How an infectious disease doctor, father of the bride planned a wedding during Omicron rise| Opinion

In a tuxedo with the microphone in hand, in a ballroom filled with over 400 family and friends, I spoke. “Planning a wedding is hard enough, but planning a wedding during a pandemic has been the greatest professional and personal challenge of my life.” I am an infectious disease doctor, an epidemiologist, and dubbed by the city mayor as the “Dr. Fauci of Memphis,”

My oldest daughter’s wedding, twice canceled, was set for Jan. 29, 2022. And, as luck would have it, after last Thanksgiving, the Omicron tsunami struck. Over the Christmas holidays I tried to postpone the wedding again. In a tearful conversation with my daughter, a lawyer, and son-in-law, an aerospace engineer, my daughter made it clear. “Dad, if we don’t have the wedding now, we will never have it.”

The future of large personal events such as weddings, bar mitzvah, and anniversary parties rests on shaky ground with new variants, waning immunity and low booster vaccinations. How can we plan with such uncertainty in the peri-pandemic era?

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Our large Indian wedding may serve as a case study.

A year in advance with cases on the decline my daughter rebooked the Hilton hotel in Memphis as well as the many vendors. We truncated the guest list from 800 down to 450 confirmed RSVPs, but kept the wedding as a three-day celebration according to tradition.

As a family we agreed to put in place a four-part COVID-19 prevention strategy: communication, vaccination, masking, and most importantly COVID-19 testing, both the rapid and the PCR test.

First and foremost, we communicated with guests of our expectations as hosts in a four page document knowing some were overly-concerned and some nonchalant. My parents from Boston were upset with all the fuss I was making. So to allay concerns I hosted a zoom call which successfully became a fun pre-wedding pep rally. But, deep down I was nervous. “What if the wedding were to become a super-spreader event?” I fretted.

Dr. Manoj Jain (right) with close family friend Dipak Doshi (left) at the wedding ceremony unmasked after PCR tests were negative.
Dr. Manoj Jain (right) with close family friend Dipak Doshi (left) at the wedding ceremony unmasked after PCR tests were negative.

The second part of COVID-19 strategy was masking. We offered colorful decorative KN95 masks that matched guests' outfits. However, throughout the wedding weekend, food was ubiquitous so consistent masking during the wedding would be difficult.

The third part of the COVID-19 strategy required all guests and vendors to be fully vaccinated and boosted. My daughter called two guests who had answered “No” on the RSVP vaccination question requesting them to join virtually. Vaccination lowers the risk of acquiring COVID-19, though it does not completely eliminate it. More importantly if a super-spreader event were to occur, then among vaccinated individuals’ complication and hospitalization rate would be closer to the flu than the original COVID-19 strain.

Lastly and most importantly, we put forth a painstaking COVID-19 testing plan fitted with flow charts and bullet points partnering with a local COVID-19 testing laboratory.

Out of town guests were asked to do a rapid test within 12 hours of boarding a plane stopping positive cases upfront. Upon arrival at the hotel we did another rapid test along with the “gold standard” PCR test. The local guests could have their PCR test at the lab or the hotel 24 to 48 hours before the events. “We want to create a safe bubble,'' I insisted.

Dr. Manoj Jain's daughter Sapna Jain with groom Akhil Shah
Dr. Manoj Jain's daughter Sapna Jain with groom Akhil Shah

While such a protocol would likely suffice for guests, what about the hosts? A nightmare scenario would be if the bride or the groom got COVID-19. So to safeguard them we quarantined the bride and the groom for 10 days prior to the wedding. During the pre-wedding planning my daughter stayed in her room, only coming out with a mask, eating food at a separate table, and not visiting with her friends or family.

For the final week including the day of the wedding, ten people among the over 400 attending tested positive or had a significant exposure. Some had mild symptoms which they did not make much of, and would not have been tested if it were not for the wedding. Four were completely asymptomatic. The testing had paid off, and those infected did not attend.

Among the positives, four were found to be positive on arrival from out of town. With them, I had a difficult conversation both as an infectious disease doctor, a friend and a relative. We placed them in isolation and meals were delivered to their rooms. In each of the cases we did a drill down in examining their PCR results and cycle time values to determine the level of infectiousness. And only when they were non-infectious could they attend the function with a mask or travel home. Few, sadly, could not attend the wedding, yet were gracious and understanding.

The wedding was not without COVID-19 cliff-hanger events. It was the day before the wedding, in the bridal suite, my daughter pulled me to the side, “Dad, my throat is sore.” She had a long history of strep infections as a child, yet we elected not to remove her tonsils. And when fatigue sets in, she gets a sore throat. “Dad, it feels like strep” with no fever, cough, or change in taste or smell.

As a father and a doctor I felt the burden of all I had learned and all that I loved come to a head. I took a deep breath and said. “It will be fine. Drink some warm water, put on a mask and if you are not better by the afternoon we will test you.”

During the henna ceremony, with her hands and feet decorated, fitted with a KN95 mask, I signaled with my head to ask how she was doing. With a smile that I could not see behind the decorated mask, but make out with her squinting eyes, she gave me a thumbs up.

Dr. Manoj Jain with his Daughter at the Henna Ceremony
Dr. Manoj Jain with his Daughter at the Henna Ceremony

The pre-wedding and wedding events were spectacular. The bride, groom and guests remained healthy throughout. No unexpected COVID-19 cases were noted at the event. But on that reception day giving my speech as the father of the bride, I could not declare a successful COVID-19 safe marriage. It was two weeks later, when we sent out a google survey form to all guest families.

Of the half of the families that replied, 75% said they strongly agreed to feeling safe at the wedding and thought the aggressive COVID-19 protocols were necessary. And most importantly, none tested positive for COVID-19.

I am not sure if such a high-wire act of conducting a wedding at the height of the highly transmissible variant is what I would do again.

In this uncertain world, when there are no options, this is how we can do it. What the future holds for us with COVID-19 or any other infectious agent, even Dr. Fauci does not know. Still, our desire to meet and gather and our urgency for normalcy is a basic instinct.

Dr. Manoj Jain, an infectious disease physician in Memphis, is also a member of the City of Memphis-Shelby County Joint COVID Task Force.

This article originally appeared on Memphis Commercial Appeal: COVID-19 variant response critical to future of large public gatherings