CDC Recommendations for Holidays

The Centers for Disease Control and Prevention has offered guidance for individuals and families preparing to celebrate fall and winter holidays.  This guidance is meant to supplement – not replace – any state, local, or other health and safety laws, rules, and regulations.  All gatherings should take into consideration any in place guidance or laws regarding celebrations, and any restrictions on the number of people, families, or households who can gather.  Other considerations for holiday celebrations include:

• Community spread of COVID-19 in the location of the gathering and locations any attendees may be traveling from.
• Whether the gathering is indoors or outdoors.
• The number of people attending the gathering.
• Attendee behavior prior to the gathering (are they social distancing? wearing masks? washing their hands?)
• Gatherings should have preventive measures in place.

Do not attend gatherings or festivities if you or anyone you have been in contact with have been diagnosed with COVID-19, has symptoms of COVID-19, is waiting for COVID-19 test results, may have been exposed to COVID-19 in the past 14 days, or are at increased risk of severe illness from COVID-19.  Traveling during the holiday season is not recommended, but if you must travel, following the CDC guidelines for safe travel is the best way to prevent the spread of COVID-19.

COVID-19 spreads particularly well in the cool, arid conditions we experience during the winter and holiday season.  In order to prevent the spread of COVID-19, paying extra attention to mask wearing, social distancing, hand washing, and disinfecting frequently touched surfaces is extremely important.  These practices will also help limit the spread of other viruses that are particularly active during the winter, such as flu.

Indoor Air Quality

With people spending more time indoors as the weather gets colder, indoor air quality considerations have pushed to the forefront.  The Environmental Protection Agency has provided best practices for using the HVAC system to improve air quality, including helping to reduce virus contaminants indoors.  Air cleaners and HVAC filters in homes are not enough to eliminate the spread of COVID-19, and should be used in concert with best practices for preventing the spread of the virus.

In addition to limiting the number of people allowed in indoor public spaces at any given time, increased air quality measures for indoor public space should be taken this winter as well. Working with professionals to upgrade HVAC filters to the highest compatible with the system and checking filter fit to minimize bypass are just a few of the steps owners and operators of public spaces can take to increase indoor air quality.  Using portable air cleaners and directing the airflow so that it does not blow directly from person to person can also help decrease the spread of infected droplets.  Do not use ozone generators to clean the air in occupied spaces.  Reconfiguring furniture can also help reduce the airborne transmission of COVID-19.  Organize furnishings in such a way that individuals in the space are not facing each other to reduce the airflow between people.

The impact of relative humidity on the spread of COVID-19 is unclear and underscores the need for good indoor air quality and ventilation.  Evidence suggests  that infected droplets spread farther and more easily in low-temperature, high-humidity environments, where infected aerosols increase in high-temperature, low-humidity environments.  Both infected aerosols and droplets spread farther in air streams.  These steps may also help reduce the spread of other respiratory viruses that spread rapidly during the winter, such as influenza.

Influenza Season During COVID-19

With flu season barreling down on us, it’s important to not the impact that the flu will have on COVID-19 response across the country. Influenza (Flu) and COVID-19 are both contagious respiratory illnesses, but they are caused by different viruses. Because some of the symptoms of flu and COVID-19 are similar, it may be hard to tell the difference between them based on symptoms alone, and testing may be needed to help confirm a diagnosis. One important difference between the two is that we have access to flu vaccination. Common symptoms to note between the two viral infections are:

• Fever
• Cough
• Fatigue
• Sore throat
• Muscle pain or body aches
• Headache

With both diseases expected to continue spreading through the 2020-2021 flu season, CDC notes that getting a flu vaccine this year is more important than ever. For the 2020-2021 season, manufacturers have projected they will provide as many as 194-198 million doses of flu vaccine, which is more than the 175 million dose record set during the 2019-2020 flu season. Flu vaccination will be very important because it can help reduce the overall impact of respiratory illnesses on the population and thus lessen the resulting burden on the healthcare system during the COVID-19 pandemic. However, many employees get their flu shot at their work offices, and with more people working from home this year, it creates one more potential step that could get in the way of being vaccinated.

Because of the overlap in signs and symptoms, when COVID-19 and influenza viruses are cocirculating, diagnostic testing for both viruses in people with an acute respiratory illness is needed to distinguish between SARS-CoV-2 and influenza virus. In the lay public, this may lead to someone with the flu getting tested for COVID-19, or vice-versa. This could place major strain on the nation’s lab testing infrastructure. Tests for both viruses simultaneously have been developed, like CDC’s Diagnostic Multiplex Assay for Flu and COVID-19, and are becoming more readily available.

If you get sick with flu, antiviral drugs may be a viable treatment option. It is important to note that there is only one drug approved for the treatment of COVID-19 infection requiring hospitalization. During the pandemic, there have been widespread theories that antiviral drugs used to treat influenza can also be used for the treatment of COVID-19 infection. This is false and both infections require unique courses of treatment.

Since both influenza and COVID-19 are spread through respiratory droplets, mitigation strategies such as wearing masks, social distancing, hand washing, and surface disinfecting are effective in reducing the transmission of both. With widespread mask mandates and stay at home recommendations still in place to reduce the spread of COVID-19, many experts suggest this may lead to a milder flu season as seen in the Southern Hemisphere, but only time will tell.

WISE Indiana Staff Contributors: Dr. Amber E. Osterholt & Aaron J. Zych, MPH