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How to protect vulnerable family members from COVID this Thanksgiving : Shots

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The holidays are upon us. Here's your toolkit for how to keep COVID out of your festivities and keep your most vulnerable family members safe this year.

Chanelle Nibbelink for NPR

The holidays are upon us. Here's your toolkit for how to keep COVID out of your festivities and keep your most vulnerable family members safe this year.

Chanelle Nibbelink for NPR

Here’s one thing to be thankful for this year: It’s not Thanksgiving 2020. A year ago vaccines had not yet been approved, daily deaths were rising sharply – surging to more than 2,000 a day by December — and many Americans hunkered down and skipped holiday celebrations to reduce their risks.

This year, 80% of people 12 and up are now vaccinated with at least one shot, and about half of Americans are planning to gather in groups of 10 or more for the holidays, a recent survey shows.

While many of us are ready to reboot our holiday traditions, COVID cases are once again rapidly climbing — with nearly 95,000 new cases a day. Experts warn we still need to keep COVID risk-reduction in mind. Even if your family is fully vaccinated, remember your most vulnerable family members, particularly people over 80 or the immunocompromised, are still at higher risk of severe COVID.

Nearly two years into this pandemic, we’ve learned a lot about how to reduce the risks of catching and spreading this virus, including the simple steps of masking and hand-washing. Let’s not forget now.

Here are some reminders for how to keep your family gatherings safe.

If you’re gathering with grandparents or other elders, realize: They’re still at risk

Reality Check: People over 80 have an elevated risk of dying from COVID, even if they’re vaccinated

While the vaccines offer strong protection against hospitalization and death, breakthrough infections are a reality. Often, a coronavirus infection following vaccination leads to only mild illness, and sometimes people test positive but show no symptoms at all. However, older people and those with compromised immune systems are at higher risk of getting a severe breakthrough COVID case.

Though it’s rare for breakthroughs to lead to hospitalization or death, the chances for one group are higher. As NPR reported, CDC data from August showed that fully vaccinated people aged 80 or older were about 13 times more likely to die from COVID, compared to the general vaccinated population (of all ages). That’s one reason getting boosters is especially important for older adults.

“This is something that we must be conscious of as people are gathering across generations,” says physician and public health epidemiologist William Miller of The Ohio State University. “Grandpa and Grandma are protected relative to if they hadn’t been vaccinated, but they are still at risk,” he says.

That’s why it makes sense to take precautions during travel and in the week leading up to any celebration where older friends and relatives will be present.

“I would absolutely encourage people to continue to wear masks,” in crowded, indoor places such as grocery stores, Miller says, even if it’s not mandatory. This will reduce the risk of being exposed and passing on the virus. And remember, the TSA’s face mask requirement remains in effect through Jan. 18, 2022, requiring masking in airports, aboard commercial airline flights, and on commuter bus and rail systems.

So, bottom line, even if everyone invited to your holiday gathering is vaccinated, it’s still important to protect loved ones who are older or immune-compromised.

Get a booster shot if you’re eligible

Federal health agencies now recommend COVID vaccine boosters for all adults, six months after their last shot — and they may be especially important for adults over 50 or any adult with underlying conditions or a high-risk job. Getting one before holiday travel and gatherings could increase your immunity against COVID.

The agencies’ decision was based on emerging evidence that immunity can diminish over time and evidence that shows a booster dose can, just as the name implies, boost protection.

Some of the most recent real-world data come from the U.K.. Back in September, the U.K. government introduced a booster program targeting people 50 and older.

White House medical adviser Dr. Anthony Fauci said the new analysis points to a significant increase in protection (against symptomatic infection) from a booster dose. “If you look at the third dose in people whose protection has drifted down to about 63%, you boost it back up to at least 94%, which is really quite impressive,” he says. “That’s exactly the kind of thing you want boosters to do.”

Fauci says immunity begins to rebound within days after getting a booster shot, though you don’t get the peak of protection for two to four weeks. He says before joining indoor holiday gatherings, especially in places with high viral transmission, “I would recommend if you are eligible for a boost, go get boosted right now.”

Rapid tests can protect your guests. Here’s how to time taking them

As a risk-reduction measure, you might want to ask your guests to take a COVID test before a large holiday get together. A year ago, it was hard to get real-time information from COVID testing due to delays in test results and a lack of rapid test options. Now, there are plenty of over-the-counter rapid antigen tests, such as the Abbott BinaxNOW or Orasure InteliSwab, available online and in pharmacies.

“A rapid antigen test is an added layer of protection for everyone,” says Judy Guzman-Cottrill, a pediatric infectious disease expert at Oregon Health and Sciences University.

“The antigen tests are a quick snapshot to see if the viral proteins are present in that person’s nose that day,’ explains Guzman-Cottrill. So, if a person was just exposed and the virus is still incubating, they could get a negative result one day followed by a positive result the next day.

The tests are not 100% reliable if someone has just been exposed, explains Emily Landon, an infectious disease physician at the University of Chicago. “The test really doesn’t pick up really low levels of the virus in your nose, and so it’s not going to pick up a really early infection,” she says. So she recommends taking the test the morning of the gathering, or as close to the start of the gathering as possible.

