My older brother and his wife would love to fly to visit their son and his family in Florida over Christmas. They have been vaccinated against COVID and had their boosters, as has their son. However, two members of his family have refused to get shots.
My sister-in-law has chronic health problems. My brother and his wife desperately want to see their family after a COVID-enforced absence of 18 months because they know the winds of time are blowing at their backs.
Is it safe for them to travel and gather for the holidays? This is a dilemma for many of us over the next several weeks, perhaps even for the next several years, as we adapt to the new COVID landscape.
Because of my medical background, I have been involved in many intense family discussions.
Some answers are easy: check out the CDC website, cdc.gov/coronavirus. It is updated regularly, is evidence based and has focused advice about travel and gatherings. It reviews the standard recommendations that we should now all know by heart: get vaccinated and get a booster, wear masks (N95 are now available and still preferable to cloth), practice social distancing and be aware of how widely the virus is circulating where you are or where you intend to go. There are even answers to questions you didn’t think to ask.
This knowledge informs us but is useful only as it helps us to plan our social lives. For my family the personal issues are complex, an emotionally loaded three-dimensional chess game. Each of us is balancing ever-changing data with our love of family, vulnerability to COVID and tolerance of risk.
The latter, our tolerance of risk, helps to determine how we respond to COVID. Some of us are comfortable taking risks and living on the edge; some are very cautious. A great deal has been written about how individuals deal with risk but theory recedes into the background when confronted with our personal expectations about this particular Christmas.
So, my family is learning about COVID and taking the following into account:
Associated diseases matter. Diabetes, lung and heart disease, active cancers and immunosuppression put you at greater risk. The question is, “how much risk?” And to that there is no easy answer.
My sister-in-law is robust in spirit but significantly handicapped. She is knowledgeable and devours medical information but only she can balance the risk of infection against her desire to hug her grandson.
Vaccination status is important. According to various authorities, the unvaccinated are 10 to 15 times more likely to transmit the virus than the vaccinated, but even the vaccinated can still transmit COVID. New variants such as omicron challenge us. What are the habits of the unvaccinated people with whom you may be in contact? Casual or careful? Scoffing or respectful? Are they willing to wear masks?
What is the prevalence of COVID where you will be visiting? Are hospitals overwhelmed, suggesting that there are many unvaccinated residents and transmission is more likely? Will you travel through big airports with frequently canceled flights or stop at only a few lonely gas stations? If you are coming from an area with a high level of transmission, could you unknowingly bring COVID to the community you are visiting?
Testing may help limit risk, but only if you understand how it works. COVID infections start with a small number of viruses, which then multiply exponentially. Early testing is not always accurate. The man who coughed this morning in the airport or the niece who hugged you as you arrived (but was exposed to an infected 5-year-old yesterday) may have infected you despite his negative test 72 hours ago.
There are two kinds of tests now available, one quick and reasonably accurate, and the other slower and very accurate.
Rapid (antigen) tests can give you an answer in 10 minutes, but you need to interpret positive and negative results correctly.
If the result is negative, the tests are 95 percent accurate and can tell you that you do not have COVID — but only if they are done 24 to 36 hours after your exposure. If you were exposed only a few hours ago, it is possible that the virus has not had enough time to multiply and turn the test positive.
If the result is positive, the tests are 80 to 85 percent accurate. The reason that these percentages are not higher is that the test may be detecting similar viruses or other particles, not necessarily COVID. Positive tests are generally confirmed with a more accurate PCR test that’s considered the gold standard for test accuracy.
There are many companies that make rapid tests — for example BinaxNOW, DxTerity, Amazon, and more. They are available for free at most testing sites and cost $10-$20 each if you want to test yourself at home.
Currently test kits are in short supply and back-ordered at local pharmacies and online. Plan ahead. If you want to celebrate together it is reasonable to insist that everyone get a rapid test. Notwithstanding, risk is always there.
The more accurate PCR tests take 24-72 hours to return results. If positive, they mean that you have COVID or have had it within the last 30-60 days. They are performed in special labs taking advantage of rather remarkable technology that was developed 40 years ago when I was in medical school. There are few false positives or false negatives.
Much about COVID is beyond our control.
My brother and his wife are weighing their options. None are ideal. They want to go to Florida. They want many more Christmases. Will next year be better? Who knows?
At this point COVID is another name for uncertainty, and each of us must weigh risks carefully.