Written by Cheryl Alkon, contributing writer, with Vivian Lee, assistant editor
The COVID-19 pandemic may remain a concern for many people this holiday season.
Many of us were disconnected from family and friends for months — even through the winter holidays — in 2020. “As much as I would like to celebrate Thanksgiving with my children and grandchildren, it probably will not happen this year,” said Breastcancer.org Community member Betrayal in late 2020. “I am at higher risk due to age and [medications that] lower my immunity. My grandchildren are in the age groups where they are considered to be possible asymptomatic carriers. So I see them from a distance but miss their hugs and kisses tremendously.”
The good news is that rules have relaxed as more people have gotten COVID-19 vaccines.
With end-of-year holidays right around the corner, you may be planning to celebrate with people outside of your immediate household. But even if you are fully vaccinated, you may need to take certain precautions when traveling and attending large indoor family gatherings. It’s still important to prioritize your safety if you have certain medical conditions, such as breast cancer. A current cancer diagnosis remains one of the medical conditions the Centers for Disease Control and Prevention (CDC) says can put you at risk for serious illness from COVID-19 — even if you are fully vaccinated and have received a booster.
If you’re receiving breast cancer treatment and are unsure about how to handle the holidays this year, you’re not alone. We spoke with several experts who offered advice on how you can safely connect with your loved ones this holiday season.
Know your risk
As you consider your holiday plans for this year, it’s important to understand your level of risk based on your age, health, and medical conditions.
We know that the risk of severe illness if you get COVID-19 increases with age. The CDC also says that people who have certain medical conditions, including a current cancer diagnosis, may still be at risk for COVID-19 even if they are fully vaccinated and have received a booster. Likewise, people who are receiving breast cancer treatments that can weaken the immune system, such as chemotherapy, also may still be at risk for the virus. It is less clear whether a history of cancer increases your risk, but the CDC says it may.
If you are at higher risk for COVID-19, regardless of your vaccine status, the CDC recommends that you continue taking the same precautions as unvaccinated people, including wearing a well-fitted mask over your nose and mouth when you are indoors with people outside your immediate household.
It’s a good idea to talk with your doctor about your level of COVID-19 risk and the precautions you should continue taking, especially if you plan to gather with friends and family for the holidays.
“It is important to ask your medical team about any additional risk factors you may have over the average person, both for your sake and for your family,” says Julie L. Salinger, LICSW, MSW of the Dana Farber Cancer Institute in Boston.
When it comes to determining your COVID-19 risk, it’s important to consider the types of breast cancer treatments you’re receiving, explains Megan Kruse, M.D., breast medical oncologist at the Cleveland Clinic.
“People on chemo with suppressed immune systems should be the most cautious about limiting the number of people they interact with,” says Dr. Kruse. “Many patients who are survivors may no longer be on treatments that put them at higher risk. Those people can really do what the average person can do in terms of managing their risk.”
For patients living with metastatic breast cancer, “the discussion can be a lot harder,” Dr. Kruse adds. “Day to day, they may not have to adjust their activities, but with the winter virus season, potential family gatherings may have to change.”
Gathering together safely
Many generations tend to come together to celebrate holidays at the end of the year. According to the CDC, the best way to protect yourself and your loved ones from COVID-19 is for everyone who is eligible to get vaccinated.
People who are not yet eligible to be vaccinated — such as young children — should wear well-fitting masks over their noses and mouths when they are in public indoor settings. It’s also a good idea for people who are fully vaccinated to wear a mask if they plan on gathering with anyone who remains at increased risk for severe illness from COVID-19.
The CDC also says that even people who are fully vaccinated should continue wearing masks indoors if they plan to travel to places with high transmission rates.
Being outdoors remains safer than being indoors. The CDC recommends that you:
- continue to avoid crowded, poorly ventilated spaces, especially if you plan on gathering with people from multiple households and different parts of the country
- not host or attend a gathering if you are sick or have symptoms
- get tested if you have symptoms of COVID-19 or have been in close contact with someone who has COVID-19
- never put a mask on children younger than 2 years old
If you plan to travel, the CDC adds that you should:
- consider delaying travel plans until you are fully vaccinated
- follow domestic or international travel recommendations, especially if you must travel and are not yet fully vaccinated
- wear a mask regardless of vaccine status on public transportation
If you are fully vaccinated but still feel nervous about gathering in large groups indoors, there are ways you can reduce your risk of getting sick. Here are some tips that Elizabeth Robilotti, M.D., MPH, assistant attending physician and associate medical epidemiologist at the Memorial Sloan Kettering Cancer Center, shared last year on an episode of our Breastcancer.org podcast:
- Meet outside as much as you can.
- Have a small number of attendees at your gathering.
- Maintain social distance of at least 6 feet apart.
- Have participants wear masks.
- Consider bringing your own food and utensils to minimize the number of people touching different things.
- Monitor local COVID and flu rates; look for this data either from local news reports or from your local Department of Health. Consider cancelling plans if those rates are rapidly increasing.
- Keep meetups short.
Good ventilation is an important way to make indoor settings safer. So if you end up celebrating indoors, it’s smart to avoid enclosed spaces and consider opening windows to increase fresh air flow.
If you still feel more comfortable gathering with loved ones virtually this holiday, here are some tips on how to have virtual holiday celebrations:
- Set a time that works for everyone, despite time zone differences.
- Virtually share a meal.
- Structure the event around a game or activity, like holiday Bingo, trivia, or opening gifts.
- Watch a holiday movie together through group streaming services such as Netflix Teleparty.
Remember that the important thing is for you and your loved ones to feel protected and safe.
Communicate with your loved ones
Regardless of personal levels of risk, it’s important for loved ones to respect what each individual is comfortable with this year, adds Dr. Robilotti.
“One of the most important messages about celebrating the holidays safely and happily is being respectful of everybody’s boundaries, and not wanting to put anyone in a position where they feel they have to be in the room if they’re not ready to do so,” she says.
But everyone’s relatives don’t think alike. It can be difficult to discuss why your level of risk or tolerance may differ — especially now that more people are fully vaccinated. But it’s important to have these conversations, especially to make sure your loved ones know that they should stay home if they are feeling sick, or if they have or may have come in contact with someone who is sick.
Feeling comfortable communicating what is best for you at this stage of the pandemic is crucial.
This content was developed with contributions from the following experts:
Megan Kruse, M.D., breast medical oncologist at the Cleveland Clinic
Elizabeth Robilotti, M.D., MPH, assistant attending physician and associate medical epidemiologist at the Memorial Sloan Kettering Cancer Center
Julie L. Salinger, LICSW, MSW of the Dana Farber Cancer Institute in Boston