Fran Kritz | NPR
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I went to a wedding a few days ago and just learned that several people have since tested positive for COVID-19. What do I do now?
It might be a small comfort, but more and more people are asking a variation of that question these days, says Dr. Abraar Karan, an infectious disease fellow at Stanford.
That's because COVID-19 cases are rising in some parts of the world, like India and South Africa, and in some U.S. states. So whether it's weddings, bar mitzvahs, conferences or high-profile events like the White House Correspondents Dinner, COVID-19 is clearly spreading at some of gatherings – even though guests were told they all had to be vaccinated to attend.
"For large events, especially those held indoors, the risk of being exposed to COVID-19 is increasing by the day," says Karan. "And it's more than you think because we are under-detecting cases."
Here's how Dr.Preeti Malani, chief health officer at the Division of Infectious Diseases and Geriatric Medicine at the University of Michigan, thinks of it: When you attend a function, you have to assume that there may be people there who have asymptomatic, if not symptomatic, COVID-19.
And with that assumption in mind, there are some specific ways you can protect yourself.
What to consider before the event
David Souleles, director of the COVID-19 response team at University of California, Irvine, advises checking the Centers for Disease Control's COVID-19 county level tracker before any big social gathering, especially if any activities will be held indoors. Souleles says checking the CDC data "will give you a sense of community transmission in that community so you know what you're wading into."
That's the point at which everyone needs to do some individual risk assessment, Souleles says. "If, for example, community transmission is high, and you're at personal high risk because you are immunocompromised, or live with someone who is, or want to visit someone who is, or you have underlying health conditions, you might make the decision not to go to the event because it's too much risk."
Or you might decide to accept the risk but take precautions, such as wearing a mask whenever you're indoors with other people, especially if you don't know their COVID or vaccination status, says Charlotte Baker, an assistant professor of epidemiology at Virginia Tech.
Do I go or do I say no?
Malani says with cases increasing, you may also want to think about your schedule before deciding whether to attend a social event. If you get sick, can you afford to take days off? Would you risk missing another important event on your calendar?
"There will be times in our lives when it will be especially disappointing to get COVID, even aside from the risks of severe disease, long COVID and spreading it to others," says Malani, who was recently hypervigilant on a flight from Portugal to the U.S. ahead of her son's college graduation. "And having upcoming events that are important to you may make you dial up the mitigation for some social events or meetings even if there isn't high community transmission where you will be."
Souleles also points out that "we don't necessarily always have to go to everything, particularly when the risk is higher."
Check ahead with the host or event sponsors
Ask the host questions that can help you make an informed decision about attending – although keep in mind that their answers may not fully match your needs.
Ask if people must be vaccinated and/or tested to attend, and if they have to show proof or are on the honor system. Also ask if people must be masked indoors and if masks will be provided — but bring your own in case they run out and so you can have the mask that is most comfortable for you, says Malani.
Think about your own status
Being vaccinated and boosted is still one of the most important tools to reduce both the spread of COVID-19 and also the severity if you contract the virus, says Malani. "If you're not up to date yet, a big gathering indoors should be incentive, so check CDC guidelines for timing and eligibility of vaccine doses."
If you decide to go, consider your own health the day of the event – and test yourself just in case
Are you feeling OK? Are you feeling ill? A test can tell you if you have the virus. And since many cases of COVID-19 can be symptom-free, any event-goer might "consider testing before you go to a gathering," says Souleles. "With the availability of rapid home antigen tests [you can order up to 8 for free through the U.S. government] we're encouraging people to test prior to attending events just to be sure you don't have an asymptomatic case."
Mask or no mask — and other decisions to make at the event
If you're not at particularly high risk you may decide not to wear a mask — but know that other people may make a different decision based on their risk and personal circumstances, such as living with someone who is at risk, says Souleles. Or you may decide to wear a mask for any indoor portions of events.
"Set some rules for yourself about taking off your mask," says Charlotte Baker. "It does feel awkward to be the only person not eating, for example." Baker, who is immune-compromised, says she checks the vaccination and testing status of people closest to her before taking off her mask to eat.
