Gathering for December Holidays? Follow This Checklist.
By: Tara Haelle
Tags: Health, Coronavirus, Public Health, Covid 19, Holidays

Gathering for December Holidays? Follow This Checklist.

Photo: Kira auf der Heide/Unsplash

As we head into peak holiday season, the U.S. death toll from Covid-19 has just surpassed 300,000 deaths. The nation is now averaging a daily death toll equivalent to the 9/11 terrorist attacks — every day — with no signs of slowing down. It’s no surprise, then, that the Centers for Disease Control and Prevention (CDC) advises that the “safest way to celebrate winter holidays is to celebrate at home with the people who live with you.” They even provide some great ideas on the safest way to celebrate apart from one another.

As we saw with Thanksgiving, however, millions of people will still choose to travel and gather with family for Christmas and other holiday celebrations. It’s understandable: Much of the nation has quarantine fatigue, and as Melinda Wenner Moyer previously reported for Elemental, “social distancing guidelines go against our deepest instincts and cultural norms.”

For people to travel or gather and risk catching or transmitting Covid-19 to others puts the nation’s already very limited ICU beds at a higher risk of filling up, especially if the get-togethers include older adults or other people at high risk for Covid-19 complications. But asking people to stay home for such important family gatherings during such a hard year, when most haven’t been able to see loved ones at all, is understandably hard as well.

For those who plan to travel or gather despite the known risks, there is an in-between option: one that is not completely safe but also reduces risks as much as possible. A concept in public health known as harm reduction accepts that risk elimination is not always possible. Though the concept was first developed to reduce the negative consequences of drug use, it’s now grown into other areas of public health, such as encouraging condom use among sexually active teenagers or, though still controversial, exploring vaping as an alternative to smoking. You saw it in action during the summer when public health experts offered suggestions on how to reduce the risk of infection when people were protesting racial injustice in the streets.

If you or others in your family plan to travel or otherwise get together with friends or family outside your household, the harm reduction approach means finding ways to help you reduce the Covid-19 risk this holiday season, even if it does not eliminate it. The first step is recognizing that risk is not a binary concept: Things are not “safe” or “unsafe” in a vacuum. Instead, behaviors are “higher risk” and “lower risk.” Risk is a continuum, and moving as far as you can toward the “low risk” end of the spectrum is still better than hanging out in the middle or edging toward the “high risk” end.

Infection preventionist Eli Perencevich, MD, of the University of Iowa, talks about thinking of risk like a budget, with people calibrating their “risk budget” to their threshold for risk and trying not to blow the budget all at once. “If you spend half your budget at work, then you spend less of your budget with each other thing,” Perencevich says. Each activity around other people “is a hit to your budget that adds up over time, that increases your risk by some percent,” he says. “The goal is not to spend all of your risk and get Covid.” (That said, it’s certainly possible to get Covid during just one exposure (“small expense”), before all your “budget” is spent, but the idea is to think of risk as additive—each small exposure adds to overall risk.)

The best way to visualize risk reduction is the Swiss cheese model, illustrated by Australian virologist Ian M. Mackay, PhD, in his blog, Virology Down Under. Just as layering many slices of Swiss cheese atop one another eventually covers up all the holes, using multiple risk reduction strategies reduces the number of ways the coronavirus can reach you or your loved ones.

“No single activity is a risk eliminator. They have to work together,” says Saskia Popescu, PhD, an adjunct professor of epidemiology at the University of Arizona. “Doing one of them doesn’t mean you don’t do the rest of them. And just because we slip up or make a mistake, that doesn’t mean we throw in the towel.” If you find your mask slipping below your nose while in a store, that doesn’t mean you just tear it off and give up on wearing a mask. You adjust it and try to be more conscientious about the fit next time.

Risk is a continuum, and moving as far as you can toward the “low risk” end of the spectrum is still better than hanging out in the middle or edging toward the “high risk” end.

Here are Swiss cheese slices you can apply if you’ll be gathering with family for the holidays, endorsed by Popescu and Perencevich. The key is for each member of the family to dedicate at least 10 days (preferably 14, though that starting date has passed for Christmas) to practicing quarantine behavior as close as possible to what was recommended during the March shutdowns. If you missed the boat for that, then CDC guidelines allow for seven days plus a negative Covid-19 test. While a negative Covid-19 test doesn’t guarantee you or your loved ones aren’t infected, it’s one more layer of risk reduction. See Dana Smith’s excellent guide on Covid-19 testing to learn your options and best practices.

