Don't risk your holiday plans: The basics still matter for COVID and flu

Yet another holiday season. Yet another round of highly contagious respiratory viruses threatening to ruin our festive plans.

Cases of respiratory syncytial virus (RSV) are up, flu is widely circulating, and COVID-19 is sending increasing numbers to the emergency room. Still, unlike several years ago when the novel coronavirus had everyone playing Scrooge and nixing holiday plans, experts say that’s no longer necessary for most people. But it’s still smart to take precautions to protect yourself, your guests, and your family.

“There are things we can do this winter to minimize sickness and disruption to maximize time with family. This is what the holidays are all about,” says Katelyn Jetelina, an epidemiologist and scientific consultant to the United States Centers for Disease Control and Prevention and other institutions, who blogs as Your Local Epidemiologist.

Half of Americans plan to take virus protection measures this holiday season, according to a survey by the nonprofit KFF (formerly called Kaiser Family Foundation). Some worry about their own chance of falling sick; others want to avoid spreading the disease to loved ones, since respiratory infections are so easily passed from an infected person’s nose or mouth.

“It’s definitely wise for everyone to take precautions, but certain populations—the elderly, young children, people who are immunocompromised—are more susceptible,” says Jessica Tuan, an infectious diseases physician at the Yale School of Medicine. “If you will be in contact with these individuals, you want to be especially cautious.”

Immunization is the best defense

This year for the first time, vaccines are available for susceptible people for all three of these circulating respiratory diseases.

“Are they perfect to where you won’t get infected? Possibly not, but they will prevent you from getting serious disease and that is the goal,” says Jill Weatherhead, an infectious diseases physician at Baylor College of Medicine in Houston.

RSV has been spreading for decades; prior to the pandemic five times as many infants died from this as from the flu, and many people over 65 were hospitalized. Yet the disease often flew under the radar, until it sparked an early and especially virulent season in the U.S. in 2022.

The U.S. Food and Drug Administration has now approved vaccines against RSV in adults 60 and older and in pregnant women (to protect their newborns). A monoclonal antibody is also available for all newborns and certain other babies up to age two.

(Read more about which RSV vaccines and preventive drugs are right for you?)

Flu vaccines have been available for years, of course, but not enough people have gotten theirs this year, according to the CDC; as of early December only 39 percent of Americans have been vaccinated.

Meanwhile, just 16 percent have opted for the latest COVID-19 vaccine, including only a third of people in the high-risk older adults population.

The good news: It’s not too late to get any of these inoculations to protect yourself during the holidays, Weatherhead says; you can get two or even all three shots at the same time.

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The basics still matter

During COVID, high-tech interventions like negative pressure rooms, HEPA air filters, and N95 masks overshadowed rudimentary advice like hand washing, but it’s still smart to focus on the basics, Tuan says.

Each time you soap your hands you reduce the probability of contracting a circulating respiratory virus by 3 percent, researchers reported last year. Washing also lowers the odds of spreading germs you don’t know you have by touching common surfaces like door handles and light switches.

Periodically wiping down surfaces with bleach or hydrogen peroxide also successfully reduces contagious germs, scientists reported after testing various types of cleaners. First clean the surface with water and detergent. Strong viruses require one minute or more of exposure to the disinfectant, so don’t wipe cleaners away prematurely. When hosting holiday festivities, it also helps to open a window, weather permitting.

Maintaining distance from other people when possible is also advisable. Early in the COVID pandemic people were told to remain six feet from others, a concept known as social distancing. Six feet is roughly the distance many virus-laden particles travel from a person’s mouth when they sneeze or cough, before falling to the ground.

Public health experts eventually came to realize that, like the flu, COVID is also emitted in smaller particles known as aerosols that travel much further distances. And it turns out an infected person doesn’t have to cough or sneeze to spread their germs; normal breathing transmits viruses too.

Giving others that berth helps you avoid their more concentrated germs, especially if they are coughing or sneezing, Weatherhead says. Plus, stepping back at the checkout line as you’re buying holiday gifts or food for a party is simple. “Small measures like just keeping some distance don’t cost anything,” she says.

Should you mask?

Whether to mask is an individual decision, based on each person’s level of risk and risk tolerance, Jetelina says. The KFF survey found nearly a third of people plan to mask in crowded places this holiday season. This approach does work: Well-fitting N95 masks protect against many respiratory illnesses. They also protect others by reducing the particles you spew into the air by up to 90 percent.

People at high risk for serious illness from a respiratory infection, such as those on immune-suppressing medications or who have serious lung disease, have been masking for years. Everyone else seems to wear masks sporadically, which is fine, Weatherhead says.

While traveling, Jetelina masks in airports and on planes until the wheels go up; after that, the plane’s high-quality filtration system keeps germs from widely spreading, so she takes it off.

Masking at strategic times can also protect your holiday fun. If family is coming during Christmas or if you’ve got a big trip on the books, wearing a mask a week or so beforehand increases the odds you’ll be healthy during that time.

As for home antigen testing for COVID before a gathering, taking two tests 48 hours apart catches only 39 percent of people with the disease if they don’t have symptoms. Jetelina says the low catch rate and expense of the tests mean she no longer routinely swabs before large family gatherings. If you’re planning to host someone at high risk for problems, though, that might change your calculation.

You should test when you have symptoms, since 92 percent of people in this category are flagged as positive when testing twice 48 hours apart. The federal government is offering eight free tests delivered by mail. If you got four earlier this fall, you are entitled to a second batch.

Before COVID, many of us had a lackadaisical attitude towards respiratory viruses, assuming they can’t be stopped. Too many ignored symptoms and went to work or to parties, Weatherhead says. Hopefully, this has changed.

“I think we better understand what we can do to prevent illness, as well as what we can’t do,” she says. “We all need to do our best to keep everybody in our community as safe as possible.”