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Friday, March 1, 2024

What Should You Do About Holiday Gatherings and Covid-19?

The strangest, most confusing, most taxing year we Americans have collectively trundled through is about to get even more complicated: We now all have to figure out what to do about the upcoming holidays. Should we gather indoors as usual, where we’ll most readily spread the virus? Gather outdoors in the cold, where we’re safer? Tell our families we won’t be seeing them this year except at a distance on FaceTime or Zoom?

“There is no easy answer,” says Aderonke Pederson, a psychiatrist and behavioral scientist at Northwestern University’s Feinberg School of Medicine. “It’s a difficult situation to be in.”

It’s especially difficult considering that the US is now seeing a third massive spike in cases, that traveling brings its own risks of transmission, and that Covid-19 is a far deadlier disease among the elderly, who are a part of many family gatherings. The safest thing you can do is to just stay home. But because that may be a difficult choice for many families, WIRED asked the experts how to talk with your relatives about the risks of in-person gatherings.

First things first: Talk to your family about the holidays ASAP. “Start the conversations now, because we're a month away,” says Pederson. Find a way to speak comfortably about your concerns, she says, “because at the end of the day, while we're trying to protect ourselves, we're also trying to encourage our family members to protect themselves, too.”

To be very clear: There is no such thing as a perfectly safe way for families to gather, over the holidays or otherwise. SARS-CoV-2 is a highly infectious virus, so no in-person interaction is risk-free. But there are gradients to this risk: Outdoors is better than indoors, masks worn at all times are better than bare faces, distance is better than hugs. And the fewer people, the better: California health officials suggest restricting holiday gatherings to three households for no more than a few hours, while Colorado has a two-household limit.

“The headline is that the things that you do to keep yourself safe in public from strangers apply to the family with whom you're gathering,” says Benjamin Singer, a critical care physician and pulmonologist at Northwestern Medicine. “Because for the purposes of transmission, your extended family that you're visiting are strangers. They're still people who aren't in your household.” That means the 6-foot social distancing rule you’ve been using at the grocery store also applies at your relatives’ house. Yes, that would be awkward, but necessary.

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But what about testing in advance? It’s true that families can take some steps to mitigate risks in a way that you can’t with total strangers in public spaces. For example, you can all agree to get tested before gathering and only convene if everyone tests negative.

Yet that doesn’t eradicate the risk or mean that it’s safe to gather indoors, where the risk of transmission is normally highest. That’s because people can become infected between the day that they test and the day that their results arrive. Additionally, people in the early stages of a Covid-19 infection can test negative at first but still be infectious later, whether or not they ever show symptoms.

For example, say that you’re unwittingly exposed to the coronavirus on the Monday before Thanksgiving, and you get a test Tuesday that comes back negative. You arrive at your family’s house Wednesday and celebrate on Thursday. To your horror, on Friday you start showing symptoms of Covid-19. “It's probably somewhere around five to seven days after you're exposed where your test is going to be positive, and then you start having symptoms,” says Singer. So even a person with a negative test on Tuesday, he says, is “actually probably able to spread the virus at the table during Thanksgiving.”

These kinds of lags between negative tests and symptom development have been blamed for outbreaks like the one at a Georgia summer camp, as well as the super-spreading event that infected numerous members of the White House, despite staff there having access to frequent rapid testing.

OK, so rigorous testing can’t guarantee a safe holiday gathering. And things will only get riskier if you have to move the party indoors. Over the summer, many people found ways to socialize at a distance outdoors, taking advantage of spacious and breezy spaces like parks, beaches, and backyards. But temperatures in much of the country have already grown frigid. By December, even denizens of warmer climes will be tempted to gather inside, where they are at greater risk of infection by aerosols, tiny respiratory particles that allow the virus to hang in the air. (These virus-carrying aerosols can dissipate better outdoors, where ventilation is far superior.)

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Plus, there’s another factor that makes holiday gatherings dangerous: Eating is a messy business. It requires taking off your mask. Through coughing, sneezing, throat clearing, or even talking, an infected person can expel the pathogen into the air to be breathed by others at the table. These larger droplets—bits of spittle, essentially—tend to travel about 6 feet, carrying the virus with them. Hence the 6-foot rule of social distancing. But it’s not an exact figure. “I think 6 feet is still a reasonable thing, with the caveat that it's not a guarantee,” says Singer. “It's not like if I'm 6 feet, 1 inch away from an infected person, I am safe.” After all, he points out, aerosols are also lingering in indoor spaces. Singer says there’s just no guaranteed way to avoid all of these respiratory particles at an indoor holiday celebration. For that reason, he says, “the blanket recommendation is: Avoid gathering indoors.”

