The end of the year 2021 has proven to be even more challenging than the previous year. Not because things are necessarily worse but because people are tired, want to see family and friends, are vaccinated and yet the threat of infection with the omicron SARS-CoV-2 variant is real. A year ago, the U.S. had close to 200,000 new infections per day, over 100,000 people were hospitalized with COVID-19 and less than 1 percent of the U.S. population had been vaccinated. Thus, December of 2020 proved to be one of the deadliest months of the pandemic with more than 77,000 people losing their lives to COVID-19 that month.
Today, we are seeing the rapid spread of the omicron variant and while there are over 250,000 new infections per day with the numbers rising and 77,000 hospitalized with around 1,000 deaths per day, we now have 61 percent of the U.S. population fully vaccinated. This is thus a different situation and one in which the fully vaccinated may get infected but are unlikely to get sick enough to need hospitalization or die. The result is that omicron is not impacting in a significant way the demand for holiday travel (although there have been major flight cancellations). In fact, Transportation Security Administration (TSA) screened over 2 million passengers on Dec. 26 compared to just over 1.2 million the same day last year. As people travel to go on vacation or to visit family there are many questions of what is safe to do and what precautions one should take. Here is a summary of the recommendations I have giving to family and friends:
- Be vaccinated: By now you should be fully vaccinated — and ideally boosted. If you are not vaccinated or if you have reasons to believe that you may be one of those persons that is unlikely to respond to the vaccines due to severe immunosuppression, then you should think twice about traveling or gathering with family.
- Wear a face mask: When you travel make sure you are wearing a high-quality mask. That means either an N95, a KN95 or something similar or consider double masking. Also keep your mask on the entire trip. Remember that taking your mask off for eating or drinking may be a time when you get exposed, especially if others do the same at the same time. If you want to take a drink, use a straw. To increase protection consider using goggles or a face shield.
- Use testing: If you can access rapid antigen tests or can get tested and receive your results quickly, consider getting tested 24 hours before your trip and test again 48 hours after your trip.
- Gather safety: I suggest gathering with family and friends who are fully vaccinated, not showing any COVID-19 symptoms, and ideally who have tested negative 24 hours before gathering. Also, gather in smaller groups of less than 20 people, and ideally do it outside or with windows open for good ventilation and air circulation.
- Avoid dining at indoor restaurants and avoid bars: Remember the biggest risk of infection may not be when your travel but what you do while traveling.
There is also the possibility that you will get infected during your trip and thus will need to isolate while traveling. Be sure you take that into consideration. Finding and having to pay for an additional hotel room may be difficult during holidays and also expensive. In addition, if you are traveling internationally, there are other issues to consider. You need to know that you are required to get a negative COVID-19 test 24 hours prior to your flight to the United States. Thus, if you test positive, you may need to prolong your stay out of the country. Finally, medical care may not be of the same level overseas and your U.S. health insurance may not cover the cost of care abroad.
In summary, my overall assessment is that it is still relatively safe to travel and gather with friends and family, but you have to take into consideration several issues to avoid omicron infection. While the equation has shifted, if you are vaccinated and boosted you will be much safer that if you are not.
Carlos del Rio, M.D., FIDSA, is vice president of the Infectious Diseases Society of America. He is a professor of medicine at Emory University School of Medicine and of global health and epidemiology at Emory’s Rollins School of Public Health, principal investigator and co-director of the Emory Center for AIDS Research, and co-principal investigator of the Emory-CDC HIV Clinical Trials Unit and Emory Vaccine and Treatment Evaluation Unit. He is also the international secretary of the National Academy of Medicine and the Chair of the PEPFAR Scientific Advisory Board.