Are physical gatherings safe now?

CLINICAL MATTERS

As the number of daily COVID-19 cases continues to drop, many people are looking forward to their Christmas parties. Having missed these last year, there is a pent-up need to see friends and loved ones physically, especially now that many have been vaccinated. The discovery of the Omicron variant threw cold water on a lot of these party plans. While we wait for more data on whether Omicron is any worse than Delta, it is prudent to be cautious. Delta and the old variants are still very much around and remain potent. These variants have proven to be killers before, and they can still cause super spreader events.

Are physical gatherings really safe? When case rates are low like what we have now, the baseline risk of getting COVID-19 is also low. With the increased transmissibility of Delta and the potential for Omicron to enter, however, it isn’t a good time to relax your guard. Virtual parties remain the safest option. 

Physical parties, should you choose to risk it, can be made safer using these basic infection control principles.

Keep it outdoors. The risk of contracting COVID-19 is much lower outdoors than it is indoors. As seen with Delta, small respiratory particles can remain suspended in the air for a long time. This is especially true in indoor areas with poor ventilation. Since Delta can be transmitted faster than the usual 15 minutes of exposure for older variants, one infected case in an indoor party can easily infect a lot of people.

Invite fully vaccinated people only. While Delta and the other variants of concern have shown higher rates of breakthrough infection compared to the old virus types, these types of infections are still less contagious than infections among the unvaccinated. The vaccines also prevent a significant number of infections to begin with, so even fully vaccinated people who have had high risk exposure are less likely to develop full-blown COVID-19. If someone does end up bringing COVID-19 to the party, full-vaccinated partygoers are less likely to get sick. Even if breakthrough infection does occur, it will most likely be mild.

Wear a mask and shield and avoid crowding. These old reliable measures still work. Used together, mask plus face shield plus one meter of physical distancing reduces the risk of acquiring COVID-19 by over 90 percent. These should be non-negotiable in indoor settings, and will virtually eliminate risk in outdoor settings, especially if everyone is vaccinated. Remove masks and face shields only when eating and avoid talking when the mask is off. Some people have perfected the “bite, mask, swallow” technique where they only briefly remove the mask to take a bite of food and put it back on while chewing. This may seem extreme, but it beats the hardship of getting sick with COVID-19.

Keep it short and sweet. The longer the time spent physically together, the higher the risk that someone can pass on COVID-19 to others. If the objective is to just spend some physical time together, then this can be done for about 15 to 30 minutes indoors or an hour or two outdoors. Conversations can then be continued virtually. 

Avoid aerosol generating activities. The most notorious means of spreading COVID-19 is by singing. In one of the most publicized super spreader events during the early days of the pandemic, a majority of members in a choir got sick during practice even when they followed proper physical distancing. This means laying off the karaoke for now, or go virtual! Also avoid activities that entail shouting and yelling. Live bands utilizing wind instruments will quickly turn a party into an infection party if one of the musicians is infected, so these should be avoided or at least moved outdoors. This also goes for “torotots” or trumpet noise makers for New Year celebrations. Avoid removing your mask when talking, since transmission occurs even with normal conversations.

Screen for exposure and symptoms. Testing with antigen or RT-PCR prior to parties doesn’t seem to be all that sensitive, especially with the new variants. It may end up giving people a false sense of security. The first Omicron super spreader event occurred in Norway and all attendees were reported to have been vaccinated and had been tested prior to the event. Tests are imperfect so an assessment of exposure and symptoms at the time of the party can go a long way in preventing exposure of many people. This can be in the form of a questionnaire, or just a self-administered reminder list to people who are attending the party. Symptom screens aren’t perfect either, but those with symptoms are much more contagious than those without symptoms and this can mean the difference between a controlled outbreak and an uncontrolled one. 

Layers, layers, layers. No single intervention is foolproof, but a “Swiss Cheese” model where the holes of one intervention are covered by the next layer can minimize transmission. This means that combining mask with face shield plus physical distancing plus vaccination and outdoor venues will result in a very small overall risk of infection. Safer is always better.

Keep the vulnerable safe. Even with vaccination, elderly persons and people with comorbid conditions still have a relatively higher risk of developing severe COVID-19 disease than the general population. This means taking extra care to protect these groups from infection. Many older people who did not go out at all during the pandemic died from infection brought in by visiting relatives and friends. Each event should be carefully considered on whether the risk is worth it. If the decision is to proceed, maximizing layers of protection is most prudent. 

Finally, when in doubt, just defer partying for now and go virtual. This pandemic won’t be around forever and there will come a time when we can all safely get together again. The most important thing is that we all make it to that day rather than dying of COVID-19 now.