This year's holiday season is arriving right in the midst of an unwelcome "tripledemic" of COVID-19, influenza and respiratory syncytial virus (RSV) that have helped strain hospitals nationwide.
Though COVID cases are much lower than they were last winter, case counts are ticking up nationwide, and nearly 3,000 Americans are dying each week. Meanwhile, other respiratory viruses like the flu and RSV have surged this fall.
More than 77% of hospital beds nationwide are occupied, down slightly from nearly 80% earlier this month, according to data from the Department of Health and Human Services — the highest levels seen since last winter's omicron surge.
NPR asked a handful of public health experts how Americans should approach the holiday season. They suggest that Americans take stock of the risk and take appropriate safety measures to protect themselves and those who are most likely to face severe disease — including older people and the immunocompromised.
"Everyone is obviously ready to do as much as they can that they have done in normal holiday periods, especially as many of us have given it up for a couple years," said Dr. Henry Wu, an epidemiologist and travel doctor at Emory University. "We're entering a new normal where we have to navigate how best to do what we want to do."
Now's the time to look ahead and think about what plans you have for the holidays, Wu said. Which events are the highest priorities for you? Who do you want to see?
Then, do a risk assessment. Think about how much you're willing to risk getting sick — and same for the people you plan to see. Are you a healthy young adult doing a small get-together with other healthy young adults? Or will you be attending a large, multigenerational family reunion with children and older people together in the same house?
Thinking through those questions can help you decide which safety measures to take. "Every family and every individual is going to be a little different," Wu said.
Some people may feel totally comfortable getting together at a bar. Others, not so much. "If you would like to do as much as you can to avoid getting sick when you're getting together, if you want to protect the vulnerable person, whether they're elderly or an infant, then definitely incorporate some of the lessons from the last few years," he said, including limiting your exposure before travel and testing for COVID before you go.
All the public health experts who spoke with NPR agreed on this easy way to reduce the risk to you and those around you: Get your shots!
The bivalent COVID-19 booster shots made by Pfizer and Moderna are available to almost all Americans, including most children. And for those who need or prefer a non-mRNA shot, the Novavax vaccine is available as a booster to adults who completed an initial vaccine course at least six months ago.
Flu shots, too, are important. The CDC estimates that at least 13 million Americans have already been infected with the flu this season, and over 100,000 hospitalized — a caseload much larger than last winter, when many Americans were still following COVID-related precautions.
But flu shot uptake this year has been low. Only about a quarter of American adults have been vaccinated, according to the CDC. Those who haven't gotten their shot yet should seek one soon, said Dr. Preeti Malani, an infectious disease specialist at the University of Michigan.
"The sense is that this year's vaccine is actually a pretty good match to the strain circulating. And much like COVID vaccines, flu shots don't prevent all infections, but they can help prevent hospitalizations, deaths, as well as transmission," Malani said in an interview last week with NPR.
This was the other easy source of agreement. "If you have symptoms, if you are feeling unwell, we are going to ask you to stay home. We are saying we don't really want people to gather if they're feeling unwell," said CDC head Rochelle Walensky in an interview with NPR last week.
One scientific review of 130 COVID studies conducted by mid-2021, published earlier this year in the journal PLOS Medicine, suggests that the risk of getting infected from someone who's asymptomatic is much lower than from someone with symptoms.
That makes staying home when sick "one of the most profoundly important things we can do this holiday season to keep other people safe," said Dr. Monica Gandhi, an infectious disease specialist at the University of California San Francisco. "That means not going to that holiday party when you're coughing and sneezing."
If you do feel sick, get tested — COVID tests are widely available this year at pharmacies and grocery stores. And health care providers can arrange a flu test.
"If you are diagnosed early, we have antivirals that can be used to shorten your disease course and your disease severity," Walensky said.
"I consider ventilation one of the strongest things we can do to protect ourselves during respiratory pathogen season," said Gandhi.
Respiratory diseases such as COVID have a difficult time spreading outdoors, where natural airflow is remarkably effective at dispersing droplets and pathogens.
Not everything can realistically be moved outdoors. Many social gatherings and religious services will be indoors. For family members traveling long distances to see each other, spending a lot of time indoors together is inescapable.
For more flexible plans, like catching up with an old friend from high school, you could consider outdoor activities if the weather allows — like a walk in the park, ice skating or strolling an outdoor holiday market, rather than getting together at a bar or restaurant.
For the indoor gatherings, Gandhi suggests doing what you can to improve ventilation. Open windows if the weather allows. If not, HEPA filters, cracked windows and ceiling fans can help too.
"I think that has really come out as the strongest non-pharmaceutical intervention that's been revealed during this pandemic, because it just eliminates all respiratory pathogens," she said.
Some indoor time in public might be unavoidable during a holiday season, like during travel and religious services. Health officials at the CDC, along with some municipalities, are encouraging people to wear "high-quality, well-fitting" masks in public when possible — especially those who are more vulnerable, like older people and immunocompromised people.
"Especially in crowded indoor spaces, whether it's on the subway or in an airplane, a lot of people are sick around us right now. So put that mask on," Malani said.
Studies are mixed on the effectiveness of masks on a large scale.
But in laboratory settings, masks like N95s or KN95s have been shown to block virus particles. Wearing one of these high-quality masks can cut your risk of getting infected when around others who aren't masked, though they of course aren't foolproof.
"I don't think a mask is a difficult thing to do," said Wu. "I really encourage folks to keep that mask handy and use it" when you find yourself in a crowded and poorly ventilated indoor space.