Gathering Together (Carefully) For A Pandemic Holiday

IRA FLATOW: This is Science Friday. I’m Ira Flatow. With Thanksgiving around the corner, are you worried about getting your family together for the holidays? Worried about catching or possibly spreading COVID-19, a virus that seems to be reliably spread when groups of people spend sufficient time together indoors?

But even Dr. Anthony Fauci wouldn’t tell people definitively to not travel, telling the Washington Post that some people may find their need to be together more important than the risk of catching COVID-19, as long as people understand there’s a risk. Some of you have given it a lot of thought and have told us of your decisions via the Science Friday VoxPop.

JAN MARIE: I would like to encourage everyone to stay home this Christmas season and give our healthcare workers a break. We don’t need to overrun our hospitals and make life difficult for all of those people.

SCOTT: We normally have my parents and my sister over for Thanksgiving and for Christmas. But this year, even if they quarantined or got a single test, the concerns about not catching a possible infection with a single test and the issues with asymptomatic spread even if you’ve quarantined in our area just make it too dangerous. And we’ve decided to not see each other at all.

CHRIS: I’m only traveling about 50 miles to my kid’s house. We keep a low profile and don’t visit elsewhere if possible.

TULA: This year I’m not so sure if I am going to spend Christmas alone or not. And I wish I knew what to do to stay safe and have a happy holiday season.

IRA FLATOW: Thank you, Jan Marie, Scott, Chris, and Tula, for your thoughtful comments. We may have some useful information and advice for you. So please let me introduce my guests. Dr. Julia Marcus, an infectious disease epidemiologist, associate professor of population medicine at Harvard Med School. Welcome, Julia.

JULIA MARCUS: Thanks for having me.

IRA FLATOW: And Kate Baggaley, a freelance science journalist based in New York. She’s written about this conundrum for Popular Science. Welcome to Science Friday.

KATE BAGGALEY: Thanks so much.

IRA FLATOW: Let me begin with you, Julia. There’s no arguing, is there, that more people gathering indoors is going to lead to more cases of COVID-19, right?

JULIA MARCUS: Yeah, at this point with the level of community spread we’re seeing across the US, it’s pretty inevitable that if people gather across the country and travel and gather in indoor settings for Thanksgiving, we will see some cases attributable to that holiday.

IRA FLATOW: So why give advice on holiday gatherings then?

JULIA MARCUS: Well, I think this is just like many other areas of health, where we have to acknowledge that we can’t just tell people you cannot do this. If we think about how well that works for, let’s say, encouraging teens to not have sex or telling people don’t use drugs, this just say no approach, it always fails. And actually, it’s counterproductive because in reality, some people are going to have sex, use drugs, or in this case, get together with their loved ones. And they need tools. They need information about how to mitigate risk if they do gather.

IRA FLATOW: Kate, as a journalist, you talk to a lot of epidemiologists about holiday travel. Let’s get into that. Was there a number that they were able to put on how risky it is to celebrate with families this year?

KATE BAGGALEY: No, they weren’t. That’s one of sort of the most frustrating things about this. At one point, I asked several of them, well, OK, how about a number? How many people? And they said, oh, it just depends on so many variables. It depends on how much COVID-19, how prevalent it is in the community where you’re coming from, where you’re hosting.

It depends on how much space you have and if you have any ability to have your gathering outdoors, if you can have it socially distanced indoors. It depends on how compliant all of your guests are going to be and if everyone is going to be on the same page. There are just so many different variables that go into it.

IRA FLATOW: Julia, as an epidemiologist, do you come up with a number? Do you try to come up with a number?

JULIA MARCUS: Well, binary thinking is very appealing. And we want to have some metric we can use. Within six feet is unsafe, beyond six feet is safe, and any other number of binary ways we can think about this. But the reality is that risk is not binary. It’s actually– it’s a spectrum.

What we can do, instead, is provide relative risk and say, doing this is going to be safer than doing this. And that, I think, even though it’s maybe less satisfying for people, is more to the uncertainties here and the way that risk works and at least gives people a framework for decision making.

IRA FLATOW: All right, then, let’s talk about some of the things you can consider. Give us, Dr. Marcus, some idea of the things we should be thinking about.

JULIA MARCUS: I think when we’re thinking about assessing risk, there are a few things to consider. Some of them are more in our control than others. So the first thing I would say is thinking about community spread and the area where you’re hosting or traveling. And of course, it’s pretty high in a lot of places right now. And that’s something we can’t personally do something about. I mean, obviously, our collective actions are going to influence community spread. But at any given moment, as an individual, we don’t really have a lot of control over that.

Another thing to consider is people’s vulnerability to a bad outcome from infection. So thinking about the people involved in any gathering, are they older? Do they have any underlying conditions that might put them at higher risk? And that may influence decision making. And again, that’s not really within our control.

