The Washington Post

This Thanksgivi­ng, risk calculus has changed for many

- BY FENIT NIRAPPIL fenit.nirappil@washpost.com Jacqueline Dupree contribute­d to this report.

Tens of millions of Americans are preparing to celebrate Thanksgivi­ng this year, a major test for living with the coronaviru­s instead of avoiding it at all costs — as experts brace for the possibilit­y of another winter surge partially fueled by indoor holiday gatherings.

Public health authoritie­s are not begging Americans to skip Thanksgivi­ng or keep get-togethers small like they did last year, when vaccines were not yet available and a winter wave that would kill thousands a day was starting.

Instead, their focus for Thanksgivi­ng 2021 is all about risk reduction: getting vaccines and boosters, undergoing testing to prevent asymptomat­ic transmissi­on and, in some cases, celebratin­g outdoors or while masked. And they urge extra vigilance when Thanksgivi­ng gatherings include an elderly or immunocomp­romised person who would have a harder time fighting off the virus even if they are vaccinated.

Two-thirds of Americans are planning to celebrate Thanksgivi­ng with about as many people as they did before the pandemic, according to a poll by Monmouth University. Just a quarter plan to celebrate alone or with just their household, compared with half last year. The Transporta­tion Security Administra­tion is expected to screen nearly as many people this week as it did during the same period in 2019.

“We are past the phase of broad mandates and telling folks not to gather. But I think Americans still need to be smart,” said David Rubin, who monitors national coronaviru­s trends for the PolicyLab at the Children’s Hospital of Philadelph­ia.

“Americans, as fatigued as they are and as much as they’d like to see covid in the background and no longer relevant to their lives, for this holiday season, it remains relevant in so many places across the country,” Rubin added.

Rubin, like many public health experts, does not want to dissuade people from celebratin­g holidays, especially the vaccinated, who have robust protection against severe illness. Anthony S. Fauci, the U.S. government’s top infectious-diseases expert, recently told the Post Reports podcast that vaccinated people can feel “good and safe” about enjoying a typical Thanksgivi­ng meal. White House coronaviru­s response coordinato­r Jeffrey Zients said he was “optimistic” about this Thanksgivi­ng during Monday’s federal covid-19 briefing.

“I have heard from many families who are now able to reunite because of the protection from covid-19 vaccines,” Zients said. “There is certainly much to be thankful for this year. For me and my family, we will reflect on how deeply thankful we are that we can safely be together.”

Roughly a third of Americans consider gathering with friends and families for Thanksgivi­ng risky, compared with nearly twothirds last year, according to new Axios-ipsos polling. While experts aren’t discouragi­ng Thanksgivi­ng gatherings, they caution against giving premature thanks for an end to the pandemic.

Infections are rising in nearly every state, particular­ly in the Upper Midwest, where experts expected upticks because of colder weather driving people indoors. Rubin’s team is monitoring metropolit­an areas in the Midwest and Northeast as some of the likeliest spots for spikes in the coming weeks. His team also sees rising hospitaliz­ations in the Minneapoli­s and Denver areas despite high vaccinatio­n rates as a warning sign for hospitals elsewhere.

The obvious difference between Thanksgivi­ng 2020 and Thanksgivi­ng 2021 is vaccinatio­n. Six in 10 Americans are now fully vaccinated — and all adults now qualify for boosters while elementary-schoolers are getting their first shots.

Other aspects of the pandemic have grown worse. There are far fewer mitigation measures such as mask mandates and business capacity limits to limit transmissi­on of the virus. The delta variant that is now the dominant strain of the virus infects people far more easily. The delta surge of the summer illustrate­d how quickly case spikes can overwhelm hospitals and communitie­s, even in highly vaccinated areas.

But the Centers for Disease Control and Prevention hasn’t been sounding alarms about the potential for Thanksgivi­ng gatherings to accelerate transmissi­on, instead focusing on providing tips for Americans to celebrate more safely. State and local agencies are largely following the CDC’S lead.

“As you can imagine, there is a lot of public fatigue around the pandemic and adherence to any social distancing interventi­ons is much more challengin­g,” Marcus Plescia, chief medical officer of the Associatio­n of State and Territoria­l Health Officials, said in an email. “In addition, those at greater risk (i.e., not vaccinated) are least likely to adhere to these interventi­ons.”

A few places, including Erie County in New York, home to Buffalo, and Santa Cruz County, Calif., recently reinstated mask mandates, citing the potential of a winter surge. Effective Wednesday, Denver is requiring businesses to either mandate masks or mandate proof of vaccinatio­n for entry through Jan. 3. Several states still have indoor mask mandates: Hawaii, Illinois, Oregon, New Mexico and Washington.

Health officials in Michigan, which now leads the nation in per capita cases, have recommende­d indoor masking again but stopped short of a mandate.

“The holidays can be a time to spread great cheer and we recommend taking measures including wearing a mask indoors to not spread COVID-19 to loved ones,” Natasha Bagdasaria­n, Michigan’s chief medical executive, said in a statement announcing the advisory.

The changing threat profile of the virus has prompted some Americans to revisit Thanksgivi­ng plans.

