An Epidemiologist Explains How to Celebrate Safely This Holiday

Photo: Greg Pease/Getty Images

The holiday season is fast approaching, and for many people that means making decisions soon about how to celebrate safely. Making those choices may be tough: While reducing the risk of spreading Covid-19 is top of mind, pandemic fatigue, feelings of isolation and loneliness, holiday-related emotions, and pressure to see loved ones may all factor into your plans.

The Coronavirus Blog asked Lisa Maragakis, MD, MPH, senior director of infection prevention with the Johns Hopkins Health System, for guidance. Maragakis strongly recommends celebrating only with people in your household and avoiding travel of any kind. But if the holidays get complicated, there are steps you can take to reduce the risk for yourself and everyone around you.

Coronavirus Blog: We all know we shouldn’t be spending time with people outside of our household this holiday, but if that situation does arise, how can we reduce the risk of transmission?
Lisa Maragakis, MD, MPH:
The safest thing to do this holiday, even though it’s extremely difficult, is to celebrate with our immediate household members and forego gatherings, especially indoor gatherings. Studies show us that indoor gatherings are a high risk for transmission of the virus. If you do end up in a situation where you’re around individuals who are not from your immediate household, that’s when it is so important to practice the infection prevention measures of physical distancing.

Maintain at least six feet between yourself and others, and wear a mask. And I would advise avoiding close contact or being indoors with others who are not wearing masks, because we know masks protect others from our own respiratory droplets — the small bits of fluid that can be expelled when we cough or sneeze and even sing or talk. Masks also protect us from other people’s respiratory droplets. So, wearing a mask, physical distancing, avoiding indoor gatherings — especially large gatherings that can lead to superspreader events — is really the guidance.

Some people may opt to have outdoor gatherings this holiday. Is that less risky?
We know that outdoors is a much lower risk than indoors. Our main focus should be on avoiding indoor gatherings. That being said, we still need to be cautious at outdoor gatherings. It is still important to maintain physical distance from those who are not from your immediate household and to wear a mask. One of the dangers is that we often eat and drink when we gather socially, and that involves removing your mask. Inherently, that is a risky situation. And we feel comfortable around our friends, our family who are not always part of our immediate household, our community members, and our neighbors. I do think it’s a risk, and we have to remember this holiday season not to let down our guard, especially for social gatherings where food and drink are involved and physical distancing and masking may not be employed.

Does gathering in outdoor enclosures, like three-sided tents or shelters, increase the risk?

The reason outdoors is less risky than indoors is because of the ventilation. The volume of air is greater, and air circulation is greater, which reduces the chance that an airborne or respiratory droplet carrying the virus will be transmitted from one person to the next. But it doesn’t completely eliminate the risk. Structures that have sides interrupt that airflow and air circulation. It’s not as risky as being in an indoor location, but the more sides you have, the less air circulation and the higher the risks.

How effective is the popular “fly there, wait five days, get tested” strategy?
The safest thing to do this holiday is to not travel. There’s a strong recommendation against traveling for the holidays unless you absolutely have to. We know some people must travel for the holidays — for instance, students who are coming home from school or individuals who need to travel to assist a family member or friend. Quarantine and testing are strategies that can be helpful in that situation.

We have to remember, however, that a test is only one point in time. A negative test result is not a complete guarantee that you are not harboring the virus and might not later go on to have higher viral loads that would be detected. I think the safest thing, if you must travel, is to observe a quarantine period. The safest quarantine period is 14 days. We know that the CDC recently released shorter quarantine periods, particularly in combination with testing, but we need to realize there still is a chance that after this shorter quarantine period and test, you could go on to have the virus. So, 14 days is the safest right now. Seven days, plus a test, is part of the CDC recommendation.

What You Should Know About the CDC’s New Quarantine Guidance

A shorter quarantine will reduce people’s burden and hopefully improve adherence, while still preventing spread of the…

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coronavirus.medium.com

If a person is being pressured by their loved ones to travel, how can they effectively explain why they need to stay home?
I think the conversation we’re having right now is what is the most important way to get accurate scientific information to everyone who needs it? There’s a lot of misinformation out there and a lot of families who are putting pressure on family members to travel or gather for the holidays. I think this stems from a lack of understanding of the basic science behind how viruses are transmitted from one person to another.

I think it’s important to go back to the basics and explain very patiently and clearly that we want to be with each other, we all know the holidays are a special time to gather with family and friends, but this year it’s incredibly important to interrupt the viral transmission from one person to the next. And the way we do that is by limiting social and physical interactions with each other, and when we must be with others, maintaining that six feet or more of physical distance, avoiding indoor gatherings, and wearing masks. This year, the holidays pose special risks, and we should really avoid unnecessary travel and in-person gatherings with those outside of our households.

How does someone balance the safety precautions around Covid-19 with protecting their own mental health and that of others during the holidays?
It’s incredibly important for all of us to recognize that while we are dealing with the risk of the virus, we have very real risks of mental health issues and wellness that are equally important for everyone to stay well. We need to be able to address both of those risks simultaneously, especially during the holiday season, when we know that many people struggle with depression, anxiety, and feelings of isolation, even in a normal year.

This year, while we need to avoid traveling and gathering in person, we should make an extra effort to reach out to our family, friends, and those in our community who may be experiencing these feelings of depression and social isolation. We can do that virtually this year. We can do it by picking up the phone and checking on each other and making sure that we provide social support and tend to the physical needs of those who are really struggling and suffering right now.

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How are you planning to spend the holidays?
I’m going to celebrate the holidays this year with my immediate family — in my case, my husband and my two sons. We are not traveling, and we are not attending or hosting any gatherings this year.

We do have some hope on the horizon that the vaccine authorizations may come soon and that we may indeed have a light at the end of the tunnel in the next several months. We hope. But right now, the most important thing — and what we are doing at home — is celebrating with our immediate household and avoiding those risky situations.

Front-runners in the coronavirus vaccine race won’t make nearly as many doses this year as were predicted, but they may kick into high gear next year