BALTIMORE — The coronavirus pandemic continues, and in some parts of the country and world cases are rising again — not news anyone wants to hear as the holidays approach. But after more stringent advice last year to stay home, experts say the public is now armed with more information and defenses and might consider an extended gathering of family or friends.
More people are vaccinated, or like newly eligible younger children, might have at least one shot. Older or sicker people can get boosted. There is a bit more availability of home COVID-19 tests, though imperfect and costly as they can be.
Decisions on how large a group to gather and how far to go this year might come down to individual risk tolerance, said Dr. Kawsar Talaat, a vaccine researcher and associate professor in the department of international health at the Johns Hopkins Bloomberg School of Public Health in Baltimore.
Here is an edited and condensed interview with Talaat.
Q. The pandemic isn’t over, so even if everyone is vaccinated, are there any precautions needed to travel or dine with relatives or friends?
A. People have so much COVID fatigue at this point. I think we need to sort of weigh the risks and benefits. If everyone is vaccinated, I think having dinner together is fine. If you can eat outside that’s better. But as things get cold you may not want to and may not be comfortable. If somebody is at high risk you might not want to take them to a crowded restaurant.
The thing about the vaccine is we can be relatively assured we won’t get severely sick and should be able to do some normal activities, especially in areas where there is a low incidence of COVID.
Q. What if there are a couple of people not vaccinated, such as young children? Can they eat indoors, unmasked safely?
A. It becomes a very personal decision on the part of each family. How comfortable are they and what risks are they willing to take. And how long do we as a society keep up our extraordinary efforts?
For example, we went out to dinner and everyone but four children were not vaccinated. We ate outside. Occasionally we’ll go out with our now not-quite-vaccinated child and sit at a table far from others. It’s a risk we’re willing to take for a sense of normalcy, but others are not willing to take the risk, particularly if they have high risk individuals in their household.
Absolutely the size of gatherings matters or if people are coming from a lot of different areas.
I know they’re in short supply, but one thing you can do is have everyone tested when they get to where they’re going with rapid tests. They’re fairly accurate but not perfect. They’re an added layer to give you a sense of comfort. If somebody is sick or with some symptoms, you’ll definitely want that person tested and to stay away until the results come. You want to get that person a PCR test [not typically available as a home test].
Q. What about 5-11 year olds, newly eligible for vaccine? How much protection do they have a couple of weeks after one dose?
A. They absolutely have some. We don’t know how much because we don’t have that data yet, but they will have some protection. With adults there was a pretty good amount of protection, and our hope is we find a similar amount in children.
Q. Also, if you’re traveling, how long is OK to delay the second dose, slated for 21 days for the Pfizer-BioNTech vaccine just approved for younger kids?
A. You probably have a slightly better immune response if you delay. Your body has time for a memory response. It’s just easier to stay on schedule. And there is no recommendation to delay because there is just no data on such a recommendation, including the length of time to delay. I like to use data when I can. We just don’t know. And we do know one dose for adults is not enough.
Q. Should adults get a booster before the holidays?
A. Not everyone is eligible, but in Maryland no one asks you when you go get one. My perspective on boosters is that there is a benefit for individuals getting boosted, but the benefit is relatively small unless they are high risk individuals or they live with someone at high risk.
As a society, boosters aren’t the way to get out of the pandemic. It’s getting unvaccinated people their first doses. I fully recognize we’re not going to give our doses to Burkina Faso, where less than 1% of the population is vaccinated. But we really need to focus on that around the world and in this country.
Q. How protected are seniors, boosted or not, in a crowded house?
A. I completely agree seniors should get boosted. In people who are older — and we really don’t know the cut off but let’s generically say people 65 and older — the immune response is really good initially but later there is not as good a memory response as there is in younger people. As we age we’ve used up all of our ready-to-respond T-cells and have less ability to have a good memory response. I was all for my parents, in their 70s, getting them right when they qualified.
Q. Should everyone be tested before and after travel or family visits, and what’s the timing?
A. Since my child won’t be fully vaccinated, I’ll feel better at the house we’re staying in if everyone gets tested so we can walk around without masks. That’s assuming we can get enough tests for people who are there. I don’t know there is an ideal time to test. The way the test kits work is you’re supposed to do more than one over a few days for them to be accurate, but that ends up being expensive and maybe a waste of resources. But they take 10 minutes when you get there. You can isolate someone if they are positive.
Q. Do you expect a blip in COVID-19 cases after Thanksgiving and other holidays, and how bad might it be in a place such Maryland with a relatively high vaccination rate?
A. We’ve seen that in places with high levels of vaccination the surges are not as high. In place with lower rates, yes, I expect there will be a blip. We see Europe in its next wave and we’ve been trailing them in surges, so it’s already something to be worried about, especially in areas with lower vaccination rates.
Maryland is very patchy in terms of its vaccinations. Not sure I believe Montgomery County has vaccinated 99% of the residents with at least one dose, but there are counties maybe in the 90s and other counties where there are only 50% vaccinated. And people will be traveling all over the place.
Q. Should kids not fully vaccinated quarantine and be tested before returning to school after travel or visits?
A. I don’t think so. You really can get COVID anywhere. Everywhere you go they screen you and ask if you’ve left the country, but there is COVID in my neighborhood so what does it matter. But if anyone has symptoms, absolutely they should isolate and test before going back to school or work and interacting with people. If you’re fully vaccinated, I don’t think you need to quarantine.
Q. What else should people know ahead of the holidays?
A. The most important thing is if anyone has symptoms anytime make sure they are tested before interacting with others. Otherwise, there really isn’t a right answer for everyone in every situation. You have to take into account your own personal comfort level.
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