Baker suggests some dining options for those who want to stay masked indoors. That includes not eating the meal but having some snacks with you that you can eat on your own when you're not with others; asking the host if you can have a private space to eat, indoors or outdoors; or take the meal to eat with you later, when you're on your own and taking off your mask poses no risk.
"Setting those rules before you go — as well as rehearing what you will say beforehand if people comment on your mask — will help you stick with your resolve," says Baker.
And be prepared for comments if you stay masked. "I've gotten used to people calling me a moron," says Dr. David Taragin, a neurologist in Silver Spring, Maryland, who continues to wear a mask in indoor situations. "It doesn't bother me much, since I want to take control of my own situation, and it also helps me have the conversation with my patients about being cautious."
If you're on the road for an event, carry rapid tests with you, says Souleles, so if you develop symptoms you can check to see if it's COVID or not. (Travelers can also find pharmacies and clinics that provide low-cost or free rapid tests at this government website.
And remember, fresh air is an ally. "We do know that outdoor events are much safer than indoor events in terms of reduced transmission," says Souleles.
If you are immunocompromised...
For individuals who are immunocompromised or have underlying diseases, the stakes are higher. So when you think about how measures to take before attending an event, you are facing more serious consequences should you become infected. Contracting COVID could land you in the hospital, says Baker.
"You may feel pressure from others to take your mask off — like during photos — so limit that and make sure you're up to date on vaccine and booster doses," she says.
Dr. Craig Bunnell, chief medical officer at the Dana Farber Cancer Institute in Boston, suggests that people who are immunocompromised check with their doctor about the drug Evusheld, in addition to a vaccine. Evusheld is a preventive antibody which can add protection against getting COVID-19 or becoming severely ill for people who are immunocompromised and may not mount a sufficient immune response with just vaccines and boosters.
Testing after an event is especially important for people who are immunocompromised or have other underlying health conditions, says Bunnell. If you test positive, your doctor may advise you to take antiviral drugs or other COVID treatments to help reduce the risk of severe symptoms. Once hard-to-get COVID treatments such as take-at-home antiviral drug Paxlovid is now in wide supply, although you'll need a doctor's prescription.
After the event...
The party is over. And even if you don't hear of any positive cases among attendees after the fact, it's a good idea to monitor yourself for COVID symptoms. If you do have symptoms, test immediately and then follow CDC guidelines for what to do if you're positive or have been exposed. Even if you have no symptoms, test three to five days after an event, says Malani, since there could be a case associated with an event you went to but didn't hear about. (Testing sooner is not going to tell you much since it takes a couple of days after exposure to develop enough viral load to test positive.)
Are you now a close contact?
If there is a known case, or more than one, from the event, you need to assess whether or not you had close contact with someone now positive and whether you were closer than 6 feet for 15 minutes or more, says Souleles. If the answer is yes, that would make you a close contact, and you need to check local public health and CDC guidelines on quarantine. The CDC recommends, for example, that if you are not up to date with your vaccinations and were in close contact with someone who was infected, you should quarantine for 5 days as a precaution and mask up around others for another 5 days.
Alert the host if you have COVID after the event is over
If you test positive, let the host know so they can share that information with attendees. And you should alert anyone you were with if you can get their contact information – even if you feel uncomfortable sharing the news.
Meanwhile, if you're the host, keep a list of email addresses and phone numbers so you can let people know if positive cases occur.
Souleles says if you are planning an event, even if transmission seems low now, consider outside spaces because case rates can change. "Outdoors is always safer."
Tested positive? Don't assume your medical appointment is cancelled
One man in his 80s, who's undergoing a series of chemotherapy treatments for cancer at Dana Farber, tested positive after attending a wedding and was surprised to find that his chemo appointment was still on.
"Some treatments are necessary and are safe to administer even if people are positive," says Craig Bunnell. "We have protocols in place to keep health staff and other patients safe, such as use of personal protective equipment that's taken off before seeing anyone else as well as alternative pathways [for taking positive patients] to treatment rooms.
Some patients may get rescheduled but we don't want patients to just assume they shouldn't come in, says Bunnell. He advises all patients who test positive and have a medical appointment to call their health provider to see if they need to reschedule.
Fran Kritz is a health policy reporter based in Washington, D.C., who has contributed to The Washington Post and Kaiser Health News. Find her on Twitter: @fkritz
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