It has been nearly two years since Covid-19 reared its ugly head, as best we know. We’re fast approaching the first anniversary of the deployment of highly effective vaccines that arm us against the SARS-CoV-2 virus. And you are asking yourself: When is it going to end?
We at STAT have an unfortunate but truthful answer. We don’t know.
But we do wonder: Surely, surely, things are getting a little bit better? With so many people having acquired some immune defenses, either through vaccination or infection, can’t we contemplate easing our way back, at least a little, toward pre-Covid normalcy?
To try to gauge where things stand, we asked a number of infectious diseases experts about the risks they are willing to take now, figuring that their answers might give us a sense of whether we’re making our way out of the woods.
Their responses signal some progress — but not as much, to be honest, as we had hoped. The experts — like much of the American public — have made clear that they aren’t going to give up another Thanksgiving for the sake of trying to stem the spread of Covid. And while they were more willing to go to indoor weddings or the movies (some even said they’d munch on popcorn), many were still very wary of hitting the gym, and flatly refuse to attend an indoor concert or sporting event.
You may recall we undertook this exercise earlier, in mid-August. For this second go-round, we asked many of the same experts — and some new ones — whether they are willing to run the risk of catching Covid by doing a variety of things we all took for granted in the pre-pandemic world. We weren’t asking them what they would advise others to do, but what they are doing or would do, in the context of how the pandemic is now playing out where they are.
At least in some parts of the country, that context appears to be changing. The Delta wave seems to have peaked nationally — though declines in new infections have stalled at unfortunately high levels, and some areas are still experiencing taxing levels of transmission. Vulnerable adults are getting booster shots. Children 5 through 11 have recently joined the ranks of those who can be vaccinated against Covid, and some significant percentage of the country’s 28 million children in this age group will have had their first Covid jab before Thanksgiving.
The 28 people who replied to our most recent questionnaire are public health experts, epidemiologists, immunologists, and virologists. Most of the questions required a “Yes” or “No” answer; many also could be answered “Masked”, shorthand for “Yes, I’d do this, but I would wear a mask while doing it.” Some questions elicited a “Maybe” or two. In many cases, the answers came with caveats.
The question that came closest to having a unanimous answer was: Would you travel by air, train or bus to spend Thanksgiving with family and/or friends? Twenty-six of our respondents said they would, though all but one said they would only do so if masked. The outlier, Amesh Adalja, said he’d wear a mask if required, but otherwise would be comfortable traveling without one.
“My personal risk tolerance is high and everyone is going to get Covid at some point,” said Adalja, an expert in emerging infectious diseases at Johns Hopkins University.
Shane Crotty, an immunologist at La Jolla Institute of Immunology, would be willing to fly or take a train masked — but would not travel by bus. “Just seems like terrible ventilation and spacing,” he said. Nirav Shah, director of the Maine Center for Disease Control and Prevention, also nixed trains.
Paul Offit, a pediatric infectious diseases expert at Children’s Hospital of Philadelphia, registered the only “Not Applicable” answer for this question. “We are driving down to my in-laws,” he explained. Michael Osterholm used to rack up 150,000 air miles a year in the before times. The director of the University of Minnesota’s Center for Infectious Disease Research and Policy, he has flown only once since March 2020 and isn’t taking to the skies anytime soon.
What about hosting or attending multi-generational Thanksgiving feasts where some attendees wouldn’t be vaccinated, either because they chose not to be, or because they were too young? Would our experts attend one of these, or urge their parents or elderly relatives to forgo attending such dinners, even if the older adults were fully vaccinated and boosted? And are rapid Covid tests being worked into Thanksgiving dinner planning?
Twelve said they wouldn’t attend a multigenerational dinner with unvaccinated guests; 14 said they would. Among the latter, four made a distinction between people unvaccinated because they are too young and people who could be vaccinated but choose not to be. “Too young: yes. By choice: no,” said Carl Bergstrom, an evolutionary biologist at the University of Washington.
