CT experts advise on masks, gatherings

For the third year in a row, the holiday season is coinciding with a spike in Connecticut’s COVID-19 numbers.

According to state data, COVID cases have jumped in the three weeks since Thanksgiving, while hospitalizations are at their highest level since February. Meanwhile, flu cases are surging in Connecticut and elsewhere, setting up what one local expert recently called “probably the worst flu year, at least so far, in the last decade.”

The spread of these illnesses, as well as respiratory syncytial virus, presents a series of conundrums for families who plan to gather for the holidays but worry about getting sick or putting loved ones at risk. Is it safe to get together? What precautions are worth considering? And is Connecticut destined for this level of sickness every winter from now on? 

CT Insider asked five infectious disease experts, including the state’s public health commissioner, about these subjects and more.

Do you expect a winter surge similar to what we’ve seen the past two years?

Dr. Manisha Juthani, commissioner of Connecticut’s Department of Public Health: I’m hoping that it will not be as high as the omicron surge was last year, and given that it’s omicron subvariants that are circulating, I certainly hope we don’t get another variant that’s going to throw us off course.

But this is our first season that we’re seeing COVID compete with all the other viruses, as we’re seeing RSV first, flu really taking off next, and I do expect that by January we’ll be hitting peak levels of COVID. 

Dr. David Banach, hospital epidemiologist at UConn Health: It’s difficult to predict that. Things at the moment are a little different from the way they were last year. Last winter we saw a surge with a specific subvariant, the omicron variant and BA.1 subvariant. Right now we’re seeing several different variants circulate, so it’s hard to know if that will be associated with a surge or if we’ll just see ongoing spread of these different subvariants.

Dr. Paul Anthony, infectious disease specialist at Hartford HealthCare: It’s hard to predict that. We may not see as much in terms of pure COVID — let’s wait and see what happens. But I do think that with the combination of the other viruses, especially the flu and RSV, I still think it’s still a recipe to be [bad] in terms of respiratory season.

Dr. Marwan Haddad, chair of COVID-19 advisory group at Community Health Center: Yes, but I believe it’s going to be exacerbated with the flu as well. 

Dr. Scott Roberts, associate medical director for infection prevention at Yale New Haven Hospital: I expect a winter increase, but I do not expect something to the level of the omicron surge where everybody that you knew tested positive. We’re seeing rises in COVID cases, but it’s not to the level of a completely new variant that bypasses preexisting immunity and what we saw with omicron when things spiked to record levels.

To what extent should Connecticut residents be thinking about COVID and other viral illnesses as they make holiday plans?

Juthani: We are most certainly in a different place than we were these past few years, and for some people they really have not had holiday plans for a couple years or canceled them or had very modified plans over the last few years, and I think we’ve seen the toll that having those types of changes in your life can also have on mental and physical well-being for many people. So I do think it’s important to be able to celebrate holidays and be with loved ones and recognize that we are in a different place in this pandemic than we have been.

Banach: People should be aware that we’re seeing high levels of respiratory infections, including flu and RSV as well as COVID. The RSV surge really led to quite a bit of strain in the pediatric world, with a lot of children getting sick, including hospitalizations. As far as flu, we’re seeing increasing flu hospitalizations throughout the state, as well as increasing levels of overall flu activity. So people should be aware of that and mindful of doing what they can to protect themselves and recognizing there’s going to be some respiratory virus spread in the coming months.

Anthony: It’s a real threat, and people should really keep that in mind. Those things are around, and if you’re going around to see friends and family this holidays, you have to be safe.

Haddad: I think we need to take stock about it. It’s important for us to think about how we can protect ourselves and our families, especially our older and younger family members and friends. Let’s all enjoy the holidays but really take into consideration how we can take some common-sense measures that can help at least mitigate infections spreading, especially to our loved ones who are more vulnerable.

What precautionary measures, if any, would you recommend?

Juthani: Our No. 1 prevention strategy is still going to be vaccines, which people have every ability to go out and get. The second thing I would say is that even though we want people to get together, if you’re sick that may be an indication that you shouldn’t be around other people. So we do have strategies that people are so well-equipped with to be able to have holidays safely.

Banach: Vaccination is critical, and that’s for both flu and COVID. Individuals, particularly those at highest risk based on age and medical conditions, should get an updated COVID booster. And then the flu vaccine is really recommended for everyone. Some people ask if it’s too late to get a flu vaccine, but it isn’t. So anyone who hasn’t gotten a flu vaccine, this is the time to do it.