Some families test before they travel, and then again, when they get to their destination, depending on the level of risk of people they’re staying with.(Note: depending on which test you buy, instructions vary. For instance BinaxNOW instructs that people should be tested twice over three days with at least 24 hours between tests for most accurate results)

William Miller is on board with a test-to-be-safe strategy, too. “It’s kind of a mindset,” Miller says. It’s a way to signal: Let’s make the visit as safe as it can be.

Think carefully about how to include unvaccinated family members

Deciding who to invite to your home is a matter of personal discretion, but experts say at this point in the pandemic, it’s pretty clear that a fully vaccinated group is the safest scenario.

“I think it’s reasonable for people to require their guests to be immunized,” says Guzman-Cottrill, especially if unvaccinated young kids are coming or people less likely to have a strong immune response to the vaccine, like the immunocompromised. “Those are the people who we still really need to make sure we keep as safe as possible because this pandemic is not over,” she adds.

A vaccine requirement could lead to some hurt feelings or conflict, but Miller suggests framing the decision as a way to protect elderly loved ones. “I really do think that it’s perfectly acceptable to say, ‘I’m sorry you’re not vaccinated. You know, Grandma’s here, and by you coming, that increases her risk substantially,'” he says.

An alternative option is to ask an unvaccinated guest to do a lab-based PCR test 24 to 48 hours before the event (as long as they’re able to get the results back in time) or a rapid antigen test COVID test just before their arrival. In addition, Landon recommends asking unvaccinated guests to take extra precautions in the week leading up to the event, including wearing masks in public places and limiting exposure to other unvaccinated people.

“We think with the delta variant, most people are getting sick a few days after exposure, but it can take up to a week, maybe a little longer,” explains Landon ” I think it makes the most sense to take precautions for one week prior to having close, unmasked contact with someone who’s at high risk,” she says.

Take precautions if your young child is unvaccinated or has only had one shot

Many children ages 5 to 11 have received their first of two recommended doses, but won’t be eligible for a second dose until after the Thanksgiving holiday. Immunity builds gradually after vaccination, but it’s not known exactly how much protection just one dose of the COVID vaccine provides to kids,” says Guzman-Cottrill.

“I know many families find themselves in this annoying state of limbo right now because their kids will not be fully vaccinated by Thanksgiving,” she says. Given this “limbo” state, “it’s really important to just keep in mind that this is not the time for those families to let their guard down,” she says. It’s not a reason to cancel multi-generational gatherings, but it’s a reminder to take precautions.

So, which precautions are recommended? It kind of depends on the health and age of the relatives who will be attending “If Grandma is a spry 70-year-old woman who has no medical problems and has two doses of vaccine plus a booster, I don’t think these kids are going to pose a ton of risk,” Landon says.

But if the grandparent is over 80 and has medical problems, the risk of a bad outcome is much higher.

An easy step to take if you’re concerned about your unvaccinated kids passing the virus to grandparents is to mask up, not only during the visit, but also for a week in advance when in public, especially avoiding crowded, indoor spaces, even if mask mandates are not in effect.

She says she would not recommend keeping kids out of school to avoid exposure, unless there are extra risks associated with your kids’ school — such as an outbreak of cases or a lack of masking. If the circumstances warrant missing school in order to protect a high-risk relative, “then that may be a layer you want to add,” Landon says.

Another option: if you live in a temperate climate, stay outdoors as much as possible for mixed-generation social events, and maybe choose to not sleep over in the same house with the grandparents.

“Just come during the day for the big event and stay at a hotel,” Landon suggests. Or have the grandparents sleep in a hotel, she adds.

Bottom line: “You have to think about the risk of the individuals involved — about what would happen if they got COVID,” say Landon. And better to err on the side of caution.

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‘Draconian’ Covid travel bans are ‘misdirected’, South African health minister says

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File photo of South Africa Health Minister Joe Phaahla | Flickr


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Johannesburg: The travel bans imposed on South Africa by a growing number of nations due to the new potentially highly-transmissible variant of COVID-19 in this country is draconian and misdirected , Health Minister Joe Phaahla has said.

The new COVID-19 variant B.1.1.529, first detected in South Africa this week, was on Friday designated as a Variant of Concern by the World Health Organisation (WHO), which named it Omicron .

“We feel that it’s a wrong approach. It is misdirected and it goes against the norms as advised by the WHO. We just feel that some of the leaderships of (these) countries are finding scapegoats to deal with what is a worldwide problem,” Phaahla said at a news briefing late Friday evening.

A variant of concern is the WHO’s top category of worrying COVID-19 variants. It was first reported to the WHO from South Africa on November 24, and has also been identified in Botswana, Belgium, Hong Kong and Israel.

“It is ironic that we are currently talking about a situation in South Africa today about small samples, (even though) we are concerned about rising numbers from the low levels of about 300 per day just over 14 days ago; to where we are now approaching 3,000 (cases),” Phaahla said.

“It is a significant rise, but in comparison to some of the countries which are now reacting in this very draconian manner, we are talking about countries that have an infection rate of upwards of 40,000 new infections per day,” he said, contrasting the COVID-19 situation in Europe and his country.

