With the omicron variant causing huge surges of Covid-19 infection, many of us are anxiously reconsidering our holiday plans. Is air travel safe? Can we still hug our parents? How should we think about testing? What about holiday parties?
I asked six epidemiologists how omicron is and isn’t changing their near-term plans. Most were already planning to keep things low-key, but they have added some modifications to make their gatherings safer in light of the variant. These include adding in buffer time between air travel and seeing relatives, testing multiple times, and taking into consideration whether contacts have been boosted as well as being vaccinated.
As you’re thinking about how to make your holiday plans as safe as possible, it helps to consider things in two stages: what you can do before you or your guests set out, and what to do once you or they have arrived. Let’s break it down.
Before you get to your destination: Planning, limiting contact, and testing
When you’re considering how safe it is to travel for a holiday gathering, you might be inclined to focus on how the travel happens: driving or flying? But experts say it’s just as important — if not more important — to think about where everyone is coming from and how much they’ve been limiting their exposure in the days leading up to the trip.
That means paying attention to the Covid-19 rates in the location you’re coming from and the location you’re going to. It’s true that the rate at which omicron spreads makes it hard to predict which places are safest, and testing data lags behind the true reality on the ground. But some places, like New York, are already seeing a lot more cases — including among vaccinated people — than other parts of the country. People coming from a hot spot may be bringing with them a worse risk profile, though they can reduce that risk by trying to limit their exposure before traveling and by getting tested (more on that below).
If the people you want to celebrate with are within driving distance, that’s optimal — traveling by car will allow you to avoid extra exposures on your way.
It’s less optimal if your holiday plans require air travel, but the experts I spoke to said you can probably travel by plane with relatively low risk, assuming you’re vaccinated and boosted and willing to keep an N95 or other high-quality mask on pretty much the whole time. (Different people have different levels of risk tolerance and susceptibility to severe disease, of course; you might reasonably feel more comfortable with this if you’re young and healthy than if you’re older or immunocompromised.) Experts say your goal should be to reduce the risk for both yourself and others.
“I would advise wearing high-quality masks during travel and staying away from people as much as possible within the airports (especially if others are unmasked to eat/drink/etc.),” Tara Smith, a professor of epidemiology at Kent State University, told me by email. “I would advise testing before travel to make sure you’re not exposing others. Ideally this would include a PCR test shortly before the flight, but realistically, these are getting harder to do because of a delay in turn-around times for testing. Rapid tests would be another alternative.”
So try to wear an N95 continuously in the airport and on the plane, limiting as much as possible your time spent maskless for eating or drinking (especially when other people are close by). And plan to take a rapid antigen test (think BinaxNowor QuickVue) right before you leave for the airport, if you can get access to one.
Katelyn Jetelina, an assistant professor of epidemiology with the University of Texas Health Science Center at Houston, is flying to California with two young daughters, whose great-grandparents are excited to spend Christmas with them. All the adults are vaccinated and boosted; the kids are too young to be eligible. Jetelina told me she’s been getting increasingly concerned about severe breakthrough cases among older adults, but rather than cancel the flight in light of omicron, she modified it.
“We changed our flight to arrive a few days earlier, so if we were exposed at the airport, then there were a few days between landing and seeing the great-grandparents. Adding a few days between the two will ensure that if we were exposed, then antigen tests would pick up the mounting infection,” she said. “We will test before leaving for the airport and every other day until the holiday event. The morning of the event, everyone is taking an antigen test.”
If you have to fly, you can similarly consider flying early and lying low — maybe in an Airbnb — for three or four days before taking a rapid test and then joining the group. This could be a particularly good option if the group includes older, immunocompromised, or otherwise vulnerable people.
Parents of children who are too young to be vaccinated may be finding it especially hard to decide on a plan that can keep things reasonably safe for both the children and those they come into contact with. The experts I spoke to recommended limiting social interactions for the kids in the days before a gathering, masking them when possible, and testing them.
