COVID-19, Flu and RSV: Why Families Need a Plan for Thanksgiving and Beyond

As Thanksgiving fast approaches and the holiday season gets underway, California public health leaders are urging folks to bolster protections against a triple threat of respiratory viruses: RSV (respiratory syncytial virus), flu and COVID-19.

"In every category that we track — whether it's test positivity, case rate numbers, wastewater surveillance, hospitalizations — we're seeing increases for RSV, flu and COVID," said Dr. Mark Ghaly, secretary of California Health and Human Services, during a news conference last week.

According to Ghaly, COVID transmission — both in test positivity and case rates — was up by 25% over the past one to two weeks.

This is further compounded by an alarming uptick in cases of flu and RSV, a respiratory virus that primarily affects infants and has been straining hospitals across the region.

Another concerning statewide trend? The vaccine uptake for the bivalent booster is low. Only around 16% of eligible Californians have gotten a second booster.

"I think people are kind of tired of talking about getting boosted, and this is another reason why we need to talk about this," said Dr. Kavita Trivedi, communicable disease controller for Alameda County’s public health department. "We know that these boosters are still really good at preventing severe disease and hospitalization."

Along with rapid testing and the expansion of treatment options like Paxlovid, boosters can help lower the risk of gathering together, said Dr. Mychi Nguyen, chief medical officer at Asian Health Services, a community health provider with sites across Oakland.

"I would tell folks, 'Have a plan,'" for gathering over the holidays, she said. "It's very important to make one before, during and after."

Nguyen talked with KQED’s Brian Watt about how to reduce the health risks of gathering this Thanksgiving — for yourself and your loved ones. Keep reading for the highlights of their conversation, which have been edited for length and clarity.

BRIAN WATT: Are you concerned hospitals and clinics will be overwhelmed in the coming weeks?

DR. MYCHI NGUYEN: As we're approaching the holiday season, we do expect respiratory viruses to increase as people gather with their loved ones and celebrate more.

We know that both flu and RSV are circulating earlier this year, with right now not a lot of folks getting boosters or their flu shots. And with the workforce shortage, we're seeing that hospitals are getting overwhelmed with the number of cases.

Given all this, is it a good idea for folks to be getting together for Thanksgiving — in the way we're used to doing that?

I would say "yes" to celebrating — with some precautions.

I would recommend that folks get tested the morning of, if you're going to have a holiday dinner. And limit your interactions with folks the weeks and days coming up for the holidays. Something that you may consider is limiting your interactions in crowds.

We know that in California — in the Bay Area in particular — if you can have good weather, dine outdoors if possible. Or if it is indoors, have really good ventilation.

And even despite your best efforts, if someone does get ill or if you have symptoms, then make sure that you get tested right away and seek treatment.

Is COVID testing something you should factor into a plan?

Yes, you don't want to be the dreaded spreader, especially to a vulnerable loved one. So I would recommend testing the day of or the morning of, if you're going to gather later that day.

It will allow for folks who do test positive to know right away — even if you don't have symptoms — to know to stay home, and probably join in via Zoom, or other ways. And if you're having symptoms, if you're feeling ill, definitely stay home and don't gather and find other ways to celebrate.

If you do get infected with COVID, tell us more about the treatment options.

As soon as you have symptoms, it is important to test right away, and if you are positive, it’s important to seek treatment. Most adults and some children 12 years and above are eligible. And a lot of folks do not know that they're eligible for treatment.

Treatment and the medications can prevent risk of hospitalizations and death up to 88%. You must act quickly for the effectiveness to take. It's usually within the first five to seven days of symptom onset. Treatment is free.

How useful is it to get boosted right before the holidays? Are we talking about some immediate protection if someone goes and gets boosted right away?

Full immunity will occur in about two weeks. So really, as we're approaching the holidays, getting vaccinated as soon as possible is very important.

You mentioned not a lot of folks have gotten their booster. Do you get this sense as well that there is vaccine fatigue?

There is a sense of vaccine fatigue that I'm seeing in the clinic. One of the things that I do [with patients] is exploring why.

Some of the concerns are perhaps side effects. And so I would ask them what happened at their previous vaccination, and we would talk about making a plan if there's some pain or a fever.

Usually those symptoms last for a couple days. We tell folks that getting COVID creates potentially more illness and [they] also [could] develop long COVID. And so the short-term benefits outweigh a lot of getting sick from COVID long-term.

Is it concerning that you're still hearing some of this hesitation as we enter the third year of this pandemic?

It is concerning. One thing that we know is that COVID is still with us. It is something that we are learning to live with, and it is very different from before.

We are in a much better place with vaccines, with testing, with treatment and really getting that information out there. Those strategies should continue to be strategies that help to fight against COVID.

How do you get the word out at this moment about the importance of getting the bivalent booster? What is this outreach looking like on the ground?

At Asian Health Services, we serve patients in English and 14 Asian languages. And we know that if folks do not have access in language, it is very, very difficult to even get testing, or vaccinations, or treatment or to learn how to prevent or take care of themselves if they do get sick. So we really provide that cultural competency, that language outreach in different ethnic media. We send patient newsletters. We go and do outreach into the community, and make sure that websites are translated into the different languages.

One thing we also know is that in addition to the language barrier, there is a digital divide. Anyone who has helped a family member navigate online accounts or get to a website knows that if you are not tech-savvy, you can get left behind in terms of accessing a lot of these resources.