Ask Us Anything About…Healthy Holiday Celebrations

Scott Gilbert – Ask Us Anything About Healthy Holiday Celebrations. I’m Scott Gilbert. Well, due to the COVID 19 pandemic, the advice last year around holiday celebrations was rather straightforward and not very optimistic. Right? Essentially don’t go, but if you do, please be really careful. A year later, progress has been made and many of us are vaccinated. But we’ll talk of a potential winter surge coming yet again. We want to check in with a couple experts from Penn State Health Milton S. Hershey Medical Center for their advice on how to keep holiday celebrations safe and healthy this year. I want to welcome Dr. Jonathan Nunez and Dr. Catherine Paules. They’re both infectious diseases specialists at the Milton S. Hershey Medical Center. Thanks a lot to both of you for being here today. Let’s start with you, Dr. Paules. How would you describe the COVID landscape as it was as we head into this holiday season, as compared with last November? I mean between vaccine availability in case counts, it appears to be pretty different from what we were up against a year ago. Is it not?

Dr. Catharine Paules – I think I did some questions about this last year, and my advice for everyone was to really avoid holidays celebrations. And this year, I feel very differently. I think if you’re fully vaccinated, you really can go and gather with your family. And we can talk about in this Facebook live exactly how to do that in a very safe manner.

Scott Gilbert – Sure. And Dr. Nunez, do you concur? It’s a different picture this year than last, correct?

Dr. Jonathan Nunez – I agree. I think it’s more optimistic than last year, especially since when we were doing our recommendations last year, there were still no vaccines available. I do think the landscape has changed slightly from last year.

Scott Gilbert – Yeah, in fact, over the weekend, Dr. Anthony Fauci said fully vaccinated family members can absolutely enjoy Thanksgiving together indoors without masks. Dr. Nunez, how heavily should vaccination status influence people’s plans?

Dr. Jonathan Nunez – You know, I think one of the big things that, as we plan for the holidays, especially as we think about Christmas holidays, I think of it also as a time to think about our patients getting boosters if they qualify for boosters. And as one thing that’s also changed recently is also thinking about our younger patients. Right? So when we think about now five to 11, also being, having the opportunity to be vaccinated. So I think of it as a kind of a check-in time to see, one, do you qualify for a booster which CDC recommendations recommend now that all adults do? And then two, is thinking about having that conversation, you know, with parents about vaccinating their young ones.

Scott Gilbert – All right. And Dr. Paules, what are your thoughts on the whole vaccine situation? I mean in one way, it does make things easier, but then again, there are other complexities of the fact that not everybody is vaccinated, and not everybody, including those under five can be vaccinated.

Dr. Catharine Paules – That’s correct. So I think last year, the recommendation was an easy one. No one should be gathering. But this year, it’s much more challenging because everyone’s situation is going to be a little bit different. And so when you’re preparing for the holidays, you need to think about who’s going to be there with you. For example, if you have a fully vaccinated group of young healthy adults, I think you can gather safely indoors without masks and enjoy a normal Thanksgiving. If you have your immunocompromised grandmother there, you may want to think hard about some other strategies. For example, being very careful ahead of the holidays, masking when you’re out in public, and really minimizing your own risk, perhaps, even taking a rapid test on the day of your gathering. And maybe if you have a very high-risk family member, even if they are vaccinated, maybe it is time to wear masks inside or maybe move your gathering outside. I heard the weather is going to be very nice on Thanksgiving here in central Pennsylvania.

Scott Gilbert – It is. I think it’s going to be up and like the mid to upper ’50s which, you know, that’s not terrible. It’s also a little unseasonable, but it could be a nice excuse to hold things outside. You’re watching Ask Us Anything About Healthy Holiday Celebrations from Penn State Health. I’m Scott Gilbert alongside Dr. Jonathan Nunez and Dr. Catherine Paules. We welcome your questions for them. Just add those to the comment field in this Facebook post. And we’ll get to those here in the course of this interview because you might have some questions about, you know, what is safe and isn’t safe to do with family. How do you keep, especially, older relatives safe? And in fact, I want to talk a little bit about that because a year ago, a lot of the questions were around people who are older, who have pre-existing conditions being at higher risk of becoming severely ill from COVID. Dr. Nunez are those the folks we’re still most worried about this year?

