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In a country where masking in public places is no longer the norm, where only 15 percent of adults have received their bivalent booster, and where new circulating Omicron variants have made certain treatments ineffective, the people most vulnerable to COVID-19 are left to tackle a precarious winter largely on their own.

People who are immunocompromised are more likely to experience serious illness from COVID-19 because their immune systems don’t work as well as they should to protect against infection. Older adults and people with underlying medical conditions are also at high risk of getting very sick from COVID-19.

“It’s incredibly sad that we’ve reached this point in the pandemic where, for the majority of folks to continue their lives as normal, we have to leave everyone else behind,” says Rachel Hoopsick, an assistant professor of epidemiology at the University of Illinois whose 5-year-old daughter is immunocompromised.

We talked to health care professionals who treat high-risk patients, have family members who are immunocompromised, or are themselves immunocompromised to get tips on how the most vulnerable people can stay safe from COVID-19 this winter.

Communicate your needs to friends and family 

In an ideal world, everyone you socialize with would be up to date with their vaccinations (including the bivalent booster and flu shot) and wear masks in public places. But the majority of the population views the pandemic as a thing of the past, making people increasingly unlikely to take those precautions.

Still, communicating your needs and setting boundaries with friends and family is an important part of protecting yourself.

Dr. Emily Landon, an infectious disease doctor at the University of Chicago Medicine who is immunocompromised, asks people to wear masks and avoid high-risk events in the days leading up to a gathering where she and her mother, who is at high risk due to her age, will be in attendance. She also asks that everyone get tested before gathering and that people with symptoms secure a negative PCR test.

“Asking people to behave differently can be a bit challenging for a lot of families, but that’s what needs to happen to help prevent the spread,” Landon says. “What really matters is that my sister isn’t going to go to her church group without a mask on because she knows that’s a risky activity.”

Landon recommends sitting down with your friends and family and explaining what it means to be immunocompromised or at high risk and why you can’t afford to get infected. Then, communicate what they can do to help keep you safe and make you feel comfortable, whether that’s only inviting people who are up to date on their vaccines, asking people to get tested before gathering, rearranging the seating chart, or encouraging people to wear N95 masks.

Vaccines and N95 masks are a must 

In addition to communicating your needs to your social circle, you should continue to take personal precautions. The most important are staying up to date on vaccinations and wearing a high-quality, well-fitting mask in public places.

Landon says high-risk individuals should “lay low” during periods of “unmitigated transmission,” when cases are rising or new variants are spreading but the majority of the population doesn’t change its behavior. During these times, she urges people at high risk to make sure they are vaccinated, wear the best possible mask when indoors or traveling, get prompt treatment if infected, and, in general, avoid situations where they might get COVID-19.

In Hoopsick’s household, everyone is up to date on their vaccinations and wears a mask wherever they go. Hoopsick’s daughter has an autoimmune disorder and takes medication that suppresses her immune system, making her very vulnerable to infection. She has luckily never been infected with COVID-19, but a number of typically mild infections have landed her in the hospital. To keep her safe, Hoopsick’s household takes extra precautions, including limiting indoor activities and opting to stay home for the holidays.

Dr. Seth Trueger, an emergency medicine physician at Northwestern Medicine who was diagnosed with a rare autoimmune disorder in 2021, stays on top of his vaccinations and wears an N95 mask indoors as much as he can, including on the bus, in Ubers and Lyfts, and at work. “I wouldn’t say it’s 100 percent—I still drink my coffee occasionally at work—but most of the time, I wear my N95,” he says. Trueger’s household has also decided against traveling for the holidays, though he says they’re fortunate to have family close by.

Ventilation tools can make a big difference

If you are planning to gather indoors with friends and family during the holiday season, take advantage of the wide array of effective ventilation and filtration tools to improve air quality. Increasing ventilation can be as simple as cracking a window open and setting up a fan in front of it, facing outward. You can also build your own Corsi-Rosenthal box or invest in a HEPA air purifier, both of which filter unwanted particles, including COVID-19, from the air.

“[If I were hosting a gathering,] I’d build a Corsi-Rosenthal box for every room, open up windows and doors, and encourage everyone to wear a mask,” Landon says. “And I would probably hand everyone a test on their way inside.”

Dr. Shikha Jain, a physician who treats cancer patients and the founder of the COVID-19 advocacy group IMPACT, recommends CO2 monitors for gauging risk while traveling or in social situations. “I use CO2 monitors to help see the air quality around me and decide whether I feel safe removing my mask,” she says. “They can definitely be utilized in concert with other risk mitigation strategies.”

Prepare for the chance that you do get infected

Besides taking precautions to prevent infection, it’s also important to be prepared for getting infected. The ability of new Omicron subvariants to evade immunity has made monoclonal antibody treatments ineffective, but there are other COVID-19 treatments, including Paxlovid and remdesivir, that continue to work.

Paxlovid is authorized for COVID-19 patients ages 12 and older who are at high risk for severe illness and must be taken within five days of symptom onset. Remdesivir is approved for COVID-19 patients ages 28 days and older and must be taken within seven days of symptom onset.

Ask your physician now about the COVID-19 treatment options available to you and how you can access them. If you do get infected, Jain recommends contacting your physician as soon as possible and going to the emergency room if your symptoms become concerning.

It’s all about weighing risk

At the end of the day, the same guidance applies to everyone: Understand your personal risk and what you need to do to protect yourself. For people who are immunocompromised, the consequences of getting COVID-19 are unfortunately more severe, but that doesn’t mean the holiday season must be spent in isolation.

“Nothing is 100 percent, but when you stack all of those risk mitigation strategies together, you’ll give yourself a higher chance of protection,” Jain says. “I encourage people to gather with friends and family and do things that make them happy. It’s all about engaging in those activities in a safe manner that allows you to participate without anxiety.”

For Landon, there are certain aspects of life that are worth the risk of getting COVID-19. “Going to church on Christmas Eve is my favorite thing to do, so I’m going to do that while wearing my mask and taking as many precautions as I can,” she says. “What I don’t think is worth it is not wearing a mask at the grocery store.”

Trueger agrees that it’s about being selective toward the risks you take. He’s taken flights for two conferences and three family trips and attends a concert, movie, or some other activity once every few months, with his N95 mask on. On the other hand, he decides not to take his mask off to drink coffee on his morning commute, as so few people wear their masks on the bus.

For Hoopsick, the risks she’s willing to take with her immunocompromised daughter are few and far between. Now with flu and RSV causing serious illness in children and straining pediatric hospital systems, the dangers are even greater.

“Honestly, it’s really, really difficult,” she says. “We’re taking it one day at a time and taking things in stride. As a family unit, we are doing the best that we possibly can in the context of a flawed system, and I know that there are a lot of families like us who are still holding out.”