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A person with rheumatic disease, as indicated by pain spots on their hands, holding a piece of paper that reads "Save the Date. John and Mary. SAT Aug 28."
Credit: Tatiana Ayazo

Weddings during the pandemic did not look like weddings of years past. Some were held in backyards, attended by only immediate (masked) family members. Others were held virtually, allowing loved ones from near and far to partake in the big day. Many were postponed to a to-be-determined date. 

But as the world reopens and all those postponed ceremonies have been rescheduled, you may be wondering how safe it is to attend a wedding if you’re fully vaccinated but immunocompromised. This can lead to difficult decisions, as 2022 is predicted to be the biggest wedding year since 1984 (with some 2.5 million weddings), per The New York Times

The U.S. Centers for Disease Control & Prevention (CDC) considers large weddings to be “large gatherings” like conferences, trade shows, sporting events, and concerts. Large gatherings bring many people from multiple households together and can sometimes involve long-distance travel — and increase your chance of being exposed to COVID-19. 

There isn’t enough data yet on how well-protected immunocompromised, vaccinated individuals are from COVID-19. Experts still recommend that most people who take immunosuppressant medications, such as those for inflammatory or autoimmune conditions, get the vaccine. But people may need to be more cautious about continuing to reduce their exposure to COVID-19 — such as by wearing face masks — even after they’re vaccinated.

“If you are immunocompromised, you obviously have to be a little more cautious than the people who are not,” says Stuart D. Kaplan, MD, Chief of Rheumatology at Mount Sinai South Nassau in Oceanside, New York and a partner in practice at Rheumatology Consultants, LLP.

In general, here are a few things the CDC recommends thinking about when planning activities like attending weddings:

  • The number of COVID-19 cases and vaccinated people in your community or the community you are visiting. You can use the CDC’s COVID Data Tracker to determine this. If you or a family member are at high risk for severe illness, you should wear a mask or respirator with greater protection in public indoor spaces if you are in an area with a high COVID-19 Community Level, per the CDC.
  • The local and business laws, rules, and regulations
  • Where you are going. Staying outdoors or being in a space with good ventilation can help prevent you from getting and spreading COVID-19.
  • Who will be with you. Make sure everyone in your family aged 5 years and older gets vaccinated against COVID-19. 

Some immunosuppressive medications may affect your immune response to the vaccine. For instance, one small study in the Annals of the Rheumatic Diseases found that only 62 percent of patients with immune-mediated inflammatory diseases (IMID) on methotrexate achieved an adequate response to the second dose of the Pfizer COVID-19 vaccine, compared to more than 90 percent of healthy individuals or IMID patients on other medications like TNF inhibitors. 

Researchers are currently studying how various medications and medical conditions affect the body’s response to the vaccine. (Read more about what research has to say about COVID-19 vaccines in rheumatic disease patients.) 

Until precise lab tests that can determine correlative protection are available, people who are immunocompromised need to be cautious even though they are fully vaccinated, says infectious disease specialist John Swartzberg, MD, Clinical Professor Emeritus at the UC Berkeley School of Public Health in the Infectious Diseases & Vaccinology Division. Correlative protection means a simple blood test measuring antibodies could tell you how protected you are.

“The most important thing to recognize is that if you’re immunocompromised, we’re not as secure in our knowledge about how protected you are from being vaccinated,” says Dr. Swartzberg. “We know that for a lot of people who are immunocompromised, they are well-protected by being vaccinated — but for others, they may not be.”

That may make it difficult to decide when to celebrate special events with your loved ones. Weddings are tricky because they’re such a milestone event. Of course, you want to celebrate your loved ones and are looking forward to reuniting with family and friends. But you’re right to be concerned about spending time in a large crowd, especially if the wedding will be held indoors.

If you’re immunocompromised, here are four questions to ask yourself if you receive a wedding invitation this year and are debating whether or not it’s safe for you to attend, or how to best protect yourself if you want to go.

How Large Will the Wedding Be?

There’s no “right” number or threshold that will determine if an event like a wedding is safe or not — but naturally, the larger the wedding, the greater the risk will be.

“If you’re going to have 500 people in a closed space, that’s asking for trouble,” says Dr. Kaplan. “If you’re talking about 50 people spread outside in a backyard, it’s probably less risky.”

In addition to asking the hosts how large the wedding will be, ask if guests will be expected to be vaccinated (or otherwise wear masks). Some venues may even require guests to show proof of vaccination, though this is now less common than it was a year ago.

“I would feel more comfortable today going to a wedding if I knew that everybody was up-to-date with their vaccinations,” says Dr. Swartzberg. “But that wouldn’t provide a lot of comfort, particularly if it was indoors. If I was immunocompromised, I would not go to an indoor wedding.”  

Dr. Swartzberg adds that he would feel more comfortable attending an outdoor wedding where he could wear a mask the entire time, and others could as well — more on that and other mitigation efforts, below. 

Will I Be Able to Follow Standard Mitigation Efforts?

If you do attend a wedding, you’ll lower your risk if you continue to follow the standard mitigation efforts that are known to lower the risk of COVID-19 transmission: Wear a mask (consider a highly protective mask like an N95 mask), stay at least six feet away from people who don’t live with you, and avoid crowds and indoor spaces that are poorly ventilated.

“You can’t be assured of protection from other people who are infected, but you can still protect yourself,” says Dr. Swartzberg. “Important things would be masking and social distancing, but at gatherings that may not work very well.”

It’s also worth considering what has changed between this year and last year: Just because we’re now a year further into the pandemic, it doesn’t necessarily mean your risk is lower than it was when wedding invitations were sent out in the early summer of 2021.

