Jorge L. Ortiz
| USA TODAY
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Dr. Eric Cioe-Peña and his wife come from large families and typically split the holiday festivities, getting together with one group of relatives for Thanksgiving and another one at Christmas.
This year, they’ll reluctantly keep their distance from both.
“We’re going to have to make sacrifices,” said Cioe-Peña, an emergency room physician and director of Global Health at Northwell Health in New Hyde Park, New York. “My wife and I decided this year’s going to be nuclear family, and we’re not inviting anybody over.”
As the holidays approach and the number of coronavirus cases surge, millions of Americans face the decision whether to eschew traditional gatherings with family and friends or risk spreading the virus among loved ones.
Anthony Fauci, the nation’s foremost authority on infectious diseases, and Robert Redfield, director of the Centers for Disease Control and Prevention, warned about the potential for a spike in infections stemming from holiday parties, even if they’re small and only among relatives.
Memorial Day get-togethers were partly blamed for an increase in COVID-19 cases the USA experienced early in the summer. Events such as a Sweet 16 party late last month in Long Island, New York – linked to 37 positive tests – and a wedding in August in Maine – which led to more than 175 infections – underscore the danger of relatively small social functions turning into superspreaders.
Last week, health officials in the Washington area said small gatherings have been a factor in the region hitting a two-month high in coronavirus cases.
“All along, there have been issues about attending weddings, funerals, religious gatherings and other events that are part of our normal life,” said Dr. Steven Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University. “They bring people together and potentially become vectors for the virus. As many public health experts mention, the virus is attending these events and can be transmitted from person to person.”
Don’t let the virus get to Grandma
The CDC, which discourages traditional trick-or-treating this Halloween, updated its guidance Monday about holiday celebrations with advice on how to reduce risk of infection.
The tips for in-person gatherings include commonly known mitigation measures such as holding events outdoors, limiting their size, having participants wear masks and maintaining social distance. The CDC encourages hosts to request that guests avoid contact with people from outside their household for two weeks before the activity.
The impracticality of some of the safety measures – it’s hard to fit everybody at a table 6 feet apart or to eat a meal outdoors in the late November chill – combined with some Americans’ defiant nature will probably lead many to ignore the suggestions.
“I know there will be plenty of families who mock this kind of advice and say, ’That’s ridiculous. We’re going to get together and enjoy Thanksgiving like it’s supposed to be, and no one’s going to tell us otherwise,’” Woolf said. “That may give them a sense of independence, but then the virus gets to Grandma, and she ends up in the hospital on a ventilator, and then you live with the guilt.”
Woolf and other experts recommend that families in separate households sit at their Thanksgiving tables at the same time and connect through a video platform such as Zoom, which might give a sense of sharing the meal. If members of different households congregate inside, opening windows would at least improve ventilation and could help diffuse the virus, reducing the chances of contagion.
For Cioe-Peña who works in public health and sees the impact of COVID-19 on a regular basis, the decision to find alternate ways to celebrate the holidays, though painful, was pretty clear-cut.
“I want to see my parents this Thanksgiving. I’d love to spend time with extended family. This year it’s not in the cards,” said Cioe-Peña, who, along with his wife, plans a Halloween candy scavenger hunt in the backyard for their two young children, rather than have them go out trick-or-treating with friends.
Others with less direct exposure to the virus’s ravages might be more tempted to take a chance, especially those who have avoided traveling to see relatives as the pandemic stretched over months.
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As the U.S. surpassed 220,000 COVID-19 deaths, the Centers for Disease Control and Prevention issued new guidance about wearing masks while traveling.
Weighing risks versus the pain of isolation
Craig Smith, an associate professor of psychology and human development at Vanderbilt University, said isolation over long stretches of sheltering in place can lead to a profound sense of loneliness and disconnection, particularly for those who have young children and are trying to balance parenting with work. Missing out on family gatherings would aggravate those feelings.
“Thanksgiving and the Christmas holidays are especially tough because, on top of the normal need to interact with friends and family, they are lifelong rituals for people of sharing those particular days and those particular meals,” Smith said. “So for many people, there’s going to be a palpable sense of loss when they’re unable to get their whole family together, but the risks, of course, are enormous.”
A study conducted for the Department of Defense indicates the risk of catching the virus on planes is minimal because of the aircrafts’ high turnover of airflow and use of HEPA filters. This week, the CDC strongly recommended that all passengers traveling on public transportation – including airplanes – and the onboard personnel wear face masks to avoid spreading the virus. The agency endorsed the removal, whenever possible, of anyone who refuses to comply.
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Those developments may prompt travelers eager for a family embrace to book a Thanksgiving or Christmas trip. Medical professionals still urge caution, noting that exposure to the virus could occur at several stages of a trip, and they insist it’s best to avoid mingling with members of households from different areas, especially those from places with high infection rates.
“People should carefully weigh the risk of travel and risk of disease at the destination before deciding to go,” said Dr. Jeff Goad, who teaches epidemiology, public health and travel medicine at Chapman University. “Certainly, older individuals and those with preexisting medical conditions should only travel if absolutely necessary.”
Some turn to antigen tests
One of the emerging options for travelers and others who want to visit loved ones is getting tested for the coronavirus in advance, now that testing is more widely available.
Dr. Peter Chin-Hong, an infectious disease specialist at the University of California-San Francisco who has studied the impact of small gatherings on virus transmission, said this approach is gaining popularity, especially using inexpensive antigen tests.
Chin-Hong pointed out these tests are less sensitive than costlier PCR tests, which are regarded as the gold standard, and better at detecting who’s infected than discerning who’s not with total certainty.
He advised limiting the size of holiday get-togethers and offered a list of things participants shouldn’t do, such as “huddling closely together at the end of the night as one large group to sing Christmas carols” or “debuting your French horn for the guests” because wind instruments can create aerosols.
For those determined to travel to see friends and/or relatives, Chin-Hong suggested getting the test done three or four days before the trip and sticking strictly to a safety protocol.
He added this warning: “A negative test is only one strategy, and safe practices for COVID prevention should still be maintained as a multimodal strategy to keep us all safe during these trying times.”