And then a third factor that is within our control is, what is the risk of the actual activity that we’re thinking about engaging in? So everything from air travel to, if we’re thinking about Thanksgiving, a gathering, is going to be indoors, outdoors, masks, no masks, how many people, and those are all things that we can tweak. And that’s where we’re really going to see potential for risk mitigation.

And then just a fourth thing to throw out there, even though this is not about risk assessment, it comes into our decision making here, is, what are the benefits of this gathering or this activity that we’re thinking about engaging in? Is it something that we can easily forego without any real impact on our mental health or other aspects of our well-being? Or is it something that we really need to do? And that, I think, is something that we’re always factoring into risk calculus, but we don’t really talk about it as much.

IRA FLATOW: That’s a very interesting last point there because I think we all think about that. Kate, I know that you have made us a timeline if we decide to travel for Thanksgiving, which is coming up in, let’s say, about three weeks. What do we need to do to plan for it now?

KATE BAGGALEY: Yeah, one of the researchers I spoke to kind of made the point that, yeah, there are ways that we can reduce our risks around Thanksgiving. But it does require some advanced planning. A lot of the steps, though, are variations on things that we’ve already been told to do, which is wearing your mask out in public, social distancing, sanitizing your hands frequently.

So one thing right now you can do is get your flu vaccine. It takes about two weeks after you get it for your immune system to develop antibodies. And what you kind of want to avoid is a situation where it’s Thanksgiving, you start to feel sick, and you’re like, oh, no, is it COVID? Is it the flu?

Another thing to do is have a conversation with everyone who would be at the gathering and set some ground rules. What precautions is everyone going to take before? What’s going to happen on the day of? That kind of thing.

Another is really stepping up your social distancing efforts about two weeks before the gathering. So really, to the extent you can, not going out to eat at a restaurant, not taking other trips, avoiding other gatherings, staying at home as much as possible, so just really minimizing the chance of coming into contact with it.

IRA FLATOW: So this is something that especially that last point I know, because we’re trying to plan our gathering and we talk to our relatives, are you going to be a social distancing? Are you going to be staying in your little bubble? And this is something because we are a few weeks away, that’s something we need to start doing pretty soon now, right?

KATE BAGGALEY: Yeah, it varies from person to person, but the amount of time between when people get infected and they start having symptoms can be two to 14 days. So really having that cushion gives you sort of the best chance possible of reducing that risk and being able to go into that gathering, knowing that there was as little chance as possible for you to have been infected and sort of bring that into the gathering.

IRA FLATOW: And let’s talk about one of the great unknowns, I mean, or the great fears of the unknown that people talk about all the time. And that is the fear of flying. What about the choice to fly or drive? I’ve seen mixed reviews of air travel so far. Let me begin with you, Kate. Is flight an option?

KATE BAGGALEY: Yeah, so I think if you can drive, that is the safest option, especially, that is, if you’re driving with your immediate household, you are coming into contact with fewer people, especially if you have a plan ahead of time, where you’re going to stop, be in and out quickly of the rest stops.

For flying, that’s something that researchers are still looking into. One good thing is that planes tend to have pretty good air filtration systems. But when I spoke to researchers, one of the points they brought up was they’re like, well, OK, airplanes, there are things that can be done for that. The waiting area of the airport is what I’m really concerned about. It’s really crowded. There’s so much you have to do in the terminal before you even get to the plane. So they really stress, if you’re going to fly, being vigilant about how close people are around you, not stopping for a meal, and that kind of thing.

IRA FLATOW: What’s interesting is that I find in my own situation, we are constantly talking with our friends and relatives about where they stand. And we’re sort of allowing them the option, without feeling guilty, about canceling their plans at any time beforehand if they feel like it’s too much of a risk. I would think that communication, Julia, is a big part of this.

JULIA MARCUS: Yeah, the communication is huge. And I think it’s interesting. For me as an HIV researcher, this is something we’ve thought about for a long time in the context of communication between partners around, let’s say, STI testing or HIV testing. And it’s something we’ve really tried to promote in the sexual health world as this non-judgemental, open communication, where people feel like they can share their risk and their testing status.

And now it’s something that we’re kind of navigating on a much bigger scale around social interaction. And I think a lot comes into play there around people’s different levels of health literacy and risk tolerance. And people are getting their information in very different places and interpreting it in different ways. So there’s a lot to navigate, but I think as much as it can remain an open, nonjudgmental conversation, and like you’re saying, allowing people to change their minds, I think that will help.

IRA FLATOW: Mm-hmm. Kate, what else should we be ready to change as we’re leading up to Thanksgiving itself?

KATE BAGGALEY: I think one thing is thinking about what’s going to happen on the day of the gathering. So, again, if you can do it outside, that’s great. If it’s going to be inside, how much can you space everyone out so they’re not all sort of crowded around one table?

Can you have windows open? Can you have things like paper towels in the bathroom for guests? Do you have some extra hand sanitizer? And thinking about things like not hugging or kissing when you greet people like you normally would and wearing masks when you’re not eating, even though it’s kind of weird and awkward and things like that.

IRA FLATOW: Julia, it does seem that ventilation is a topic that we really don’t discuss enough. I know we’ve talked about it here on the program a lot. Perhaps don’t be afraid to put a fan out, too, Julia?

JULIA MARCUS: Yeah, I mean, I think a fan on its own is not necessarily going to do much. I mean, it will disperse particles, but I think opening windows is particularly important and maybe the combination of those two things. The idea is that you want to have air exchange. And you want to be keeping the air moving throughout the room. So if you have a window open on one side and a door cracked on the other, that’s great because then you end up having the air moving across the house.

IRA FLATOW: Even Dr. Fauci is saying some people would be justified in seeing their kids or grandkids this winter. How strong, epidemiologically speaking, is the argument that mental health is more important than keeping ourselves at low risk for COVID?

JULIA MARCUS: I don’t think we can say it’s more important. I think it comes back to this question about everybody making their own decisions around this risk benefit calculus. And for some people and depending on the situation, there may be times when a risk of COVID transmission, acquisition, or transmission is not as great as the risk of, let’s say, loneliness.

Or there may be specific situations where people are at the end of their lives, and this may be their last Thanksgiving. And so that is going to factor in. And so it’s not really about saying one thing is more important than the other categorically, but more about allowing that some people are going to be weighing these competing risks.

IRA FLATOW: Mm-hmm. This is Science Friday. I’m Ira Flatow. In case you’re just joining us, we’re talking to journalist Kate Baggaley and epidemiologist Dr. Julia Marcus about minimizing risks if you travel for the winter holidays that are coming up and things that you might consider. Because this certainly will be a different holiday season. Julia, do you have any advice on what to do after the party is over and you’re on the plane and you’ve gone home, or what steps you might want to follow as a follow-up?

JULIA MARCUS: Yeah, I mean, I think this is all about layering different risk mitigation strategies with none being foolproof. And so, as much as people can minimize contacts after the event, and it doesn’t have to be 14 days of strictly quarantining, but if you can do a few days, even that is something. Four or five days can help. If you can get a test, that’s great.

And I think, also, just being conscious of who you’re interacting with after gathering with people and trying to avoid seeing any elderly relatives or other people who might be particularly vulnerable for some period of time.

IRA FLATOW: And all these things we’ve talked about today, it means a lot of work, really. Calculating the risk, enforcing distance, all this extra planning just to put a nice meal on the table with your friends. And you know what happens sometimes is that you let your guard down, right? How can we keep up this amount of vigilance and still experience the joy of gathering during the holidays? Because when we get together, then we sort of forget sometimes. Can we really do both things at the same time, Julia?

JULIA MARCUS: It’s such an important question that I think really applies so broadly right now. How can we minimize the risk of transmission while still enjoying our lives and connecting with loved ones? So I think finding the places where it’s most important to be vigilant is really important and devoting our energy to those settings, those highest risk settings where we can try to mitigate risk and be a little more careful, or especially around people who are particularly vulnerable.

And we don’t have an endless resource of energy to devote to this. And so I think we have to recognize that as well, that we can’t drive ourselves crazy with trying to eliminate risk in every situation because it just isn’t possible. And so as much as people can try to relax in lower risk settings and really enjoy being outdoors, having a picnic with people, and finding some sense of normalcy and not so that they can reserve their energy for the places where it matters most, I think that will really help.

IRA FLATOW: Kate, do you have plans?

KATE BAGGALEY: Yes, I’m with my parents now. And my brother, who lives in Florida, is going to join us. So we talked about whether he could drive, but we decided his car wouldn’t make it. And it’s a long drive, so he’s going to fly the week before Thanksgiving and start quarantining before he flies. And then, we have friends who have an extra separate space where they used to have an in-law living. So he’s going to quarantine there for a couple days, take a test before he leaves, and then take one after he’s been there for a few days. And so, that’s what our plan is.

IRA FLATOW: Well, we wish you the best of luck in following your plans. And thank you both for laying out some good advice to all of our listeners.

JULIA MARCUS: Thanks so much for having us.

KATE BAGGALEY: Yeah, thank you so much.

IRA FLATOW: And that’s about all the time we have. I want to thank my guests for joining us, Dr. Julia Marcus, an infectious disease epidemiologist, associate professor of population medicine at Harvard Med School, and Kate Baggaley, a freelance science journalist based in New York. Her most recent story about Thanksgiving safety appeared in Popular Science.

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