An overwhelming surge of the coronavirus is afflicting the United States at the very moment that extended families are considering if, and how, they can gather for the holidays. Public health experts have three words for you: “don’t do it.” There is currently no risk-free way to spend time indoors with the loved ones who live outside your home.
While there is promising news about coronavirus vaccine candidates and a COVID-19 antibody treatment, that does not change the current worsening situation. COVID-19 cases are rising exponentially across the country and hospitals in parts of the Midwest and the West, in particular, are once again close to reaching capacity.
“The problem is that, right now, the community transmission of COVID is huge,” said Dr. Abraar Karan, a doctor at Brigham and Women’s Hospital and Harvard Medical School who has been treating COVID-19 patients. He likened this period before the holidays to pulling back a slingshot. “If we let everybody congregate all of a sudden in their homes for Thanksgiving or the holidays…you are going to fire that thing and it’s going to get even worse quickly.”
While people of any age could get seriously sick from the novel virus, experts stressed it’s imperative that families remain especially vigilant in protecting the oldest and most vulnerable in their circles from COVID-19.
“We have to get through this winter, or else there’s not going to be another one to celebrate with our loved ones,” said Dr. Leana Wen, an emergency room physician and visiting professor at George Washington University’s Milken School of Public Health.
“We’re entering the stretch that will be most challenging for people,” American Psychological Association’s Lynn Bufka said of the holiday season. Symptoms of anxiety and depression have increased considerably amid the pandemic, with more than 40 percent of Americans reporting at least one adverse mental or behavioral health condition as of June. And unfortunately, one of the most powerful antidotes to feelings of depression and isolation — human contact — still presents a considerable public health risk as the virus continues to spread.
“It’s really hard,” Bufka said. “The things that we do to try to reduce transmission are things that are not very rewarding. Giving a friend a hug is really rewarding, but that raises the risk of transmission.”
With less than two weeks until Thanksgiving, public health experts and physicians say that families should be having open and honest conversations about how they can best mitigate their COVID-19 risk levels while still celebrating the holidays with each other. In many cases, this will mean forgoing in-person gatherings for remote dinners over Skype or Zoom, or limiting contact to those within one’s immediate quarantine “bubble.”
Here are some tips about how to weigh COVID-19 risks as you make plans with families and loved ones this holiday season.
When and why should you quarantine?
Gathering with people outside of your immediate household for the holidays will introduce additional risk when it comes to COVID-19 transmission, experts caution. “My across-the-board advice for everyone is do not get together indoors with extended family and friends — just do not gather,” Wen said.
That guidance also applies to people of different households who may be part of the same “pod” and have agreed to spend time unmasked only with each other throughout the pandemic. Although that risk may not be as high as the one associated with traveling for the holidays to gather with those you see less often, the fact remains that community spread is on the rise, and gathering with anyone outside your household is an opportunity for transmission.
If you do want to stay with family and friends whom you have not seen in a while, she said, you should quarantine for 14 days and take a COVID-19 test prior to seeing them. The COVID-19 incubation period — the time from when a person is infected to when they experience symptoms, if they have symptoms at all — can range anywhere from two to 14 days, so staying home and limiting your contact with others for two weeks is thought to be the best way to limit your risk to others ahead of a trip, Wen said. And of course, you should only go to see others if you test negative for the virus prior to leaving.
Does a negative test mean you’re safe?
Getting a negative result on a COVID-19 test isn’t foolproof protection — it “is just a moment in time,” said Dr. Megan Ranney, who serves as director of the Emergency Digital Health Innovation program at Brown University. You could still test positive later in the week, or even later that day, especially if you’re regularly going into work or socializing with people outside your household.
Given the variability of the incubation period, Karan recommended “serial testing” — testing before you leave on a trip and again some days after you arrive. It’s also why getting tested after two full weeks of quarantining prior to your departure is one of the best ways to reduce your chance of spreading the virus to your loved ones.
What if you cannot quarantine for the full two weeks?
Having every member of a family or friend group quarantine for two weeks prior to getting together is “not going to be practical for the vast majority of people,” Wen said.
If that is the case and folks still want to get together, she said, “they should not gather indoors. They can get together outdoors with households spaced at least 6 feet apart, but they should not be gathering indoors at this point.” Research shows that the virus spreads more easily indoors, particularly when people are gathered in a space with poor ventilation for a prolonged period of time.
So consider factors of time, distance and environment when planning holiday celebrations this year. “Sit at a table where you’re more than 6 feet apart from people who aren’t in your household, outdoors,” Ranney said. Of course, if you live in a cold climate, this option may be neither practical or comfortable, but investing in outdoor heaters or electric blankets could make it more pleasant if you have the means.
When should you wear a mask?
