With this year’s Thanksgiving the third since the onset of the pandemic, there are now many tools to help manage Covid-19 risk, including safe and widely available vaccines. But this coronavirus still presents a danger, especially to older people and those with chronic medical conditions. There are also other viruses circulating across the United States, including influenza and RSV (respiratory syncytial virus) that are causing some pediatric hospitals to be overwhelmed.
What are steps people can take to protect themselves and their loved ones against Covid-19 during Thanksgiving dinners and other gatherings over the coming holidays? Is it still important to require vaccines for attendees at such events? Does a mini-quarantine period help to reduce risk? If people are testing before gathering together, when should they test, and with what tests? And what’s the best way to protect against other circulating viruses?
To help us with these questions, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency physician, public health expert, and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also author of “Lifelines: A Doctor’s Journey in the Fight for Public Health.”
CNN: What can people do to reduce the risk of catching Covid-19 and becoming severely ill when gathering over Thanksgiving and other winter holidays?
Dr. Leana Wen: The same mitigation measures we were discussing last Thanksgiving still apply.
The most important thing we can all do to reduce the likelihood of becoming severely ill is be up-to-date with the Covid-19 vaccine. This is particularly important for individuals who are 65 and older and adults who are immunocompromised or have other chronic medical conditions that predispose them to severe disease. Note that it takes about two weeks to reach optimal protection from the vaccine, so it’s best not to wait until just before a gathering to get inoculated. And don’t forget the flu vaccine, and for those eligible, the pneumonia vaccine, too.
The virus that causes Covid-19 is airborne, and good ventilation is key to reducing its spread. Gathering outdoors remains much safer than indoors. It’s already getting very cold in some parts of the country, though, and we know indoor settings can be made safer by opening windows and doors, using fans and HEPA filters, and limiting capacity.
The more people attend a gathering, the higher likelihood that someone could be infected and not know it. The risk can be lowered if everyone agrees to take a Covid test the day of the gathering.
Of course, masking is a precaution that will reduce risk, though it’s harder to do when attending events with food and drink. Some individuals who are particularly vulnerable and really want to avoid Covid-19 may wish to wear a high-quality N95 or equivalent mask during indoor gatherings, and only take the mask off when they are outdoors. They should also eat and drink outdoors; that way, they keep their mask on at all times while indoors around others.
CNN: If someone in the family is vulnerable, should everyone else mask and reduce their risk for several days before gathering — in essence, enter a “mini-quarantine”?
Wen: Some families will want to take additional precautions and essentially enter a bubble with one another over the holidays. This is a sensible thing to do if there are vulnerable family members to consider, and when it’s not practical to only see them outdoors.
What I advise in this mini-quarantine period is for everyone to reduce their own exposures as much as possible. For about 5 days prior to the gathering, everyone participating in the mini-quarantine should wear a high-quality mask when going to indoor spaces like offices, schools, grocery stores and onboard buses and trains. They should not dine indoors in restaurants or gather with others not in their households. And just before the gathering, everyone should take a Covid-19 test.
This mini-quarantine plus testing doesn’t guarantee that everyone in attendance will be free from the coronavirus, but it will help to reduce exposure and risk.
CNN: For those testing before gatherings, when should they test, and with what tests?
Wen: It’s best to test as close to the get-together as possible. The test should definitely be taken the same day as the gathering.
In general, PCR tests are more accurate for picking up early infections compared with antigen tests. The problem is that PCR tests are much less available, especially for same-day results. A home rapid antigen test, if done just before attending an event, can be a helpful tool — with the understanding that there’s still a chance someone could test negative and be carrying the coronavirus.
CNN: Last year, the prevailing advice was to require the vaccine for all attendees at holidays. Is this still important?
Wen: The primary purpose of vaccination is to reduce the likelihood of severe illness. The Covid-19 vaccines are very good at doing this, and that’s the main reason we should all get vaccinated — and that those at risk remain up to date on their shots.
But people who are vaccinated can still carry Covid-19, so vaccination alone is probably not enough of a protection against infection. If you are really worried about contracting the coronavirus, you should take additional steps to protect yourself regardless of whether others you’ll be gathering with are vaccinated.
CNN: The coronavirus isn’t the only virus that families may be worried about. What’s the best way to protect against other currently circulating viruses, like influenza and RSV?
Wen: If there are going to be vulnerable people in attendance, those who have symptoms such as a cough and runny nose should stay home. Viruses like influenza and RSV are spread primarily through droplets, so people should keep washing their hands frequently, including after touching high-contact surfaces. The other mitigation measures that help reduce the risk of Covid-19, including ventilation and masking, will also help to reduce other virus transmission.
CNN: Many Americans have stopped coronavirus mitigation measures. Why might they want to resume them for the holidays?
Wen: The main reason is if they are getting together with a loved one who wants to continue to be cautious. Many people may not be actively avoiding Covid-19 themselves, and if they are gathering only with others who all feel this way too, that’s one thing. But many people may be getting together with family who are elderly and people with underlying medical conditions. Gatherings are generally planned by taking into the account the needs of the most vulnerable. There are steps we can take to reduce risk and allow for happy, in-person reunions over Thanksgiving and other upcoming holidays.