With vaccines for COVID-19 widely available—including for children five and up—and international borders open for the vaccinated, this holiday season was poised to be closer to the pre-pandemic standard than at any time since the virus made itself known in March 2020. However, increasing COVID-19 cases and the emergence of the Omicron variant reminds us that it is still important to remain vigilant.

Daniel Caplivski, MD, Director of the Travel Medicine Program at Mount Sinai, and Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai, explains how to protect yourself and your loved ones while travelling this holiday season and why getting the flu shot should factor into your plans.

Now that vaccines are readily available, is it safe to travel this holiday season?

I think it’s safer than last year because we have an additional layer of protection for the people who are getting vaccinated and receiving boosters. And certainly, for those who have not yet gotten vaccinated, the winter holidays are a good motivation to do so.

However, there is some uncertainty as we are facing the Omicron variant which we are still learning a lot about. The good news is that the COVID-19 vaccines are highly effective at preventing severe illness, hospitalization, and death. It is likely that we will learn about breakthrough infections with the Omicron variant, but it’s encouraging that we have these vaccines available, including booster doses.  We are in a very privileged position.

How high is the risk of contracting the virus from other passengers?

It’s a little hard to put an exact number on the risk, but there are a few variables.

One of the variables is if you, and the people in your family, are vaccinated. When you and your party are vaccinated and you are adhering to the Centers for Disease Control and Prevention (CDC) guidelines as well as masking while travelling and practicing standard hand hygiene, it goes a long way to decreasing the risk of contracting COVID-19.

And while you are travelling there are other things you can do to mitigate the risk. Doing your best to social distance if in a crowded airport, train, or bus station. If you are having a snack or meal, try to stagger your eating to a different time than whoever is sitting next to you. Keep your mask on while they are eating and then eat when they are masked. That’s the ideal timing and will help reduce your risk.

What happens when you get to your destination is a very important factor in terms of your risk of contracting COVID-19. Families will be gathering around a table where everybody is unmasked and enjoying a meal. There may be people who are coming from different parts of the country, and there may be some variability in vaccination. This situation might actually be more of an issue because for most of the time you are travelling, you will have to be masked.

In a post on how to gather safely during the holiday season, Mount Sinai infectious disease expert Krystina Woods, MD, explains how to mitigate the risk of contracting COVID-19 while visiting family and friends. It provides excellent advice for how to prevent the spread of the virus.

Would you recommend wearing a higher quality mask when traveling?

If you have access to better masks, that’s a good idea. The transmission of COVID-19 seems to happen mostly through larger droplets. However, there are certain scenarios when there are smaller aerosols generated—like a cough or sneeze—and that can lead to transmission, especially if you are in a tighter space, like on a packed airline flight. In that scenario, you would want a little more protection.

One solution is to wear an N95 or its international equivalent (the KN95 or KF94). Or you can use the double masking technique, which involves wearing a disposable surgical mask underneath a cloth mask. This gives the mask a better seal on the face by decreasing the amount of space around the mask and lessens the likelihood of transmission.

Looking back to spring 2020, high-quality N95 masks were in short supply, so they were only recommended for health care workers who were at most risk. But now, there’s been increased availability of KN95 and KF94 masks that are for use by the general public. You can upgrade to these types of masks while travelling—just make sure the masks are legitimate. The CDC has advice on how to identify counterfeit masks.

Should I change my travel plans due to the Omicron variant?

If you are fully vaccinated, including a booster, then the health risks associated with travel may not be so different than they were before we knew about this variant. However, we are still gathering information on that front.

The variable that is harder to predict is whether or not we will see further travel restrictions that might disrupt travel —such as additional testing requirements or the imposition of self-isolation periods. If you are travelling internationally, it will be important to monitor what is happening via the U.S. State Department and the CDC’s travel health site as more stringent guidelines may change the way you look at your upcoming plans.

I am traveling internationally and will need a negative test before returning to the U.S. Are there activities that I should avoid while I am away?

If you’re hoping to avoid getting stuck in an international destination, try to steer clear of unmasked situations, particularly those where you are indoors and in close proximity to others. The best case scenario would be to head to a destination where you can eat outdoors and where there is spacing in between you and others who are not in your party. And if you are indoors, wear a mask.

Additionally, there is variability in case rates both domestically and internationally. One precaution you will want to take is to monitor the infection rate at your destination.

What should you do to protect yourself once you return?

Individuals who are returning from international flights will need to present a negative test regardless of vaccine status. But regardless of whether you are travelling 50 miles or 500 miles away, we should all have a heightened awareness about symptoms. We want to make sure that we are not inadvertently playing down symptoms of COVID-19—even if we are vaccinated. The same applies for kids returning to school, especially if they’re not vaccinated.

