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Safe Thanksgiving playbook as new COVID surge expected

Vaccines and boosters are paramount to reduce risk

CHICAGO --- As the U.S. braces for a new surge of COVID-19 cases expected to start hitting around Thanksgiving, Northwestern Medicine experts offer a playbook to a safe holiday gathering. 

Vaccines are paramount for a safe Thanksgiving in 2021, which will be less restricted than last year. But Christmas will be even better once children five and over are fully vaccinated, experts say.

“Vaccines are a game changer, but we can’t let the pendulum swing too far and pretend we are back to pre-COVID normalcy,” said Dr. Sadiya Khan, assistant professor of medicine in epidemiology at Northwestern University Feinberg School of Medicine. 

Special caution has to be taken around older adults who are most vulnerable to having a severe outcome from COVID-19, if they have not yet had a booster or have underlying conditions including cancer, cardiovascular diseases, chronic kidney disease, diabetes, severe obesity or uncontrolled hypertension.

Khan, and Mercedes Carnethon, vice chair of preventive medicine at Northwestern, offer a roadmap for a safe celebration in two weeks and how that will change for Christmas.

Mercedes Carnethon

“This year celebrations can expand somewhat, but your vaccinated older adult is still at higher risk than your unvaccinated child. Children over five will not have completed the vaccination series by Nov. 25, so it’s risky if you are bringing semi-vaccinated children in front of older adults, some of whom are still at risk for severe illness and breakthrough infections.

“Older adults are still vulnerable during indoor family celebrations, even if they have received the booster. It’s worth a discussion about comfort levels of older adults and their risk status and whether they received a booster shot. Individuals who are immunocompromised still may not have a very robust response to a booster, so I would hate for someone to put too much reliance on a booster. Nothing is risk free here. 

“Everyone at the event is safest if everyone has received a vaccine. If they haven’t, disinvite them from the meal part when masks have to be off.” 

College students add risk

“College students were potentially vaccinated in April or May, so they are six months out from their vaccines,” Carnethon said. “But they aren’t considered eligible yet for a booster shot. Breakthrough infections in college populations are quite possible; it’s near the end of the quarter and college students are under stress. Stress reduces your immune response. 

“If college students are living in congregate settings and haven’t had a booster, that’s a scenario that poses risk. Vulnerable older adults should have booster shots to protect themselves. Get the booster today, so you are ramped up with the antibodies. It takes two weeks.” 

Christmas will be better

“We are so looking forward to Christmas when my children will be fully vaccinated. They are getting their second shot on Nov. 27. My 75-year-old mother in Georgia hasn’t seen my unvaccinated children since March 2020.  Christmas is going to change things. My kids are so excited to see her,” Carnethon said. 

Dr. Sadiya Khan: “If everyone at a gathering is vaccinated, a small indoor dinner is perfectly reasonable. That’s what we are planning on doing with my parents in their 60s and my children. It’s just our immediate family who are part of our bubble.

“There is no such thing as a zero-risk situation, but there are also potential ways to minimize risk but also to experience Thanksgiving. If you are traveling, be sure to mask up. We are not yet ready to de-mask, even though a lot of people are advocating for it.

“Within each family, you have to decide how much risk will you tolerate. Is the risk of having a guest who is unvaccinated worth the benefit of having them there?” 

Home testing can mitigate risk, though it’s not perfect 

“There are other precautions in terms of testing. Home COVID tests are widely available compared to a year ago,” Khan said. “We always have home tests in our house. Serial testing while you are traveling can be helpful to mitigate risks. Test before you travel and before dinner. Once exposed, COVID won’t show up in a test for three to five days. There is a lag, but the more frequently you test, the more likely you will be something up if it’s there. If it’s positive, don’t travel and follow up with a PCR test. Find out if it’s a true positive.”