Beyond that? “I think there really is a risk-benefit calculation that has to be made — and I think that’s going to be an individual, and family, choice,” said David Dowdy, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health. “Make sure that everyone who is going to be at a given gathering feels comfortable with a small (and therefore unvaccinated) child being there. The one thing you don’t want to do is make others in your family uncomfortable.”
After you get to your destination: Running a risk-benefit analysis of different social encounters, plus more testing
All the epidemiologists agreed it’s best to keep gatherings small (two to three households or under 10 people is a good rule of thumb). Ideally, everyone there should be not only double-vaccinated but also boosted. Early evidence suggests that omicron significantly reduces the protection afforded by two doses, but a booster helps restore it.
“I’m much, much more comfortable bringing my girls around boosted people than unvaccinated or those with just two [shots],” said Jetelina, whose daughters are both under 3 years old.
“If I knew everyone in my holiday gathering were fully vaccinated and boosted, I wouldn’t be terribly concerned, unless a member of my party were older and had a health condition that put them at elevated risk of more severe disease, in which case I would have some concerns for their health,” said Janet Baseman, a professor of epidemiology at the University of Washington. “We are still awaiting data on how well boosters protect against severe disease with omicron.”
Baseman added that maximizing ventilation in indoor spaces to increase airflow can help; if you have access to a HEPA filter, now’s a great time to get it running. Alternatively, you can open windows if it’s not too cold.
It’s important to avoid larger gatherings, especially if some people there may be unvaccinated.
“I had decided earlier in the year that I am not gathering inside with unvaccinated individuals,” Smith said. “It’s a risk I’m not willing to take.”
Dowdy told me that, as recently as November, his team at work routinely had social lunches of around 10 people and he never thought twice about attending. But his assessment has changed over the past couple of weeks. “I wouldn’t personally be going to an indoor holiday party with more than a few people,” he said.
Note that if people take a rapid test a day before the gathering and get a negative result, that doesn’t necessarily mean they’re negative when they show up to the party. The test only reveals that they’re probably not infectious at the moment they put that swab in their nose; a day later, they may be carrying an infectious level of virus. At a Christmas party in Norway, the vast majority of guests were double-vaccinated and everyone had reported a negative result (PCR test or rapid test) one to three days earlier; nevertheless, 80 out of 111 guests ended up being diagnosed with Covid-19, likely with the omicron variant.
A demo of how fast you can turn positive:— Billy Quilty (@BQuilty) December 16, 2021
Yesterday morning, yesterday lunchtime, yesterday evening, this morning.
Do LFTs *just* before meeting up. pic.twitter.com/3zM2rDkoa7
So don’t be shy about asking people to test an hour or so before showing up at your door. They can even do a rapid test in the car right outside your house.
Kate Grabowski, an epidemiologist at Johns Hopkins, noted that it’s also good to have extra rapid tests on hand in case anyone becomes symptomatic in the days following the gathering (though it’s very hard to get tests now in many places). “Being able to know your disease status early into symptom onset is very critical for getting the best clinical care,” she said.
For some people, the happiness, sense of meaning, and mental health benefits that come with seeing family will outweigh the risks this holiday season.
“I’ve seen my nephew one time in the last three years due to the pandemic. We are literally missing out on his entire early childhood,” Grabowski told me. So her boosted sister and brother-in-law will fly in with their 4-year-old son to spend the holiday with her, after taking precautions like getting vaccinated, masking, rapid testing, and reducing exposure. “We have decided to take this calculated risk. Others may not feel comfortable, and that’s totally okay.”
Eleanor Murray, an epidemiologist at Boston University, is among those who feel more comfortable lying low for the time being, while cases are skyrocketing. She told me she decided not to fly out to see her relatives for the holidays. “But that doesn’t mean I don’t think that other people can plan fairly safe ways to gather,” she said. “If we all make our holidays a little bit safer, our actions could add up to something big.”