You have to monitor yourself and not assume that a little cough is just a cold because it could be something more. COVID-19 is still with us. We should still be aware of that even with mild symptoms could actually be the virus—especially if you’re vaccinated. So, pay attention to how you are feeling.

Are there any additional behaviors that the public should be aware of when they’re traveling during the holidays?

Getting people vaccinated is still on the to-do list. While a large number are vaccinated against COVID-19, there are many who are not. I hope that the holiday travel season will motivate some of those people to get vaccinated. And even though last year was a mild flu year, we don’t know what this year has in store, so people should get their flu shot as well as their COVID-19 vaccine.

Additionally, people who are vaccinated but immunocompromised should make sure that they get their booster before they enter crowded settings like airports and airplanes.

For everyone else, continue to do the things that we have been practicing for the past 18 months. Wear a mask, practice social distancing, and exercise proper hand hygiene. I think all of those continue to be important.

As more and more venues open up for entertainment or sporting events, you may be wondering how safe it is to attend.

One thing for sure: In the wake of the news about the Omicron variant, experts say it is more important than ever to follow CDC guidelines for preventing the spread of infection, which includes masking, practicing social distancing, getting vaccinated, and adding boosters for adults when eligible. While scientists are still determining how well the vaccines protect against this new variant, having as many people as possible vaccinated ultimately prevents new variants from circulating in the community.

Michelle Cespedes, MD, an infectious diseases expert for the Mount Sinai Health System, discusses the best practices to protect yourself from a COVID-19 infection at indoor and outdoor events.

How safe is it to attend a large gathering—like a basketball game or Broadway show—that requires proof of vaccination?

In New York, large venues are requiring all participants to be vaccinated and a mask mandate has been reinstated due to the highly transmissible Omicron variant. However that may not be the norm for everybody. So whether the venue requires it or not, it is important to be vaccinated. This protects you, but it also protects everyone you come into contact with after the event. It’s important to remember that people you come into contact with afterwards may not have the ability to fight off the virus, due to being immunocompromised or having some other underlying medical condition. If everyone is vaccinated at the event, the risk of catching COVID-19 or spreading it is low.

Should I wear a mask at the event?

If attending an indoor event, even if vaccination is required at the venue, I recommend wearing a mask. You probably won’t be able to social distance very effectively as seating is often tight and people are close together trying to get to their seats. That’s one reason why I recommend that you wear a mask inside.

Also, if you are vaccinated, there is a chance that you can still catch the virus, but you probably won’t have severe symptoms. And you want to be mindful of people you might spread it to after the event. Someone who is immunocompromised is at a higher risk of having a severe case of COVID-19, even if they are vaccinated. If the event is outdoors, you’re safer. But you still may want to wear a mask if you can’t stay three feet away from other people.

How safe are bars and restaurants?

Most restaurants and bars have outdoor seating these days. But as the weather gets colder, that may not be an option. While many places have improved ventilation and filtration systems, I still recommend that you wear a mask while indoors except when you’re actively eating or drinking. Certainly wear it when the server brings your food. The best protection is to be vaccinated and check that the people that you are with are vaccinated, too.

What about gatherings where there are children who may not be vaccinated? Should I be concerned?

There may be times when families gather where children who are not yet eligible for  vaccination are present. If you are at increased risk of a severe case of COVID-19, such as those who are immunocompromised or have a medical condition that can lower their immunity, it may be best to avoid such gatherings. If you do attend, it’s best to take extra precautions and wear a mask.

The good news is that vaccines are now available for children as young as five years of age. It’s important to get your kids vaccinated as soon as they are eligible, because we’ve seen that the Delta variant is able to affect kids more readily.

As we enter a second pandemic holiday season, many are comforted by the added protection of vaccines and the widespread availability of reliable testing to combat COVID-19. But the unpredictability of the virus means that we should continue to be vigilant.

Krystina Woods, MD, Hospital Epidemiologist, Medical Director of Infection Prevention, and Deputy Chief Medical Officer at Mount Sinai West, explains why it is safer to gather with family and friends this year and offers advice for how to navigate get-togethers that have a mix of vaccinated and unvaccinated guests.

Is it safe to gather with family this holiday season?

This holiday season is a lot safer compared to last holiday season. We have vaccines, which didn’t become available for most of the public until January 2021, as well as a third dose available for those who are immunocompromised, as well as boosters for the elderly, and those with underlying health conditions or who are at high-risk of contracting COVID-19 due to their occupation. Also adolescents and children, even those as young as five years old, are now eligible for vaccination. The increased availability and eligibility of these vaccines adds an extra layer of protection that we didn’t have last year. You may still become infected, but the vaccines increase the likelihood that your symptoms will be mild and there is a lower chance of serious illness and hospitalization.

We also know more about the virus in general, how to treat it, and what we can do to mitigate its spread. Having learned all this definitely puts us in a better place.

