AHA News: Holiday Visits, Even With Vaccines, Are a Balancing Act for Families

THURSDAY, Nov. 18, 2021 (American Heart Association News) -- Annie Clement has a lot of feelings about attending her family's big traditional holiday gathering.

Last year was the first time the 43-year-old did not go home for Christmas. This year, she was excited when a COVID-19 vaccine finally became available for her 10-year-old daughter, Hazel Clement-Weber, allowing her to start thinking about a visit.

Clement was less thrilled to think about being in close quarters with relatives who don't take the virus as seriously as she does.

"It all stresses me out," said Clement, a community college teacher in Rochester, Minnesota.

With 28 million 5- to 11-year-olds now eligible to be vaccinated, many families will face similar issues. Experts say the key to handling them lies in a combination of understanding risks and benefits, accepting that everyone has different priorities and talking openly about what matters most.

"I think people should enjoy their holidays to the extent they feel comfortable," said Dr. Jennifer Su, a pediatric cardiologist at Children's Hospital Los Angeles. "It would be short-sighted for me to apply a blanket statement that every family should do one specific thing."

Even though having a vaccine for kids is "an amazing step forward," she said, risk factors stack up during the holidays. Cold weather drives people indoors. While celebrating, they tend to let their guard down.

"That introduces risk, because you don't know the status of the people around you," Su said. "With the introduction of more and more people, the risk gets a little bit higher. With travel, the risk gets a little bit higher. And specifically with people who aren't vaccinated, the risk gets higher."

But, she said, "we need to weigh that with the fact that we've been isolated for a year and a half now." Many people have experienced loss during that period, "and we're certainly in a time of year where we might want to seek more social support as well."

Also, we've come a long way from where we were last winter, Su said. "And that's in large part because a large portion of our population has been vaccinated, especially the highest-risk groups."

To her, that means holiday gatherings can be done "in a relatively safe manner." But protective practices – wearing masks indoors in public, regularly washing hands and other steps spelled out by the Centers for Disease Control and Prevention – remain important.

"If you're not vaccinated, you should get tested before you travel as well as after you travel to make sure that you're not unknowingly transmitting" the virus, she said. Anyone with symptoms also should be tested. "It could be COVID, and you probably don't want to risk your entire family."

Families should know where they can get tested quickly and might consider traveling with test kits. And they should keep travel plans flexible.

"We're not going to take that risk down to zero with our recommendations," Su said, but we can limit it to a comfortable level.

Of course, family members are likely to have different levels of comfort, said Eve Wittenberg, a senior research scientist at the Center for Health Decision Science at the Harvard T.H. Chan School of Public Health in Boston.

Because of COVID-19 vaccines and treatments, Wittenberg said the stakes now are lower than in 2020 for most people. But not for all.

"Especially when you're talking about families, the more people you put in the bundle, the more chance there is someone who might not be fully protected even by the vaccine," she said.

So families have to make a calculation. On one side is risk: Nobody wants to expose a frail grandparent or, for that matter, a friendly flight attendant, to the coronavirus. On the other is the benefit of family connections.

The best way to approach that decision, Wittenberg said, is openly.

Families should be "very clear and straightforward about what the risks and trade-offs are," she said – not to pressure people, but to identify "the little levers" that drive everybody's choices.

Once people have clearly spelled out their primary goal – whether it's continuing tradition or protecting health – solutions are possible.

If one person says they want to get together but everyone's health is a primary concern, others might agree to host a smaller gathering, wear masks or even agree that everyone should be vaccinated first. Or they might decide not to gather in person.

People still will argue, Wittenberg said, because that's "just part of being human." But when people identify and isolate what's important, they end up with a decision consistent with that priority. "And then people generally are comfortable."

For the holidays this year, Su, her husband and their children, ages 6 and 2, plan on driving to the grandparents' house. Everyone eligible will have been vaccinated, so they will not wear masks for the family gathering indoors. "That's what we've chosen as our acceptable risk."

Clement had weighed the risks and made plans to spend Christmas at the South Dakota ranch she grew up on. She and her husband are vaccinated, and she assumed her daughter would be, too.

But the day before Hazel was to get vaccinated, she tested positive for COVID-19. Fortunately, it's been a mild case.

Her vaccine plans are on hold, but with Hazel now having some immunity, their travel plans are intact.

But it won't be worry-free. She has friends who just lost family members to COVID-19. And her extended family has a history of heart disease, an underlying risk factor for severe COVID-19.

She's hoping that when all is said and done this season, "the only stress was family stress and not COVID stress," and that "we were just together as a family, and we were all healthy."

American Heart Association News covers heart and brain health. Not all views expressed in this story reflect the official position of the American Heart Association. Copyright is owned or held by the American Heart Association, Inc., and all rights are reserved. If you have questions or comments about this story, please email editor@heart.org.

By Michael Merschel