Happy Thanksgiving week! This is a friendly reminder that although there are a ton of circulating viruses, you and your family can have a healthy gathering while taking care of the larger community (i.e., overflowing hospitals). Here are a few key steps for this week:
If you’re sick today…
There’s a good chance you’ll be contagious on Thursday, regardless the type of virus. I would seriously consider, unfortunately, staying home. The infectious windows for the “triple threat” viruses are as follows:
Flu: Contagious for 5-7 days after start of symptoms.
RSV: Contagious for 3-8 days after start of symptoms. Some infants and people with weakened immune systems can spread the virus even after they stop showing symptoms, for as long as 4 weeks.
COVID-19: We see strong evidence (here, here) that an Omicron infection lasts, on average, 8-10 days. Some people will be infectious for less, and some will be infectious for more. You won’t know unless you test.
Cadence testing (COVID-19)
Cadence testing will help catch false negatives for COVID-19. Antigen tests are not perfect, especially among asymptomatic people, but they can help. (You can expect the average antigen test to catch 44% to 70% of asymptomatic cases).
For cadence testing, it’s best to test tomorrow morning and again on Thursday morning before getting together.
Both negative: You’re good to go, especially if you have other measures in place.
Positive tomorrow: Bummer. But you could be at the end of your viral journey. Test again on Thursday, but be prepared to cancel.
Positive Thursday: Stay at home. Sorry.
Mask before event
Mask everywhere in public for the next four days leading up to the event. Masks work against all respiratory viruses. Be sure to wear a good one (like N95).
Ventilation
On Thursday, get that air moving. Buy a CO2 monitor if you want to ensure good ventilation.
Newborns at event
If you have a newborn (under 6 months), I would be a little more cautious this Thanksgiving. For example, wear your baby in a carrier so that people won’t ask to hold the baby. If you do let people hold them, don’t let them kiss the baby or ask them to wear a mask.
Sick after event?
If you’re over age 65 or high risk, get tested and get an antiviral as soon as possible. We have them for the flu and COVID-19.
For children under 2, sometimes it’s hard to know when and where to get care, and pediatric hospitals are under incredible stress right now. As a mom, I found this interview helpful on what signs to look for. When in doubt, call the pediatrician.
Bottom line
Have a wonderful and healthy Thanksgiving! See you on the flip side.
YLE
P.S. If you would like more details on any of the above, check out this previous post.
“Your Local Epidemiologist (YLE)” is written by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, data scientist, wife, and mom of two little girls. During the day she works at a nonpartisan health policy think tank and is a senior scientific consultant to a number of organizations, including the CDC. At night she writes this newsletter. Her main goal is to “translate” the ever-evolving public health science so that people will be well equipped to make evidence-based decisions. This newsletter is free thanks to the generous support of fellow YLE community members. To support this effort, subscribe below:
All good advice, and I hope all had a good Thanksgiving.
I'd take a bit of exception to home testing (lateral flow rapid antigen tests) advice for the future. The biggest drawback to those tests compared to a properly performed PCR test is, rapid antigen tests have no mechanism to amplify the viral load; what you've got in the area sampled, usually the nasopharynx or anterior nares, is what the test has to work with. If concentrations are below the sensitivity of the test, or borderline, you might get a false negative test. Cadence testing is good to help with finding and clarifying a false negative test, and I've used it successfully for that purpose.
Symptoms are important, at least in the less sensitive lateral flow tests. If you're not symptomatic, you probably won't have sufficient viral load in the nose to test positive... but if you KNOW you were exposed, and 4-5 days have passed, it's OK to test; you could have an asymptomatic infection. Also, how you get ready before the test is important. I've seen package recommendations, and have discussed with colleagues, that blowing your nose before the test is a good practice and also helps standardize the testing procedure. Also, if administering the test, make sure to follow the package instructions as to where to sample, or if they're not clear, sample about as far back as you can see in the nose. The deep "brain biopsy" sampling done early in the pandemic has its place but there are possibilities for problems. The swab should be rotated, and the same swab used for both nares (sides of the nose). Follow the instructions for the medium used for the lateral flow test (it varies from manufacturer to manufacturer; I'm now good with at least 4 different tests and their only common point is 15 minutes of toe-tapping while you wait for a result.
In general terms, I've always treated a positive test as, well, a positive test. A negative is a "presumptive negative" but must be confirmed by retesting. Said retesting should be planned. I like to test 24 and 48 hours after the first negative test, and if symptoms subsequently develop, test again. If all are negative, you should be good.
I also like the idea of testing just before the event. One last check, to make sure everything is OK.
As an anecdote, I recently had an influenza-like illness. I'm fully vaccinated, and up to date including the bivalent booster (all Moderna). I've also had my annual flu shot. I was symptomatic and miserable, but 4 successive lateral flow tests were negative. My own primary care doc accepted this as "you've probably got a version of the flu we didn't cover in the vaccine", a position I agreed with. Unlike previous bouts of COVID, documented by positive PCR or home rapid antigen testing, I had none of the other ugly symptoms like loss of smell or taste. I just felt miserable for 7 days.
Thank you for your advice. I hope you and your family had a wonderful holiday and are staying safe. I wonder if you could address the Covid studies cited in the thread below? Is the analysis accurate? Thanks again for all you do to help us non-scientists navigate Covid. https://twitter.com/yaneerbaryam/status/1595751639314481152?t=Yn30IZ4_tvibgtBXeoeKTg&s=19