An ongoing dialogue on HIV/AIDS, infectious diseases,
November 18th, 2020
Just Another Urgent Plea from Your Friendly ID Doctor for Risk Mitigation as the Holiday Season Approaches
Trivia quiz — name that president.
There’s lots in the press about how to have safe holiday gatherings in 2020 as cases of COVID-19 increase pretty much everywhere in this country.
How about this simple strategy?
Celebrate only with the people you live with already.
Bingo. That way Thanksgiving will be no riskier than your daily meals together.
End of advice column, right?
The problem is that this is analogous to advising abstinence for birth control or for prevention of sexually transmitted infections. It’s scientifically accurate, but the chances of 100% adherence by 100% of the population are zero.
So if we assume that this advice will not be followed by all — and that’s quite a fair assumption — how can we mitigate the risk?
Let’s make a list:
1. Keep the gathering small. Got a kid in college coming home for vacation? Sorry, the roommate can’t join the fun this year. No neighbors either.
2. Eat outside. Not so easy in New England, but as my hardy friend said, there’s no such thing as bad weather, just bad dressers. Plus the long-term forecast predicts warmth! Optimism!
3. Stay distanced if indoors. No, there’s nothing magic about 6 feet apart. But 6 feet is safer than 3 feet, and 9 feet is better than 6. You get the idea.
4. Wear masks while indoors and not eating. You do it now in public. You do it if someone comes to the house for a delivery or an appliance repair. Do it at home too if you have a visitor, even if it’s a family member.
5. Ventilation, ventilation, ventilation. This is for those who can’t eat outside. Open the windows. All of them. Here’s some more detailed advice from an expert, which most of us ID doctors emphatically are not:
I’ve seen a lot of questions about the importance of ventilation and the spread of SARS-CoV2. I have expertise in the science of indoor air quality & want to share some simple steps you can take to make your home & family safer during the pandemic. 1/
— Paula Olsiewski (@polsiewski) November 17, 2020
6. Keep the eating and drinking together time short. Risk of COVID-19 is a complex summation of distance, time, and activities during exposure to a person who’s infectious. And there’s hardly anything riskier than eating and talking together indoors — especially if the conversation becomes raucous, with people shouting.
7. In the week before the gathering, strictly limit social activities. Restaurants around the country are still open. Many places of worship are too. Time to start getting take-out food (tip well!), or joining your congregation electronically.
8. Give elders and otherwise vulnerable people an easy way to opt out. Even better, encourage them to join by zoom, facetime, google meets, or whatever platform is easiest for them. Study after study after study shows that this isn’t the same disease in everyone. Look at this figure — is there another infection that so shockingly discriminates by age?
The effect of age on the #COVID19 infection fatality rate. Just published @nature, data from 45 countries, 22 seroprevalence studies https://t.co/TWSogoHMMh
by @meganodris @hsalje @SCauchemez @fdlwang @datcummings @andrewazman and colleagues pic.twitter.com/pXtvZky4xA— Eric Topol (@EricTopol) November 2, 2020
9. Remember, it’s likely going to be weird like this for just one year. Got to love those vaccine study results — roughly 95% efficacy for two different vaccines! In a year’s time, let’s make getting your COVID-19 vaccine the ticket to gathering safely.
10. Get tested. Even better, get tested more than once, especially in the days leading up to the event.
Some might be surprised to read the advice about testing, which has gotten a bad name because it’s not fail-proof.
Am concerned that headlines like this (which are widespread) will discourage people from testing before seeing family. No, the tests aren't perfect, but they are *far* better than nothing. Get tested! Even if symptom-free! https://t.co/uBJ2O6rxeN
— Paul Sax (@PaulSaxMD) November 16, 2020
But this is not an all or nothing thing. Some testing is better than no testing. Remember, a negative test if done on a person without symptoms — even using less-sensitive antigen tests — lowers the likelihood that this person has contagious COVID-19.
It doesn’t replace the other strategies. But it does augment them.
Thank you for your time.
9 Responses to “Just Another Urgent Plea from Your Friendly ID Doctor for Risk Mitigation as the Holiday Season Approaches”
Paul E. Sax, MD
Contributing Editor
NEJM Journal Watch
Infectious Diseases
Biography | Disclosures | Summaries
Learn more about HIV and ID Observations.
NEJM Journal Watch — Recent Infectious Disease Articles- Do Children Need a Booster of Typhoid Conjugate Vaccine?
- Infection with Tecovirimat-Resistant Mpox Virus Is on the Rise in the U.S.
- Kidney Transplantation: Offering HOPE for Those with HIV
- Observations from ID and Beyond: Brave New Name — How PCP Became PJP and Why It Matters
- HIV Preexposure Prophylaxis in the U.S. — Recent Trends
Great advice, though the original Pilgrims brought infectious diseases to people without pre-existing immunity, so at least it can be thought of as a Thanksgiving tradition!
