Thoughts on Family Gatherings for Thanksgiving
November 22, 2022
I’m taking this coming Friday off from writing a regular post, but many are thinking about how to address the risk of COVID-19 during our third Thanksgiving during the pandemic. More families are gathering together, and Thanksgiving dinners often include the elderly, the very young, and those with compromised immune systems at highest risk of hospitalization or death if they get a respiratory illness.
Here a few thoughts about choices for those attending or hosting multi-generational family gatherings, and recommendations offered by some experts who I trust. The approach to Christmas (or Chanukah or Kwanzaa or Winter Solstice) later this fall will be similar.
Test or no test?
StatNews reports that two thirds of the 34 infectious disease experts who responded to its survey were doing at-home rapid COVID-19 testing before their Thanksgiving gatherings. The home antigen tests are less sensitive early after infection, so it’s best to test more than once (usually separated by 48 hours) if you can. I’m writing this note a bit late for that for this Thanksgiving, though.
Many experts also recommend testing after such gatherings; Jeremy Faust suggests daily testing for 5-6 days, but many would suggest beginning testing 3-4 days after exposure. Anyone testing positive after a family gathering should notify other attendees so that they can test, too.
Influenza infections are quite high right now, and there is currently no home test for flu. Anyone who has respiratory symptoms or feels sick should stay home, regardless of what a rapid test shows!Mask or no mask?
StatNews reports that the vast majority of its surveyed experts are masking in stores and crowded places; all but one of their experts masked on planes. Some experts recommend masking in the days leading up to Thanksgiving to avoid bringing COVID or other respiratory diseases like influenza and Respiratory Syncytial Virus (RSV) to the gathering. Katelyn Jetelina reminds us that an N95 or KN95 or KF94 mask is far better than other alternatives. Those who are immune compromised might want to mask when they are not eating or drinking during holiday gatherings.
If you are traveling to your gathering, on a plane, train, or other public conveyance, then strongly consider wearing the most protective mask that you can comfortably use for the length of the time you travel. Planes in particular are very full these days and masks in the airport and on the plane will lower your risk of becoming infected with any virus, including the coronavirus.Increase ventilation!
Cracking the window in a car or opening some windows in the home can dramatically improve air exchange - and decrease risk of COVID-19, flu or RSV transmission. HEPA filters can help in the home, and some are using portable carbon dioxide meters to determine if ventilation is adequate. Outdoor air has a CO2 level of about 400 parts per million, and it’s best to ventilate to keep indoor air at about 800 ppm or less.What about vaccination?
All of the experts surveyed by StatNews either already had their bivalent booster or planned to get it before Thanksgiving. I got my bivalent booster earlier this fall. But the case for excluding family members who are unvaccinated is not especially strong. Almost all non-vaccinated people at this point have at least some antibodies from past infection, and even those vaccinated and boosted can bring an infection to the family gathering. Many of the experts reported that all of their family members were vaccinated and boosted, making this a nonissue.Where does handwashing fit in?
Influenza and RSV can be spread through contact with surfaces - so handwashing and hand sanitizer remain a good idea.
More information in these sources:
Your Local Epidemiologist (Katelyn Jetelina)
Inside Medicine (Jeremy Faust)
StatNews survey (Helen Branswell)
Force of Infection (Caitlyn Rivers)
Ground Truths (Eric Topol)
Holiday Advice (Centers for Disease Control and Prevention)
Hope all have a safe and happy Thanksgiving.
Jeff