You’re reading The Checkup With Dr. Wen, a newsletter on how to navigate covid-19 and other public health challenges. Click here to get it in your inbox.
Here are five tips for assessing and managing covid-19 risk:
(1) Determine your level of risk tolerance. A lot of people no longer prioritize avoiding covid-19. They have returned to all pre-pandemic activities, and Thanksgiving for them is no different than any other gathering they’ve been attending.
Still, many others do not wish to contract the coronavirus. Perhaps they are medically vulnerable and susceptible to severe illness. Perhaps they are worried about long covid. These individuals will probably wish to continue taking precautions over the holidays.
(2) If you’re hosting Thanksgiving dinner, know your guests’ preferences. If all of them have returned to their pre-covid lives, and you’re the same, then you might not need mitigation measures. Attendees should be aware that they could contract the coronavirus from this gathering, just as they could from dining in restaurants, going to the gym and attending concerts.
If there are guests who wish to be cautious, discuss with them how careful they want to be and how many layers of protection you need to institute.
Outdoor gatherings remain the safest option. If weather permits, you could host the entire dinner outside. Indoors will be much higher-risk. You could reduce that risk by asking everyone to take a rapid test the same day of the event. Some hosts offer rapid tests at the door to reduce inconvenience and to ensure that all guests are tested.
(3) Consider a voluntary quarantine. I’ve received numerous questions from readers asking what to do if they have visitors staying with them for several days. If the guests, hosts or both really want to avoid covid, consider asking everyone to undertake a voluntary quarantine for at least three days — ideally five days — before getting together.
During this quarantine period, everyone should reduce their in-person maskless interactions to a minimum. Don an N95 or equivalent mask at work and school and while traveling. Do not gather indoors with individuals outside your immediate household.
Upon arrival, take a rapid test. If you’re the host and want to be cautious, then ask your guests not to gather indoors with anyone else outside of your households while they are staying with you.
(4) Prepare what you can. Those vulnerable to severe illness from covid-19 should get the bivalent booster now if they haven’t already, and everyone 6 months and older should get the flu shot. It takes about two weeks to reach optimal protection. Getting the shots today — a week before Thanksgiving — won’t give you full protection by then, but it will give some additional immunity.
Now is the time to stock up on rapid home coronavirus tests. Make sure you have enough for all the events you’re attending that require them. You might consider purchasing tests in bulk if you are hosting an event.
(5) Plan for different scenarios. I’ve long been a proponent for everyone having a covid plan. Are you eligible for Paxlovid? How will you access it during holidays and after hours? If you’re traveling and you test positive, do you have a place where you can isolate?
Also, think through what you will do if gatherings take unexpected turns. If you find out that people you’re hosting didn’t quarantine as they promised, are you willing to take on the additional risk? Or will you ask them to make alternate arrangements?
If you are someone else’s guest, you might end up in situations that are higher-risk than you anticipated. What if a lot more guests turn up than you were told would arrive, and you have no idea whether they were cautious or took a test? Decide, in advance, how strongly you feel about avoiding covid, communicate it with those you’re celebrating the holiday with and know your limits for when you might wish to leave a gathering.
I will be off with my family next week. The Checkup will be back in your inbox on Thursday, Dec. 1. Until then, happy Thanksgiving!
Ask Dr. Wen
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“I see in your columns that you are not recommending a booster for all groups. Would it not benefit everyone if everyone got the booster so that fewer new variants of concern would arise? Also less opportunity for vulnerable people to get infected?” — Valerie from California
Your argument would be right if it were true that vaccines — and up-to-date boosters — provide substantial protection against infection. This is what we thought when coronavirus vaccines were first introduced. If that were true today, then yes, boosting everyone would lower the transmission of the virus overall, lowering the chance that new variants develop.
Unfortunately, we know this is probably not the case with existing vaccines. Vaccine effectiveness against infection with the omicron subvariants is not that high. One study, published in JAMA, found that during the time of omicron predominance, vaccine effectiveness against symptomatic infection after two months was only 29 percent in children 5 to 11 years old and 17 percent in adolescents. Another large study, published in the New England Journal of Medicine, followed more than 11,000 health-care workers. After their second booster, vaccine effectiveness against symptomatic infection decreased from 52 percent during the first five weeks to virtually zero at 15 to 26 weeks.
I think it’s important we continue to stress the primary reason for vaccination: to reduce the chance of severe illness or death. That’s a compelling reason to get the booster. It cuts your chance of getting very sick and, on a societal level, helps prevent hospitals from being overwhelmed.
It’s therefore easy to make the case that people most vulnerable to severe illness, such as nursing home residents and the elderly, need to be up-to-date on their boosters. But it’s not so clear that such a public health justification applies to people who are already unlikely to become very sick. Some people will want the booster because they want any reduction in likelihood of getting the virus. But others might wish to wait. Both are reasonable decisions.
“I give blood regularly, usually platelets. Does it matter how long I wait to donate after either a flu shot or covid booster?” — JP from Virginia
The American Red Cross specifies that there might be a short waiting period if you received a live attenuated virus, which is not the case for the coronavirus or flu vaccines in the United States. If you received any of the coronavirus or flu vaccines authorized by the Food and Drug Administration, you do not need to wait before giving blood as long as side effects from vaccination, such as fatigue and headache, have subsided.
“Because tests are often negative when one has already contracted the coronavirus, and only become positive a couple of days or more later, what is the point of testing immediately before attending an event or visiting someone’s home?” — Hope from Minnesota
The reason to test before attending a gathering is to find out whether you could be infectious to others. If you are infected, but with such a low amount of virus that a rapid test cannot detect it, there’s a good chance you are not actively contagious to people around you yet.
That’s why rapid tests are best when they are taken as close to the event as possible. If you take a test the day before an event and it’s negative, but you were already infected, you could develop a high-enough viral load to be contagious to others the next day. But if you test negative just before attending a gathering, chances are the amount of virus will still be low.
Of course, rapid tests do not provide a 100 percent guarantee against infection. But if everyone tests just before a gathering, it will decrease the likelihood of asymptomatic spread.
The Post has also compiled Q&As from my previous newsletters. You can read them here.
What I’m reading
While many people experience significant side effects from coronavirus vaccines, such as fatigue, fever and arm pain, others do not experience any symptoms. I’ve heard from readers worried that the lack of symptoms indicates the vaccine didn’t work. A new study in JAMA Network Open puts this concern to rest. A strong antibody response is observed in nearly all individuals, including those who had no self-reported symptoms following vaccination.
Binge drinking and alcohol-related deaths rose during the first year of the pandemic, according to a new report by the National Center for Health Statistics. Such deaths have long been steadily increasing over the past two decades, but 2020 saw a sudden 26 percent increase in deaths compared with the year prior, from about 39,000 deaths to 49,000. For women, the largest increase in death rates was among those 35 to 44 years old, with a 42 percent increase between 2019 and 2020. For males, those 25 to 34 experienced a 46 percent increase, and those 35 to 44 had a 45 percent increase.
I appreciated this Atlantic op-ed by economist Emily Oster, who has been a strong advocate in favor of school opening throughout the pandemic and has received both praise and harsh criticism for her views. She argues that both those for and against pandemic restrictions have become defensive and more retrenched. “Treating pandemic choices as a scorecard on which some people racked up more points than others is preventing us from moving forward,” she writes. “We have to put these fights aside and declare a pandemic amnesty.”