Megan Ranney, an emergency physician at Lifespan Health System in Providence, R.I., said her youngest son has just qualified for vaccination and won’t have had his second shot by Thanksgiving, but everyone else will be fully vaccinated and (if eligible) boosted. “So, weighing the risks vs. benefits, we have made the decision to go ahead with a get-together.”
And one, coronavirus expert Stanley Perlman, said he’d attend, but would wear a mask as much as possible. “I would want to be masked when I am not eating and use social distancing when eating. Especially with family, I think that I need to be there,” said Perlman, a professor at the University of Iowa.
To the question of whether they would urge older relatives to skip Thanksgiving dinners that involve unvaccinated guests, 16 said yes, 12 said no, and two indicated the question wasn’t applicable to their situations. “I’m the elderly relative,” said Eric Topol, founder and director of the Scripps Research Translational Institute, who added he wouldn’t be sharing his Thanksgiving table with anyone who was not vaccinated.
One of the no votes was Crotty. “The vaccine is sufficient protection. Family is important,” he said. A number said they’d be comfortable with aged loved ones attending a multi-generational gathering if rapid tests were used. “If people can get a Covid test done before the gathering, and if the vulnerable people are boosted, I would feel comfortable,” said Akiko Iwasaki, a virologist and immunologist at Yale University.
Given the number of references we saw about the potential of rapid tests to help navigate Thanksgiving gatherings, we were a little surprised more people aren’t making them a fundamental part of their holiday planning. Twelve said they would, 10 said they weren’t planning on it, three said there wasn’t a need in their situations, two said maybe and one didn’t know. One respondent, coronavirus virologist Angela Rasmussen of the University of Saskatchewan’s Vaccine and Infectious Disease Organization, pointed to availability and cost of tests as potential barriers.
Among the non-holiday questions, only one drew a response nearly as one-sided as the question about traveling for Thanksgiving: Would you attend an indoor concert or sporting event, if mask wearing was not required and enforced? Twenty-three of 28 said no.
“With a good-fitting N95, the risk is low,” said Sarah Cobey, an associate professor of viral ecology and evolution at the University of Chicago. “But this sounds like a situation with shouting or singing at close quarters. Unless others were recently tested and ventilation were excellent, my enthusiasm would be dampened enough to tip the cost/benefit ratio.”
(Among those who said no was Robert Wachter, the chair of the University of California, San Francisco’s department of medicine — even though he recently attended a James Taylor concert. Mask wearing and proof of vaccination were required, he explained; otherwise, he would have passed.)
Four experts said they would attend a large indoor event while masked. “I’d be much more comfortable if there was a vaccine requirement,” admitted Craig Spencer, director of global health in emergency medicine at New York-Presbyterian/Columbia University Medical Center. One — Adalja — would attend regardless of the mask policy.
More of the experts were willing to attend an indoor wedding or religious service, even if guests were not masked. “I would accept some risk here,” said Natalie Dean, assistant professor of biostatistics, bioinformatics and epidemiology at Emory University’s Rollins School of Public Health. “Weddings are important events, more so to me than indoor concerts.”
Jason Salemi, an epidemiologist at the University of South Florida, might attend a wedding, but only if masked, and even then, he’d add caveats. “It would have to be someone incredibly important and I would likely only attend the service and not the reception unless it was held outside.” Iwasaki said she would attend, masked, again raising rapid tests as a tool for navigating a situation like this safely.
Like Dean, Ranney has reached a point where she believes some risks have to be taken. She recently went to a funeral where many of the people attending ignored a mask requirement. “I weighed the number of people, the size of the room, the amount of ventilation, and our local levels of infection, and decided that — given the reality of life, and the emotional importance of this moment — that it was worth staying,” she said, adding that after coming to her decision, she moved to an area that had better airflow.