The additional measures like masking and rapid testing, they can be impactful, particularly for higher risk individuals. Those masks do provide some protection, particularly the high-quality masks, for those who are at highest risk.

Anthony: First and foremost, the easiest one is if you don’t feel well, don’t go, because you don’t want to be sharing things with your family. Also, if you’re not feeling well, get tested, because if this is flu or COVID, there are medications they can give you, but they only work if taken early in the course of the disease. Then there’s the usual stuff: Wash your hands thoroughly, do not touch your face at this time of year, and then when possible, especially indoors, wear a mask if you’re around people who might be at risk.

Haddad: Good old hand-washing. Avoiding indoor crowds if you don’t need to be [in them], especially leading up to the holidays and family gatherings. Vaccinations, making sure we are boosted for COVID, that we get the flu vaccine. And do we talk about the dreaded word, “masks”? I think masks still work, and I think in certain situations where you may be potentially more exposed, put those masks on for that period of time and then take them off when you leave that situation.

Roberts: I recommend everybody to maximize protection against the big three that are circulating right now. So for COVID that includes maintaining up to date on vaccine status, it includes masking when in high-risk areas, like when traveling for the holidays or indoor gatherings that are congregated and crowded, and then rapid testing before the holiday gathering. And have a treatment plan so if you do test positive. Can you get Paxlovid?

Flu is similar. There’s a vaccine for flu and there’s a treatment. And then masks also work for flu, similar to COVID. RSV is more challenging because we don’t have a vaccine, we don’t have treatment, and in contrast to COVID and flu it spreads somewhat differently. The primary way RSV spreads is through touch and contact. So hand-washing and disinfecting infected surfaces are much more critical for RSV than for the others.

What role, if any, can rapid testing for COVID play for people who are planning to gather?

Juthani: It is another additional layered strategy that we can use. For some people, they may say, ‘It’s going to be a relatively small group, and we all want to gather, and I gather with other people and everybody is comfortable gathering without other people.’ That may be a strategy one family takes. Another strategy may be that you have older people in your family and you want to protect them and they want to be protected.

But we know the strategies that can work. Testing before gathering is a strategy. I’m not saying everybody needs to do it, but it’s one that can reduce risk when you’re going to be gathering. Another strategy, some people might say there is so much respiratory disease … we just want everybody to mask because it makes us feel more comfortable. A lot of these COVID precautions have become hot-button topics for people, some families more than others, and different people are going to make different choices.

Anthony: Rapid testing is a great option. If you have symptoms and you have a rapid test that says you have COVID, you have COVID. But sometimes it might cause a false negative, where it’s negative and then you go for the PCR test and, surprise, you have COVID.

Haddad: Rapid tests continue to play a very important role, just keeping in mind that the rapid tests that we have right now at home are for COVID and that we need to keep thinking about influenza and we don’t have rapid tests for that. So home tests are still very important, especially if you’re sick, but the other important measure is: If you’re sick stay home.

Roberts: I still think rapid testing is a really effective strategy to identify who is actively shedding virus and actively shedding virus. A rapid test can detect, are you contagious right now? The best advantage to them is they can be done moments before the gathering. If everyone had a rapid test that was negative at my gathering, even if they had all these high-risk behaviors, I would feel reassured.

Have you been wearing a mask in public? Has your personal masking philosophy changed since the summer?

Juthani: If I’m going to a grocery store I’ve been wearing masks. Because quite frankly for me, it doesn’t do much to harm me, and I feel like maybe it can help me and others. But have I been in social gatherings where I don’t wear a mask because I have not chosen to do that? Absolutely.

I recently traveled. I wore a mask in the airplane, I made a mask in the airport, but then if I was at dinner with seven or eight people I didn’t wear a mask when I wasn’t eating. And that is a choice that I’ve made. Masking is another strategy we have, and I certainly use it, but I don’t use it in every circumstance where I’m indoors. 

Banach: I always wear a mask in the hospital. As a general practice I don’t wear a mask in public, but I think there may be some situations that could arise, particularly in areas where I’m in a crowded area, where I would consider masking. But I do have patients, particularly elderly patients and those at higher risks, who do benefit from masking more frequently.

Anthony: It hasn’t really [changed]. During the warmer months I wouldn’t wear it if I was outside because [the virus] was very diluted, but indoors absolutely.

