Winter is approaching again, which means people in many parts of the country will be spending more time indoors. While many in the U.S. hoped for a carefree summer thanks to COVID-19 vaccines and fresh outdoor air, that didn’t quite turn out. In August alone, more than 26,000 people in the U.S. died from COVID-19, and 4.2 million infections were recorded. Vaccination rates in the U.S. hover at 77.8% of people 12 and over and 65% of the total population. This is certainly much more than many other countries in the world, but also not enough to effectively tame the spread of the virus. But many local governments across the country are proceeding without mitigation efforts like mask mandates that had previously helped drive cases down. Plus, there’s delta, a variant that is significantly more infectious than the original virus that swept the country last winter.
But it’s not all bad news. A vaccine for children under 12 is on its way, with Pfizer releasing promising data for children between ages 5 and 11. It’s potentially on track to receive emergency use authorization for that age group before Halloween, according to Anthony Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases.
So, where does all of this leave us during fall and winter? How will this holiday season be similar or different to last year’s? We asked three experts to share their visions for what’s to come over the next several months of the pandemic: Natalia E. Castillo Almeida, M.D., assistant professor in the division of infectious diseases at the University of Nebraska Medical Center; Eleanor J. Murray, Sc.D., assistant professor of epidemiology at Boston University School of Public Health; and Jessica Malaty Rivera, M.S., an epidemiologist and research fellow at Boston Children’s Hospital.
Here’s where they see hope, and where we may still struggle.
What should we expect over the coming months with this pandemic? How will this fall/winter be similar or different to last fall/winter?
J.M.R.: It’s really hard to say. I think we were spared by a really bad flu season last year in part because there were so many closures. Schools were not happening in person, mask mandates were in place all throughout the country, and there were relatively few indoor activities. We can’t really rely on those same kinds of things this year. So I am pretty concerned between the combination of cold weather, bringing people indoors, school season continuing, holiday travel, and just holiday activities. I think that we could potentially be seeing some pretty dark days in the fall if we don’t continue to vaccinate enough people each day in the United States. We know that variants emerge in the context of an under-vaccinated population. Delta started in India, where there were hardly any vaccines. So we risk the emergence of new variants the longer we go with this under-vaccinated population.
E.M.: We definitely should be thinking about a lot of the same precautions as last winter. This winter, we do have the reassurance that, for people who are vaccinated, they’re less likely to be infected. And if they are infected that they’re less likely to transmit to other people. So if a gathering you’re interested in is all people who are vaccinated, then the overall risk to people attending that gathering is relatively low. Even if somebody did show up infectious, the number of people that would be infected at that gathering is much lower than if nobody was vaccinated.
As the holidays approach, what kind of precautions should people consider for gatherings?
E.M.: The first thing is: What is people’s vaccination status? For a gathering where everyone’s vaccinated, things are looking better than last year. Where there’s even one unvaccinated person, things are a little bit more gray. At the gathering itself, we want to think about, can we be outside? Can we open windows or doors just to get some airflow increased? Can we have fewer people crowded into one space? Those kinds of things are great for the day of. Beforehand, can people who are going to attend do some kind of two-week quarantine? Maybe not completely, but at least not dining in restaurants and things like that that are more risky activities.
J.M.R.: For my family, we have chosen to not travel this holiday season. I would rather keep things as low-risk as possible, especially because my kids’ vaccinations are imminent assuming that the data is all good in the next couple of months. If you’re going to travel, make sure that you’re vaccinated. I think that unvaccinated people should not be going on planes. If you’re going to travel, keep your risk very low before you arrive and when you arrive. I’m talking about always wearing your mask and avoiding high-risk situations like indoor dining, especially if you’re in a place where transmission is high. If you’re going to a place where the hospital situation is pretty dicey, I would especially keep your risk low and try to stay home as much as possible if you’re going to be in those areas. You just don’t want to risk anything bad happening to you or the people around you.
What about testing? How does that factor into holiday plans?
N.C.A.: If you need to test for certain reasons like air travel or possible exposure, go ahead. Otherwise, I wouldn’t recommend testing unless you are having symptoms. I think some of these tests just give a false sense of security to people.
E.M.: The rapid test, if that’s negative, you’re probably not actively infectious right now. And for the next few hours you’re probably safe for the people around you. The rapid test is just giving you a little snapshot in time. If people are thinking about Thanksgiving and there’s some unvaccinated kids there, they might want to have everybody who shows up do a rapid test, and you can only come in if your rapid test is negative. But it doesn’t replace the idea of going to get a PCR test if you think you’ve been exposed and you’re worried.
J.M.R.: I think that a lot of people misuse rapid antigen tests to justify high-risk behavior, but that’s not what they’re intended for. Rapid antigen tests are really, really good at detecting a positive case during an active infection, especially if they’re sick or symptomatic. They should absolutely be part of a much more robust testing cadence that would include PCR to make sure that you’re okay. So it’s concerning that people would just say, Well, if I take this rapid test I can go do whatever I want. It would have to be in combination with low risk exposure, possibly a PCR test before, too, within 72 hours. And maybe a rapid test kind of before the event, just as an extra cherry on top.
What else are you concerned about this coming winter?
N.C.A.: I would recommend people to get the flu shot. We don’t want cases to increase in the hospital because we’ll be seeing co-infection with COVID.
J.M.R.: Flu shots are important right now. If people are wondering if they have to get one or the other, the answer is both. I wouldn’t even worry about spacing them out much. We can’t risk this twin-demic of having a really bad flu year plus COVID-19
When do you anticipate kids getting vaccinated? Why are vaccinated kids a key part of managing the pandemic?
