Cases and hospitalizations are continuing to trend upwards, but wastewater surveillance data indicates that perhaps we've already reached the peak of this increase. We won't know if it's a pause on the way up or the true peak until next week. It's a clear continuation of the up-and-down pattern that we've watched play out over the past few months. 

I am continually reading the most recent research on COVID-19 and trying to understand what is causing the pattern we've seen, and in my opinion, this is one of the most unclear points of the pandemic. Will the new variants cause surges when they become dominant? Why do surges that increase equally rapidly sometimes continue upwards to record levels (like in early 2022) and sometimes peak and go back down quickly (like in September 2022)? Is competition between COVID-19 and other respiratory illnesses like RSV and influenza partially responsible? I don't know and from what I'm reading from other epidemiologists, they don't know either.  

COVID-19 continues to surprise us, but there are also reassuringly predictable components. For the most part, the vaccine provides a high level of individual protection, as do high quality masks. We've seen a push towards individual responsibility from the state and federal government over the past year+. That approach is typically not aligned with the central concept of public health, and I'm not sure it's the most helpful approach over the past year, but we certainly do seem to find ourselves in a position right now where individual choice has a huge impact on how you are faring right now in the pandemic.

With an important exception! As discussed last week, the data from the past few months are clear in that older adults, over age 65, are at greatest risk of severe disease and death. We're seeing that play out in local data. Being up-to-date on the COVID-19 vaccine lowers the risk of severe disease among older adults, but the risk is objectively higher in that age group for all, including those who are  vaccinated and boosted. This is where I would stress moving beyond individual responsibility - if you are planning to visit an older adult, I suggest adopting a public health approach to that visit. Be cautious in the week or so leading up to the visit. Test several times with rapid tests at home, or with a PCR the day before visiting. If you're not feeling well or you have symptoms like coughing or sneezing, even if you're testing negative, skip the visit. Depending on the type of visit and how vulnerable the person is, consider air filtration and masking inside during the visit. 

It's definitely possible to have a safe holiday season if you consider your activities, and for the most part, I'd expect the holiday season to seem mostly normal. Gatherings of younger adults and kids probably need little precaution beyond normal etiquette for gathering (i.e., don't go if you're feeling sick!), particularly if everyone is up-to-date on their vaccine. It's all a calculation of risk at this point, for you and your loved ones. I suppose the short version of what I'm trying to say is: think about your own risk level and risk tolerance and cherish being together with friends and family during this season, but consider the risk level of your family and friends when they're part of your plans, and match your mitigation strategies to the level they need to stay safe.

Megan W. Harvey, PhD (she/her)
Epidemiologist

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