Dr. Jonathan Nunez – I would say that, you know, overall, the risk is still higher and our older patients are patients that might have pre-existing conditions, especially, conditions where, you know, they’re going to have an immunocompromising condition. But one thing I would say is that’s changed slightly as well is that the Delta variant has affected younger patient populations as well. And I think one thing that we’ve been noticing even in our hospitalized patients is that the demographics has changed slightly. I’m seeing younger patient populations as well. So as I think about, again, and they know I might be harboring on the same message, I think it’s really thinking about, you know, if we qualify for a booster thinking about that opportunity for getting the booster. And I think if our younger patient populations qualify for a vaccine, really thinking about providing them protection with the vaccine.

Scott Gilbert – Yeah, and now that so many Americans are eligible for booster shots here, I mean, let’s talk a little bit about that, Dr. Paules. I mean, is that, I know that, you know, there’s the basic level of vaccination, but that’s a lot to weighing around what is it, about six months?

Dr. Catharine Paules – Yeah. So I think the concept of boosters has been one that’s been heavily debated both in the United States and internationally. And to me, there are some clear people that should go out and get a booster. And those are people that are over age 50, and those with underlying health conditions. And then, of course, immunocompromised patients have been recommended for a third shot for quite some time to get their levels up to where we are. Now, if you’re a younger individual without any health problems, the CDC says you can get a booster. And so the goal of the booster in your situation may be to prevent transmission to others in the setting that you’re going to, rather than keeping you out of the hospital. And so that’s the way I think about booster shots right now. In older people, it’s to protect them. In younger people, it’s more to protect those around you and to keep you from getting an illness that might land you out of work and things of that nature.

Scott Gilbert – Now, Dr. Paules, what if our plans include getting together with family members who have already previously had COVID, and they have those antibodies from that. Maybe they’re not vaccinated, but they’ve had COVID, does that count for something?

Dr. Catharine Paules – Well, I think it does count for something. The problem with infection is that it’s a variable response in terms of protection after you have that infection. So if someone has had a Delta infection, and they were pretty sick, maybe they were even in the hospital, I would agree. I think their protection is pretty good. I would still recommend them to get at least one dose of vaccine, but their protection should be pretty good. And that’s compared to somebody that may have had an asymptomatic infection maybe six or seven months ago. In that case, I wouldn’t trust that protection. And so everybody’s situation will be a bit different. And my take-home message is you still need to get vaccinated even if you did have that infection. And talking about, talking to your doctor about the timing of that and when it makes the most sense based on your health conditions.

Scott Gilbert – You’re watching Ask Us Anything About Healthy Holiday Celebrations from Penn State Health. If you have questions before you go over the river through the woods, wherever you plan to go this holiday season, please feel free to drop those in the comment section of this Facebook post. And we will pose them to Dr. Jonathan Nunez and Dr. Catherine Paules, who are here with us today, taking some time to share some great information on the very latest about the pandemic. There are, unfortunately, there is talk of a winter surge in COVID cases being in the offing. I’m curious for each of your takes on this, including whether it may be the last surge we’ll see, hopefully, Dr. Nunez, what are your thoughts?

Dr. Jonathan Nunez – I was going to first say this is an excellent question for Dr. Paules. And then I can add my comments after.

Scott Gilbert – Yeah, feel free to [inaudible].

Dr. Catharine Paules – Well, I would say that we’re always wrong about what’s going to happen with COVID-19. And so I do think we’re in a better situation than we were last year because we have vaccinated a number of high-risk individuals, and that may help keep them out of the hospital and keep some of that healthcare surge down. However, I don’t think our vaccination rates here in Pennsylvania are high enough to prevent a surge altogether. I still think we’re going to have a lot of patients in the hospital, and we may have other respiratory viruses causing people to be in the hospital, which we didn’t see last year. And so I encourage everyone, if you have not been vaccinated, go out and get your vaccine, get it today. And so that you’re not one of the patients I’m seeing in the hospital. And if you are a high-risk individual at high risk of hospitalization, now’s the time to think about that booster shot. We can’t relax things. We’ve seen this happen across the world, even in very vaccinated areas, they’ve had health care strain, and so we need to be prepared as if that’s what’s going to occur.