Before traveling or gathering

In the seven to 14 days before gathering, the goal is for each member getting together to adhere to the following behaviors to the extent possible:

Do not leave your house except to go to work if required, run an essential errand that absolutely cannot wait until after the holiday and cannot be delivered, or exercise away from anyone outside your household. Many families have already decided it’s too risky to gather with those who must work in places with other people, such as teachers, essential retail workers, and health care workers. If your family will be gathering with an essential worker in the bunch, everyone (especially the essential worker) should be even more conscientious about mask-wearing, hand hygiene, and not touching their face at work in the weeks leading up to the gathering.

Use curbside delivery or contactless curbside pickup for as much as possible. If you must go into a store, wear a mask, remain distanced from other people, and spend as little time as possible (ideally less than 15 minutes) in the store.

When using drive-throughs for pharmacy, food, or other items, wear a mask and only roll down the window for exchanging the money and purchases.

Do not socialize indoors with anyone outside of your household. If you socialize with any nonhousehold members outside, everyone should wear a mask and remain at least six feet apart (ideally more). Some families insist on no socializing with people outside their household at all, but outdoor, distanced, and masked “has got to be as close to a zero risk as possible,” Perencevich says. “But no indoor socializing at all, regardless of masking, regardless of anything.”

Avoid any doctor appointments that are not essential in the days leading up to the gathering. Health care appointments are now very low risk in most places, but it’s best to delay routine or nonurgent visits because the less contact with other people you have, the less risk you accumulate.

If someone has not been able to avoid people through the methods above or is an essential worker, the day least likely to give a false negative for a Covid-19 test is the fifth day after exposure.

Quarantining for 14 days before a gathering is the safest, according to the CDC. Quarantining for 10 days or seven days plus receiving a negative test on the fifth day after exposure reduces the risk of Covid-19 by about 95%, Perencevich says. Remember, though, that tests only capture a single moment in time and can be inaccurate if it’s a false negative or a poor sample, Popescu says. The safest bet is to quarantine the full period ahead of the gathering.

Traveling

If you’re traveling, follow CDC recommendations to reduce risk as much as possible. Driving is safer than flying for avoiding Covid-19 infections and safest if you only stop for gas and bathroom breaks. If you enter a public bathroom, wear a mask at all times. (Adding eye protection, such as a face shield or goggles, is even better.)

If you’re flying, first be sure you’re not sick and quarantine before and after your flight as long as possible, up to 14 days. Perencevich recommends wearing a surgical mask or, if you have it, an N95 mask with a face shield or goggles to protect your eyes. Wear these in the airport and for the duration of the flight. He recommends skipping the free drinks and not touching your face or fiddling with your mask unless you’ve washed your hands or used hand sanitizer before and after.

Also, try to fly with an airline that has spaced-out seating and choose a window seat to stay away from people in the aisle, Popescu says. If you do need to take your mask off, be mindful of when you do it, Popescu says. If everyone around you is taking theirs off at the same time, wait.

Gathering

On the day of the gathering, again, the Swiss cheese model is a guide: The more you do, the safer everyone is.

Communicate to everyone beforehand what is expected during the gathering, such as mask-wearing, hand hygiene, and other safety measures.

Limit the number of people as much as possible and ask anyone who feels sick, has a fever, or has other symptoms to stay home.

Consider having everyone wear masks except when eating or drinking. Taking turns eating and drinking also reduces the likelihood of everyone having their masks off at once.

Eating outdoors where the weather allows reduces the risk even further. One of Perencevich’s friends is opening their garage door and having Christmas in the garage.

If you can’t gather or eat outdoors, open a window if possible, even for short periods if it’s too cold to leave it open.

The less time everyone spends together indoors, especially without masks, the more risk is reduced. If you normally stay overnight with family, try to stay in a hotel this year if your budget allows it. (If you stay with family anyway, it’s still worth following the other practices listed here to reduce risk.)

Keep background music or other noises low so that people aren’t speaking loudly or having to shout to talk.

Clean and disinfect common surfaces, such as countertops and doorknobs, regularly.

Have a convenient area for hand washing and/or have hand sanitizer available for everyone, and have extra masks on hand for anyone who forgets theirs.

Try to limit alcohol and drugs — they lower inhibitions and thus adherence to distancing practices; plus, they increase the risk for accidents and injury, and it’s a good time to avoid the hospital.

Finally, transparent communication with everyone is key. If someone does develop symptoms of Covid-19 after the holiday, they should contact a health care provider about testing and inform everyone else who was at the gathering. It’s not possible to remain completely safe if you’ll be gathering with family and friends, but you can reduce the potential for harm as much as possible with some forethought, planning, and communication.