VPM intern Adiah Gholston spoke with Micheal Stevens, an interim hospital epidemiologist at VCU Health, about how to keep your family gatherings as safe as possible this upcoming holiday season. Below is a transcript of their interview, which has been edited for clarity.
Is it safe to gather indoors or should families consider an outdoor gathering if they have a large amount of people coming over?
Right now, we still have substantial or high COVID activity in the state. And on top of that, we're starting to see some influenza activity, although it's not nearly as high. The risk for folks is going to be highest when they're meeting with family that they don't usually live with, right? There is risk. So what can we do? So one of the things you mentioned, is one of the things people can do, they can gather outside, preferentially over inside. Now is that going to be a realistic option for the entire Thanksgiving holiday? For a lot of people, maybe it's not.
Number two, you can mask indoors when you're not eating, that's going to minimize risk because the time of exposure to somebody who's on mask makes a difference in terms of your risk for getting COVID. When you're eating and you're unmasked, you can try to maintain some social distance to the extent that you can, so multiple tables spaced near or around the house.
The third thing, and probably the most important of these things at this point, right, the most important thing is to get vaccinated, but you can't go back in time and get vaccinated. If anybody has any symptoms, even if they're vaccinated, you shouldn't gather, because you could put other people at risk.
Since how long and how much a person is exposed to COVID heavily affects how sick a COVID infected person gets, should families limit their gathering times to lessen the severity of a potential break out?
Although 15 minutes has been thrown out there in the past, where that's the amount of exposure time you need to get infected, the reality is, you probably can get infected in the right circumstances in much less than a 15 minute exposure. The Delta variant, we know that people who get infected, even if they're vaccinated, have 1000 times more virus that they're shedding than with one of the original variants of COVID. It's a lot of virus that they're exposing other people to and that's why I say this 15 minute, this magic 15 minute idea, It really has gone out the window.
So would you say that the amount of people gathering would be a more important factor than time duration?
Yeah, I would say a couple things are probably the most important, like the number of people gathering, the vaccination status of the people gathering and their ability to respond to vaccines. Are they immune compromised? Are they higher risk for that? And then your ability to adopt other ways to sort of reduce your risk. Can you social distance? Can you eat outside? Can you mask indoors when you're not eating? If you really want to make sure you've done everything you can, doing one of those antigen test kits and have them come back negative and you're asymptomatic and you're vaccinated, these things probably will give you some peace of mind that you're not going to spread COVID.
Is it still a high risk for the elderly to be attending family gatherings at this time?
What I'll say is that the vaccines have been incredibly effective at reducing the risk for severe infection, including in the elderly. If people are fully vaccinated and have had boosters, and don't have some additional new compromising condition, they are probably pretty well protected. But being older, people have something called immune senescence, which means you just become a little immune compromised because you're older. If you're going to have complications from a milder infection, it's probably just being higher risk just being older. People who are immunocompromised for sure may not respond to vaccines effectively. That population really should consider themselves at risk, like they hadn't been vaccinated. People who are gathering with folks that are in this that have these conditions really should take very careful precautions to prevent themselves from getting infected.
What should families do if some children are not eligible to get COVID-19 vaccine?
In that situation, I think you adopt some of the things that we're talking about. Again, don't gather if you're sick, indoor mask, to the extent that you can social distance, these sorts of things. If you can adopt these things, then you're much less likely to expose the child and get the child sick. Unfortunately, kids can get pretty ill with COVID. This wasn't really what we were seeing at the beginning of the pandemic, but it is more common now. And so you want to protect those kids who can't get vaccinated yet.
Should people consider the location of the gathering when trying to keep everyone safe?
Unfortunately, because there's so much COVID, everywhere, I think you're sort of stuck saying, ‘assume everyone's at risk. Assume that during transit, they put themselves at risk for exposure, and infection acquisition.’ You wouldn't look at it as one part of the country is safer than another. I guess you could go to an area where there's less COVID, but you're probably just taking higher risk and infusing that into folks that you're encountering along the way and then at the end destination.
If there is debate within a family about whether they should include an unvaccinated member, how can a family potentially include this member but still ensure everyone's safety?!
Upfront, folks have to be real transparent about what their expectations are for unvaccinated people coming into their environment. What are they comfortable with? What can everybody sort of agree to? A way to do this would be to definitely get people on board with the idea that they're not gathering if they have any symptoms because any symptoms could really be COVID. That's number one.
Number two, if that person is unvaccinated at this point, you have to make a decision about including them or not. If you're going to include them, really doing the indoor masking should be your default position. You really should consider screening them, just like the CDC says, screening people who travel for COVID before they gather one, two, three days before they come into the environment. And then doing those things, right. Other folks who reduced their risk should probably also adopt indoor masking and some of these other things, too