Scott Gilbert – You know, speaking of that booster shot, let me ask you about that question that they kind of comes up especially a lot lately because guidance seems to have changed with regard to, you know, whether it’s okay to get an mRNA vaccine, a Pfizer, or Moderna vaccine if you got J and J previously, that’s to the Johnson and Johnson vaccine. Dr. Nunez, I understand that that is actually recommended now?

Dr. Jonathan Nunez – I would say that overall, when I’m talking about patients and vaccinations, one of the big things is making sure that they’re comfortable with any shot that they usually will get. You know, I think one of the big things, I would state that I usually have pushed for more patients to get mRNA vaccines. I don’t know if Dr. Paules feels differently. You know, I think one of the things that I’ve been noticing overall, generally is a little bit more protection, actually. But I don’t know if Dr. Paules feels any differently.

Dr. Catharine Paules – I agree. I think, again, we’re in a very different place than we were in the past. We know a lot about the mRNA vaccines now. We know they’re highly effective. And we know their safety profile very well. So when I have someone that’s not vaccinated, I generally do recommend an mRNA vaccine to them. For patients getting a booster shot, again, I talked to them sort of about the data that exists, which isn’t a whole lot. In terms of mixing vaccines, there’s some data but not as much as we’d like. Oftentimes, I will discuss with the patient, maybe, getting an mRNA booster. The CDC allows that, allows you to boost with anything you’d like to. And so I really talk about the gaps in knowledge with my patient and get them, you know, what we both agree is the right vaccine for them.

Dr. Jonathan Nunez – One thing I would add to that that’s different also from the beginning with vaccine rollout is I just think there’s more availability, actually. So I think at the moment when we only had certain vaccines that were available, you really were targeting our patients to consider vaccinations. And I think now, it’s much [inaudible] to get the vaccine of your choice.

Scott Gilbert – Sounds good. You have been watching Ask Us Anything About Healthy Holiday Celebrations. We welcome your questions for Dr. Nunez or Dr. Paules, just add those to the comment field here. And we’ll make sure we post them to you. It can be even while you’re watching this live, or even if you’re watching the interview after the fact on playback. We can get you a typed-out answer. So feel free to bring those questions on. You know, I’m curious for those who plan to travel away from home for the holidays. To what extent does their destination matter? I mean, Dr. Paules as of yesterday, a new infections were on the rise in 38 States. Is that a bit of a concern?

Dr. Catharine Paules – Yes, I think that’s absolutely a concern. There have been experts that have said maybe we will avoid a winter surge. I think we’re in a tough spot going into the winter. I do think we will have a surge and how many people end up in the hospital will be dependent on vaccination in the region. And I do think you need to think hard about traveling if you’re not vaccinated. In fact, I would recommend against it. If you are vaccinated, then take precautions, wear a mask while you travel. And again, if you’re going to be gathering with someone that’s at high risk of complications, you really need to be careful before you go and you may think about wearing a mask or maybe taking a rapid test on the day that you’re going to gather with your family.

Scott Gilbert – Yeah, in fact, the CDC is recommending that people wait to travel until everyone in their party has been vaccinated. In fact, there are a lot of really good recommendations from the CDC, online@cdc.gov. We’ll make sure we put those in the chat below this Facebook post, so you folks can follow the direct link to that as well because, again, a lot of good advice specific to the holidays in that page from the CDC that we will share below. You know, Dr. Nunez, we talked about social distancing, masking, washing hands. We’ve been talking about those things for a very long time and not to sound cynical, but are some people just kind of done with the pandemic and done doing those things? Or do you feel like those messages about the need for those kind of common-sense precautions, do you feel like those messages are still getting through?