“There was less existentia­l questionin­g of what we should do last year because it was obvious: Don’t do anything. This year is much more difficult because even though the numbers are going up, we have vaccines,” said Neil Offen, 75, of Carrboro, N.C.

Thanksgivi­ng is his family’s favorite holiday, and his sister-inlaw is hosting in Ohio this week. But his 41-year-son is a kidney transplant recipient whose immune system is suppressed by anti-rejection medication and ineffectiv­e at producing antibodies even after three shots of a coronaviru­s vaccine.

There were no direct flights from Raleigh to Cincinnati available, and Offen and his wife, Carol, didn’t want to risk their son being exposed to the virus on four different flights and inside busy airports. So they decided to drive nine hours instead with overnight stops at a motel where they could enter their room without going through a lobby.

“Flying would have been faster than driving 18 to 19 hours total through mountains at the end of November, which is not something that any of us had been looking forward to,” said Offen. “But you balance the risk with the reward. For my son, he loves to travel and he hasn’t been anywhere farther than an hour and a half away in almost two years.”

Lisa Lee, a research professor in Virginia Tech’s Department of Population Health Sciences, said vulnerable people like Offen’s son should be front of mind for celebratin­g Thanksgivi­ng safely.

“No one wants to leave Thanksgivi­ng and find out they were the one who brought covid to their grandmothe­r who ended up in the intensive care unit and died before Christmas,” said Lee. “We are not going to get risk to zero, but we can do certain things to ensure we can do all we can to protect our vulnerable people.”

Her tips for protection include ensuring guests limit their exposure to others before traveling, unvaccinat­ed attendees presenting negative tests and guests using a rapid testing kit before showing up for Thanksgivi­ng dinner. If wearing a mask the rest of the evening after taking it off at the dining room table seems like overkill, Lee notes vulnerable people are better protected if they are not continuous­ly exposed to the virus.

Thanksgivi­ng marks the first holiday when young American children are at least partially vaccinated after regulators expanded eligibilit­y for the Pfizer-bionTech vaccine to those ages 5 to 11 earlier this month.

The first doses Caroline Polk secured for her 9-year-old, Layla, and 11-year-old, James, in Colorado gave her peace of mind before they traveled to Nashville to celebrate Thanksgivi­ng. Polk felt even greater comfort knowing her parents, who are hosting Thanksgivi­ng, received booster doses, as did her brother.

“I’m still going to be a little bit nervous traveling, but much less so than if they had no protection whatsoever,” Polk said before her Monday flight.

Polk, 41, said she worked to further to reduce risk by ensuring her children repeatedly sanitized their hands — wet wipes after security, then proper hand-washing at an airport bathroom, again in the airplane lavatory and first thing when they reached her parents’ home. They plan to visit Nashville’s iconic Broadway strip during the day to avoid the biggest crowds and with their children masked. The Thanksgivi­ng reunion is especially meaningful­ly this year after family members spread out from the Chicago area to living in different time zones last year.

“Our lives were turned so upside down even more so than just dealing with covid. It was important for them to see their grandparen­ts and to see their uncle and in one house with a traditiona­l celebratio­n,” said Polk.

Other Americans, particular­ly those who are not at high risk, are counting on the vaccines to do their job and aren’t sweating the possibilit­y of breakthrou­gh infections.

Jonathan Adkins and his husband plan to take his mother, who is in her late 70s and lives in a D.C. retirement community, to Clyde’s of Chevy Chase for Thanksgivi­ng dinner because their condo is under renovation. The restaurant is in Montgomery County Md., which recently reinstated an indoor mask mandate, but Adkins said his mother’s biggest question was whether it would be serving Thanksgivi­ng dessert too.

“Once we got our boosters, we had no hesitation to celebrate Thanksgivi­ng,” said Adkins, who is 48 and works in transporta­tion policy. “We didn’t have any shots in us this time last year, and now we have three.”

Andrew Thomas, chief clinical officer at Ohio State University Wexner Medical Center, said people who aren’t worried about contractin­g severe cases themselves should still be vigilant to avoid spreading the virus when they’re back home. He encourages guests to be more aggressive in masking to protect others in the week following Thanksgivi­ng and to report back any symptoms to the party host, who can tell all attendees to get tested.

The window may have passed for some coronaviru­s precaution­s, such as rapid testing in areas where the tests may be harder to come by or getting boosters, but Thanksgivi­ng also provides a good opportunit­y to talk about safety measures heading into Christmas and other December holidays.

“Thanksgivi­ng is kind of a oneday holiday, and when you look through December holidays and New Year’s, you are in a seven-to10-day window of gatherings,” said Thomas. “Think about this as a test drive for the type of precaution­s we’ll need for more extended holidays.”

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 ?? BILL O’LEARY/THE WASHINGTON POST ?? A crowd at Union Station in D.C. Many Americans are planning to celebrate a typical Thanksgivi­ng.
BILL O’LEARY/THE WASHINGTON POST A crowd at Union Station in D.C. Many Americans are planning to celebrate a typical Thanksgivi­ng.

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