Haddad: Now with the rise, I do carry a mask with me a little more often. I’m using it only if I go into a crowded space, so I have it with me. I’m not masking everywhere, but I’m definitely masking when I’m going to a crowded store or I think there’s going to be an area where there’s poor ventilation. It hasn’t been inconvenient for me, but it’s something I have to remind myself of since most of us have been walking around maskless for a while.

Roberts: I still wear a mask in public, especially now because cases are surging and I know I’m going to holiday gatherings in the near future. So I’m doing that to protect my family and the rest of the people at the holiday gathering.

I have loosened compared to last year. I have gone to a few events unmasked in as safe a way as I’ve been able to do it. But it’s people who I know are not sick and relatively small gatherings. I probably will loosen my restrictions post-holiday when I know I won’t be seeing vulnerable people. But certainly while we’re seeing flu go up, COVID go up and the holidays right around the corner, I am certainly still masking just to be safe. 

Between COVID, the flu and RSV, which virus are you most concerned about this winter? Do you still think of COVID as a unique threat, or is it now just another disease?

Juthani: We still have to recognize that we have 300-400 deaths from COVID a day still in this country. That’s a lot of deaths. People have become sort of immune to that.

I’m more focused on flu right at this very moment because our numbers are escalating. COVID numbers are also escalating, but they are just starting to escalate in the last week or two. But I’m worried about both.

Banach: At the moment we’re seeing flu really have the most impact in terms of infections and hospitalizations. That could change in the coming weeks and months, but I think flu is a major concern at this point. In terms of COVID, it has some unique characteristics that warrant additional attention, but we are going to see it circulating along with the other respiratory viruses, so I think in some ways it does get grouped together. 

Anthony: COVID is still a little higher compared to the others because it’s still more lethal than the others. But all three of the leading [viruses], each can cause problems in their own way.

Haddad: Given the amount of vaccination that we’ve had already, [COVID] hasn’t been as intense as we were thinking about it early in the pandemic. We are seeing that people who are boosted are having less complications and severity compared to those who had the primary series but aren’t boosted. But we can’t continue to ignore the numbers. When you look at the numbers, there are still hundreds of people a day [nationally] dying from COVID. So as a viral illness, it’s still fairly high up. So I think we need to improve our booster rates for COVID for further protection, at least from death and hospitalization.

I am worried about flu, along with COVID. Both are really causing a lot of hospitalizations.

Roberts: I’m most concerned about the flu right now, and the reason is because the levels are hitting record levels. A few weeks ago we had more flu cases than COVID in our hospital for the first time. With flu, historically the treatments and the vaccines are not as efficacious to the level that we’re seeing with COVID. Flu also hits the very young a lot harder than COVID has, so that concerns me as someone with young kids.

I would say RSV, but we all got RSV about a month ago, so I feel more reassured with that. So I’d say flu is my No. 1 right now, just because we have the tools to fight COVID.

To what extent do you think this level of winter illness is a ‘new normal’?

Juthani: I don’t think that where we are this year is going to tell us the story yet on what our new normal is. What we’re seeing for the first time this year is what flu and COVID together look like. It’s really still a story to be told, and it’s a story that’s probably going to take a few years to tell. Over the next three years or so I think we’ll start to get a pattern of what is COVID going to do, what are the other viruses going to do as they compete with COVID to find vulnerable hosts, and what is that going to look like.

Banach: I think it’s a little premature to comment on that.

Anthony: I think COVID is here to stay. How it evolves from here, only time will tell, but it’s definitely here to stay.

Haddad: I don’t know whether I can predict that. This is a particularly bad year because this is the first year where most people have taken off the masks and the precautions have disappeared around the COVID issue, and because we’ve sort of been protected from the flu for the last couple of years because of the masking and all of the prevention measures we took for COVID, now without that we’re seeing a huge resurgence and a very early resurgence of the flu that’s really taking society by storm.

So I don’t know if this is a resetting point. Maybe this is our first year where we’re going to have to endure this and then maybe in subsequent years it’s going to get better. But I think we’re going to go from year to year now, and not only worry about the flu but we’re going to have to worry about COVID and which strains are going around, whether it’s COVID or it’s the flu. And we’ll probably have good years and bad years.

Roberts: I think we will over time get more back to a pre-COVID state of things. I don’t think we’re there yet because we’re seeing very odd and unpredictable patterns in how these viruses are behaving due to everything that was done for COVID. My best prediction is that year by year we will more and more normalize to the pre-COVID standard over time.