Don’t Cancel the Holidays Just Yet, Some Medical Experts Say

Just how much celebrating the pandemic-weary public can do turns on the vaccinated or unvaccinated question.

Omicron might turn out to be an early Christmas present.

Monica Gandhi MD, MPH, an infectious disease expert and a professor at the University of California, San Francisco, has been one of the more positive voices throughout the COVID-19 pandemic. In a Q&A with Infection Control Today® (ICT®) in October 2020, Gandhi predicted that the world will be able to return to some semblance of normal by January 2022.

In another Q&A in September 2021, Gandhi elaborated a bit on why she feels that eventually we’ll put COVID-19, and all of its iterations, behind us. One of Gandhi’s specialties is treatment of HIV/AIDS and, as such, she “thinks about immunology all the time.” She said that even though the emergence of the Delta variant came as an unpleasant surprise, one of the things the variant is doing it increasing immunity among the populace.

Gandhi also said that she takes heart in some of the science that has been rolled into the battle against COVID-19. “If you look at all of this amazing immunological research that comes out after the vaccines, they are producing cells that look like they are going to last for a really long time. That go into your memory. Memory B cells. Memory T cells. They go into your lymph nodes and they stay there a really long time. We’ve literally done lymph node biopsies…. So, immunologically, the right responses have come out of these vaccines”

Gandhi also said in that September 2021 interview that history predicts humanity’s ultimate victory over SARS-CoV-2.

“There has not been a single infection that we’ve not been able to get through,” Gandhi said. “If you develop an effective vaccine for an infection, you are going to get through. Because immunity is the only thing that’s going to get you through.”

In an article published December 19 for the publication SFGate with a headline that asks: “Should You Cancel Your Holiday Plans Because of the Omicron Variant?”, Gandhi responds: "No, I would not advise vaccinated people to change their holiday plans due to Omicron.”

For the unvaccinated, however, Gandhi said: “I would avoid parties and travel if I were an unvaccinated adult. Please get vaccinated if you are not yet vaccinated, as the vaccines are safe and effective.”

In an email exchange today with ICT®, Gandhi said that she thinks that “Omicron is going to be much more mild, as the South Africa experience doesn’t lie and that is actually among unvaccinated and vaccinated. There are also two studies now that show Omicron can’t infect lung cells, so the virulence studies are very encouraging!”

Now that 61.1% of the United States is fully vaccinated, with all but the youngest children eligible, the definition of a safer holiday looks different. The availability of vaccines–including booster shots–as well PCR and antigen COVID-19 tests—means more people may be ready to travel and get together. And if Omicron overtakes Delta, that could turn out to be a good thing. Gandhi tells ICT® that “Omicron infection (more mild) will give immunity against Delta among the unvaccinated. So, I can only see this as positive. I would do focused protection (strong masks) for vulnerable (immunocompromised, elderly) through the winter, but we can’t ask the public to wear N95 (nor should we want to, given vaccines).”

For health care professionals working in hospitals and other facilities, Gandhi said that “being more prudent about masking through the winter is a good idea.”

Linda Spaulding, RN-BC, CIC, CHEC, CHOP, a member of ICT®’s Editorial Advisory Board, thinks that health care workers are under such strain that the entire health care system in the US could collapse. In a Viewpoint on the ICT®’s website, Spaulding writes “there is no one left to cover sick calls and vacations now. There are no vacations for nurses and doctors. There are no Christmas celebrations or New Year celebrations for these workers.”

Gandhi’s advice for the public was echoed in a recent press briefing sponsored by the Infectious Diseases Society of America (IDSA) that featured experts laying out a holiday plan that takes into account individual and collective needs and risk tolerance.

While the Omicron variant has dominated headlines, at the moment Delta continues to account for the vast majority of infections, according to Joshua Barocas, MD, a visiting associate professor of medicine at the University of Colorado School of Medicine in Aurora and an IDSA public health committee member. Omicron has been found in just 3% of tests nationwide, he said, except for New York and New Jersey, where its prevalence is at 13%.

“This is limited data, because we don’t sequence everything,” Barocas said. “But what we do know is that this variant does appear to transmit more rapidly. Its severity is truthfully yet unknown.” This uncertainty does not seem to be stopping the U.S. and other nations from getting on with life, he observed, and now that we have vaccines and other tools in our arsenal, we need to figure out how best to use them, ideally after assessing our own individual risk profile and coming up with a multilayered approach.

If someone is planning to visit unvaccinated family members, Barocas suggested that everyone in the group take extra precautions such as masking when together, meeting outdoors, and using rapid home antigen tests. In a lower-risk scenario such as a gathering in which everyone is not only vaccinated but boosted, perhaps masks no longer need to be part of the calculus. “Ultimately, the higher the risk situation, the more personal protection you need to keep yourself healthy,” Barocas said. “The lower the risk situation, the lower the mitigation you need.”

Travelers should prepare in advance, as the experience has become increasingly complex, said Romney Humphreys, PhD, D(ABMM), M(ASCP), medical director of the clinical microbiology lab at Vanderbilt University Medical Center. “It really does feel like a brand-new process,” she said “[Y]ou may need to show proof of vaccinations for some locations, and most countries are requiring some form of testing both upon entry into their country and, in some cases, after entry a couple of days later.” Entry into the US depends on receiving a negative result after testing 1 day prior to travel.

Humphreys feels that home rapid tests can provide value during the coming winter surge, although these tests can be hard to find. She recommends that people test on consecutive days, particularly if they have symptoms, but cautions that a negative result is not a guarantee. “Testing really is not a substitute for public health practice,” she said, urging people to continue getting vaccinated, wearing masks, washing hands, and distancing when necessary.

With an increasing number of fully vaccinated people testing positive for COVID-19, the experts suggested a different way of considering our ultimate aim as a society when it comes to the virus. “I’m not sure right now the goal is to decrease transmission,” Barocas said. “The goal is to decrease the burden of disease, and we have to remember that just because something is transmissible or that someone is infected does not mean that they have disease, or symptom-carrying disease, or substantial disease.”

That said, vaccines are at the top of the list when it comes to our pandemic tools. “Vaccination takes the cake,” Barocas stressed. “It is one of the best mitigation strategies that we have, and while we can’t necessarily say how much more important it is on a quantitative level than, say, standing 6 feet away from someone, we do know that of the interventions that we have proposed, put forth, and approved, vaccination seems to be the highest level of risk reduction.”

A version of this article first appeared in Contagion®.