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COVID-19 and the upcoming holidays

Thanksgiving is in five days. Hanukkah in 8. Christmas in 35. And the pandemic landscape continues to rapidly change. More likely than not there will be a mix of people attending your holiday celebration: family members that are ineligible (0-4 year olds), partially vaccinated (5-11 year olds), vaccinated but not protected (immunocompromised), or just plain unvaccinated (22% of 12+ year olds are still unvaccinated in the United States).

The CDC released their guidelines for a safe holiday season two weeks ago. Unsurprisingly, the guidance is vague and does not address many situations we find ourselves in this year. So, I put together my thoughts…

Everyone is fully vaccinated

If everyone, and I mean everyone, is fully vaccinated then I would approach the celebration like we did before the pandemic. No restrictions. Vaccinations are, by far, the best protection we could ever ask for. We need to start trusting them.

Fully vaccinated means:

• 2 weeks after second dose in a 2-dose series, such as Pfizer or Moderna

• 2 weeks after Johnson & Johnson vaccine

The definition of “fully vaccinated” does not change for boosters. So, if you have two doses of Moderna/Pfizer or 1 dose of J&J you are still considered fully vaccinated. But, among those that should get the booster (65+ and long term care residents), I would strongly suggest one before the holidays.

I would not consider immunocompromised fully protected even if they’ve received the recommended doses. A layered approach to the holiday celebration is best (see below).

Partially vaccinated

There will be quite a few people in-between doses during the holidays. If a 5 year old was vaccinated this weekend, for example, they would not be fully protected come Thanksgiving. There’s just not enough time.

So, what’s the efficacy of one dose? For 5-11 year olds we don’t really know. This wasn’t technically reported in the clinical trials. We can extrapolate from the data, but I would be cautious in doing this. The trial wasn’t designed to answer this question and, because of this, we don’t have confidence in this number. In the adult trials, efficacy after the first dose was ~85%. But this was pre-Delta; and we know Delta has changed the game. Kids probably mount partial protection like adults, but we don’t know the number.

How you celebrate and prepare for the holidays in this gray area is dependent on risk tolerance, who is attending the holiday celebration, and where you are physically located. For example,

• If everyone is fully vaccinated except the partially vaccinated child, this is a very safe situation and a layered approach may not be necessary.

• If your celebration is in a county of “high” or “substantial” transmission and unvaccinated adults are attending, this could be a more risky situation for the partially vaccinated child. I would go with a layered approach.

Other populations, like pregnant people, may also happen to be partially vaccinated during a holiday celebration. A recent study found that pregnant people mount a suboptimal response after the first dose. The second dose is crucial. So a layered approach to the holidays, in this situation, is best.

(To be continued- next week we’ll see what it means to use a “layered approach.)

Dr. Katelyn Jetelina has a Masters in Public Health and PhD in Epidemiology and Biostatistics. During the day she has her own research lab and teaches graduate and medical students. In her “free” time, she writes the blog, Your Local Epidemiologist, to “close the communication loop” between science and the public with 100% data-driven posts backed by the most recent scientific evidence. https://yourlocalepidemiologist.substack.com/

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