Omicron and the holidays add up to 'perfect storm' for COVID cases, expert warns

Omicron and the holidays add up to 'perfect storm' for COVID cases, expert warns
The omicron variant has made holiday gatherings riskier and testing more important. Credit: Duke University

The newest COVID-19 variant—omicron—casts a larger shadow each day, driving infection rates up just as millions of Americans prepare to travel for the upcoming holidays.

Should people get tested first? Should they hug grandma? Will students coming home from college become huge virus vectors?

For a citizenry tapped out from the pandemic, it's a lot to process. At Duke, vaccine expert Thomas Denny spent Thursday morning responding to questions about the new variant, testing, holiday travel and other issues on peoples' minds right now.

Denny, COO of the Duke Human Vaccine Institute, discussed these issues in a virtual media briefing with reporters.

What do we know right now about the omicron variant?

"Each day we're learning more. The facts that I think we're fairly comfortable with: Number 1: All of our testing modes that we have do pick up this new variant. All of the vaccines we have … do provide coverage to this variant. However there is some diminishing coverage."

"If one is boosted, that is, having the third shot, it looks like you have excellent coverage. The message here is: everyone get vaccinated and get your boost as soon as you're eligible."

"The transmissibility seems to be much more increased. This seems to be a bit higher in terms of transmissibility. We think that people are being, if you will, symptomatic or showing the status of infection within about 1 to 3 days, whereas with Delta we were looking at more like 5 to 7 days."

It appears that the clinical course, or the symptoms, are a bit less for omicron. The one area that we're concerned about, if you have much more transmissibility and have many more infections at any one point, the chance you can overwhelm the just becomes that much more likely because you have so many more people that are infected so the chances that some will have complications, or a high number will have complications, are there. So the message, the here, is make sure you're vaccinated and make sure you can get a boost."

I have family coming to visit, some of them elderly. Should I get tested before they arrive even if I've had no known exposure to COVID?

"In advance of families coming together, I try to encourage all to be as aggressive as they can with masking and social distancing in whatever environment they're in prior to coming together. Hopefully, they are all vaccinated."

"The best would be to be tested as close to the time that you would be coming together as a family or group of friends.

Should people just not travel or have gatherings this year for the holidays?

"If I was in a setting where no one was vaccinated, I'd certainly think of that."

In a family that's fully vaccinated and willing to exercise some caution, I think we can have some family gatherings. Having said that, this variant has thrown us a curveball at the worst possible time. I think a lot of people are re-thinking how they will get together and what they will do. Every family has to decide what's the norm for them; what they're comfortable accepting."

I am traveling to visit family for the holidays. How important is it that I get tested before traveling, and how long before I leave should I get tested?

"Ideally, one would be tested before they travel so they're sure they're not putting other people at risk.

The problem there is: you can test negative prior to travel … you could get exposed during travel and be positive when you come together as a family. So it really takes a lot of common sense with social distancing and masking and deciding where they're traveling to … and what testing they have access to."

"Pre-screening can be a very , acknowledging it can be expensive."

The federal government has announced plans to make tests more widely available. How important is that?

"The best thing we can do is have as many different testing platforms available that people do not have to purchase. There's some good in-home testing assays out there. Then you have access to test centers.

Testing has plagued us since the beginning. We got behind in the availability of testing early in this pandemic and have been playing catch-up. We've gotten better. We don't have the supply chain issues we had a year ago or 18 months ago but it's still a challenge."

Between college students returning home and people traveling for the holidays, are we looking at a spike in omicron cases in early January?

"It's a perfect storm in my view. It's also going to be bringing challenges as we bring students back to campuses. We have a more transmissible, rapidly transmitting virus that is coinciding with a time when most of us are spending a lot of indoor time. We're coming together in groups because it's the holiday season. And then, in the process of all that, everyone is either traveling to or from a location. It's creating a perfect storm. I do not see how we don't see a high rate of omicron being present by the time we get to January.

Almost all NC counties are in the red zone for transmission. Should travel advice differ based on where you're going or where you're coming from?

"That's the kind of information families need to use in terms of how they strategize for the holiday season. If you're living in an area that is very low prevalence of infection, and everyone is staying within that area and not traveling … your likelihood of infection is reduced. But if you're living in a high-prevalent zone, or you're traveling amongst a number of high-prevalent zones, and you're coming together in groups and you have people who are not vaccinated, the likelihood increases."

Vaccines may be the first line of defense but has the U.S. approach been too one-dimensional this past year?

"We need as many tools in the toolbox that we can get access to. The first part of it is the easy part, the public health approach. The masking, the , just being smart about where you go and how you interact with people. The second part is the access to vaccines and being vaccinated and being boosted.

The third part: we're getting close to it now with both Pfizer and Merck getting approvals for medicines that are antiviral medicines. If you get infected you can be given this medication. The key, you have to start them fairly soon after infection. If you get to the point of feeling sick, it's more prudent to get tested to make sure you're negative or positive before you get very sick and have less chance of having some of the medicines newly approved (be) effective for you."

Are restrictions by local governments on public health measures like mask mandates hindering progress?

"When you're dealing with public health emergencies, we need to treat them as a public health emergency and not politicize them. I think the unfortunate part of this pandemic is that early we politicized whether wearing a mask was good or not good. That unfortunately set us out on a path that we have not been able to recover from. I would just hope that we do not politicize responses to this pandemic or future ones, and that we follow good science and good public health policies."

"What the public needs to understand is that science is evolving facts. We get a set of facts and findings and we make what we believe is the best judgment today based on those facts and findings. A week from now or two weeks from now we may have another set of facts and findings that call upon us to revise or amend the decisions we made earlier."

"That's what happens with science. This is a war. We're in a war with something that is changing constantly and we just have to be able to understand what we need to do, and really need to be able to communicate it with society."

Can we predict what pandemic will look like in the next year?

"I truly hope, going into 2022, we're going to turn the corner. We have to realize this virus is going to become endemic. It's not going to be eliminated from society. There's too much of it there, it's too much a part of us. We have to learn how we're going to deal with it, and how we're going to prevent severe disease."

"About the only tool we have to prevent severe disease is the vaccines we now have. Hopefully we'll get another generation of vaccines … that will prevent even transmission of the virus or certainly not require us to have so frequent level of boosting. Until then, we're going to have to remain on guard and utilize good, sensible public health prevention techniques."

Provided by Duke University
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