One tool you can use to limit viral spread involves simply asking friends and family if they’ve been sick lately. If the answer is yes, you can walk them through the risks for people who are planning to be present, and see if it’s better to see each other another time. And if the answer is no, that’s one less anxiety for everybody. But even though this sounds easy enough to do, it’s not the norm — which is why it sometimes feels too awkward to even consider.
We spoke to two experts on the importance of pushing through the awkwardness to have these conversations, as well as some tips for making it easier.
Why does it matter if a friend or family member has been sick lately?
The fact that most people don’t automatically consider how their sickness could impact others is unfortunate, to say the least, says Linda Yancey, MD, an infectious disease specialist at Memorial Hermann hospital in Texas. While Dr. Yancey is optimistic that the pandemic is winding down, she says that doesn’t mean it’s time to move on from concerns about spreading illness, in general. (And you definitely shouldn't throw caution to the wind when it comes to hanging out while sick.) COVID-19 is still out there, as well as other viruses, like flu and RSV, that can pose a significant threat to infants and people who are immunocompromised.
Mild cold symptoms can be serious for certain people and young children
The CDC recommends staying home from work, school, and public areas whenever you’re sick as a way to control the spread of viral illnesses. Problems arise when someone is really in the mood to hang out but has a bit of a sniffle—they might not see themselves as being actually sick enough to stay home. It might seem like no big deal to people without risk factors, and it may not be. But for people with little kids or suppressed immune systems, one person’s mild cold can turn into a medical emergency.
Most adults who have RSV will experience the symptoms of a mild respiratory virus, for example. But infants who are less than six months old, and children under 2 who have a congenital heart or lung condition, are at a high risk of ending up in need of hospital care if they contract it. As Dr. Yancey explains, children in these demographics can end up struggling to breathe if the infection becomes severe. Two in 100 babies under six months who get RSV may need to be hospitalized, and this year’s RSV season has been worse than any in recent memory.
Similarly, influenza is known to impact one in five adults every year during a normal flu season. Most people get better within a week or so, but 200,000 people end up hospitalized from flu or flu complications annually. Just this past week, over 8,000 Americans needed to be hospitalized with the flu. People over the age of 65 and children younger than 5 are at the highest risk for severe complications, like pneumonia.
Culturally, we are accustomed to powering through illnesses
Americans are particularly predisposed to lacking understanding when it comes to limiting disease spread, says Dr. Yancy. This is due, in part, to a lack of guaranteed sick leave or paid time off, she says, because people are, in essence, incentivized to go to work sick.
So, if you’re not calling out of work when you’re sick, why would you bail on the things that you actually enjoy doing? There’s also a social stigma that surrounds canceling plans with others, and that can be hard to deal with. “Fundamentally, people don’t want to let down the people around them,” says Dr. Yancey.
All of this underscores why it’s important to normalize conversations about symptoms and individual risk factors when making plans with other people. Nobody wants to let their friends and family down, so why not take the time to let them know that it’s not a disappointment to admit that they’ve been sick lately? In fact, it’s often more disappointing for them to soldier through a social engagement without regard for getting others sick.
But how do you broach this subject in the most respectful, productive way?
How to talk with loved ones about hanging out while sick
Maybe you’ve gone over what you’re going to say a million times in your head, but when the time comes, it’s hard to get the words out. One way to reframe the conversation in your mind is to understand the value of providing context as opposed to convincing people when you’re communicating a boundary, says Terri Cole, LCSW, a family therapist who specializes in helping people have boundary-setting conversations.
Here are a few tips to try when having these difficult conversations.
Have some background information ready
Explaining why you feel the way you do is an important step. For example, It’s perfectly okay to point out that six-month-olds face a particular threat of serious illness from RSV, and that you’re concerned about bringing yours to your family’s holiday party if someone’s recently been sick, says Cole. You don’t have to write a thesis on it, she says, but you can provide this background information as you prepare to pose your question.
Don’t make the conversation a formal, sit-down event
You might have a person in your life who is, let’s say, a serial viral vector offender. You know, the person who keeps casually wiping their nose with their sleeve right before they lean over to greet you with a hug. It’s tempting to announce that you “need to have a talk” with this person and schedule a sit-down. But Cole says that setting the scene for a serious conversation about symptoms and sickness might not have the outcome that you’re hoping for. “A production rarely results in anything positive, because it puts people right on their guard,” she explains.
Instead, Cole says, consider making a casual request via a simple script. Something like:
- I’d like to make a simple request: Can we agree to let each other know this season if we or any of our kids are feeling sick, because I’m being really mindful of my wellness and their wellness.
- She also recommends adding something that invites all parties to share equal responsibility, such as You can count on me to let you know if anyone has a fever or congestion and to opt-out of attendance if we aren’t feeling well.
Make sure to communicate well before a gathering
When you communicate your health preferences and deal-breakers ahead of time, you're giving others the opportunity to care for you well and address your concerns. Without that communication, you’re not giving people that chance. Cole says, “For some people, having a sick person at a gathering they attend is a dealbreaker for them. And the other people at the gathering have the right to know this.”
Try to get on the same page about what hanging out while “sick” means
It’s also helpful to establish some objective metrics when you’re talking about these things. You may not all start out on the same page about what constitutes hanging out while “sick” — but you can get there. Dr. Yancey suggests that a fever of 101 or higher is a “nice dividing line” when it comes to making sense of symptoms. “If you have a fever of 101, that’s not a good time to gather with others. You’re genuinely sick. You can argue about definitions of congestion or what is really a cough, but a fever is what it is.”
Dr. Yancey also cautions against making the assumption that you or others have already had whatever’s been “going around” before you head into a holiday gathering. “Unfortunately, COVID, influenza, and RSV all present very similarly. They are all predominantly upper respiratory viruses. Fever, congestion, cough, and sore throat can be present with any of the three,” she says.
Know that you still might get sick this season
You can’t always control how other people define “being sick,” and even with your best efforts, you still may come down with something at some point. Some level of infection can feel basically inevitable during a cold and flu season that just happens to coincide with the busiest months for hanging out with friends and family indoors. Still, asking people if they have been sick recently is one tool at your disposal if you’re trying to protect yourself or more vulnerable people who live with you.
Beyond getting vaccinated and having these proactive conversations, it’s important to be consistent in your own behavior around hanging out while sick. Remember that if you’re asking others to be upfront about recent symptoms, you’re going to need to do the same.
“The bottom line is if you are sick, if you're symptomatic, if you have a cough, cold, congestion, certainly fevers, you really do need to stay home to protect yourself and the folks around you,” Dr. Yancey says.
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