“Last June, the case numbers were the lowest we’ve seen since the beginning of the pandemic, but July ushered in the beginning of Delta and that ushered in the beginning of Omicron,” says Dr. Swartzberg. “What’s different between now and the summer of 2021 is that now there is a tremendous amount of virus circulating.”

This year, there are also fewer mitigation efforts being taken by establishments themselves. 

“Most of the restrictions have been eased in restaurants and catering companies,” says Dr. Kaplan. “Most restrictions have also been lifted in terms of the maximum number of people that can be at events, which I think is a little bit on the dangerous side. As we know, COVID is not gone and there are still people who get severe cases.”

Plus, we now know that vaccines may not give long-lived protection in preventing infection against new variants, even though they are still very effective for preventing hospitalization and death if you do get infected.

“You can be asymptomatically infected and spread the virus, or you can be symptomatically infected and spread the virus if you’re fully vaccinated and boosted,” says Dr. Swartzberg. “So that’s something that has major implications for wedding safety.”

That said, getting fully vaccinated (including any recommended additional doses or boosters)  is still the biggest mitigation effort against COVID-19 that you can take. Talk to your doctor for their opinion on how much of an immune response you may have garnered from the vaccine, and if they recommend you avoid gatherings for the time being. Keep in mind there’s no way to know for sure what kind of response you had to the vaccine (antibody testing is not recommended), but your doctor may be able to provide some guidance based on the medications you take and your overall risk factors for COVID-19.

Also ask the hosts how practical it will be to follow standard mitigation efforts. For example, an outdoor wedding in an orchard with tables and chairs that can easily be moved to allow for social distancing will be better suited for reducing your risk of exposure to COVID-19 than a wedding in a crowded ballroom with no flexibility to move furniture.

And, as difficult as it may be, remember that it would be safest to avoid embracing loved ones at the wedding. If you’re immunocompromised, “avoid close contact with people outside of your household, including kissing and hugging,” says Dr. Kaplan. 

Should I Skip the Reception?

If you don’t know if everyone at the wedding will be vaccinated, consider attending only the ceremony.

“You can take multiple steps to chip away at your risk,” says Dr. Swartzberg. “The first big one would be making sure everyone there is vaccinated — in that case, if you’re at the table with someone without a mask on, the risk of transmission is very small. But you may want to chip away even further at your risk by not attending the reception at all.”

Consider other factors that may increase your risk at the reception: For instance, if dinner will be served buffet style, it may lead to crowding around certain dishes (making it difficult to social distance). Otherwise, you likely don’t need to worry too much about the items you touch or the food you eat.

“I’m not very worried about inanimate objects or the food you eat,” says Dr. Swartzberg. “I don’t think there’s any good evidence that’s going to transmit the virus. But still, if you’re going to be at a buffet and handling the same serving utensils as other people, perhaps carry hand alcohol with you and use that to reduce any theoretical possibility of transmission.”

You may also want to refrain from lingering around the dance floor if you attend the reception.

“Close dancing is something to be careful about — when the dance floor is packed with people, that’s going to be a high-risk situation,” says Dr. Kaplan. “Also, if there’s a lot of singing, shouting, or loud talking, that’s going to be a risk since COVID-19 is spread through droplets in the air.”

Finally, when considering whether to attend the reception or not, think about if it will be indoors or outdoors. “If it’s outside, you tremendously reduce your risk as opposed to being inside,” says Dr. Swartzberg.

Is There a Virtual Attendance Option?

If you’re concerned about traveling (especially now that mask mandates have been eliminated) or being around large groups of people, ask the hosts if a streaming option is available through services like LoveStream or Wedfuly.

This may also be the right choice for you if you have to travel a long distance to attend the wedding and are not yet comfortable flying or using other forms of public transportation, particularly since mask mandates on public transportation have been removed.

“If you’re going to a community where there’s a high rate of COVID-19 cases, that may influence your decision,” says Dr. Swartzberg.

The bottom line is that the decision to attend a wedding if you’re immunocompromised is very personal. As with much COVID-19 decision-making these days, there aren’t necessarily right or wrong answers, but rather making choices based on your own risk-benefit analysis. If you’re fully vaccinated and the wedding has elements that make it a lower-risk gathering (it’s outside, you know guests will be vaccinated), it will be safer to attend than one with higher-risk elements (it’s indoors, you know many guests will not be vaccinated).

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Dockterman E. 2021 Could Be the Biggest Wedding Year Ever. But Are Guests Ready to Gather?. Time. May 29, 2021. https://time.com/6051959/weddings-covid-19/.

Haberman RH, et al. Methotrexate hampers immunogenicity to BNT162b2 mRNA COVID-19 vaccine in immune-mediated inflammatory disease. Annals of the Rheumatic Diseases. May 25, 2021. doi: http://doi.org/10.1136/annrheumdis-2021-220597.

Interim Public Health Recommendations for Fully Vaccinated People. COVID-19. U.S. Centers for Disease Control and Prevention. May 28, 2021. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html.

Interview with John Swartzberg, MD, Clinical Professor Emeritus at the UC Berkeley School of Public Health in the Infectious Diseases & Vaccinology Division

Interview with Stuart D. Kaplan, MD, Chief of Rheumatology at Mount Sinai South Nassau in Oceanside, New York and a partner in practice at Rheumatology Consultants, LLP

Safronova V. The Wedding Boom is Coming. The New York Times. February 19, 2021. https://www.nytimes.com/2021/02/19/style/weddings-2021-coronavirus.html.

Marriage in the ‘New’ America: A Pandemic, Equality, and an Industry Ready for Change. American Wedding Study. Brides. October 6, 2020. https://www.brides.com/american-wedding-study-5079338.

More than 593,000 people have died from coronavirus in the U.S. The Washington Post. June 1, 2021. https://www.washingtonpost.com/graphics/2020/national/coronavirus-us-cases-deaths/.