said. “We just have to use them.”

Here’s what to keep in mind as you map out your family’s plans for the holidays.

PLAN AROUND THE HIGHEST-RISK MEMBER OF YOUR FAMILY

Individual risk tolerance may vary among your family members, but in general, plan around the person at your gathering who is highest risk. That means taking more precautions if you have a family member who is older than 60, on immunosuppressant medications, received a transplant or is a cancer patient, said Dr Michelle Prickett, pulmonary and critical care specialist at north-western Medicine.

“It requires everyone who’s going to these gatherings to buy into the idea that we’re going to do the best to protect each other,” said Dr Adam Ratner, a paediatric infectious disease specialist at New York University Langone.

You should talk with your family members ahead of time before gathering and figure out your game plan.

Ask if people are up to date on their vaccinations, and encourage people to take additional precautions if a high-risk family member is attending, which could include limiting the number of people you invite to Thanksgiving dinner or investing in a few heat lamps so that you can move the meal outside.

“This is something you can manage,” Dr Prickett said. “But you can’t put your head in the sand.”

GET THE NEW BOOSTER

“The biggest way to protect yourself and others is to stay on top of your shots,” said Dr Joseph Khabbaza, a pulmonary medicine doctor at Cleveland Clinic. The new bivalent booster is a critical tool for warding off infection — although many people are not even aware that it is available. You can find the new booster at pharmacies and health centres across the country, and anyone 5 and older can receive it. (You can get your booster at the same time as your flu shot.)

Dr Ashish Jha, the White House coronavirus response coordinator, has urged people to get the new booster by Halloween, so that it kicks in before Thanksgiving gatherings.

The Centres for Disease Control and Prevention recommends the shot for people who are at least two months out from their last infection or vaccination, but many doctors say you should wait at least three months — even if you’re trying to maximize protection before a family gathering. If you get a new shot too soon after recovering from Covid, “your antibodies are just going to chomp up that booster,” and it won’t necessarily raise your level of protection, Dr Chin-Hong said.

PAY ATTENTION TO YOUR SYMPTOMS

In the days leading up to a family event — and especially the morning of — watch out for Covid symptoms: sore throat, congestion, coughing, fatigue, headaches and muscle pain. People infected with BA.5, the dominant variant of Covid, are less likely to report losing their sense of taste and smell, but those are also crucial symptoms to watch for.

The dominant variant currently has a shorter incubation period — which means if you go to a packed bar on a Friday night and don’t have symptoms by Monday, it’s unlikely you have the virus, Dr Chin-Hong said. If you still don’t have symptoms by Wednesday, you’re probably in the clear, he said, although you should take a test to confirm.

However, it is still possible to have an asymptomatic case of Covid — and as more people build up immunity to the virus through vaccination and prior infection, asymptomatic or very mild cases will be more common, said Dr Céline Gounder, an infectious disease specialist and senior fellow and editor at large for public health at Kaiser Health News.

Even if you do not have symptoms, you can still spread the virus, she said, which makes it important to test right before gathering with a vulnerable person.

“If you’re going to sit down with Grandma for Thanksgiving dinner, I would test immediately before,” she said.

If you do feel sick, stay home — even if you’re negative on a rapid test. “Anyone who isn’t feeling well should stay home,” Dr Ratner said, “because the tests aren’t perfect.”

TEST WISELY

The question isn’t whether to test before a family gathering; it’s when to test and how many times.

Experts differ on the exact timing and combination of tests you should take, but for the most accurate measure of whether you’re contagious before an event, take an at-home rapid test right before. “You can just have a little testing party outside, where everyone says, ‘OK, now we’re good; we’re negative; we can go in and see Mom,’” said Dr Stuart Ray, an infectious diseases specialist at Johns Hopkins University School of Medicine.

You should also take a rapid test the day before, he advised.

“Rapid tests are very good, but they’re not perfect,” Dr Prickett said.

PCR tests are more sensitive, but it can take several days to get the results back, she said, and so a 5-day-old snapshot of your infection status won’t be helpful in determining if you’re contagious at the moment.

If you can get a quick-turnaround PCR, that can boost your confidence that you’re negative; if not, take at least two rapid tests, 12 to 24 hours apart. (If you have had Covid in the last two to three months, though, PCRs can stay positive beyond the point at which you’re contagious, Dr Ratner said, so you should rely on rapid tests.)

And think about if the test makes sense to you, Dr Ratner said. If you’ve been masking and limiting your contact and do not have symptoms, a negative test seems logical.

If you wake up with a scratchy throat and have interacted with someone who tested positive, though, take another test the following day, and consider staying home even if the tests are negative, depending on how risky you deem yourself to be.

CONSIDER A “MINI QUARANTINE”

You might want to minimize your exposure in the week before heading home for the holidays, Dr Prickett said. That means wearing a mask in public indoor spaces and also limiting the time you spend around crowds — such as timing trips to the grocery store for when it isn’t super packed, she said.

This is especially important if you live in an area with high levels of Covid cases. You want to check case counts like a weather report, Dr Chin-Hong said — and keep in mind that these offer an incomplete picture, since rates of testing have plummeted.

Of course, total isolation isn’t feasible for many people. But the level of risk you encounter in a workplace, for example, where you can potentially wear a mask and may interact only with a set group of people, is likely lower than in environments such as a restaurant or bar, Dr Ray said.

MASK UP WHILE YOU TRAVEL

While your risk may change slightly depending on which mode of transportation you take, Dr Gounder didn’t recommend prioritizing one form of travel over another. But whether you’re taking a plane, bus or train, make sure to wear a mask.

Even if you’re the only person on a plane or train wearing one, a high-quality mask can still protect you, doctors said. “It’s way, way better than nothing,” Dr Ratner said, “and way, way worse than if everyone was masked.”

He recommends people use an N95, KN95 or KF94 mask and that they keep it on for the entire trip or take it off for as short a time as possible. You might want to fill up on a big meal before your journey, so you don’t have to take off your mask to eat.

“If you really wear it carefully, if you cinch it down, it’s very unlikely that this virus is going to make it through this mask,” Dr Ray said.

VENTILATE YOUR SPACE

If you can’t hold your event outside, you can still increase air circulation and reduce the risk of trapping and transmitting the virus in a tight indoor space. Even cracking open the windows can improve air flow. You can also purchase portable air purifiers with HEPA filters.

These devices can be expensive, but they can effectively capture some virus particles in the air.

Experts acknowledged that these precautions can be exhausting but stressed that advance planning can help us protect each other over the holidays.

“I do not think it’s going to be like this forever,” Dr Ratner said. “But we’re still in this.”