Covid-19 and the holiday season: Tests, travel, and vaccine questions answered

The second holiday season of the pandemic is here but one change makes everything about this year different: vaccinations. Last year, vaccines were a hope on the horizon — one many people pointed to as they canceled plans, mailed presents, and said, “next year.” Well, “next year” is now. And while the pandemic is not over, what is safe and what is not has changed remarkably — and that includes your holiday plans.

Variants and new understanding about the vaccines, as well as widespread efforts to reopen public spaces where viruses typically spread means that knowing what is safe this holiday season is tricky.

A recent survey conducted by Ohio State University’s Wexler Medical Center found that roughly half of Americans will ask their guests to wear masks to Thanksgiving get-togethers, and almost 75 percent say they plan to only celebrate with members of their household. To help guide your own thoughts, William Schaffner, an infectious disease specialist at the Vanderbilt University Medical Center says there is one step you can take which could make a significant difference for everyone involved in your festive plans.

Should I get tested before going to a holiday party?

Yes, says Schaffner, though getting a test is perhaps more important for some people than others.

If you’re unvaccinated, for example, you absolutely want to get tested before seeing anyone outside your immediate household. That’s also true if you’re going to be around children who can’t get be vaccinated yet or people who are at high risk of getting Covid-19 even if they have been vaccinated.

If you are vaccinated, then the longer it’s been since your last Covid-19 vaccine dose (whether a booster or the initial series), the better it is for you to get tested before you go on a holiday trip or to a party or dinner with others.

Should I get a PCR or a rapid test?

If you have decided you’re going to get tested before seeing anyone outside your household this Thanksgiving, then you need to grapple with a new question: What test should you get and when should you get it?

PCR Test: If you’ve been tested for Covid-19 before, then it’s very likely that you’ve had a PCR test. In this test, you get a mascara-brush-shaped swab shoved up your nose and/or inside your mouth, and then a technician drops it in a test tube, sends it to a lab, and you get your results in as short as a few days or as long as a few weeks.

PCR tests, Schaffner says, are the most reliable tests available for Covid-19. If you do the test within the first five days of symptom onset (assuming you have symptoms), the test is more than 90 percent accurate. They are also the standard for flights outside of the U.S. and to certain territories, so check the guidelines for travel in and out of your destination.

PCR tests have a significant downside, especially when it comes to getting tested before the holidays: You need to go to a healthcare facility to get one, typically, and you have to wait days, sometimes weeks, for the results.

How long results take to come back to you depends on where you are in the country, so you need to build in time for the results depending on the availability and proximity of laboratories that can process the test.

Antigen/Rapid Test: If you don’t have time for a PCR test, the faster option is a rapid test (hence the name).

Rapid tests are also widely available. You can even purchase them in some drugstores and online. They’re extremely convenient — you can do it at home and get results in about 15 minutes. They’re widely used in the U.K. for quick contact tracing and testing following exposure, and some experts are calling for more widespread use of the tests in the U.S. for this reason.

But “false negatives can happen,” Schaffner says, though only in certain circumstances.

“[False negatives in rapid tests] usually only occur in circumstances where the virus load is very low,” he says. “So you’re probably not as much of a risk to others.”

In other words, if the amount of virus in your system is small enough that it can’t be detected by a rapid test, it’s unlikely that you’re going to transmit it to others easily, either.

That said, this is also where individual circumstances come into play. If you plan to see someone who is really high risk, you may not want to take the chance of a false negative. But if you’re going to see people who are both fully vaccinated and healthy, a negative rapid test may be enough to set minds at ease.

No test is perfect, Schaffner says, but “this is about minimizing risk.”

Do booster shots increase Covid-19 immunity?

While testing is important, it’s not the only line of defense from Covid-19.

Hopefully, you are fully vaccinated against Covid-19 (two shots of either Moderna or Pfizer or one shot of Johnson & Johnson), but we now know that immunity can wane over time. If you’re above the age of 18, living in the U.S., and it’s been more than six months since your last shot, you’re eligible for a booster dose.

The science of how booster shots work is pretty well established at this point. You can read more about it here.

Schaffner describes boosters as a “reminder” to your immune system. Renewed immunity to the coronavirus will reduce your risk of getting sick should you be exposed to the virus and also reduce the risk of you transmitting the virus to another person.

When does immunity from a Covid-19 booster kick in?

After the first round of Covid-19 immunization — two shots of an mRNA vaccine or one shot of Johnson & Johnson — you are considered “fully vaccinated” two weeks after your second dose. That’s because it takes time for your immune system to make the necessary antibodies and ready other defenses against the virus.

That’s not the case with the booster, Schaffner says.

“Your immune system is already primed,” he says.

“Your immune system’s response to the booster is much more rapid [than it is to the initial vaccination]. It can start increasing within a day or two. It’s usually at the maximum [protection] within a week,” he adds.

Schaffner has one last piece of holiday-related health advice — though it doesn’t have anything to do with the novel coronavirus.

“There’s another respiratory virus we’re starting to see out there,” he warns.

“We should all get our flu shots because the boosters won’t protect us from that.”

Schaffner says you can get both the booster and your flu shot at the same time.

“I often say a vaccine deferred is also the vaccine never received. If you have the opportunity to get them both, I certainly would,” he says.

So get vaccinated, get tested, and hopefully, you’ll have a little more togetherness this holiday season than last.