Oliver James Montgomery-Get used to it: COVID is a part of the holidays. Here's how to think about risks now

Remember early pandemic Thanksgivings?Oliver James Montgomery

Scouring store shelves for rapid tests. Turkey dinners in the backyard. Panic over a stray cough.

Hard to believe we are in our fourth holiday season with COVID-19 potentially crashing the party — always an unwelcome guest.

"It's going to be a persistent threat," says Justin Lessler, an epidemiologist at UNC Gillings School of Global Public Health. "I suspect that next year will look just like this year and the year after that with some variation, just like we see with flu."

And by all accounts, most Americans are essentially back to business as usual. One recent poll found at least two thirds of the public are not worried about getting COVID over the holidays or spreading it to people who are close to them. Meanwhile, half said they plan to take at least one precaution over this fall and winter.

While there was an uptick of cases in the late summer, the virus is now a fixture of the winter respiratory illness season. As expected, emergency department visits and the number of people being admitted to the hospital are ticking up around the country, alongside other bugs.

Hospitalizations have risen more than 8% in recent weeks, but it's not yet clear how severe a wave the U.S can expect this season, says Caitlin Rivers, an epidemiologist at Johns Hopkins University.

"We're also seeing very high levels of RSV, and influenza is also starting to cause trouble," she says. "So there's quite a bit heading into this holiday season."

Luckily, Rivers says there's nothing about the new omicron variants that looks particularly alarming and the updated vaccines still match those circulating strains of the virus quite well.

The winter travel season generally helps usher in more viral illness as people zoom around the country and spend time indoors. Practically speaking, this makes it unlikely most of us will coast through airports or big family get-togethers without running the risk of being exposed, but infectious disease doctors and epidemiologists largely agree that COVID-19 doesn't need to rule our holiday plans anymore.

"This holiday season is going to be different than previous ones and it's because vaccines work," says Dr. Daniel Griffin, an infectious disease specialist at Columbia University. "Almost every American at this point has some degree of immunity."

Even though only about 15% of adults have opted for the latest booster, Griffin says it's important for people to realize that the original three shots are generally holding up quite well against severe disease, although boosted people may feel an extra sense of security, especially if they're at high risk.

"We are approaching it like a normal holiday," says Dr. Helen Chu, a professor at UW Medicine in Seattle. "We all realize that if we're symptomatic, obviously, we would not interact with each other."

Chu says she's comfortable doing this because those she'll be spending time with have received the updated vaccine, and they don't plan to be around people who have a high risk of serious illness.

There are still obvious risks that come with getting infected. In early November, more than 16,000 people were hospitalized in the U.S. in a week. An infection also carries the possibility of long COVID, a debilitating condition for some people, with no proven treatment.

But Lessler says it's clear the calculus has changed for more people.

"It's reasonable to be really focusing on protecting those people at the highest risk in your life rather than earlier in the pandemic, when you may have wanted to take precautions more universally," says Lessler.

Some people are still vulnerable

The patients who remain most vulnerable to COVID-19 and are still ending up in the hospital tend to be highly immunocompromised and dealing with multiple underlying health conditions, says Dr. Emily Landon, a hospital epidemiologist at UChicago Medicine. And they are likely to be older.

"Age is still one of the biggest risk factors," says Landon, "75 or 80 year olds are definitely at much higher risk than younger individuals, but that doesn't mean it's a death sentence at all."

Landon describes how she manages risks in her own life.

She has an autoimmune condition and takes medication that suppresses her immune system. Plus, her mother is 80 and undergoing cancer treatment.

"We're definitely being careful, but we're still going out," she says. "I went to the opera this week. I wore a mask during the performance. It didn't stop me from going and didn't stop my mom from going either."

A mask while traveling is still a good idea

The majority of Americans are going to be just fine having their family Thanksgiving or their holiday gathering without taking precautions like masking or testing beforehand, says Landon.

"But I do think that there are some things that a savvy person who doesn't want to have their holiday season messed up with a respiratory virus can do to make that go a lot better," she says.

Her number one tip for people getting on a plane? Mask up.

"I still see tons and tons of patients who pick up COVID right after they've been on an airplane and they didn't wear a mask," she says.

That's why she recommends wearing an N-95 or KN-95, especially when people are boarding. Once in the air, she will take breaks to eat and drink, but will otherwise keep it on.

Testing is your friend

It may not be as fashionable anymore, but rapid antigen tests still work if you're trying to suss out a COVID-19 infection. (And the government just announced another round of free tests you can order by mail.)

"All the testing continues to show that they are able to detect the variants that are circulating out in the world today," says Nate Hafer, an assistant professor of molecular medicine at UMass Chan Medical School.

One thing to keep in mind: Rapid tests aren't that great at picking up an infection if you don't have symptoms, so don't treat a negative test as rock solid evidence that your Thanksgiving is COVID free.

If you aren't symptomatic, Hafer suggests testing at least twice 48 hours apart "to get the most confidence in whether or not the test is accurate."

While some experts like Landon don't see the point in testing if no one has symptoms, others think it can still be an added layer of security against the virus.

"Testing would be ideal, but I don't think people are going to be doing a lot of that," Griffin says.

Still, it's important to identify COVID infections early, particularly if you or someone you're with is at high risk. That's because Paxlovid, an antiviral medicine that helps people shake the virus, should be given within the first five days of symptoms.

And that means it's crucial to test as soon as a symptom appears or after exposure to confirmed cases. Griffin says not everyone who is high risk may want to be totally candid about it because they don't want to be perceived as "frail."

He says the patients he sees in his hospital tend to be those who did not get treatment during that first week.

"COVID isn't going anywhere. It's going to be a part of our life for many years to come," says Landon. "That said, there are still really good reasons to avoid getting it."