“We don’t want to apportion blame, but just in terms of the way the virus moves as people move, it is not inconceivable that it might be possible that this may have even arisen in those countries which have been even more liberal in terms of crowds with no masks at stadiums and so on, the minister said, adding that the travel ban on South Africa are “unjustified”.

Many parts of Europe and the US have opened up stadiums for crowds at sports matches and concerts.

Phaahla said he was aware that the announcement on Thursday by South African scientists about the discovery of the new variant had caused some consternation and uncertainty.

This is expected in a situation of this nature, where we are dealing with a moving target, but we want to assure South Africans and people elsewhere in the world that we believe that some of the action has actually been unjustified, Phahhla said.

I’m referring here specifically to the countries in Europe.”

All that we did together with our scientists who made the discovery of this variant was basically to be in line with the norms and standards as prescribed by the WHO – that as a world community as we deal with this pandemic and any other matter which challenges the world health as a whole, rather than just individual countries we should act with transparency, he said.

The UK announced on Thursday that all flights to and from South Africa and five neighbouring countries would be banned from Friday following an announcement that the new Omicron variant of COVID-19 had been detected in South Africa.

Many other European countries followed suit, most of them indicating that only their own citizens would be allowed back, subject to a quarantine period.

Foreign minister Naledi Pandor also slammed the UK’s for its decision, which was emulated by others, of imposing travel ban on South Africa.

Whilst we respect the right of all countries to take necessary precautionary measures to protect their citizens, we need to remember that this pandemic requires collaboration and sharing of expertise, she said.

Our immediate concern is the damage that these restrictions are causing to families, the travel and tourism industries and businesses, Pandor added.

Along with South Africa, its neighbouring states — Botswana, Namibia, Mozambique, Zimbabwe, Lesotho, Eswatini, Malawi, Zambia and Angola — have also been slapped with travel bans, crippling their economies which are largely reliant on tourism.

The Department of International Relations and Cooperation (DIRCO) in a statement urged world leaders not to implement knee-jerk policy decisions in response to the detection of the Omicron variant.

DIRCO said it noted that new variants have been detected in other countries as well and each of those cases had no recent links with Southern Africa.

It’s worth noting that the reaction to those countries is starkly different to cases in Southern Africa…This latest round of travel bans is akin to punishing South Africa for its advanced genomic sequencing and the ability to detect new variants quicker. Excellent science should be applauded and not punished, it said.

DIRCO officials are in discussion with the countries that have banned travel to and from South Africa to dissuade them from continuing the restrictions.

South African President Cyril Ramaphosa on Saturday convened a meeting with the country’s leading virologists and the Coronavirus Command Council. He is expected to address the nation on the current Covid situation on Sunday evening.

While some analysts expect him to announce a firming up of the current lowest Level One of a five-level lockdown strategy, others, including the business sector, have urged him not to move to a harsher level as it would cause even greater harm to the economy, which was just beginning to recover after a one-and-a-half year of lockdown.

Phaahla said the scientists who are constantly monitoring the mutation of the virus informed the authorities so that the WHO and the health sector all over the world could also stay informed.

At no stage did (our scientists) say that they have evidence that this virus is more transmissible. They simply said that as has been the case with other mutations, some of them have had the effect of being more transmissible without also necessarily meaning that in terms of its seriousness (it would have) more impact on the severity of illness,” he said.

The scientists did emphasise that these are very early stages in terms of the specifics of how this new variant is going to unfold, the minister said. Phaahla reiterated that there was no evidence that the current vaccines would be ineffective against the new mutation.

We want to dispel any notion, as has been bandied about by various commentators. At no stage did the scientists who discovered this variant say that (it) would be resistant to the vaccines which are being utilised, he emphasised.

Earlier, South African Medical Research Council CEO Professor Glenda Gray came out in defence of the scientists who had flagged the new variant. Gray said releasing such information could assist in changing behaviour and result in reducing the spread of the virus.

“When you discover a new variant of concern or discover something that can have an impact on transmissions, it behoves you to alert the country. The scientists were doing their job. We don’t know how this new variant will impact us or on vaccine efficacy. If this alert makes people vaccinate, that’s a good thing, she told news24.com website.

Gray opined that banning international travel was not an effective way of stopping the spread of new variants.

“I think that it’s hard to contain variants – we saw with the Delta variant. By the time people recognised that a variant is present in the country it has probably already moved. I’m not convinced that restrictions on travel help. It didn’t help us with Delta, and I’m not sure it will help with this, she said.

Dr Richard Lessells, an infectious diseases expert who is part of the KwaZulu-Natal Research and Innovation Sequencing Platform (KRISP) team, who along with Professor Tulio de Oliveira announced the detection of the new variant, said there was sufficient reason to be concerned, but work had already begun on answering important questions posed by the variant.

Lessells said Omicron was different from the Delta variant, first detected in India. Much of the science done to understand the Delta variant was done collaboratively around the world, he said. — PTI


Also read: What’s the new Covid variant in South Africa, and why it’s of ‘serious’ concern even in India


 

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