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
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.