Great advice, except I have been trying to get tested before the thanksgiving day and am unable to. Let alone more than once!
Dr. Sax, Answers to your pictorial quiz.
The great vaccine President Gerald Ford of swine flu ’77 infamy and his Vice President but cannot remember that turkey’s name. Some things but not all have improved since then.
Tim Lane
The trivia answer is President Gerald Ford. I don’t know the turkeys name.
Thank you. I just called my sister and brother and cancelled my Thanksgiving plans. I want to be part of the solution rather then the problem.
My family and I are in the middle of a full two-week quarantine (no stores, no socially distanced visits with friends, etc) so that we can join one other household for three days. I suspect that being in the same house for three days means that other mitigation strategies (masks, ventilation, etc) may be pretty nigh worthless. Enough time in the shared “soup” means everything is cooked, no? But it’s just so frustrating that one article after another addresses the other strategies and never says anything about whether, in fact, a two-week full quarantine is enough.
I fully agree Covid 19 is something we should take heed to and act in caution of. However, how I earnestly ask you to consider how this one particular meal is different to the meals people have been having with those surely not from their households and consistent daily contacts in restaurants, bars and cafes across the country for the past few months. These gatherings are surely related to the spiking number of cases seen now. While I agree that risk is certainly present at the thanksgiving table, sitting amongst others that are not necessarily within one’s close circle on a day to day basis, this contradicts the behaviors of most of the country’s citizens who have been going to eat at public venues throughout this entire pandemic when regulations permitted. Again, I follow what this article says in terms of logical behavior advised, however, why should we expect anyone to follow this advice when people have been having their versions of thanksgiving dinner/drinks on a daily basis for months now. By associating the equivalent of a death threat to this particular meal is a game on people’s emotions. Where has the “plea” been throughout this entire chaotic year? In my current zip code, the majority of cases are linked back to 20-29 year olds, whom are seen frequenting social establishments. Ignorance and/or arrogance in regards to infectious disease and the patterns of transmission seems to be analogous to the use of birth control and the consequences; simply in that people frankly don’t care, have poor understanding (likely) or walk around with attitudes of invincibility. Again, I do not disagree with mitigating risk, in fact, I strongly advocate and have respected it for almost 10 months now. I just do not follow how playing on the emotional plea of not eating dinner with one’s family is a strong plea, especially since it rather literally fits the definition of insanity that this pandemic has so aptly displayed in terms of actions and mitigation of this virus. If/when people do not meet for thanksgiving dinner next week, I’m sure they’ll be voicing their woes about it with friends, coworkers and strangers the following Friday night at the local indoor drinking establishment.
And while bullet point 9 relays the idealized notion that this virus and year are an anomaly in time, being expected to resolve once the year changes from 2020 to 2021, I’d of course have to play devil’s advocate again and ask the following….in January 2020, when various countries in the world were starting to feel the shortness of breath that COVID was causing which soon turned to suffocation of entire continents, the US was a little late to the prevention/mitigation game. Not many expected nor anticipated the year to turn out in such a way. And even if experts were anticipating such chaos to ensue, the people of the country didn’t put too much focus on altering their actions if they could help it. This begs the question, how will next year be different unless people act now. While I’d like to be optimistic, how can true change occur when again we are wallowing in the definition of insanity.
You are right. And whatever the lesson is that *will* be learned … we will know what it is retrospectively. But some lesson (I do not know what) *will* be learned. On the basis of my limited span of years on this planet and some awareness of what has transpired in different places and different times I can offer this: we will learn (again) that “leadership” is not some pretty and vacuous topic to be skimmed over in a forgettable high-school civics lesson. Leadership is profoundly influential, whether for the good or for the bad. The Germans, for example, did not “throw in the towel” until after the Russian army had destroyed every last brick in the city of Berlin. And the English — after an initial period of phlegmatic disagreement and wishful thinking — rallied behind Churchill, for a fight “in the cities; in the streets” etc. etc. if need be.
Great advice for any antisocial nerd with no concept of what it means to be close to family. I’m sure this guy has fifty Christmas dinners left in his life but if I am elderly and dying I’m not going to miss my only chance to see my great grandbaby and maybe see my loved ones for the last time. Thanks to the shutdown my cancer and cardiac patients are dying en masse since the clinics are unable to work them in or do the things needed for them to live.
My family chose liberty since summer and not even a single case of CoVID while you panicky chicken littles have wasted the last nine months of your life in front of your computer wearing no pants.
You think being alone with zero human interaction is life but us normal people don’t. Virtual Christmas dinner is like cyber sex, it may prevent an STD or two but it’s not what most of the silent majority want.
You stay home and pretend you are in( your own ) prison and preach while the rest of us work and enjoy our lives.
Ask any psychiatrist, home alone with your computer 24/7 is not healthy even if you talk to people on your zoom.
I call my way normal human inclination and your way weird and disturbed. If it’s so great why not live like that after the pandemic? Maybe if death rate was over 0.5% for healthy people…