Discover more from Your Local Epidemiologist
The holidays with my family
Many families have really good questions regarding the intersection between Delta/Omicron and the holiday season. I can’t answer your individual messages for a number of reasons. But I do understand that it’s incredibly difficult to navigate this landscape especially with a mutating virus. Just when we thought we had a good grasp, this darn thing changes.
So, I can share my plans, what I’m thinking for my little family, and where the risks lie and don’t lie. Maybe it will help. Maybe not. Maybe I will regret this, but ‘tis the season.
Setting the Scene
There are 2,500 counties with “high” transmission in the United States. We’re in the middle of a massive wave and have many signals that this wave is going to get bigger. But, vaccines are doing a really nice job keeping people out of the hospital (see figure below). While severe disease and death isn’t the only outcome, evidence shows that vaccines also help reduce the risk of long COVID.
We’re getting more and more answers about Omicron, but there’s still a lot of uncertainty too. Vaccines will continue to keep people out of hospitals, but avoiding breakthrough infections altogether is becoming less and less likely. We don’t know the severity of Omicron disease. For example, we don’t know if the high rate of pediatric hospitalizations in South Africa is a “true signal” that can be translated to the United States.
We also know that infectious diseases violate the assumption of independence. This is unlike other health problems, like diabetes: you getting diabetes doesn’t impact the person next to you. The decisions you make can impact the health of your kids, your grandparents, and the community around you.
Concurrently, mental illness is on the rise. Most recently (August-September 2021), NPR, the Robert Wood Johnson Foundation, and Harvard polled parents to assess the impact of the Delta wave on mental health. They found that 36% of households with children were struggling with stress, anxiety, depression, or sleeping difficulties.
The great news is we have some very effective tools to balance quality of life with a raging pandemic: vaccines, masks, ventilation, and testing. And we can use them smartly to enjoy the holiday season.
I have a 14 month old and a 2.5 year old, and we’re lucky enough to have healthy girls. They are ineligible to be vaccinated, but my husband and I are boostered and continue to wear masks at indoor public spaces. Throughout the pandemic, I would consider us “moderate” risk takers. I won’t take my girls to the indoor trampoline park, but my husband has a high exposure job, we certainly go to the grocery store, and they attend childcare with vaccinated teachers who wear masks. We do the best we can.
We’re flying to CA for the holidays. We’ve decided that we’re not cancelling our flight—for us the benefit to our mental health of seeing family far outweighs the risks of flying, even with Omicron in sight.
I did, however, change our flight to depart a few days earlier. This would ensure that if we did get exposed at the airport, there would be enough time in between the flight and the holiday events with grandparents, great grandparents, pregnant friends, etc. for the virus to be detected through tests.
I’ve flown several times with the girls throughout the course of the pandemic and have never been necessarily concerned about the flight itself. The air filtration is great on planes, there’s mandatory masking, and flight attendants do a darn good job of enforcing it. (Thank you!) If this wasn’t the case, there’s no way I would fly with my girls.
I don’t pre-clean the tray tables. While these are probably gross for other reasons, there is very little risk of COVID19 surface (i.e. fomite) transmission. And, given that my toddler eats stuff off the floor, I don’t know how much good this would do if COVID19 was on surfaces.
I try and get my toddler to wear a mask as best as she can, but I’m sure you can guess how well that goes. I use a lot of gummy bears and put a mask on her puppy stuffed animal. This sometimes works. Sometimes not.
I get more concerned about exposure getting to and from the flight. But I’ve learned that if we decide to fly I have to accept the possible risk of COVID19 exposure. I used to stress about my daughter taking off her mask or someone coughing or unavoidable crowds. But it didn’t make it a fun experience for anyone. So I accept the risk while trying to be smart. For example, we try and find a table away from crowds while waiting for the flight. Once we land and if baggage claim is packed, one of us takes the girls outside while the other waits for luggage.