You might be wondering if you could get sick from touching the same tabletops, door knobs, or cutlery an infected person has used. In the early days of the pandemic, many of us obsessively disinfected our groceries out of an abundance of caution about fomite spread, the technical term for passing the germ via shared objects or surfaces. At the time, scientists didn’t know whether such a novel coronavirus would spread mainly through the air or by surfaces, or what would happen if, say, someone coughed on a bag of chips, you touched the bag of chips, then touched your face or rubbed your eyes, transferring the virus. “While that sounds plausible, we just don't have evidence that that really happens,” says Singer.

Surface spread can’t be entirely ruled out, but guidelines from the Centers for Disease Control and Prevention now say that it is “not thought to be a common way that COVID-19 spreads.” The scientists who have spoken to WIRED agree. Since the spring, most research has shown that while the virus can remain infectious for several days on glass and plastic in controlled lab conditions—which are dark and cold—it has a harder time surviving on fabric and skin (especially if you wash your hands), when exposed to sunlight, and also potentially in the saliva that would help it stick to surfaces.

Faced with the prospect of a holiday meal with so many restrictions and unknowns, some members of your family may decide that gathering is just not worth it. That’s an emotional minefield, especially if other family members do not agree, but it’s not impossible to navigate. “I think the first biggest thing is try not to judge one another,” says Barbara Young, a licensed marriage and family therapist, “and then at the same time doing what you need to do. What I hope is that families will have an open discussion, and everyone can put on the table what they feel comfortable with.”

This isn’t a perfectly neat binary, to be sure, but some members of the family may be more lax about Covid-19, while others are more freaked out. Young says they should try to find common ground around the holidays. “I think people really need to sit with themselves and be like: What am I actually comfortable with?” says Young. “And: What will I not be haunted by after the fact?” For instance, how might you feel if you reluctantly agree to a celebration where you know the precautions will be lax and then later bring the virus home with you?

Ideally, your family members can all agree on guidelines ahead of time, so you’re not left hashing it out in the moment while losing patience with one another. “I feel like the name of the game in 2020 is try not to judge others, and try to keep yourself safe at the same time,” Young adds.

“I do think we should start with: What are our core values?” says Pederson, the psychiatrist and behavioral scientist at Northwestern. “As a family, what is the number one thing that's important to us? And that is that we're able to protect each other, and we're able to care for each other. That we can all agree on, regardless of where you stand on how much you should wear masks and how much social distancing one should engage in or what is the ideal number of people.”

Still, that’s a whole lot of room for disagreement. Let’s say you’ve taken the stance that the gathering should be outdoors and everyone should keep their distance and wear masks. Those are not just your opinions—they’re the guidance from experts the world over, who’ve spent the most of the year decoding the novel coronavirus and how it spreads. “I think that can be a strategy of making the conversation less about your own specific view,” says Pederson, “and kind of sharing: 'I think that's what we should do, because this is what's recommended from other bodies.'”

Sometimes an agreement on what will make for a relatively safe holiday gathering just won’t be possible, and that’s fine, she says. You do you. “If you're in a situation where you have done all of these things,” says Pederson, “you've reassured your family that you care about them, you have shared your concerns, you have brought up the safety guidelines—and you have family members who are still refusing to follow the health care guidelines that are put forth by health care institutions—then I think that's the point where it's OK to sit out this year's Thanksgiving. And to sit out this year's Christmas, if need be. Because I think it's really important for us not to feel pressured at this time into putting ourselves at risk.”

That pressure will be all the more difficult to bear given the overwhelming weight of the pandemic. By November, Americans will have spent nine months in lockdown. Many will have been physically separated from their family for all of that time. Some have lockdown fatigue, and they’re far from alone: The recent spike in cases in Europe indicates that people have been gathering again, perhaps fed up with the seemingly endless isolation. But now is perhaps the most dangerous time to socialize, as we’ve entered flu season. Hospitals in some regions are already overwhelmed with Covid-19 patients and may be pushed to their breaking points if a wave of flu sufferers arrives.

The real gut punch is that the holidays are supposed to be our pillars of normalcy. Nearly a year into the constant chaos of a pandemic, we all want to find comfort in rituals and long-time favorites. But, says Pederson, “This is not going to be one of those automatic holidays, where you're just setting dinner times and going to your favorite grocery store to get your turkey package.” The coronavirus disruption cares not about our traditions. “The holidays bring it up in a new, raw way. Because what do you want to do when you're going through a hard time for several months at a time?” Pederson continues. “You want to gather with family, you want to do those things that you're used to doing, those traditions that kind of help us reset.”

But maybe this is actually a chance to flip that, to reset those traditions. “Another way is to just look at it really creatively: If we had the opportunity here this year to do new traditions to creatively think out of the box, what would we do?” says Young. “You know, look at that as a time to just explore something completely new and different.”

Find a game to play over Zoom or FaceTime, or synchronize a Netflix movie between households. Maybe you’ll all agree that now’s the perfect opportunity to stop making turkey, objectively the very worst of the bird meats, and make something that you like better or that defies the family recipe book. Or have everyone make the same really complicated dish and see whose looks the least like garbage. Not a bad way to close out a year of total chaos, if you ask me.

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