For each of the past two years, Thanksgiving heralded the start of a spike in COVID-19. A third pandemic winter finds the US with more tools to fight back coronavirus – an updated booster, multiple home tests, a helpful antiviral drug – and many previous restrictions are being washed away as people return to public and social settings.
That may leave some wondering how to navigate a time in a pandemic where precautions are largely up to the individual. With the coming of the holidays and the numbers of COVID show signs of adhesion again – although not at previous levels of growth so far – what are currently the best practices for staying healthy? How much care is needed?
“I think it’s become much more of an individual judgment call,” said Dr. Bob Wachter, chief medical officer at UCSF. “So I rarely tell people what to do, except for things that make no sense to me not to do, like getting a booster if you haven’t had one in over six months.”
Instead, Wachter said he will often share with people the strategies he and his family are pursuing. That includes being up-to-date on COVID-19 vaccines and wearing a KN95 mask in crowded settings, he said. it I’m not eating indoors in restaurants now, and his 12-person Thanksgiving gathering took place mostly outdoors with attendees taking rapid antigen tests beforehand.
“That to me is a reasonably careful, moderately careful way of living life that’s not that heavy,” Wachter said. “But I certainly know perfectly reasonable people who are doing less than that and have simply decided they’re willing to take the risk.”
People’s practices should consider their own health status as well as that of the people they live with or interact with frequently, experts said. Older adults and people who are immunocompromised or have underlying medical conditions are at higher risk for severe outcomes from the virus.
“I would recommend continued masking for people at high risk,” said Dr. Warner Greene, senior fellow at the Gladstone Institute. For everyone, tracking local coronavirus trends can help inform decisions, he said.
“If your community is in the middle of a lot of growth, you’d want to be more protective,” Greene said. “If you’re in a low virus area, you can probably get away with less intervention. That said, any time you’re in a crowded place, especially indoors, you’re putting yourself at risk, even if the viral load in the region is low.”
In California, mask mandates were lifted months ago for all but a few settings. Health officials, however, continue to cite wearing a mask indoors in public, staying home if you’re sick, testing for symptoms and good ventilation among steps to take to protect yourself from the virus.
Infectious disease specialist at Stanford, Dr. Abraar Karan said he sees sense in masking, “even if you can’t do it all the time, in high-risk environments and at times when there’s more community transmission.” He defined “high risk” as crowded indoor spaces, such as grocery stores, or environments where you may not be able to distance yourself from a person with symptoms.
“I’ve seen some arguments from people who have said, ‘What’s the point of wearing a mask with COVID? It’s so transmissible that if you don’t get infected now, you will get infected later,’” Karan said.
“I don’t think that makes sense. We don’t use that logic to stop washing our hands or cleaning our food. What you’re doing is reducing your risk of getting sick, and I think that’s a very reasonable thing to do.”
Health experts have expressed cautious optimism that any U.S. winter outbreaks will not be as bad as the last two. True, newer subvariants of omicron in circulation seem to be more immune-evasive. But waves of BQ.1.1 cases in New York and XBB cases in Singapore have not led to large increases in hospitalizations.
California is certainly seeing its metrics increase. On Tuesday, the state reported 3,532 confirmed COVID-19 patients in hospitals, 125% more than a month ago. That included 613 patients in Bay Area hospitals, the first time since August the number reached 600.
The state last week also reported a positive test rate of 7.6%, up from 4.2% a month earlier, and its rate of 10.6 new daily cases per 100,000 residents marked a 63% increase over that time. The infection carries the risk of long-term development of COVID. And the increase comes amid increases in flu and RSV already pediatric hospital testing in regions including the Bay Area.
“We’re seeing significant increases right now across the Bay Area in all three of these viruses,” said Dr. Matt Willis, Marin County health officer. “Each one is slightly different in terms of the measures we can take to protect ourselves, but they all have one tool in common, and that’s a face covering.”
Willis said Marin County as of Tuesday had almost as many hospitalized patients for the flu as for COVID-19. “We’re recommending that people, especially if you’re at high risk for a bad outcome if you get infected, take that measure to cover their face with a high-quality mask in a public indoor setting,” he said. .
If you’re gathering with family or friends, especially those at risk for serious illness, Willis suggested wearing a “vigilant” mask for four or five days beforehand “helps make sure you’re not contagious during that gathering.” He also suggested everyone in attendance take a quick antigen test before such gatherings.
“I think it’s pretty clear that we need, for our mental health and well-being and relationships, to come together during the holidays,” Willis said. “So this is really about making sure we can be with our loved ones as safely as possible.”
The California Department of Public Health requires masking, regardless of vaccination status, in health care, long-term care, and adult and senior care settings for 10 days after confirmed exposure to the virus, and in businesses or locations that require them. . Otherwise, the guidance is based on Community levels of COVID-19 reported by the US Centers for Disease Control and Prevention.
At the “Low” level, which currently includes all Bay Area counties and most of the state, CDPH guidance says that masking comes down to personal preference while people at higher risk should consider masking in public places crowded with people. Los Angeles County was also at the “Low” level on Tuesday, but health officials there resumed the “strong recommendation” of wearing indoor masks in public this month, citing rising COVID rates.
A well-fitting N95 or KN95 mask can be a “very powerful public health tool” to combat the transmission of the respiratory virus, said Dr. John Swartzberg, an infectious disease expert at UC Berkeley who also acknowledged that mask messages are likely to be met with near-fatigue. three years after the pandemic.
Another dilemma during the colder months can be whether you should dine inside a restaurant. Swartzberg said the decision should weigh both a “personal calculation” of one’s risk factors (age, health) and a “public health calculation,” including, for example, not doing something if someone has symptoms of respiratory virus.
“I think most people would predict we’re going to see an increase in cases this winter,” Swartzberg said. “The question we all have is how much is an increase? And (there’s) no way to answered this.”
Chronicle staff writer Aidin Vaziri contributed to this report.
Matt Kawahara is a staff writer for the San Francisco Chronicle. Email: mkawahara@sfchronicle.com. Twitter: @matthewkawahara