At our family gatherings, my girls are lucky enough to still have three great grandparents, grandparents, and grand aunts and uncles. They are all vaccinated (and boostered), but obviously much older in age. With Omicron on the horizon, I’m getting more concerned about the older population. While their risk is much lower with vaccines, they’re typically the ones that have severe breakthrough cases.
Although everyone’s vaccinated (except my girls) for our first family event, we’re still using antigen tests. I’m using the same plan I put together for Thanksgiving: testing two days before the event and then the morning of. Please go to my previous post to see all the details. I walk through the chart below.
If all is good, then we won’t mask indoors. Sometimes the great grandparents do this anyways, which is obviously great. But other than that it will be as normal as pre-pandemic.
Unvaccinated Adults at the Holidays
Even in my family there are people who are against COVID19 vaccines. At this point, I don’t think there’s much that can change their minds to get a vaccine. It’s just something that I have to accept.
Some have had COVID19 before. Some not. A family member who recovered from an infection less than 90 days ago certainly puts me at more ease than one that hasn’t.
Their willingness to use other public health mitigation measures directly impacts our decision to go to that particular event. There’s no way they will wear masks inside. But if they’re unwilling to do antigen tests too then my little family will stay behind for the second family event and do something else instead. To us, the benefits don’t outweigh the risks to my unvaccinated girls here.
Uber/ride share: This is a strong no for me when I’m with my unvaccinated girls. Especially in places with high community transmission. COVID19 is airborne and can linger in the air for up to 16 hours. I think of it like cigarette smoke: If someone smoked in the car before we got in the Uber and it wasn’t aired out, then it would be in the air we breathe. Thankfully I have family who can drive us. If not, we would rent a car. This isn’t risk free, but there’s probably far fewer strangers getting in and out in the past 16 hours. If I had to take a ride share, I would keep the windows down.
Holiday parade: We went to the local holiday parade. It’s an outdoor event, so I wasn’t worried at all. It also wasn’t shoulder to shoulder crowds. We didn’t wear masks, nor did I think we needed to.
Santa’s lap: This is where I get a little more nervous, because it’s dependent on others making smart choices. One thing that this pandemic has made very clear is that many people don’t make the same decisions I do. Santa also interacts with hundreds of kids a day in close contact without a mask. So, we’ll probably skip Santa this year. If my kids were vaccinated, I would be more comfortable with this.
Nutcracker: I’ve gotten a lot of questions about attending a Nutcracker play or other holiday program inside. I would be comfortable doing this if my kids were fully vaccinated and everyone wore a mask inside. This provides a fantastic bubble around you.
Holiday parties: My work is having a small indoor holiday party, but everyone is vaccinated and the kids aren’t going. I will be attending.
Church and religious services: I’m not religious, but my dear epidemiologist friend, Dr. Emily Smith, has been providing great advice on religion throughout the pandemic. She had a recent post saying to pull back on religious gatherings.
This isn’t a “no risk” plan. But there is no “no risk” plan. There is risk in everything we do, especially with Omicron uncertainly on the horizon. Importantly everyone has a different risk tolerance—the amount of risk you’re comfortable with may be very different from the risk I’m comfortable with. Also, the value certain activities bring to your quality of life is very different from what they would bring to mine. No one can weigh those benefits and risks but you.
For what it’s worth, my goal this holiday season is to protect my girls and the ones I love while balancing the immense joy I have being with family and at the beach for the holidays. This may mean that I get a breakthrough case but it may not. We can live with COVID19, we just have to do it smartly.
Scary Mommy invited me back to talk about Omicron, holiday plans, and the future of this pandemic. Join me next Tuesday, Dec 14 at 7pm EST. It’s free and you can register here. It will be live streamed from my Facebook too. If you can’t make it, it will be recorded. Hope to see you there!
“Your Local Epidemiologist (YLE)” is written by Dr. Katelyn Jetelina, MPH PhD— an epidemiologist, biostatistician, professor, researcher, wife, and mom of two little girls. During the day she has a research lab and teaches graduate-level courses, but 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, rather than decisions based in fear. This newsletter is free thanks to the generous support of fellow YLE community members. To support the effort, please subscribe here: