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A photo of a respiratory protective mask in the middle of Christmas decoration. Wooden Table, Christmas balls and garland. Daylight.
Credit: Clement Surcouf/iStock

By now, you’re no stranger to preparing for the holidays during the pandemic. If you’re high-risk for severe COVID-19, you likely have the checklist of questions and concerns memorized: Is it safe for me to join family gatherings this year? Should I still ask my loved ones to get tested before we get together? What about traveling?

Even if you’ve gotten the answers to these questions in years past, we are clearly now in a different stage of COVID-19 than we were in 2020 or even 2021. There are more preventive measures available — including vaccine boosters designed to target the latest Omicron variants and treatments like Evusheld.

That said, there are also fewer precautions being taken by the general public (for instance, it is no longer mandated to wear a mask on an airplane), which makes the steps you take as an immunocompromised individual even more important.

“We’re clearly in a transition from a pandemic to endemic,” says William Schaffner, MD, professor of infectious disease at Vanderbilt University Medical Center. “During the pandemic, almost everyone was being careful, social distancing, and masking. But as we’ve moved into the endemic phase, many people have taken off their masks and are no longer observing social distancing.”

A pandemic is when a disease has spread over several countries or continents and causes widespread disruption, whereas an endemic is when a disease is spreading at expected or “baseline” levels through a community, per the Mayo Clinic. Although there’s no single, clear consensus among experts on what to call the current stage of COVID-19, one thing is certain: This year poses different solutions and challenges than previous years, especially if you’re high-risk.

Here’s what you need to know about protecting yourself from COVID-19 during the 2022 holiday season.

Omicron Variants Have a Short Incubation Period

At the beginning of the pandemic, it may have been reasonable to get tested a few days before gathering with others for the holidays. However, the incubation period (the time between infection and when symptoms actually appear) has become increasingly shorter with each dominant variant, which affects the optimal time for testing.

According to a 2022 review in JAMA Network Open, the average incubation periods for COVID are as follows:

  • Alpha: 5 days
  • Beta: 4.5 days
  • Delta: 4.41 days
  • Omicron: 3.42 days

“The incubation period is not an exact number — some people can get symptomatic two days after they get infected and it may be closer to a week for other people, but it’s important to know that if you do develop symptoms only a few days after being at a social event or being around other people, it could absolutely be COVID-19,” says David Aronoff, MD, Chair of the Department of Medicine at Indiana University School of Medicine.

Everyone at your holiday gatherings should get tested shortly before the event to protect attendees who are immunocompromised and high-risk.

“Rapid antigen tests that can be purchased at local pharmacies and conducted at home are easier to get than they have been before and are pretty reliable,” says Dr. Aronoff. “If someone is asymptomatic and anticipating going to a social gathering, testing the day before or the day of attending is a good practice.”

And of course, if somebody has symptoms, they should get tested. If their initial test is negative, they should still stay home and retest the next day. Early in COVID-19, people may test negative and then later test positive, says Dr. Aronoff.  Even if it doesn’t turn out to be COVID-19, it’s a best practice to encourage guests to stay home if they’re experiencing any symptoms, since we’re also in cold and flu season.

And remember, you’re not putting anyone out of their way by asking them to get tested right before your gathering. Experts recommend that families and friends plan their gatherings around the highest risk person in attendance, meaning they should be taking the same precautions you are as an immunocompromised individual.

“Talking and getting everyone on the same page is important,” says Dr. Schaffner. “In our family, there are several high-risk people, so we would ask everyone to be tested against COVID-19 before gathering. That would offer a layer of reassurance and comfort as we all get together.”

Dr. Schaffner adds that because one member of his family is quite immunocompromised, everyone continues to wear masks indoors during gatherings.

Your Risk on Airplanes May Be Higher — But a Mask Still Helps

In April of this year, the Transportation Security Administration (TSA) stopped requiring masks on public transportation. That means this will be the first holiday season since the start of the COVID-19 pandemic in which your fellow airline passengers could be unmasked.

That increases your risk of contracting COVID-19, but keep in mind that wearing a mask does still protect you — even if you’re the only one doing so.

“It’s more important than in the past for people who are vulnerable to wear good-fitting, high-functioning masks,” says Dr. Aronoff. “We know from experiments and public health data outside of airplanes that two-way masking is the most protective form of masking. The risk is higher if others are not wearing masks than if everyone is wearing masks.”

When you travel, opt for KN95 or N95 masks, which are more protective than other types of masks. They also offer two-way protection, so you’re less likely to transmit and contract the SARS-CoV-2 virus when wearing one. The plane itself will also help reduce transmission: Airplanes have a rigorous air exchange system, in which fresh air is brought into the airplane and exchanged very frequently through HEPA filters.

However, Dr. Aronoff notes that those filtration and ventilation systems aren’t activated until the plane takes off and is in flight, so it’s important to wear your mask the full time when you’re boarding and sitting down. “During boarding, takeoff, landing, and at the gate are probably the most important times to have a mask on, particularly when others are not masked,” says Dr. Aronoff. “It’s still helpful to wear masks throughout the flight, but it can also be uncomfortable and you may want to take a drink or a bite of a snack. The time to do that would be during flight.”

It’s also best to avoid connecting flights, if possible, since that can mean more gates, more waits, and more crowds.

Read more about how to stay safe from COVID-19 when traveling — even when others aren’t wearing masks. 

You Can Now Get a Booster for Dominant Variants

As an immunocompromised individual, it’s important that you make use of every protective tool available to you.

That now includes a new booster shot that is designed to target circulating variants: The U.S. Food & Drug Administration (FDA) recently authorized bivalent formulations of the COVID-19 vaccines for use as a single booster dose at least two months after a primary or booster vaccination. Bivalent means a vaccine works by stimulating an immune response against two different antigens — in this case, the original SARS-CoV-2 strain and another strain common between the BA.4 and BA.5 lineages of the Omicron variant.

BA.4 and BA.5 lineages of the Omicron variant are causing the most COVID-19 cases in the U.S. right now and are predicted to circulate throughout the fall and winter, so it’s key to get your booster ahead of traveling or gathering with loved ones.

“It’s really important for people who are eligible and able to get vaccinated against SARS-CoV-2 to get boosted,” says Dr. Aronoff. “That goes not only for vulnerable people, but for people near them who may be attending gatherings. Vaccines continue to keep people out of the hospital and continue to save lives.”

Have a conversation with your doctor about COVID-19 boosters, even if they haven’t brought it up yet. For rheumatology patients who have been vaccinated but have not received boosters, the most common reason cited was that they had not been told by their doctor to get an additional dose, per a new study that will be presented at the American College of Rheumatology (ACR) Convergence 2022 this November. However, experts agree that most high-risk individuals would benefit from the extra layer of protection a booster provides.

Make sure you’re also up to date on your flu vaccine and, if you’re eligible, the pneumococcal vaccine (to prevent pneumonia, an infection of the lungs). Pneumonia can occur with both COVID-19 and the flu — and can also cause mild to severe illness.

Additional Measures Like Evusheld Can Protect You

Immunocompromised individuals can now further protect themselves before COVID-19 exposure with Evusheld, produced by AstraZeneca.

“Evusheld is a combination antibody that can provide protection that lasts about six months against COVID-19, including the Omicron variant,” says Dr. Aronoff. “People who are highly immunocompromised or worried that they can’t get the vaccine either because they won’t mount a response or because it’s contraindicated should talk to their licensed health care professional about Evusheld.”

There are also now antiviral treatments to help you fight off respiratory infections like COVID-19, but it’s key to take them right away. Talk to your doctor about your action plan for cold, flu, and COVID-19 symptoms this holiday season: 

  • As soon as you develop symptoms, will you call or email your doctor? 
  • What will be your plan of action if you come down with symptoms while traveling? 
  • If you have COVID-19 and can’t leave home, is there a pharmacy nearby that can deliver your antiviral medication?

“If you develop symptoms, don’t try to tough it out,” says Dr. Schaffner. “Contact your provider promptly because the medications we have — whether it’s Paxlovid for COVID-19 or Tamiflu for flu — work best if they’re started as quickly as possible after the onset of symptoms. We adults have a tendency to put things off, but that postpones those decisions and doesn’t work to our benefit.”

The Tried-and-True Mitigation Efforts Still Work

Since the beginning of the pandemic, you’ve heard the laundry list of mitigation efforts to prevent COVID-19. Even if you don’t see the general population taking these steps anymore, they can still protect you as a high-risk individual.

The U.S. Centers for Disease Control and Prevention (CDC) says that the following steps can still help to prevent the spread of COVID-19:

  • Stay up-to-date on your COVID-19 vaccines, which includes getting your booster if eligible (this is especially important if you have a weakened immune system).
  • Improve ventilation and filtration to prevent virus particles from accumulating indoors (this may involve opening windows, changing air filters frequently, or even moving your holiday dinner outside if possible).
  • Wear masks or respirators (for instance, N95) that fit snugly over your mouth and nose.
  • Increase space and distance from others and avoid crowded areas.
  • Practice good hand washing.

“Those original mitigation efforts are still pertinent, particularly because influenza started about a month early, and those who are at an increased risk for COVID-19 complications are the same folks who are at increased risk for complications from influenza,” says Dr. Schaffner. “Anything you can do to reduce your risk as we try to navigate this winter respiratory virus season is important.”

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Coronavirus (COVID-19) Update: FDA Authorizes Moderna, Pfizer-BioNTech Bivalent COVID-19 Vaccines for Use as a Booster Dose. U.S. Food & Drug Administration. August 31, 2022. https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-moderna-pfizer-biontech-bivalent-covid-19-vaccines-use.

Endemic vs. epidemic vs. pandemic: What you need to know. Mayo Clinic. March 10, 2022. https://www.mayoclinichealthsystem.org/hometown-health/featured-topic/endemic-epidemic-pandemic

How to Protect Yourself and Others. COVID-19. U.S. Centers for Disease and Prevention. October 19, 2022. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html.

Interview with David Aronoff, MD, Chair of the Department of Medicine at Indiana University School of Medicine.

Interview with William Schaffner, MD, professor of infectious disease at Vanderbilt University Medical Center.

Mudano A, et al. COVID-19 Vaccine Uptake and Reasons for Hesitancy in a Large Rheumatology Practice Network [Abstract]. American College of Rheumatology. October 19, 2022. https://acrabstracts.org/abstract/covid-19-vaccine-uptake-and-reasons-for-hesitancy-in-a-large-rheumatology-practice-network/.

Wu Y, et al. Incubation Period of COVID-19 Caused by Unique SARS-CoV-2 Strains. JAMA Open Network. August 22, 2022. doi: https://doi.org/10.1001/jamanetworkopen.2022.28008.

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