Infectious disease doctor pulled off 400-person wedding during omicron surge

This is a MedPage Today story.

For Manoj Jain, MD, MPH, an infectious disease specialist in Memphis, Tennessee, Memorial Day 2019 was a particularly meaningful day: His daughter, a lawyer based in Boston, became engaged to be married. The family looked forward to a large Indian wedding that was set for Memorial Day 2020. Then COVID-19 hit.

The wedding was postponed and rescheduled. Then rescheduled again, and multiple times after that. In December 2021, Jain said he mentioned to his daughter and her fiancé that he didn't feel there was a way they could safely hold the event in late January 2022. Their response was devastating to hear.

"'Dad, if we don't do it now, we're not going to do it again,'" Jain said his daughter told him. "That whole statement made me think 'Oh, my gosh, I've got to plan something different.'"

Jain, an adjunct assistant professor at Emory University Rollins School of Public Health in Atlanta, shared how he successfully pulled off a large-scale wedding at the height of the Omicron surge during a Johns Hopkins Center for Health Security webinar this week.

"This pandemic has had a professional toll on so many of us," Jain said, but added that personal events have prompted difficult questions as well, as people weigh whether to hold weddings, anniversary celebrations, and bar mitzvahs.

"That's been a huge challenge," he said. "And [the wedding] has certainly been a big challenge for me."

Jain explained that he rallied his family together to devise a game plan to have the celebration -- and avoid having it become a superspreader event. Some of the parameters that were set for the event included:

• Mandatory vaccination for all wedding attendees
• No one with symptoms, or recent household contact with someone with COVID, could attend
• Mandatory COVID testing
• Highly recommended masking

Jain explained that the family held a series of Zoom calls with potential attendees, breaking down those requirements, and that the personalized calls and messaging were crucial in making sure everyone agreed to the protocol.

Out-of-town guests were required to complete a rapid test within 24 hours before leaving for Memphis, and then complete another rapid test and a PCR test with a 6- to 12-hour turnaround time. Local guests had to complete a PCR test 24-48 hours beforehand, or be tested at the wedding venue (a hotel) the day before the event (Jain said he worked with several of his laboratory assistants and a local lab to get the testing done).

He reported that, out of some 400 guests, there were 10 positive cases identified through pre-festivities testing -- six prior to arrival, and four on arrival (one via rapid test; three via PCR). These people were told individually that they could not attend the wedding and all complied, Jain stated, adding "Imagine if those 10 came to the wedding, what a superspreader that could have been."

Additionally, there were two invitees who had previously decided to not get vaccinated so the bride told them they could not attend, he said.

Not surprisingly, Jain said that his biggest fear was that the bride or groom would test positive before the wedding. To limit the chances of that, the bride was in quarantine in the family home in the days before the wedding. She ate separately from other family members and wore a mask when she was with them.

Jain said that he even asked the salon employees who were going to do the bride's make-up to undergo testing before she arrived for her appointment.

A family member told Jain that he was overdoing some of the cautionary measures and that, as a result, no one would come to his daughter's wedding. "The virus has no boundaries," Jain said he replied.

He also noted that the hotel's ventilation system was out his hands, so the family opted to focus on the protective measures they could control.

Jain said that the wedding went off without a hitch, and that none of the guests tested positive afterwards. While he acknowledged that he wasn't conducting a scientific study, anecdotal evidence matters. "We can do a large event safely," he stressed.

MedPage Today asked Jain if the recent lifting of mask mandates on public transportation, such as airplanes, would have changed his plans for the wedding. Jain reiterated the importance of masking. "I think we need to continue the mask mandates on planes ... it's a terrible idea to give that up," he said.

He added that his current concerns include uncertainty about the BA.2 subvariant, so, "Masks are very simple ... they are very protective."

Jain said that he is hopeful that more families and friends will be able to gather safely in the months to come. "We are resilient," he said. "We will find ways to do things."