More of our experts are now willing to go to a theater to see a movie than when we last asked them. In August, only 5 of 27 respondents said they would go to the movies; this time 16 of 28 said they would, though most said they would wear a mask.
Jeffrey Duchin, health officer for the Seattle and King County public health department and an infectious diseases professor at the University of Washington, said he’d go to a movie if everyone was required to be vaccinated and the theater was well ventilated, with air-quality monitoring.
But even those caveats aren’t enough for Rasmussen. Saskatchewan is battling a large wave of infections right now. “I am still heartbroken at not being able to see Dune because it just doesn’t feel right to go to a theater while our ICUs are so full,” she said. Shweta Bansal, a Georgetown University researcher who studies how social behavior affects infectious disease transmission, agreed. “Happy to still watch movies on a smaller screen!”
We asked if people who went to movies would eat popcorn during their film; nine of the 16 said they would. Uché Blackstock, an emergency room physician and CEO of the consulting firm Advancing Health Equity, said she’d be masked when she wasn’t nibbling. Others said it would depend on how crowded the theater was. “Yes, if there’s spacing between folks and it’s not a cramped movie theater,” said Syra Madad, senior director for the special pathogens program in the NYC Health + Hospitals network.
But Andrew Pavia, chief of pediatric infectious diseases at the University of Utah, thinks eating at the movies is a bad idea right now because it “increases the risk.” Ellen Foxman, an immunologist at Yale University, shared that view. “NO,” she wrote, all caps.
Another change from August is that slightly more of our experts would be willing to exercise in a gym. We initially forgot to ask that question the first time we did this; when we realized our error, we fired off another round of emails and tweeted the answer: 15 said no way, four said yes, and another four said yes if masked. (Four didn’t answer.)
This time, 15 of our experts still aren’t ready to return to the gym — “Sadly, no,” said Jeanne Marrazzo, director of the division of infectious diseases at the University of Alabama in Birmingham — but at least three said they wouldn’t want to anyway. “I like to do sports outside in general,” said Florian Krammer, a professor of vaccinology at the Icahn School of Medicine at Mount Sinai Hospital in New York; he runs in Central Park. Rasmussen said she prefers her Peloton bike; “doing cardio while masked sucks.” And another no seemed to be on the verge of turning into a yes. “Not ready yet but thinking about it,” said Carlos Del Rio, a professor of epidemiology and global health at Emory’s Rollins School of Public Health.
Thirteen of the experts said they would exercise in a gym, mostly with masks and other caveats. Esther Choo, an emergency room physician and professor of emergency medicine at Oregon Health and Sciences University, said she would work out in a gym while masked — “and if ventilation and spacing are adequate and masking is enforced.”
A new question this time relates to a challenge many employers and office workers face: When is it time to go back onto the office? And under what conditions?
While 17 said they wouldn’t work in an office with others while unmasked, 11 said they would. Topol revealed he’s already doing it. “All the people I work with have been vaccinated,” he said. For some the question was moot; they work at institutions that have indoor mask mandates.
Among those who said yes, caveats were common. Saskia Popescu, an infectious disease specialist and assistant professor in George Mason University’s biodefense program, said she would, depending on the size of the office, spacing between work stations, the ventilation, and whether there were vaccine requirements, as well as the rate of local transmission. Jesse Goodman, an infectious diseases professor at Georgetown University, likewise would work unmasked in an office — but only with people who were vaccinated and who he knew were trying to limit their potential Covid exposures.
Finally, we asked whether people were planning winter vacations outside the country. There was an even split in responses — 12 yeses, 12 noes, with three maybes and one to be determined. In a couple of cases the deciding factor against international travel wasn’t Covid, it was being the parent of really young children.
Ranney attached a couple of exclamation marks to her yes on this question. “We are booking a vacation to the Caribbean once my little guy is fully vaccinated, where we’ll be able to spend most of our time outside,” she said. “It will be our first time on an airplane as a family since Covid began.”
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