COVID-19: Advice for the Holidays

As we head into the holidays, we all want to see our loved ones, our family, our friends. We want to hug them and spend time with them and cherish the time we have together. But we also need to do it safely during COVID-19.

That’s why it’s important to plan in advance, start thinking about this now, and be open and honest with your loved ones about your plans.

Here are a smattering of thoughts about various aspects of the holiday season and my best advice for navigating it as safely as possible.

Introduction: Thanksgiving at the Pongs

You know, I love Thanksgiving. Thanksgiving has been my favorite holiday for years. I love the crisp fall weather. I love to eat. I love to cook. I love to have family members from all over the country crowded into my little house for a big meal. At our last Thanksgiving, our family’s youngest kids and our oldest elders were all sitting together sharing a whole day of stories and dancing and singing and eating.

This year we’ve been thinking about ways to celebrate differently though, because most of the things that I love about Thanksgiving are the same things that COVID-19 loves. Remember SARS-COV-2, the virus causing COVID-19, is a respiratory virus.

It’s transmitted by droplets and aerosolized virus that come out of the mouth and nose of an infected person and end up getting deposited or wiped into the mouth or nose or eyes or deposited in the airways of the next victim.

So activities that bring people into close proximity, especially indoors, especially without masks, when they’re talking, laughing, singing, or shouting to be heard are very high risk activities — all the things that happen at my Thanksgiving.

This year, as we’re thinking about ways we might celebrate, we have to consider ways that we could do so that don’t increase the risk of transmitting this virus to those people we love. We can see right now, this is October, we can see rising COVID-19 rates, rising hospitalization rates happening all around the country.

Unfortunately, this rise seems to be in cities, suburbs, and rural areas. It seems to be affecting the whole country. Not every location in the country, but across the entire country. So we really have to be careful with this.

Plan smaller get-togethers, outdoors if possible.

As we’ve been thinking about trying to celebrate, we’ve considered hosting a series of smaller get-togethers over the few days of the holiday weekend. Instead of gathering everyone at one time, possibly having one set of kids from one household for one meal, another set of kids from another household, perhaps parents on a different day, and even then we would spread them out in the house so that people in any one household aren’t sitting at the same table as someone from another household.

I think it’s important that we consider trying to still be outdoors. If you have a way to heat an outdoor area, it might be a much better move than to try and bring people inside the house this year.

We’ve talked about cooking our usual dinner, but boxing it up and taking it over to our children and our parents to try and minimize having them mixing together. I’m not worried about transmission of this virus through food or through the dishes though. I will probably wear a mask and kitchen gloves when I’m boxing up food for other people.

Drive if possible, but only with your household.

Travel to Thanksgiving or other holiday celebrations also brings some risks this year. I would really discourage riding for more than a very few minutes in a car with someone that isn’t living in my household. It does not take long to fill the air of a car with the exhaled breath of either of its occupants. Think about the last time you had a teenager in your car after soccer practice or football practice, and you know, it doesn’t take long before you’ve got to get the windows open.

So I really would discourage travel in the same car and I think airplanes carry similar risk. The holidays tend to be a time when people who are going to travel are traveling around the same days.

Airports, bus terminals, airplanes, and buses have tended to be fairly crowded places and mixing that many people from different places together makes it hard to avoid breathing the same air, makes it hard to avoid the possibility of droplet contamination. So I think that driving is best if you can do so with your own family.

Hotels should be fine, but take precautions.

I’m not terribly worried about hotels. Early on I had a lot of concerns, but I think that if I was going to stay in a hotel right now, I would try and arrive a few hours after the last time someone was in the room. I would talk to the folks at the hotel about that and try and see if that’s possible. I would wipe off the high touch surfaces upon arrival – the doorknobs, the remote control, the faucets, things like that. And otherwise I would ask that no one else come in the room until we were done with it. So, I would make my own bed, but I think hotels are probably reasonable.

Avoid eating indoors at restaurants.

You have to think about any choke points where groups of people might gather. And I would still be pretty careful about eating indoors in restaurants. I wouldn’t recommend that right now. For the same reason we talked about how we do our seating inside the house, I think restaurants are very high risk. But I don’t worry much about takeout food. I think that the other thing, if you do choose to get together, trying to do some things that minimize risk again, I would try and get as close as possible to an outdoor setting.

And what I mean by that is having a relatively small number of people in a relatively large airspace. If it’s possible to have the air turning over, I would, even though it’s cold for a few hours, having the heat turned up a bit and having the doors open, trying to move the air out of the house makes sense to me. If you’re able to be outdoors, I would. Otherwise keeping people spread out in the biggest room you have makes sense.

Wear a mask if indoors and keep things brief.

I think we should be wearing masks. If we’re mixing people indoors from different households, I think you should have a mask on unless you’re eating and I would try and have people from the same household sitting at the same table, separated from the other tables.

I think we need to keep these gatherings fairly brief. The longer we are there, the longer somebody who’s infected could be filling the air.

Avoid buffet lines, serving each other food, and too much alcohol.

I think it would be best to try and plate the food. I think that having people sharing a buffet line or crowding together to serve themselves, I think sharing the same utensils to serve, carries a fair amount of risk. Similarly I think we need to consider limiting the amount of alcohol we serve, as our best intentions are often melted away by a few drinks.

Hosts, take care of yourself.

If you’re the host, I think it’s important that you take care of yourself. We know that with most respiratory infections, if you are run down, if you’re not getting enough sleep, if you’re not eating, if you’re drinking too much, your risk is higher of getting sick.

If possible, consider quarantining in the weeks before.

Another thought that I learned from one of my patients the other day might work for some of you. He and his siblings live with their families in different households. And so they decided that they would all quarantine for a couple of weeks before getting together.

The idea was that if you didn’t expose yourself to anyone outside of your household, and if no one had any symptoms for a couple of weeks, the likelihood of being able to transmit this virus is much lower. It takes a lot of faith, it takes a lot of trust, it takes a lot of willpower to not go out in the world for that two weeks. But it is an opportunity if you want to try to get together with people you don’t live with. May not work for everyone, but if it works for you, I hope it helps.

Ultimately, search for the Goldilocks solution.

As my patients and I’ve been discussing for the past several months, the key to safely navigating this pandemic, and especially this holiday time, is to search for the Goldilocks solutions.

Do not assume that COVID makes it impossible to celebrate all that we’re grateful for, with those that we love, but also do not get frustrated and throw in the towel at all of these steps we can take to try and protect ourselves and protect our families.

Keep working together to find those creative ways to make it work, ways that allow us to live safely through this time. I wish the best for you. I hope you have a great Thanksgiving, despite it.