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Upcoming holiday season
Thanksgiving is in 20 days. Hanukkah in 23. Christmas in 50. And the pandemic landscape continues to rapidly change. More likely than not there will be a mix of people attending your holiday celebration: family members that are ineligible (0-4 year olds), partially vaccinated (5-11 year olds), vaccinated but not protected (immunocompromised), or just plain unvaccinated (22% of 12+ year olds are still unvaccinated in the United States).
The CDC released their guidelines for a safe holiday season two weeks ago. Unsurprisingly, the guidance is vague and does not address many situations we find ourself in this year. So, I put together my thoughts…
Everyone is fully vaccinated
If everyone, and I mean everyone, is fully vaccinated then I would approach the celebration like we did before the pandemic. No restrictions. Vaccinations are, by far, the best protection we could ever ask for. We need to start trusting them.
Fully vaccinated means:
2 weeks after second dose in a 2-dose series, such as Pfizer or Moderna
2 weeks after Johnson & Johnson vaccine
The definition of “fully vaccinated” does not change for boosters. So, if you have two doses of Moderna/Pfizer or 1 dose of J&J you are still considered fully vaccinated. But, among those that should get the booster (65+ and long term care residents), I would strongly suggest one before the holidays.
I would not consider immunocompromised fully protected even if they’ve received the recommended doses. A layered approach to the holiday celebration is best (see below).
There will be quite a few people in-between doses during the holidays. If a 5 year old was vaccinated this weekend, for example, they would not be fully protected come Thanksgiving. There’s just not enough time.
So, what’s the efficacy of one dose? For 5-11 year olds we don’t really know. This wasn’t technically reported in the clinical trials. We can extrapolate from the data, but I would be cautious in doing this. The trial wasn’t designed to answer this question and, because of this, we don’t have confidence in this number. In the adult trials, efficacy after the first dose was ~85%. But this was pre-Delta; and we know Delta has changed the game. Kids probably mount partial protection like adults, but we don’t know the number.
How you celebrate and prepare for the holidays in this gray area is dependent on risk tolerance, who is attending the holiday celebration, and where you are physically located. For example,
If everyone is fully vaccinated except the partially vaccinated child, this is a very safe situation and a layered approach may not be necessary.
If your celebration is in a county of “high” or “substantial” transmission and unvaccinated adults are attending, this could be a more risky situation for the partially vaccinated child. I would go with a layered approach.
Other populations, like pregnant people, may also happen to be partially vaccinated during a holiday celebration. A recent study found that pregnant people mount a suboptimal response after the first dose. The second dose is crucial. So a layered approach to the holidays, in this situation, is best.
A layered approach
If there are unvaccinated (for whatever reason) at the holiday party, I strongly suggest a layered approach. The more layers we have the more protection for you, the attendees, and the community at large. Here are some key layers:
Get people vaccinated. Open a line of communication with unvaccinated, eligible adult family members. About 11% of unvaccinated secretly get vaccinated. So this conversation may be easy because you’ll find that in fact they are truly vaccinated.
If this is not the case, this conversation will probably be difficult. But difficult conversations pay off: 30% of unvaccinated adults change their minds because of family and friends. Here are some tips on how to have that conversation (Vaccine Hesitant: How can you help?). Once you find the reason for hesitancy, point them to evidence-based resources. Here are a few previous posts for common COVID19 vaccine concerns:
1-pager of responses to the top 6 hesitant reasons for a vaccine (here)
Pregnancy and COVID19 vaccine (here)
Vaccine got to us fast (here)
Real world safety and effectiveness of the adolescent vaccine (here)
Importance of a 5-11 year old vaccine (here)
Test, test, test. One of the greatest failures of the pandemic is not rolling out affordable, rapid testing for everyone. And, of course, not communicating this option to the public.
A rapid antigen test is your best bet before a holiday event with unvaccinated. In fact, it’s your best bet for anything— coming home from a work trip to unvaccinated kids; visiting grandma at assisted living home; seeing an immunocompromised friend; hosting a party. On a population-level, we don’t leverage these enough.
A rapid test (also called an antigen test) can be run at home and produces results in about 15 minutes. Antigen tests pick up when someone is most infectious. They aren’t as sensitive to PCR tests though, which means there will be more false negatives. But you can still trust them and a much better option than not testing at all. And, honestly, more feasible than PCR’s that typically take a few days to get back (and in the meantime you could have been exposed).
While PCR’s are much more expensive, rapid tests are still pricey for the average American (about $15-25). So, many people find it impossible to use these weekly or for test-to-stay programs. It may be a wise investment for a holiday event, though.
They can be hard to find, too. It looks like Walmart has some in stock right now. You can also find these at pharmacies, like Walgreens, or public health departments. Access and price may improve with the recent White House announcement in spending a billion dollars to make tests more available (about time).
If everyone comes to the holiday event with a negative rapid antigen test, then this event is very low risk.
Then there’s the usual layers. If #1 and #2 don’t fly with the family, then:
Masks work great inside
Outside is better than inside
Airflow is key
People that feel sick or have symptoms shouldn’t come
And, you could always have a smaller celebration with immediate family
If you’re fully vaccinated, you’re as safe as you’re going to be. Go fly with ease.
For those with unvaccinated children (like me)… The plane is actually incredibly safe. This is because TSA is requiring masks until January 18, 2022 and airlines have been amazing at enforcement (unfortunately at the expense of harassment and even attacks). If masks weren’t required on planes, I’d be pretty uncomfortable flying with my unvaccinated girls. The planes also have amazing filtration systems.
I’m typically more concerned about exposure to and from the plane. Crowded terminals. People taking off their masks. Crowded baggage claim areas. When I travel with my girls we find a little corner that’s largely away from the crowds (this is impossible in the San Diego airport, though). When we get luggage, my husband or I take them outside while the other fetches bags. I try and get my toddler to wear a mask. I don’t wipe surfaces. We do the best we can.
Bottom Line: We can and should celebrate the holidays even if some people are partially vaccinated or unvaccinated. Just take the right steps to celebrate safely. This will protect you, the vulnerable, and the community around you.