With omicron looming over the holidays, here's how to stay safe

Here we go again.

Just when you thought it was safe to go back to almost normal times, a new, highly mutated variant of the coronavirus has reared its ugly head in the U.S.

Scientists say it's still too soon to know whether the omicron variant causes more or less severe disease, though early evidence does suggest it's better at evading the immune system than previous strains. And, omicron has raised several red flags that suggest it could be the most transmissible variant yet.

All this has many people wondering whether it's time to change our behavior for safety's sake.

The good news is, you don't have to hibernate like it's 2020. Experts note we're in a much different place than we were last winter, with COVID-19 vaccines and boosters now widely available. There's good hope that the current vaccines offer protection against severe disease with omicron.

That said, if this pandemic has taught us anything, it's that when you don't know what you're dealing with, "we should invoke the precautionary principle," says Dr. Abraar Karan, an infectious disease physician at Stanford University.

In other words, don't panic, but do be thoughtful about what risks you want to take.

We spoke to several infectious disease experts for advice on living in the age of omicron. But remember: Things are changing quickly, so stay alert. Public health advice may change as we learn more.

Should I be masking again indoors, even in places where masks are not required?

If you're not vaccinated, mask up indoors — and please, get your shots, experts agree. For the vaccinated, you should be wearing masks if you are at higher risk of severe disease because of your age or underlying health conditions — or if you spend time with people who are vulnerable. We know that vaccines aren't always as protective among older people and the immunocompromised.

"The things that we've gotten tired of doing, we need to keep doing, especially masking up in indoor places," says Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention.

That advice would hold true even without the omicron variant, says Dr. Monica Gandhi, an infectious disease specialist at the University of California, San Francisco, "because we still have [delta] cases circulating in this country."

While you don't generally need to wear a mask outdoors, it makes sense to if you're in a crowd and you don't know the vaccination status of the people around you, said Dr. Julie Vaishampayan, chair of the public health committee of the Infectious Disease Society of America, during a media briefing Thursday.

Do I need to upgrade to N95, KN95 or similar highly protective mask?

While three-ply cloth masks or surgical masks do a good job at preventing the wearer from spreading infectious particles if they fit snugly and offer the wearer some protection as well, many experts think it would be better to use an N95 or KN95 respirator in crowded indoor public spaces.

This is especially key if you're high risk. "If people around you aren't wearing masks and you are older or you have a weakened immune system, then you should consider upping your mask game and using an N95 mask," says Frieden.

Stanford University's Karan suggests people with other underlying conditions that put them at higher risk — such as obesity, lung disease or poorly controlled diabetes — should also consider upgrading to a high-quality N95 or KN95 mask.

And, if you live with people who are at risk, consider upgrading your mask as well, Karan says. Double masking with a surgical mask topped by a cloth mask will also boost your protection, notes Gandhi.

Should I cancel my holiday travel plans?

Not necessarily just yet, but do be very thoughtful about them, says Dr. Henry Wu, director of Emory TravelWell Center and an associate professor of infectious diseases at Emory University School of Medicine. "Anyone who's thinking of traveling should pause and consider both your own risk, as well as certain other practical issues about your destination."

For starters, the U.S. is now requiring all travelers entering the U.S., including Americans returning home, to be tested for the coronavirus no more than one day before departure. If you're in another country, you'll have to make sure you know where to get a test that qualifies within that time frame, which could be a logistical headache.

And remember, the situation on the ground is changing, so keep a watch on the CDC's travel notices. "You certainly want to avoid traveling to countries that are in the midst of a surge and potentially have overwhelmed health systems. You certainly don't want to risk needing to go to an overcrowded hospital if you have your own health problems, COVID or not," Wu says.

Domestic travelers aren't required to test before flying, but it's still a good idea to do so before departure and after arrival — especially if you are visiting someone in a high-risk group. That's what Wu plans to do when he visits his elderly parents in Hawaii next week. "I will, even though it's not required, test myself before my trip and I think I'll bring some self- test kits when I get home, just to be even more sure that I'm not infectious at that time," he says.

If you're unvaccinated, over the age of 65 or have medical conditions that put you at higher risk of severe disease with COVID-19, you should seriously reconsider if now is a good time to travel, Wu says.

And of course, if you do fly or take public transport to your destination, wear a high-quality, snug-fitting mask like an N95 or KN95.

With all the concern that omicron might evade our vaccines, should I bother to get a booster?

The Biden administration came out this week urging people once again to get a booster to help protect against omicron. The recommendation is in line with recent science showing that boosters raise your antibody levels.

A recent preprint study even showed that getting a third dose of the mRNA vaccines could "generate a much broader immune response," says Dr. Kavita Patel, a nonresident fellow at the Brookings Institution and a primary care physician. This could give broader coverage against a variant like omicron she says, "which is why I think you're hearing a number of us, many doctors, public health folks, scientists saying boosters do matter."

Paul Bieniasz is a virologist at Rockefeller University who studies how the immune system response broadens over time, and he concurs. "I'm somebody who's been vaccinated three times, and I think that that's absolutely the right way to go," he says.

"I think anyone who is around immunocompromised individuals should absolutely be ensured that they boost," Gandhi says. "I was actually not going to get a booster because I was protesting global vaccine equity. And I just received one because I need to be around my immunocompromised father."

Is it safe to have a large, indoor social gathering, like a holiday party? Should guests all test in advance?

Safety is important, but so is gathering with loved ones at this time of year, and there are steps you can take to lower the risks for everyone. "What we need to do is add more layers of protection," says Vaishampayan.

First, says Karan, make sure everyone present has gotten a COVID-19 vaccine and booster shot if they're eligible.

If you have access to rapid antigen tests, have your guests take one, especially if they're traveling from other parts of the country. "That's a great way to prevent somebody who is infected from coming in and infecting somebody else," Dr. Carlos Del Rio, an infectious disease specialist at Emory University, told reporters this week.

As Karan notes, "testing is really a snapshot in time," so make sure guests test the day of the actual gathering if at all possible. That's because if a person was just exposed and the virus is still incubating, a person can test negative one day and positive the next.

Rapid antigen tests aren't cheap, however. Even the most inexpensive one will cost you around $12 per test — if you can find one. The Biden administration this week announced plans to address that: People with private health insurance will now be able to get reimbursed for the cost of at-home tests, and health clinics will offer free tests to the uninsured. In the meantime, if you have to ration, Gandhi suggests prioritizing testing anyone who isn't vaccinated or is vaccinated but showing symptoms.

If the weather allows, it wouldn't hurt to move the party outdoors, says Vaishampayan. At the very least, think about ways to improve ventilation indoors — by opening windows as temperatures allow, for example.

And if you're a guest who's immunocompromised, keep toward well-ventilated areas and mask up unless you're eating or drinking, Gandhi says. Or consider skipping large gatherings, says Karan. "If you have a high-risk person at home, this is probably not the time to have a large gathering because vaccines here don't completely stop transmission, they just reduce the chance it can happen," Karan says.

Should I hold off on dining indoors at restaurants?

There's not a clear-cut answer for everyone or every situation, says Wu. "I really just assess each situation individually," he says. You should consider transmission levels in your community, whether there's good ventilation, and most of all, your risk level or that of people you live with or spend time with.

Wu says that when he has a social appointment at a restaurant, "I quickly assess how crowded it is, how good is the ventilation, and if it seems risky, and I can pass, I certainly will."

Karan says if you really want to play it safe, skip the indoor dining until scientists know more about omicron. If you do decide to dine indoors, he says get boosted for added protection. But his best advice? "Be conservative right now."

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