We are at a very different place heading into the holiday season than we were last year, and with some forethought and precautions, we all can have a good end of the year.
Looking at US data,
- COVID cases last year were about double this year’s rate
- Flu hospitalizations this year are 37 times last year’s rate and 5 times the year before COVID. The last time they were this high was in 2009, but at this point back then, the case growth had already leveled off. So far, the US is still on a steep climb in the number of flu cases.
- COVID case rate last year was about 2.3 times this year’s rate
- Flu in Europe has not had near the impact of flu in the US this year, with only Russia and Austria in what is considered by the European CDC to be at high levels of flu transmission
Other Respiratory Diseases
The third main virus that has been a major concern this year has been RSV, with many pediatric hospitals running out of room in their advanced care units. Fortunately, over the past 3 weeks, the rate has dropped by 50%, although it is still about double the long-term average. The European RSV data is slightly delayed, but a similar pattern is present there, although a bit too early to say that the peak is passed in Europe.
Also, remember that these are not the only respiratory diseases confronting us. There are 4 other coronaviruses and about a hundred “common cold” viruses circulating, and while the case numbers of those viruses are not closely tracked, the consensus amongst physicians is that the number of “colds” is also way up this year.
Putting these all together, the North American and European healthcare systems are being hit hard this year, and many authorities are concerned about post-holiday surges in all respiratory diseases. Recall the major surge in COVID cases due to Delta that we saw almost immediately after the New Year last year. That’s what gives people pause.
At the same time, however, Omicron is not Delta in terms of severity and between vaccination and the number of people who have had COVID over the past year, we do have a much better baseline immunity in most of the developed world than we did a year ago. However, on the side caution, the uptake of boosters has not been very good anywhere in the world and while we know that basic vaccination, especially with at least one booster, is still very effective at preventing severe disease and death, the efficacy wears off over 4-6 months, especially against simple infection and mild to moderate illness.
Looking at influenza, the vaccination rate against flu in the US is lower than at any time in the five years for which we have good data and is running about 8-10% below the long-term average and almost 20% below the season just before COVID kicked off. Currently, in the US, only about 46% of the population is immunized and in Europe, reports are that uptake is even lower, especially among at-risk populations.
What can you do to protect yourself and your family?
The number one thing, far and away more important than anything else, is to get a flu vaccine. This year’s vaccine is an excellent match to the circulating virus, so even though the raw efficacy of flu vaccine is not as high as some other vaccines, even if you get flu, being vaccinated will help prevent severe flu and help decrease the amount of virus you are spreading into the environment.
Moving to COVID vaccination, while we have not been as big an advocate for COVID vaccine boosters as some physicians, we do believe that especially through this winter season, anyone with risk factors for severe COVID, including those over 60, should most likely get a booster. There are good reasons not to get boosters, such as people with various autoimmune diseases, but for the great bulk of the at-risk population, the benefit, even if short-lived, outweighs the risks. For younger, healthy people, the case is not as strong, but if you are regularly around anyone who is at-risk, being vaccinated can help prevent spreading the infection to the at-risk person, so that’s a consideration. And for kids, it really is a close call. For kids as individuals, COVID risk is certainly present, but it’s relatively low, and for the vaccine, while it has been demonstrated to be very safe, there are some people, especially adolescent males, for whom there are some small risks, so it comes down to considering multiple factors including if they are routinely around at-risk people such as grandparents, what their school requires, and have they already had COVID. One last vaccine point is that while there have been studies recently saying that vaccination can reduce the risk of long COVID, there have also been recent studies saying that the incidence of long-COVID may be overestimated, possibly even significantly overestimated. That’s not in any way to say that it doesn’t exist, but as they have tightened the definitions and more carefully evaluated cases, some of the original studies may have cast too wide a net and pulled in other issues.
Outside of vaccination, we’re back to the swiss cheese approach to prevention: Consider how these various viruses are transmitted and take steps to lower your risk. Looking back at the past two holiday seasons: In 2020, it was all about surfaces: wiping down high-touch areas, very careful hand hygiene, and even cleaning presents before you opened them. But then we learned that COVID spread not primarily by surfaces, but was an aerosol, so Holidays 2021 were about clean air: reduce indoor density, bring in fresh air, have functions outdoors where possible, and consider the use of high-grade masks to reduce inhalation of these aerosolized particles.
So, what about 2022? Unfortunately, this year, it’s a little of both. Influenza is primarily spread by particles on surfaces and unless you are in a very dense environment where someone coughs, sneezes or sings right in your direction from a close distance, or you’re touching surfaces without hand hygiene, your influenza risk is lower. But Omicron COVID is still an aerosol, so minimizing shared air is still important. Fortunately, aerosols, even infectious ones, disperse and diffuse very rapidly, so if you are in a location with reasonable ventilation and not jam-packed, your risk is lower. The kinds of places to be concerned about are places like crowded bars or clubs, but restaurants, stores, and offices that generally are not shoulder-to-shoulder with people straining to talk over the noise are not at excessive risk. Still, even though the data on masks in real-world use has been somewhat mixed, if you do have a higher risk, either because of a medical condition, age, or lack of a recent vaccine, wearing a high-quality mask may moderately reduce your risk.
Wiping down high-touch surfaces is still helpful, especially for flu and many minor cold viruses, and hand hygiene is still important. For this season, we would again break out hand sanitizer and carry some with you whenever you are and about in public locations.
If you are traveling, wearing a mask in the most crowded parts of your journey such as when boarding a plane or off-loading, can help reduce risk, but once everyone is seated on a plane and the engines are running, the transmission risk is actually fairly low.
If you are gathering for holiday parties, especially with family, do pay attention to density and ventilation, and try to keep anyone with any upper respiratory disease symptoms away from the group. That last part is hard for families, especially with little kids who have runny noses all winter, but at least try to keep them somewhat separated from grandparents or others at risk.
In summary, families, friends, and organizations can get back to much more normal activities this holiday season, and if you take some simple steps that we have all learned over the past two seasons, risk can be reduced to a reasonable level. We do think it would be naïve to say that we’re completely back to normal. We would be very surprised if we do not see an uptick in all the infectious disease parameters, we have been following for the last three years, but most people recognize that risk is a balancing act, and accepting reasonable risk while applying reasonable mitigation strategies will still result in some people contracting the various circulating respiratory diseases, but that’s a part of life.