Multiple studies have demonstrated that wearing a mask is one of the best tools we have to protect ourselves and others from the virus. We know that mask-wearing in public is crucial to slowing the spread in our communities, but masks can also add another layer of protection when spending time with family.
Every health expert who spoke with PBS NewsHour emphasized the importance of celebrating Thanksgiving outside and at a distance with masks on — or avoiding gathering at all.
But if you’ll be traveling to stay with people you don’t normally interact with over the holiday, consider wearing your mask in shared indoor spaces like living rooms and kitchens, too. “Cloth masks have been shown to stop transmission of the virus when worn by both people,” Ranney added. “So one person wearing a mask is good. Two people, or all the people [in a household] wearing a mask is far better.”
That advice is particularly important for those who traveled by plane, train, bus, or by a multi-day car trip, options that increase the chance that you may pick up the virus up in transit, even if you tested negative right before you left.
Is it safe to travel?
Experts recommend avoiding long-distance trips and nonessential travel if possible. The U.S. government classifies nonessential travel as recreational in nature — for example, tourism, or going to celebrate holidays, or weddings, with friends or family.
Otherwise, driving a relatively short distance that requires minimal stops and no overnight stays is the safest way to travel. Multi-day car trips and plane rides open up new exposure pathways at hotels or the airport, as do bus and train rides. While studies have shown that COVID-19 transmission risk is relatively low on airplanes under ideal conditions, this can quickly change if you spend a long time in the airport, or are at a restaurant or bar where customers are not wearing masks.
“I’m less worried about the travel period itself, but I am very worried about people going between different virus hot spots and, given how much infection there is in so many communities around the country, I would really urge people not to engage in nonessential travel at this point,” Wen said.
It’s also important to check the quarantine requirements or other travel regulations at your destination, as well as its current hospital capacity. You can track each state’s case numbers over the past seven days on the Centers for Disease Control and Prevention’s website.
With cases rising in nearly every part of the U.S., you should be particularly cautious if traveling to a hot spot, Wen said. “Is there even room in the hospitals if you do end up getting sick?” If not, you may want to reconsider traveling and think about having a virtual celebration with loved ones instead.
Can you visit your grandparents?
Some family members could be at higher risk for serious outcomes if they were to contract COVID-19 because of advanced age or certain health conditions. Ranney recommends considering two key points when making choices about seeing family:
- What is your risk of catching or transmitting the virus, particularly if you didn’t fully quarantine for two weeks before traveling?
- If someone you plan to see over the holiday caught the virus from you, what is their risk of getting severely ill or dying?
If that risk level is high, she recommends against spending time with those loved ones if you haven’t taken other pandemic precautions. “I would not see older relatives indoors without a mask unless I’ve done that two-week quarantine and ideally a negative test on top of [that,]” Ranney said. “It’s just not safe for them.”
What about the December holidays?
If you’re traveling at Thanksgiving to be with loved ones, and also want to celebrate the December holidays with the same group, consider staying put for the next month, if you have the option.
If you’re already working from home or can choose to do so, or if you’re a college student who doesn’t need to return to campus to finish up the semester, staying in one place through the New Year (or whenever you’re ready to return to where you live most of the time) is one of the safest things you can do. Returning to your community only to travel again a few weeks later increases your risk of contracting the virus and spreading it to other people, or vice versa.
What’s the harm in taking the risk?
Some families will get together despite public health warnings and suffer no consequences, Ranney said. But others will undoubtedly not be so “lucky.”
“We have so many well-documented stories at this point of family get-togethers leading to multiple illnesses, hospitalizations and deaths among families that I can’t say strongly enough how much I dissuade people from [gathering],” Ranney said.
The reality is that these next few months will be unlike any of the ones we’ve experienced during the pandemic so far. Now, the virus is simply everywhere.
Our first winter of this crisis hasn’t even begun, and health care systems in hard-hit states are already buckling under the weight of too many critically ill patients. Exhausted health care providers have been pushed to their breaking points after weeks — or months — of treating an endless stream of COVID patients, and not being able to save all of those lives.
As a doctor who has seen the human toll firsthand, Karan urged Americans to think twice before gathering. “I’ve seen this disease tear families apart. I’ve seen this disease kill parents and infect kids,” he said. He spoke about holding up an iPad for a dying COVID-19 patient to talk to her daughter on Mother’s Day. “We don’t want to do this again. If this means one holiday season you don’t see your loved one, well, that actually could be the difference between being able to see them next year.”
If the nation shut down right now, Ranney estimated that we would see this current wave of ever-rising case counts crest toward the end of December. But with no lockdown in sight, those numbers are bound to worsen.
“That, to me, is the worst possible scenario, is that we see family after family devastated because of Thanksgiving get-togethers,” Ranney said.
This story has been updated to clarify a quote from Dr. Karan about a dying patient.