Maximum avoidance or anything goes? Disease expert says find happy medium for holidays
What’s your risk tolerance level, current health status and the health status of those around you?
The answers to those questions are key factors in determining how to gather safely with friends and families for the holidays.
The News Tribune recently talked with Dr. Chris Baliga, medical director for infection prevention and control for Virginia Mason Franciscan Health, about best practices to avoid having a superspreader event along with your turkey and mashed potatoes.
The interview has been edited for length.
Q: What should be top of mind with the various combinations of people vaccinated, partially vaccinated and not vaccinated?
A: First and foremost, get fully vaccinated as best you can. Know your audience. Know who you’re going to be with. If you know there’s somebody who has not gotten vaccinated and they’ll be at the party, should they be a different part of the party? Is there a way that you would treat them differently? If you have somebody who has one of these conditions that puts them at higher risk or has an immune weakened condition such that they may not have responded to the vaccine fully, do you treat that situation differently?
Part of this goes to the travel component. How are you going to get there? If you were to take a plane, then you are going to be wearing a mask, at least while you’re in the screening areas. And if not, you will be getting talked to by a flight attendant, and we know how that’s been going recently. So it’s probably worth just wearing the mask and not trying to fight with everyone.
But you’re in an airport, you’re in a crowded place, you’re on a train where there’s lots of people around you, that itself is a risk and so being diligent, wearing your mask while you’re traveling is a good thing to do.
Or you can come up with a smarter way to travel. I will be in a car so that I’m not going to be putting myself or my loved ones in that environment where I’ve potentially been exposed in the travel process.
Q: Does everyone need to still wear masks if they are vaccinated, but coming from say a high-risk job or higher level of potential COVID exposure?
A: Realistically, if you were to wear a mask, it would be safer. But I think most people — especially with small groups of loved ones — unless they’re concerned about someone who isn’t vaccinated or may not respond as well (to the vaccine), are probably not going to wear the mask. And so it really comes down to your layer of protection or concern. If you are somebody who feels that they’re at high risk of potentially getting COVID even though you’re fully vaccinated and you’re worried about spreading it, wear the mask. I think that’s the easiest thing to do.
The other option, of course is to try to get tested before the get-together to see if there’s anything else there. But if you are vaccinated and the people around you are vaccinated, the risks come down considerably.
Q: Are home tests a good option now?
A: I think so. The tests that are out there now, or especially if you’re buying them at a drugstore, they’re more reputable than they were early on in the pandemic and we had a lot of questionable tests that were coming into the market. The ones that are there now I think are pretty reliable. They don’t cost that much. They’re quick.
Q: How important is ventilation now? Do we have to still eat outside or with the windows open if everyone’s vaccinated?
A: The short version of this is ventilation matters. It will increase or decrease the risk depending on how much is there but then you still get to what you’re alluding to — having all the windows open is cold. Here in the Pacific Northwest eating outside at Thanksgiving, depending on the forecast, may or may not be good. Again, it’s risk prevention. It’s trying to decide what is the real risk that’s happening there. Again, if you have people that are higher risk that they either didn’t react to the vaccine, they didn’t take the vaccine for some reason, they’re elderly, they have some other condition, then with that population you say, ‘Well, do I feel comfortable sitting there with the windows closed and a bunch of people in the room?’ You know, maybe maybe not. If you know everyone, you trust them.
I think realistically most people are going to choose to have the meal with their masks off and the windows closed, just for comfort.
Let’s say you have an infectious disease doctor coming over for Thanksgiving meal who sees COVID patients most days of the week. It may change your calculus of what you want to do and then maybe then it does make sense to have the windows open. Or, if I were the one there putting people at risk, maybe I would sit further away and wear a mask versus having everyone keep the windows open. There are all these permutations of what you can do.
The key to this is if everyone is vaccinated, you don’t need to be quite as compulsive as we would have been last year in this scenario. But there’s always risk, and it’s really what you’re comfortable with yourself.
Q: How much should people factor in local case rates or whether where they are going is a particular hot spot for cases?
A: Unfortunately, we’re all hot spots here. if everyone was coming from an area that doesn’t have a lot of COVID, then I don’t think you need to do as much. There aren’t that many parts of the U.S. where that’s true, however, and as we know case rates are starting to go up again. Here in the Pacific Northwest, we’re still on the downswing from our last surge. Pierce County remains in the highest level of transmission on the CDC ranking. And so it’s true if we didn’t have a lot of COVID in the community, you wouldn’t have to worry about it because the chance of it spreading is low but unfortunately for us right now that’s not us.
Coming into Christmas and New Year’s and the rest of the holidays, you may see that we’re at a higher level than we are now going into it. But if magically the cases go away, I think it would be a different discussion.
Q: This is our first real holiday indoor test with COVID. What lessons will we learn?
A: You know, it doesn’t seem like vaccination is going to be the end all to get us free of the pandemic. I think it’s very helpful. And so I don’t want to minimize it at all. However, even with vaccination rates that are fairly high where I am in King County, you still see a good amount of COVID. Moving forward, how do we learn to live with it? What are the layers of protection that you want to do? And then we need to find a path forward to living our lives.
Q: Given that you are an infectious disease doctor, what must that be like when you enter the room for the holidays?
A: Early on, I was shunned by my friends and family, so a lot of FaceTiming because they were worried that I would catch COVID and bring it home. But nowadays, I think my friends and family are used to it. And I will say they have more questions for me about my work than they used to. That’s probably the biggest change.
But I tell my family, I tell my friends, I am not particularly worried about contracting COVID at work. When I’m seeing patients, I’m wearing N95, I’m garbed up. I’m worried about catching COVID outside of that environment — the grocery store, or I’m on a bus. That’s where I think my risk is highest. So when you think of it that way, I’m not necessarily at higher risk of bringing something in to the family gathering than anybody else who was out and about.
There’s a group of people that are still living in an extreme state of worry and maximal avoidance at one end of the spectrum, and then the other ones that are just going about their lives like they did before COVID.
And I suspect most of us are somewhere in the middle.
This story was originally published November 23, 2021 at 9:16 AM.