There will be a mix of vaccinated and unvaccinated at my holiday gathering. What precautions should I take to keep myself and my family safe?

To the extent that you can, the best thing you can do for your unvaccinated family members and friends is to try to get them to understand how important the vaccine is and to be an advocate for vaccination. The best gift you can give your loved ones is to make sure that they are protected coming into the holidays.

However, that process takes three to five weeks, depending on which vaccine is used, and it is certainly not going to help you in the moment that someone is walking through the door into your Thanksgiving dinner. If you’re inviting somebody into your home, you have to decide the appropriate level risk to yourself and your family, and whether or not you’re willing to assume the increased risk that comes with having someone who is unvaccinated come into your home.

In a post on how to safely date during a pandemic, Mount Sinai pulmonologist Lina Miyakawa, MD, advised asking potential partners the following risk profile questions. They provide a great start in assessing anyone who enters your home for a holiday get-together.

The other tangible precaution you can make is to take the festivities outdoors. We have seen that gathering outdoors presents a significantly lower transmission risk than gathering indoors. Unfortunately, this is not always easy in the New York area especially as the weather gets colder, but it would be helpful. Other options include opening up windows to improve ventilation. There are also some filtration units that can be purchased for homes that help facilitate improved air quality indoors. And then, distancing and asking the unvaccinated individual to wear a mask will also help. What you’re looking to do is layer interventions to decrease the risk.

Should an unvaccinated family member get tested for COVID-19 prior to gathering with family and what about a vaccinated family member?

That’s a difficult question to answer. But, I think if I were in a situation where I was going to have a gathering inside my home and I had an unvaccinated adult coming, I would ask them to produce a negative test. I would not mandate that unvaccinated children be tested, but I would strongly encourage it. We know children can spread COVID to adults. For vaccinated family members, testing isn’t essential. But if you’re having someone older or immunocompromised at your holiday dinner, you may want to ask a vaccinated person to get tested, if they work in a high risk setting. For example, if they work in a hospital, grocery store, or some other essential work that interacts with multiple members of the public.

Often times, we can have a false sense of security around negative test results, so I would caution that I wouldn’t necessarily assume a person who tested negative can’t have coronavirus.

It is important to remember that there is an incubation period of two-14 days with this virus. If, for example, your guest receives a negative test on Tuesday, this result does not tell you what their status will be on Wednesday or Thursday. So, if they attend Thanksgiving dinner and start experiencing COVID-19 symptoms on Friday, everyone who they encountered will likely have been exposed to the virus.

Despite this, it would be good to know that at least when that person is entering your home, they are negative. And if they were to be positive, then they would not come. So there is some benefit in testing.

Is masking and distancing necessary while gathering with family?

I encourage anyone who has not been vaccinated to mask. We know that if an unvaccinated person were to be positive, the mask will help to contain some of their virus by physically containing some droplets.

Also, as far as distancing and masking goes, you have to consider the venue and the mix of vaccinated and unvaccinated individuals. If you’re outdoors, the necessity to mask is a lot less—even if you have some unvaccinated guests. If you are indoors, and everyone has been vaccinated and feels well, I don’t feel strongly that you must be masked in that situation.

In short, to make a decision about whether or not you need to distance and mask, think about where the gathering is taking place, the ventilation and air filtration within the space, the risk profile of your guests, and the mix of vaccinated and unvaccinated guests.

How can families maintain safety in the days following a get-together?

I think it’s important to monitor yourself. Not just in the 14-day period following the gathering, but on a daily basis. If you begin to feel unwell, it’s important to stay home and get tested. Because you want to make sure that if you are not feeling well, and if you do end up testing positive, that you haven’t gone on exposing more people than was necessary.

So, just as a general rule of thumb, I think it’s a good thing to check in with how you are feeling. You don’t need to quarantine yourself after gathering with family, but be mindful of how you’re feeling in the days following.

Also, in addition to COVID-19, flu and several other respiratory viruses are starting to circulate. That is only going to ramp up throughout the winter and the holiday season. Many of these illnesses have overlapping symptoms. You should not assume that your sniffles are just a cold, it could be something more. Don’t be overly anxious about it, but if you’re feeling out of the ordinary, consider if you are really well enough to go to work, school, or to socialize.

Is there anything else that people should consider as they gather with family this holiday season?

It is important to stress that vaccines are safe and available for a wide range of the general public, including children as young as five. Everyone who is eligible should be vaccinated. Getting vaccinated will give everyone a level of comfort when they’re visiting family.

There are also a lot of questions around boosters. For people who fall into the categories that the U.S. Centers for Disease Control and Prevention has outlined as who should get boosters, they really should consider getting one coming into the winter season. This is not just to protect themselves as they mix with their family members, but because other viruses are floating around which could adversely affect them. We want to make sure everyone is as healthy as possible.