COVID update and safer holiday tips
Multilayered precautions help prevent uninvited viral guests this holiday season and beyond
With the holiday season well underway, here is an update on the current COVID situation as well as tips for making your holidays and winter safer using multilayered precautions.
CDC wastewater map shows ongoing viral spread
Ongoing COVID viral spread is apparent in the CDC’s latest wastewater map, with high or very high levels across almost two thirds of states and territories in the US. Out of 54 total states and territories, 35 showed high or very high COVID wastewater levels as of 12/9/2023. It’s clear that multilayered COVID precautions are warranted.
Wastewater surveillance is a useful tool, but it also has its limitations. If you are living in a state with low or minimal wastewater levels (or insufficient data), do not take the comparatively lower levels as a reassurance of safety. We do not know what these levels translate to as far as the risk in our daily lives, and viruses do not respect state (or national) boundaries. Variability in sampling, number of testing sites, and other factors mean that data may not necessarily be comparable between different locations.
Local wastewater dashboards may give you a more detailed view of the situation in your area, or in areas you may be visiting. An example from Wisconsin is shown below.
On 12/14/2023, the CDC issued an alert reporting increased respiratory disease activity for winter 2023-2024, including increases in COVID, RSV, and influenza rates. The CDC’s alert encourages increased vaccination and use of FDA-approved treatment options. I strongly recommend up-to-date vaccination for everyone who is eligible, as well as use of treatment options (Paxlovid is discussed below). Despite their effectiveness, vaccination and treatment still cannot guarantee a mild illness or a full recovery from COVID. We must prevent COVID spread through multilayered precautions, including masking, testing, ventilation/filtration, and physical distancing.
COVID continues to pose a significant threat to both individual health and public health, with COVID being the 4th leading cause of death in 2022, behind only heart disease, cancer, and unintentional injury. It is now well-proven across multiple studies that COVID causes damage to many organs throughout the body and causes Long COVID.1 As you continue or restart multilayered precautions to avoid COVID this winter, know that you are well-supported by scientific evidence.
Safer gatherings
Whenever people gather, there is a risk of COVID transmission. Taking multilayered precautions can drastically reduce the risk. The more precautions everyone at the gathering can collectively take, the better. One-way masking is better than not masking at all, but universal masking, improving indoor air quality with ventilation and filtration, and other group actions will have an even greater impact in reducing the risk. No one wants their holiday gathering to become a super spreader event!
It is always OK to decline an invitation to a social event if it doesn’t seem safe. Healthy relationships are built on mutual care and respect for each other’s boundaries.
Virtual options are a win-win
The safest option, which I personally use regularly, is virtual options for meetings and gatherings. Whether we use them for daily casual conversations or larger celebrations, virtual options are a fulfilling way to keep in touch with loved ones without the risk of spreading COVID. Remote options ranging from snail mail to phone calls and video calls also help us stay connected across long distances. Virtual options can expand our social connections beyond the people we might see in person in our daily lives.
Take precautions for holiday travel
If you choose to travel, wear a well-fitting mask (N95-equivalent or better) throughout your travel, including on planes, buses, trains and in airports or other transportation hubs.
If you need to remove your mask to eat or drink, try to do so in a safer spot such as outdoors or away from people, and minimize your time unmasked if there is shared air. Just in case, bring extra masks, as well as COVID tests and other basic hygiene supplies such as hand sanitizer.
Prepare as best you can for the possibility of delays and cancellations. If possible, plan your trip so you might have safer options for meals and sleeping arrangements. When you return home, additional precautions (from masking up to quarantine) are worth considering around any household members who didn’t travel.
Multilayered precautions day-to-day
Holiday shopping and even routine activities like grocery shopping pose extra risks this winter. When possible, use shipping, curbside pickup, or delivery options to reduce exposure. If you must go inside a store, keep trips short and wear a well-fitting mask.
Workplaces also present increased hazards as workers may not be provided appropriate paid sick time to stay home when ill. Masking, using portable HEPA air purifiers, and using work-from-home options when available can help reduce your risk.
Treatment options
If, despite your best efforts, you develop a COVID infection, Paxlovid is recommended as COVID treatment to prevent severe disease. As an added bonus, Paxlovid also reduces the risk of developing Long COVID by about 26%.2 Most Americans (75%) have an underlying condition that places them at higher risk for severe COVID, which should qualify them for Paxlovid prescription after consultation with a healthcare provider.3 These conditions include diabetes, high blood pressure, being overweight, pregnancy, anxiety, and depression, among many others.
Test-to-treat options are available, although they vary by state/location. There is a free Home Test-to-Treat program for patients who are uninsured, rely on Medicare, Medicaid, or VA insurance, or receive care from Indian Health Services. In Wisconsin, the telehealth option for COVID treatment was extended and continues to be available through April 10, 2024. Pricing and insurance coverage for Paxlovid will be changing as it transitions from the government supply to the commercial market in December 2023.
Avoid unproven methods
Here are just a few of the things I do not recommend for COVID treatment or prevention: nasal sprays, mouth washes, eye drops, or supplements. So far, none of these have been well-proven to be safe and effective for COVID treatment or prevention, and none are approved by the FDA. Although some of these approaches seem innocuous enough at first glance, they can cause harm and may cause a false sense of security. Be vary wary of claims made about over-the-counter products or products that can only be purchased from international pharmacies. Counterfeit and adulterated products are also a concern; unfortunately, supplements and over-the-counter remedies are not tightly regulated in the US. Large-scale clinical trials are needed to show that any drug or supplement is both safe and effective. Regardless, there is no substitute for proven layers of protection. There is much more to say on the topic of unproven methods, but I hope this helps for now.
Happy Holidays!
I hope all of you have a happy and safe holiday season. 😷🎉
Xie Y, Choi T, Al-Aly Z. Long-term outcomes following hospital admission for COVID-19 versus seasonal influenza: a cohort study. The Lancet Infectious Diseases. 2023;0(0). doi:10.1016/S1473-3099(23)00684-9
Bowe B, Xie Y, Al-Aly Z. Postacute sequelae of COVID-19 at 2 years. Nat Med. 2023;29(9):2347-2357. doi:10.1038/s41591-023-02521-2
Thaweethai T, Jolley SE, Karlson EW, et al. Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection. JAMA. Published online May 25, 2023. doi:10.1001/jama.2023.8823
Xie Y, Choi T, Al-Aly Z. Association of Treatment With Nirmatrelvir and the Risk of Post-COVID-19 Condition. JAMA Intern Med. 2023;183(6):554-564. doi:10.1001/jamainternmed.2023.0743
Ajufo E, Rao S, Navar AM, Pandey A, Ayers CR, Khera A. U.S. population at increased risk of severe illness from COVID-19. Am J Prev Cardiol. 2021;6:100156. doi:10.1016/j.ajpc.2021.100156