E.M.: Unvaccinated people still spread delta really easily. And that includes kids. I think for a lot of working-age individuals, one of their primary sources of exposure right now is from their unvaccinated kids who are at school with other unvaccinated kids in settings where there’s not a lot of great other precautions happening.
J.M.R.: When we talk about protecting our entire community, kids are part of that. It is very difficult to operate with this population continuing to be unvaccinated. We know that in a number of places, pediatric cases are spiking. And we’ve seen even places like the southeast, Texas to Florida, having a really, really high percentage of kids being hospitalized with COVID-19. Pfizer just released a press release with preliminary data showing really, really positive results in the 5 to 11 age group. It showed extremely high neutralizing antibodies, similar to those who received the adult dose. We still need to see the full data, which will be released upon FDA submission, but the goal right now is to submit that.
Do you think there will be more requirements for vaccines or negative COVID tests in places like restaurants or grocery stores?
E.M.: I think what we might see is the use of vaccine cards and rapid testing combined, especially places like sports stadiums or concert venues where you have a lot of people. And that’s a way to at least get a little bit more reassurance that there are not actively infectious people at those events. I don’t know if we will see them at supermarkets.
J.M.R.: I do. It’s happening in a lot of places already. I think vaccine requirements are one of the essential ways to keep people safe, especially because we can’t really rely on the honor system, unfortunately.
Do you expect more hospitals to go into crisis mode? How should that impact people’s choices about socializing during the fall/winter?
E.M.: Yes. If you look at the numbers, roughly half of people in the U.S. have some protection from the vaccine. But delta is roughly twice as infectious as the previous variants. And so in a lot of ways, we’re in the same situation we were in the beginning of the pandemic—and yet a lot of places have thrown out all the other tools [like masking and distancing]. If we can get everybody vaccinated rapidly, then maybe we don’t need to worry about it. But if we can’t, and obviously we can’t until the under-12s are vaccinated, then we need to think about masking, distancing, and these other strategies.
J.M.R.: Yeah. I mean, we’ve already seen policies enacted in places like Idaho and other states. They’re making horribly difficult triage decisions because they have to decide who’s more likely to survive and which beds and which ventilators to give them. It should remind people that not only are you at risk of being hospitalized and or dying if you’re unvaccinated, but flu could be really bad this year. Not to mention the fact that accidents happen, and you could be in a situation where you might need critical care and there’s just no room to attend to your appendicitis or your broken foot or your allergic reaction.
Do you think boosters for the general population are likely—or wise?
N.C.A.: Boosters have been approved for select individuals, like immunocompromised people and those who are 65 and older, but the FDA rejected a more broad approval. I think it’s important for people to know that the FDA continues to review the data. And I think boosters for the general population are likely to happen. It will be just a matter of when. Once the data show that a booster would be recommended for everyone, I would say it would be advisable to get that booster.
J.M.R.: The only people right now that show a biological need for an additional dose are people who’ve had an organ transplant or people who are at a very, very high risk of severe outcomes. I think this goes back to a broader global equity issue. We need to focus on vaccinating the unvaccinated because that’s where the vulnerabilities lie in our communities. This is a global pandemic. We have to have a global response. The longer we allow places to have between zero to 3% vaccination rates, the more risk we are for this continuing over and over and over again with more variants emerging.
Are we at a point in this pandemic where vaccinated people should just accept that they’ll catch COVID?
E.M.: No. We still have a lot of tools that work really well. Before we had the vaccine, lots of places were able to bring transmission of the virus down just through masking and distancing and these kinds of things. And now we have also vaccines. We should be able to keep the virus under control. The second thing is that if people who were vaccinated decide, “Oh, I’m going to get it eventually I might as well get it now,” they become a huge source of risk for the unvaccinated. A large chunk of that group is children. I think we often hear the media talking about the unvaccinated like it’s this group of extremists, and it’s like, no, it’s your neighbor’s kid. It’s your kid.
N.C.A.: I think COVID-19 happens in a small proportion of fully vaccinated people, even with the delta variant. When those infections occur among vaccinated people, they tend to be mild. I don’t think that vaccinated people need to accept getting infected, but I think they need to accept the fact that still wearing mask and washing hands and social distancing need to be a crucial part of their lives.
J.M.R.: It’s not just about you, right? You could still potentially get the virus while vaccinated and still potentially spread it to others. Others around you may not be vaccinated and they could have really, really horrible outcomes. So, unfortunately the responsibility of keeping your exposure risk low and keeping your risk of infection low is still as important as ever.
For people who are not vaccinated yet, what message would you send to them?
E.M.: Getting vaccinated really makes it a lot easier and safer to plan Thanksgiving, to plan Christmas, to be able to see family without having to worry that after seeing families someone is going to end up in the hospital. Because even though the vaccine doesn’t mean you can’t get infected, it is so good at preventing hospitalization and death.
J.M.R.: What we’re seeing right now in hospitals across the country is proof that you are at a much greater risk of not only getting COVID-19, but having a severe outcome with this disease, if you’re unvaccinated. And unfortunately it’s not just about you. Delta is extremely transmissible. If you are infected with delta, you can affect many, many people around you.
N.C.A.: You may not have decided to get the vaccine yet, but I encourage you to get information from your health care providers. I understand people’s frustration with the level of confusion and information, but we, as health care providers, would like to know what would make you more comfortable getting the vaccine and what information you need. So just keep an open mind. Our only goal is to keep you, your family, and your communities safe.
Quotes have been edited and condensed for clarity.
Related:
- Dr. Fauci Says U.S. Is ‘Turning the Corner’ on Current COVID-19 Surge
- Here Are the Side Effects to Expect After Your COVID-19 Booster Shot
- 9 Things to Know About Getting Your Flu Shot During the COVID-19 Pandemic