Baylor College of Medicine

Building Your Holiday Bubble - The Sequel


Nov. 3, 2021


Dear Members of the Baylor College of Medicine Community,

It is hard to believe, but it is November, and we are at the starting line of another holiday season. For the second year, we feel the usual sense of hope and anticipation as we look at gathering with friends and relatives. For the second year, this anticipation is tempered with an undercurrent of viral-induced apprehension.

It would be wrong if we did not pause and acknowledge that from the perspective of the pandemic things are materially better than they were a year ago. November 2020 the COVID-19 burden on hospitals was steadily rising. What we feared came true – we were on the ascending side of a major COVID-19 surge, and would not peak until weeks after the holidays. Today we are clearly on the declining side of a major Delta-driven surge, a much more comforting place to be. This time last year, we were still about a month away from the vaccination of the United Kingdom's 91-year-old Margaret Keenan, the first person in the world to be inoculated against SARS-CoV-2. Today, Ms. Keenan is alive and well, and recently received her booster. In addition to Ms. Keenan, a short year later we have administered almost 425 million vaccine doses in the U.S., and a staggering 7 billion doses world-wide.

It would also be wrong if we did not acknowledge that we still have further to go before truly putting this scourge in the rear-view mirror. Although declining, three-quarters of communities in the country are still showing a high level of disease transmission, while only 2 percent are classified as low. We are well off our pandemic peak of 4,000 deaths per day in the U.S., but still over one thousand people die of COVID-19 in this country each day, far too many. We have made tremendous progress in getting people vaccinated, but there are still plenty of unvaccinated, immunologically susceptible people out there to allow the virus to spread.

It is wrong to fail to acknowledge our progress, and wrong to declare premature victory. As we prepare to celebrate – and we need to celebrate – how do we strike the right balance between embracing the upcoming holiday season and remaining appropriately cautious and responsible?

To that end, I pulled together the Baylor Holiday Bubble, 2021-2022 edition, in consultation with experts on our faculty. As you contemplate gathering people together over the holidays, these guidelines are designed to provide you with a quick assessment of your risk, and specific advice on how to mitigate that risk while still enthusiastically embracing what the season has to offer.

I would encourage you to print the tool (three pages, and to print properly it requires legal-sized paper). Share it with those who you plan to welcome into your holiday bubble this year. There are three simple components to the process.

First, there is an assessment of the risk status of those attending your holiday gathering. I have heard many state something to the effect of "I am in my 20s and perfectly healthy. I am unlikely to get seriously ill from COVID-19, and do not feel the need to take any particular precautions." With respect to getting together for the holidays, I would agree, if you plan on gathering exclusively with other young and perfectly healthy people. When you start to add others to the mix – the elderly, those with chronic medical conditions, people with compromised immune systems, it changes the dynamic. This is not just about protecting your health, but the health of those around you. The first step of the tool rates the risk of your bubble participants.

Second, the tool asks you to assess the current viral disease burden in the community where you will gather, as well as the burden of disease in communities from which your bubble participants are travelling. By way of analogy, if I am sitting in my office wearing a 90-percent effective insect repellent (vaccine, in my analogy), and there is one lone mosquito buzzing around (low disease burden of SARS-CoV-2), I am highly unlikely to be bitten (infected). On the other hand, if I am wearing exactly the same equally effective repellant, and am in a room with 10,000 mosquitos (high disease burden), I will be eaten alive. As you are planning your holiday activities, the disease burden in your community is important to understand. If it is low, as you shop, dine and mingle in the community you are relatively unlikely to run across an active case of COVID-19. If the disease burden is high, there is a much better chance the couple sitting at the next table at your favorite restaurant has active disease. In Houston, as you move around our community the likelihood of being exposed to someone with COVID-19 is still higher than anyone would like, but it is about one-fourth of what is it was at the height of the pandemic. Progress.

Third, the tool asks you to rate your personal risk tolerance. Are you concerned about COVID-19, or do you not feel it is a particular risk? To be clear, whether you are worried or not does not change your actual risk. The risk tolerance question is included to help to drive discussion among the people who intend to gather to celebrate. Hopefully families and friends can gather in a manner that respects everyone's point of view, and allows all to enjoy the holidays while feeling safe.

The three steps of the tool generate a numerical score which places your gathering into a "lower-risk" and "higher-risk" category. As a final step, review the specific activity guidelines for your risk category at the end of the document. Allow me to make you suffer through one more analogy. When I drive my car to the grocery store, I put on my seatbelt. Period. I drive and do not worry about being injured in a car accident. On the other hand, I have a friend who is seriously into amateur auto racing. The roof of his car is reinforced with a roll bar, he buckles securely into a safety harness and wears a helmet. It would be silly for me to follow his protocol on my drive for groceries, and irresponsible for him to rely on a standard seat-belt alone. Our precautions should be titrated to our actual risk. The Baylor Holiday Bubble is intended to be like Goldilocks' "baby bear" of holiday safety planning – neither too restrictive nor too relaxed. Just right.

I wish you all a joyous and safe holiday season, filled with friends and family. I think you will also join me in hoping there is no need for a "Holiday Bubble, 2023 edition."

Stay well.

James T. McDeavitt, M.D.
Executive Vice President and Dean of Clinical Affairs

Feel free to share/post this message using the following link: