Nov 23, 2020 9:00 AM

Author: Kylene Metzger

As the holiday season approaches, COVID-19 transmission in Utah is not slowing down. Unfortunately, small household gatherings are a key contributor to the spread of the virus. Following coronavirus safety guidelines will be key to reduce the possibility of infection. Infectious Diseases experts at University of Utah Health discussed ways to keep families safe during the holidays.

Andy Pavia, MD, chief of the Division of Pediatric Infectious Diseases

Emily Spivak, MD, associate professor in the Division of Infectious Diseases

Carlos Gomez, MD, assistant professor in the Division of Infectious Diseases

How can people gather safely?

Dr. Gomez: It’s key that we adapt and change behaviors this time of the year. My biggest concern is people won’t take seriously the recommendations to keep gatherings small. If not, COVID-19 cases will peak two weeks following Thanksgiving week. We need to keep in mind that people with health vulnerabilities can get exposed during the holidays, which can increase the number of cases in the state.

Dr. Spivak: With our current community transmission rates, it’s strongly discouraged to gather with anyone outside your household. By household we mean people who you sleep under the same roof with. College students who don’t live with you aren’t part of your household, so that’s something you need to think about.

What are some alternative ways people can safely celebrate the holidays?

Dr. Spivak:

  • Have a Zoom dinner. That way you are still socially engaged and staying safe.
  • Eat with your immediate household and go on a walk outside while masked with others.
  • Take a pie to your family members or neighbors.

Dr. Pavia: If you and everyone else are wearing a mask in a big living room for 15-20 minutes, that’s less risky than breaking bread together. There is no absolute. There is only very unsafe, safe, and more safe. If it’s a big room where you can keep the windows open, and you can keep visiting short, then that is a safer alternative.

What is your advice for the number of people in a gathering?

Dr. Spivak: If people choose to gather and eat inside, there’s a lot to think about. A state order limits social gatherings to a maximum of 10 people. I would make it smaller than that. The smaller the group, the easier it is to maintain physical distance. Masks should also be worn at all times besides when eating or drinking.

If it safe to gather if families are eating indoors but six feet apart?

Dr. Spivak: That’s potentially not safe. You’re bringing people outside of your household who, based on community transmission rates, have a very high chance of asymptomatically having COVID-19. Even if you are eating spaced out, there is potential for aerosolized transmission, especially if there’s talking involved. There is also poor ventilation inside. This is why we shouldn’t be gathering for Thanksgiving.

Is it safe to share a meal buffet style if families decide to gather together?

Dr. Spivak: Family style sharing is not a good idea. Individually served meals is preferable. If someone is cooking, they should stay in the kitchen and wear a mask.

Is it safe to drop off food for family or neighbors?

Dr. Gomez: In general, food delivery and takeout is considered safe. There is no evidence that handling or consuming food is associated with COVID-19. Those who make the food should wash their hands before handling and wear a mask.

Is it safer if families are gathering outdoors with heaters?

Dr. Pavia: This is much safer. The less time you spend with your mask off and the much further apart you are, the safer you are. You can still get infected outdoors if you have enough people who are close enough together and if you spend time together with your mask off.

Is there a safe way to gather with family members if they have been quarantined?

Dr. Gomez: If they have been quarantined for the full 14 days and took all the precautions by keeping away from other people, then that’s potentially doable. If someone is waiting for a COVID-19 test result or if they feel they have been exposed to someone in the last two weeks, that person should not gather with other family members or friends. They can put others at risk of COVID-19 infection.

It’s also important to remember who is at home and vulnerable to infection. Some people are at higher risk if they get infected. This includes people with pre-existing conditions. If we do a great job at Thanksgiving, we may have a better Christmas. We need to keep the long-term perspective and do what we can to help prevent the spread of COVID-19.

If you’ve been quarantined, would it be relatively safe to get together with family for a few days?

Dr. Gomez: If the person has been compliant with isolation and is wearing a mask and physical distancing, then there is a good chance they can safely stay with family members in their home. There is a false perception among the public that they are doing the right thing by following guidelines. The rate of transmission of the virus is extremely high. There is a 44% rate of asymptotic infections. It’s hard to tell at this point who is infected and who is not.

Dr. Pavia: If you get together, you are only as safe as the most cavalier person. You could have done everything right, but that one person who has come in close quarters without being masked or played basketball puts everyone at risk.

Dr. Spivak: Many people say they don’t know where they got it. People are under the perception that the houses around them, the people across the street, and their cousins don’t count for wearing a mask. They point to the grocery store or the restaurant they ate at. I’m not saying you can’t get it in those settings, but we’ve had months and months of wearing masks in those places. People seem to forget to wear a mask at settings like BBQs. Transmission happens in those smaller social gatherings.

If someone has already been infected with COVID, do they still need to wear a mask if they plan to gather with family?

Dr. Spivak: There is emerging evidence about immunity. Antibodies wean over time, but the cells that remember the infection will remount those antibodies during secondary exposure. We’re finding antibodies probably last longer than we originally thought, although it hasn’t been proven. However, the messaging is still very clear. If you’ve had COVID, you probably know how sick you could get and that you wouldn’t want to give it to someone else. You should still wear a mask and do all the things we are recommending for everyone else so that we send a consistent message. You should protect the people around you in case you have live virus in your respiratory tract that you can transmit to others. If you tested positive in the last 10-14 days, you really should probably stay home for the holidays.

What is the risk if you get tested several days before gathering with family?

Dr. Pavia: There’s no guarantee. You may be incubating the virus, you may have been exposed just a day earlier, or you may test positive in the days to come. It provides some protection. The best way to use testing is to get tested and then have a period where you have no risk of contacts. That period should be at least 7 days if you want it to work.

What is your advice for those who want to celebrate with older family members?

Dr. Gomez: Due to current transmission rates, gathering with older adults would put more at risk of infection. It’s important to keep the long-term perspective. We may be turning the corner in finding a COVID-19 vaccine. We understand there is pandemic fatigue and social isolation. If we do well in the coming weeks, we will have more time to gather and spend time with loved ones.

What does COVID-19 transmission currently look like in Utah schools? What should parents consider if they plan to gather for the holidays?

Dr. Pavia: Every school district is doing things differently, and every school district is experiencing the pandemic differently. Some, such as Salt Lake School District. stayed on distance learning all semester. In fact, they’ve had fewer cases among high school students than other districts that have had in-person learning.

When there is a lot of spread in high schools, it poses a risk to other people who might gather together for the holidays. We’re seeing more and more high school kids get infected with COVID-19. We’re also noticing that they aren’t getting very sick, so they aren’t getting diagnosed early. This poses a real risk to people around them, such as their friends and older relatives. If your school has gone on distance learning due to COVID-19 cases, it may be protecting your holidays somewhat.

Is there a safe way to get college students back into your bubble if they are coming home for the holidays?

Dr. Pavia: The safest way is to have them isolate for 14 days before they come home. That’s not going to happen with college students. The next best thing is to have them get tested for COVID-19 several days before leaving and then quarantine themselves. They should not come in contact with anyone without a mask, and they should distance themselves six feet between others.

We’ve learned that airplanes are safer than we thought. There have been cases of transmission on flights. They mostly happened on long-haul flights, where people weren’t wearing masks consistently. But on medium-haul flights with empty middle rows where everyone was wearing masks consistently, transmission seems to be very uncommon. Airplanes also have good air exchanges and air filters.

Everything else about air travel puts you at high risk. This includes:

  • Lining up to board
  • Deplaning
  • Crowds at TSA checkpoints
  • Taking public transportation to and from the airport

How can our actions during Thanksgiving impact Christmas and other upcoming holidays?

Dr. Pavia: We’ve seen this with a number of holidays this year. People are getting together with people who are not in their immediate bubble, which has spread infection. Because of the expediential way infection spreads, gathering on Thanksgiving can have an enormous amplifier effect. We saw this on Memorial Day, the 24th of July, and Labor Day. Thanksgiving has the potential to be the scariest holiday yet because there is so much disease in our communities right now. The chances of someone coming into your home who has the disease is pretty high. Being indoors has a greater potential for spread.

If we don’t do a good job at gathering safely during Thanksgiving, are we looking at higher death rates and COVID-19 case numbers before Christmas?

Dr. Pavia: This is the situation we all fear. It takes two weeks to see hospitalizations and four weeks to see deaths after each infection. It’s going to take a couple weeks for any surge that comes out of Thanksgiving to amplify. If we do well, we can avoid a surge of deaths that will start to occur around Christmas and the new year. Some people have said, “Gather at Thanksgiving and regather at your funeral on New Year’s Day.” That’s a bleak way to put it, but at this point, we need to be honest. The thing I want people to remember is there is an end in sight. It’s not around the corner, it’s not in January, and it’s not in February. But there’s no reason to risk people’s lives in January and February when a vaccine is going to start to be available to the general public in April, May, or June. That’s when we’ll finally see an end to this.

What is the advice for people at risk for mental health issues during the holidays?

Dr. Pavia: We can’t ignore the mental health impacts of this pandemic. People are isolated, depressed, and fatigued. Dealing with loneliness and isolation is important, but we have to do it safely. That means doing things like Zoom calls, visiting outdoors, and enjoying walks together while wearing a face mask. Just because someone needs a hug, it is not worth their life or yours.

Dr. Spivak: People think of Thanksgiving as all or nothing: We either all get together and eat or it’s not Thanksgiving. We should instead think of more creative ways to see each other. That could be visiting with someone outside or visiting inside for a few minutes with masks on. There are safer ways to have human touch and connectivity.

Kylene Metzger

Public Affairs

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