It’s the most wonderful time of the year — and the most infectious.
As COVID-19 cases surge across the New York City area, driven by the highly contagious omicron variant of the coronavirus, families and friends are debating whether and how to gather for Christmas and New Year's Eve.
Daily new cases are now nearly double the rate of last winter’s surge, with more than a tenth of all tests done in the city coming back positive for the virus, according to city data.
Yet the public has received conflicting messages from various political and health leaders, underscoring a broader uncertainty over how quickly the omicron surge may come and go and just how many severe infections or deaths it could cause.
President Joe Biden has said that it is not necessary for vaccinated people to cancel Christmas, even as some health experts are advising against gatherings altogether.
New York City health commissioner Dr. Dave Chokshi said that people should consider virtual or outdoor gatherings wherever possible, and base any indoor gatherings around the needs of the most vulnerable person in the group, whether that’s a child, an elderly person or someone with a preexisting condition.
“I am worried about risk, but primarily for people who are most vulnerable to severe outcomes,” Chokshi said on NY1 on Thursday morning.
For people intent on gathering, the gold standard for safety measures is a multi-level approach, according to Dr. David Abramson, a clinical associate professor at New York University’s School of Global Public Health.
The first thing, he said, is to make sure that everyone has received a booster shot at least two weeks before the gathering. They should also have tested negative for the coronavirus with a PCR test no more than 72 hours beforehand, and avoided contact with others, even on public transit, in the days between the test and the gathering.
“If you can accomplish that, sure,” Abramson said. “Short of that, if you can't make all of those things happen, I really dont think it’s a great idea to gather.”
Even so, Abramson said, breakthrough infections could still happen, though they would likely be mild.
Dr. Stephanie Woolhandler, a professor of urban public health at Hunter College, added that everyone should take a rapid test — or two — as close to the gathering as possible.
“The rapid tests are not perfect, and it's not a guarantee, but it should be reasonably low risk if everyone’s taken a rapid test and everyone’s vaccinated,” she said.
Abramson and Woolhandler both underscored that families should avoid in-person gatherings with relatives who are elderly, have preexisting conditions or are immunosuppressed.
That goes doubly if the gathering involves bringing a child that is not vaccinated or who is not yet eligible for a vaccine, they said. Studies have shown that young children are often the index, or initial, case in household-wide infections.
“If you have a loved one who is very high risk, now is not the time to visit them with an unvaccinated child, or even a vaccinated person,” Woolhandler said. “We are seeing so many breakthrough cases.”
If families do plan to gather with elderly people, it is key to make sure they are boosted.
“My dad’s coming for Christmas. I'm not letting him through the door unless he gets the booster,” Dr. Ted Long, head of the city’s Test and Trace program, said at a news conference last week.
Health experts and public health officials are clear on one thing: If you are unvaccinated, you are at the highest risk, and you should avoid travel and gatherings altogether.
“If you are unvaccinated, you should not travel,” Dr. Chokshi said at a news conference Tuesday. “That’s for your safety as well as the safety of others who you will be in contact with.”
There is not enough data to know whether the relatively milder disease caused by the omicron variant holds true for people who have not received any vaccine dose, Dr. Mitchell Katz, head of New York City’s public hospital system, said at a news conference Wednesday. That means, he said, that the risk of severe disease for those people is very real.
Other health experts have said that it is best to avoid gatherings for now altogether, given the high rate of virus spread.
“There's so many unknowns here, and it's such a moving target, and it’s changing so rapidly,” said Dr. Robyn Gershon, a clinical professor of epidemiology at NYU’s School of Global Public Health. “We have no way to know, at that moment, at that dinner, without masks, with poor circulation, who is positive.”
Gershon, who says she is particularly risk averse, noted that gatherings within a small social pod, where the members have limited interaction with people outside the pod, could be safe, especially with testing and isolating ahead of the gathering.
But few people have maintained such tight knit pods through the pandemic, and the omicron variant is so infectious, she said — possibly three times more contagious than delta — that people could catch it grocery shopping or on the subway.
“I don't know how you can eat a meal, and have drinks, and cups of coffee, and cake, and not waft virus in the air if someone in that group is positive,” she said.
Woolhandler said she feels that now is the right time to be more cautious, as the virus spikes locally, and potentially strains hospital resources: An infection that requires hospitalization, but is treatable, could become more deadly if patients do not get sufficient attention from an overstretched ICU or emergency room.
And even though the FDA has authorized a new pill for treating COVID-19 at home, there are not nearly enough courses of the drug available now to meet demand.
“Right now, in a way, it's probably the most unsafe period for folks, in part because there are better treatments coming down the pipe, but we don't really have them yet,” she said.