By Phenelle Segal, RN, CIC, FAPIC, Founder, Infection Control Consulting Services (ICCS)

The risk of getting infected with COVID-19 when gathering with friends/family during the holidays is lower if the people congregating are all vaccinated and boosted. If not boosted, people should seriously consider the added protection it provides. Limiting the size of crowds gathering is also advisable.

Fortunately, the symptoms of Omicron to date in vaccinated persons appear to be mild and short-lived, but we don't want to pass it to others, nor do we want to be presumptive. Omicron is tricky

The following steps should be highly considered:

1. Symptoms: Omicron is causing cold- or allergy-like symptoms in vaccinated persons. There is more severe disease in the unvaccinated, so limit or forego contact with them if possible. Scratchy or sore throat seems to be high on the list of initial symptoms. I highly suggest that if anyone has any symptoms suggested of "allergies" or a cold/respiratory infection, they isolate for at least 5-7 days (as per Dr. Fauci during media discussion) and symptoms must be significantly better (no fever for 24 hours or more without fever reducing meds). Testing is an option too (strategies discussed below). Omicron is highly transmissible while acting like a mild infection.

2. It is also causing headache, body aches and mild GI symptoms with some people complaining of a mild fever — all indicative of general viral syndromes particularly in the winter.

3. There are other lousy viruses circulating, and I suggest these strategies so that you're protected from these additional illnesses.

4. Testing: If a person tests negative via rapid test (particularly if symptomatic), it doesn't mean they are COVID free. The question is whether the "negative" person is incubating it and are they transmissible? That's based on how much virus is in the nasal passages or throat. Could they have another respiratory virus?

In summary, if anyone has any cold-like symptoms or thinks they have allergies, they must isolate as they can infect a lot of people if it's "hidden" COVID or another virus. Symptoms and a negative rapid test (ensure you research which home-based test kits are reliable) could still be a mild Omicron infection that is transmissible, but we don't know how infectious.

5. Rapid test kits are effective at detecting Omicron, but it all depends on whether there is enough virus to detect and at what stage the illness is tested. There is a risk of people who are infected testing negative, but if they are asymptomatic, it is thought that the likelihood of transmitting Omicron may be less. However, we really don't know all the details at this juncture.

6. Before traveling and during a trip, you could undertake screening daily to help identify the virus. There is no hard science to support this strategy, and you will need access to tests to do so, but some took this approach during the Thanksgiving holiday and will also be doing so for the upcoming holidays.

7. It is advisable to stay home or isolate if you develop symptoms while away.

8. Isolation: If a test is positive on rapid and/or PCR, CDC has not changed its isolation guidelines to date (I’m expecting updates soon). but, as mentioned above, Dr. Fauci has stated 5-7 days may be all that is needed, provided the person is no longer symptomatic and feeling better. Bear in mind though that these are suggestions and not evidence-based, written guidelines. 

Strategies to Prevent Infection: The Most Important Information

Follow these strategies to reduce your risk of infection:

• Step up your masks to a well-fitting KN95 that has at least 5 layers or an N95 that is vetted by OSHA/NIOSH.

• Masks should be worn in every indoor setting prior to gathering, including elevators, offices (even if others are masked and/or the office is quiet), stores, and public transportation.

• If possible, limit mass transit use or avoid altogether as COVID and respiratory viruses, including the flu and RSV, are also circulating. Given how many people take mass transit, the amount of circulating virus is exponentially increased, and we suspect that virus can bypass your mask if it is not well fitted.

• Always keep your fingers away from your eyes and nose.

• Wash your hands when you get home from shopping or other tasks outside the house. Do so when inside the house at intervals, but especially upon returning home.

• I'd hold off on going to the gym during this heightened period, but if you must go, I'd wear at a minimum a tight fitting KN95.

Finally, enjoy your time together and be wise!