Where are you most at risk for COVID? As temperatures drop, here’s how to assess the risk of activities such as indoor gatherings, flights and travel.

A year ago, COVID-19 cases across the country started to increase. It was a three-month surge, which remains the worst time of the pandemic in Massachusetts. By mid-November, the outbreak eclipsed spring 2020 totals. The first two weeks of January still represent the state’s highest daily totals at over 5,000 per day.

This year, the holidays will come with several vaccines available, which doctors say are still the best way to beat the virus. Yet vaccination rates are not high enough to achieve herd immunity, which means another winter flare is expected.

“We are not going to reach that number to completely crush it,” said Dr. John Haran, associate professor at UMass Chan Medical School.

Experts all agree that the least risky events are those that take place outdoors, such as Halloween. But as fall and winter begin to arrive, bringing cooler temperatures, some outdoor activities just aren’t possible in Massachusetts.

As events unfold indoors, MassLive asked Dr Haran, who has also worked with researchers from the Centers for Disease Control and Prevention on COVID, about the best ways to protect yourself against COVID.

Risks related to indoor / outdoor activities

As with any vaccine, breakthroughs are possible. The delta variant, the predominant variant in Massachusetts, showed the greatest resistance to the vaccine, meaning even fully vaccinated people share some sort of risk before colder weather.

Yet unvaccinated people are by far the greatest risk, especially for severe cases of COVID that can lead to death.

“It’s all a risk assessment,” Haran said. “If you never leave your house, you will never be hit by a car. So what we’re talking about is that there are some clear things we know now that increase the risk. “

Haran does not recommend individuals to hibernate all winter indoors. But it’s important to understand the risks and have conversations.

Haran said to take advantage of the hot weather for as long as possible. Haran recommends wearing a mask indoors. Or skip a mask by bundling up with a few extra layers of winter clothing outside.

“When you go inside, masking is very important to protect yourself or to be outside in very crowded areas,” Haran said. “But the transmission rate is so low on the outside, that it is the best thing to do.”

Group bringing together risks

Much of what Haran recommended for activities extended to even larger gatherings. The key to any gathering is communication, Haran said.

Just as an event would include a time, location, and even what to bring, it should also look at the status of the vaccines and what customers think of the masks.

“If you meet families and friends, you have to understand that if you feel uncomfortable, they will wear a mask inside even if they don’t agree with it,” Haran said. “I think I’m having these conversations. It is important. You don’t want to step into something that you feel uncomfortable with.

Risk of small groups of fully vaccinated individuals

Fully vaccinated people should have some confidence in getting together with other fully vaccinated people indoors, Haran said, but the risk is still there.

“You could get sick and unfortunately the way this virus works, we don’t know why people are infected,” Haran said.

Haran said the data related to why a certain person contracts a disease requires years of research. Unlike the mRNA vaccines developed to fight the coronavirus, which have been around for about a decade, COVID-19 has only been around for about 18 months in the United States.

It is again important to have a conversation about the gathering. Available data shows that severe cases of breakthrough are very rare in young people who are not immunocompromised, Haran said.

As a person ages, their immune system is not as strong. COVID will grasp every possible benefit, which is why many cases of serious breakthroughs involve older people.

Older or immunocompromised people may still want to wear a mask indoors during gatherings with other vaccinated people, as their risk is higher.

This does not mean that young people who are vaccinated cannot become seriously ill or even die from COVID.

“There are other diseases that have been around forever that we are still trying to figure out,” Haran said. “We try to work fast but we have to admit that we don’t know what we don’t know. There’s going to be healthy young people that get sick from it that’s been vaccinated, and in the end it’s going to be itchy until we make more inroads with it. “

Risks associated with flying or traveling

Airplanes circulate air constantly. Ventilation continuously brings outside air into the aircraft. Combine that with the mandate that requires all passengers on board to wear masks, regardless of their immunization status, makes the flight relatively low-risk, Haran said.

“The concern is what you do when you get to this place,” Haran said.

It doesn’t just extend to COVID.

Haran warned that travelers should not only inspect transmission rates at their destinations, but understand the capacity of the hospital on site.

Something as simple as falling and breaking a bone may not receive treatment at a local hospital because they are overcapacity.

“In places like Texas or Florida, I’ve talked to a lot of people and I just tell them it’s absolutely crazy, just because of your risk of contacting people who might pass it on to you, but also, you trip and fall, breaking a leg and no one can fix it, “Haran said.” There are so many falls and problems. These risks are different kinds of risks.

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