Dr. Jonathan Nunez – I agree with you, I think I can understand everyone’s frustration and feeling tired. How I always explain it to my patients, especially in my primary care clinic is that we’re not out of the pandemic. The pandemic is still here. And vaccines are a great tool to help prevent infection. But you know, I think still taking precautions will reduce that risk even more. And just remember not everyone may be vaccinated yet, especially if we think about children under the age of five. You know, I think in the end of the day, we’re trying to protect [inaudible]. Our loved ones are at high risk. We’re trying to prevent the patients where we know that even if they’re vaccinated, they may not have as robust of immune response because there’s some underlying pre-existing condition. So I would say that, you know, I think it’s still going to be here for now. And as Dr. Paules was mentioning, as you’re thinking about traveling and seeing loved ones, I think one of the big things is trying to minimize high-risk activities before you go see them.

Scott Gilbert – Yeah, and another number you reference, some CDC guidance there would just throw out there the CDC also says unvaccinated adults are about 12 times more likely to end up in the hospital due to COVID than vaccinated people. You know, Dr. Paules, some experts are cautioning against piling up too many activities. For example, maybe going out to eat a couple of days in a row, going to a party, then heading to a family gathering. I mean, would you agree with this guidance, and if so, why is it important?

Dr. Catharine Paules – And Again, I think it really depends on your individual circumstances. Like I said at the beginning, if you’re vaccinated, you’re a young person at fairly low risk of complications and you’ve been fully vaccinated and you’re gathering with a bunch of other young people at very little risk of complications that are fully vaccinated, I think you have to adjust activities very little. But if you’re gathering in a multi-generational setting, as many of us will be on Thanksgiving, where young children might not be vaccinated or may have only received the first shot, and older people may, you know, be at higher risk of complications despite vaccination status, then you as that young healthy adult, you have a responsibility to your loved ones to really minimize their risk if you’re going to gather.

Scott Gilbert – So I’m going to ask both of you here for the last question. I got to put on your family counselor hat here a bit. I mean, imagine some families could be divided between those who want to take precautions, and others who feel, in the very same family, feel that they’re unnecessary, and refuse to do so. What’s your advice for navigating this type of family dynamic? Again, I know it’s not an infectious disease question, per se. But it’s something we’re all going to be faced with this [inaudible].

Dr. Jonathan Nunez – Under this mask, I’m smiling because I think we’re going through a similar experience in my own family. I think one of the big things is, you know, recognizing to have that conversation. And I think one of the big things as we go visit is there may be people who may not be comfortable with visitors. So I think one of the things that we plan with these family gatherings is making sure that one, everyone is actually, feel comfortable for that. And I think one of the big things in the end of the day, we’re just trying to protect our loved ones. So I think, like, as I have these conversations with my own siblings, I think one of the big things we’re just trying to protect is our older parents and our grandmother. So I think it’s, it’s having those conversations actually is very important. There shouldn’t be an assumption that everyone feels comfortable with visitors.

Dr. Catharine Paules – And I’ll agree with Dr. Nunez. I think this is very challenging for families because I’ve actually experienced it myself as well. Obviously, as an infectious disease doctor, I see COVID-19 every day and just how horrible it is. And, you know, the patients that die and end up in the hospital and wish they had done things differently and taken precautions and gotten vaccinated. And so when having these conversations with my own family, you know, I tell them what I’m comfortable with, and if that’s, you know, not what can be implemented for everyone, then I don’t attend, and it’s a hard, it’s a hard decision and a hard conversation. I will say that one easy strategy is to move things outdoors. And that is probably the easiest, simplest thing you can do. And if the weather is nice, you can just move outdoors and really lowers the risks substantially.

Scott Gilbert – Right. Exactly, and you still get to get together as a family. And again, it’s looking like the weather is not too bad for this coming Thursday. So can’t really go wrong with that. And I have to say, I mean when you folks have these conversations with family, at least you get to say, “Hey, listen, I’m a doctor.” Right? That’s got to count for something. Right? I would hope. Dr. Jonathan Nunez, Dr. Catharine Paules, thank you very much for your time today. We really appreciate the time that you’ve spent here talking with us. And if you’d like more information, again, we’ve dropped some information from the Centers for Disease Control and Prevention into the chat below this Facebook post. So be sure to check that out. I wish both of you a very happy, healthy, and safe Thanksgiving, as well as all of our viewers. And thank you very much for watching Ask Us Anything About Healthy Holiday Gatherings from Penn State Health.