In 2019, my primary concern when booking holiday travel was: What’s the best day of the week to score a deal on plane tickets? In 2021, it’s … more complicated. Our calculations involve local vaccination and case rates, what kind of mask to wear on planes, and when to time our COVID tests.
We are, of course, trying to avoid getting COVID, though things will likely go OK, for us, if we do. My 3-year-old isn’t vaccinated, but the risks to him are very low. Everyone else in the family is vaccinated, and the risks posed by breakthrough infections are less certain but still low. The Centers for Disease Control and Prevention data from September reveals a vaccinated person has something like a 1 in 25,000 chance of being hospitalized due to COVID—with those odds much higher for the elderly and medically vulnerable and much lower for the young and healthy. For now, it appears that for many people breakthrough infections are real but weather-able. Yes, long COVID is still a concern, but there’s emerging evidence that vaccines could reduce the risk of developing the condition by up to half (though the science is far from settled).
I also will admit that “trying to avoid getting COVID” could be something of a lost cause: We will be at an airport with strangers during one of the busiest travel weeks of the year, and then in close contact with family. For the vaccinated and healthy who venture out into the world, like my partner and me, it may not be a matter of if we’ll get a breakthrough case, but when. The outbreak over the summer in Provincetown, Massachusetts, suggested breakthrough infections were more common than previously thought, meaning vaccinated people started reconsidering what they felt comfortable doing. But they also showed off how well the vaccines work at preventing bad outcomes. In the months since, you’ve probably heard stories about people in your circle who get COVID and have been sick but OK; maybe you’ve gotten it yourself. If this is your experience, maybe you just don’t feel viscerally that Thanksgiving is such a big risk. This feeling has certainly caught on among folks with microphones. Based on the relatively low risks posed by breakthroughs to most people, pundits are calling for relaxing precautions like classroom closures and indoor masking, and, more broadly, pleading for a return to “normal.”
Wouldn’t it be nice if we could just each decide when the pandemic is over for us, personally, and each make the calculation for ourselves? But it’s not so simple. There are many who can’t opt out of the pandemic in that way—and whose health is intrinsically linked to the rest of ours. I spoke to Chantelle Marcial, who lives with rheumatoid arthritis and is less protected by the vaccine compared with someone without the condition. Marcial understands the frustration many people feel living in an ongoing pandemic. But for her and the other millions of immunocompromised people, a breakthrough case isn’t a nuisance—it’s a potentially serious concern. “There’s a distinct loss of the idea of community happening, and people doing things for the sake of community, as opposed to the sake of themselves,” Marcial said. The broader community includes the health care workers who could spend January tending to holiday revelers in the ICU. “I don’t think any nurse who has taken care of COVID patients for any prolonged period of time—at least in my organization—I don’t sense from any of them that they think that this is over,” Joseph Falise, an ICU nurse manager at the University of Miami Hospital and a board member at the American Association of Critical-Care Nurses, told me.
What you do on Thanksgiving, and after, can still affect those more vulnerable groups. “People should know that gathering inside with groups, even if you know everyone, is still high risk,” Julia Raifman, a professor of health law, policy, and management at Boston University School of Public Health, told me—even if everyone is vaccinated. If a vaccinated person brings the virus to Thanksgiving, they do have a decent chance of transmitting it to others, given the close quarters of intimate holiday gatherings. In these settings, the effectiveness at preventing transmission—even to other vaccinated people—could be as low as 34 percent (thanks, delta). And then people involved in the gathering will go back to their friend groups, child care setups, and workplaces, potentially spreading the virus further. What this means is that widespread holiday gatherings, even among vaccinated families, will contribute to winter caseloads and—this is the part that really matters—put vulnerable populations in danger.
This is scary and frustrating. And maybe these facts have put you in the camp of people who think it is simply wild that much of the country is heading to holiday gatherings as if the pandemic is over. Maybe these facts have made you personally very fearful of getting COVID, not because of your health, but because of what contracting COVID means for the larger project of stopping the pandemic, or because of what “getting COVID” means to you, emotionally. But I don’t think it means that the healthy and vaccinated need to be huddling in their homes in fear or even that worried and anxious, per se, about catching COVID (which can be distinct from “catching COVID, then spreading it”). What it means is embracing the toolkit and knowledge we have to manage COVID risks—both to ourselves and others—while still living life. Social isolation, after all, comes with real mental health consequences and, for society, economic costs.
It is possible, thanks to vaccines, rapid testing, and high-quality masks, to gather for the holidays relatively safely and fairly responsibly. (It is also possible to bemoan the patchwork of imperfect policies that make these individual decisions so difficult and tricky. Imagine if home rapid tests were free!) We should assume that we are going to get COVID at some point, and that our loved ones are going to get COVID at some point—by acknowledging this reality, we can use our tools most effectively. Once you’re infected, it’s possible to find out quickly and take actions that dramatically reduce the number of people you may spread the virus to.
COVID is not a risk we should live with by trying to tuck it out of our minds, the way we do with so many dangers of modern life. People often compare the risks of COVID to the risks of driving. “You look at automobile accidents, which are far greater than any numbers we’re talking about,” then-President Donald Trump said in March 2020. “That doesn’t mean we’re going to tell everybody no more driving of cars. So we have to do things to get our country open.” There’s a way in which this analogy is correct. Driving is risky, and many of us do it every day. But comparing the risk of COVID today to the risk of driving today isn’t quite correct. Driving used to be far, far more dangerous than it is currently. In the 1960s, before regulation, 140 people died per day from automobile crashes, and people recognized it was an issue. America was becoming increasingly motorized, and cities and lives were organized around the car. In a loose sense, driving became “endemic,” the way COVID will be … eventually.
When it came to road safety, we didn’t throw up our hands and accept these high risks. Nor did we give up on driving altogether. Instead, we found a middle ground. We designed safer roads. We manufactured safer cars. We mandated seat belts. (And, yes, in the meantime, we drove.) In America, these technical innovations and regulatory measures reduced per capita driving deaths by half—and worldwide have saved millions of lives. The same can be true with COVID. Instead of engineering innovations, we have biomedical innovations—vaccines, antivirals, monoclonal antibodies. Instead of road design, we have building design—better ventilation. Instead of seat belts, we have masks. One thing that is not a useful tool here is excessive worry about getting COVID or a sense of shame if you do: Precautions don’t work any better if you are anxious.
It’s also worth noting that “enough” precautions is slightly subjective and situation-dependent. Risk reduction this holiday season might look a little different for everyone. It might make sense to reduce the number of people at your holiday gathering, or limit it to the vaccinated, but not cancel it. It might mean eating outdoors if weather permits, or cracking the windows. It might mean using rapid tests before gathering if you can find them (and afford them). It might mean reducing your own exposure and getting PCR-tested before and after travel. It might mean upgrading to a better mask for traveling—and encouraging others to do so as well. Reasonable people can disagree about what precautions work best for them, but if we’re all giving it thought and effort, that will help a lot. And remember that attending gatherings with some guardrails doesn’t preclude advocating for better policies or donating or volunteering with organizations that reach out to those who have not been vaccinated but may want to be—including lower-income families, the food and housing insecure, and people with disabilities.
It is impossible to create a bulletproof plan against COVID. That is fine. But that also doesn’t mean you should act as if it’s 2019. Realizing that risk reduction is possible should prompt you to take precautions when you return to your community after the festivities, as well as have a plan as to how your family will isolate if one of you tests positive. The point isn’t to try to get this perfect on our own. The point is for each of us to do what we possibly can, and then, to let go.