With new cases of coronavirus in the U.S. climbing at exponential rates and hospitals across the country hitting capacity, most public health experts (including those at the Centers of Disease Control and Prevention) have implored Americans to refrain from large family gatherings this holiday season. Yet in a survey of over 2,000 people released by The Ohio State University Wexner Medical Center in October, two in five people say they will likely attend a holiday gathering with 10 people or more. The survey also found that one in three people will not ask guests to wear masks. (Sigh.)
The (very understandable) longing to spend the holidays with loved ones safely has led to a game of endless what-ifs. What if I quarantine for two weeks before and after? What if I get a COVID-19 test first? What if I drive instead of fly? Are any of these precautions enough during this third wave, which is worse than what we faced in the spring or summer? Seeking clarity, I called up Iahn Gonsenhauser, MD, chief quality and patient safety officer at The Ohio State University Wexner Medical Center, and asked him the most pressing questions about seeing friends and family this holiday season.
How safe is it to see friends and family if you get a COVID-19 test first?
Dr. Gonsenhauser says if you plan to spend time with people who don't live in your household, there's always a risk of getting COVID-19, regardless of any precautions that are taken. "There is no way to reduce the risk completely, no matter how cautious you're being," Dr. Gonsenhauser says.
That said, there are some things you and your family can do to better minimize that risk. "If you are going to deploy a testing strategy before seeing loved ones, it takes more than one test and also requires some behavior modifications," Dr. Gonsenhauser says. (Basically, don't just rely on tests.) He says the accuracy of the various COVID-19 tests varies wildly—a rapid antigen test, for example, will give you results faster than a PCR test but has a very high false-negative rate.
Additionally, taking a test too soon after exposure might not accurately detect COVID-19, regardless of the test type. Dr. Gonsenhauser says that there is a lapse of a few days between when someone is exposed to COVID-19 and when they test positive. For example, if you spend the day traveling and then get tested the next morning, you could potentially have COVID-19, but the test can't detect it yet. "It takes time for the virus to replicate itself in the body to levels the test can pick up," Dr. Gonsenhauser says.
Thus, Dr. Gonsenhauser says the best time to get tested for COVID-19 before seeing loved ones would be two to three days before the event. "Then, you'll need to quarantine so you don't run the risk of being exposed to COVID-19 after you get tested," he says. (Real quarantine—no walks, no trips to the grocery store or drugstore, nothing.) He recommends getting a second COVID-19 test the day you leave, to account for the unreliability of the first test and the chance that you may have contracted the virus too close to being tested. "Then, you would have to remain very, very cautious while traveling and if you are exposed in any way, then you will need to quarantine once you reach your destination and then get tested again two days after arriving," Dr. Gonsenhauser says.
This protocol would have to be followed to the letter by every single person who will be attending the gathering—any slip-ups could put the entire group and others at risk. Dr. Gosnsenhauser says the strategy may only make sense if someone plans on staying at their destination for a prolonged amount of time—like if you are a college student coming home for winter break, for example.
When will the pandemic end? We asked an epidemiologist for answers:
A patient safety doctor's hierarchy of holiday celebrations
Even if everyone in your group has followed quarantine and testing protocol perfectly, Dr. Gosnsenhauser says there are still some forms of celebration that are riskier than others. "Nothing can take the risk [of COVID-19] away," he says of in-person celebrations. He says the safest option is for people to stay in their respective homes and celebrate virtually—which may be discouraging to hear, but this certainly isn't a time for sugarcoating.
He says the next safest way to celebrate would be the "drive-by" method that was popular in the spring. "This is when people go to their loved ones' houses, but stay in their car or keep a six-feet distance from each other and visit while wearing masks. This gives a way to visit, but then you're going home and having your meals and indoor celebrations separately."
The third option, he says, is having an outdoor celebration. "There's a pretty big jump in risk from the drive-bys to this one," he says. "But this would involve having a celebration somewhere with open-air and each household is seated at their own table with no co-mingling or passing the dishes between the tables, which should be six feet apart from each other." The riskiest way to see loved ones during COVID-19, Dr. Gosnsenhauser says, is visiting inside as a group with no masks. (Something he absolutely does not recommend.)
Dr. Gosnsenhauser knows that all of this is pretty discouraging. "With COVID-19 numbers increasing across the country, it's a really scary situation right now," Dr. Gosnsenhauser says. That said, it's worth remembering that the pandemic won't last forever. This year's holiday celebrations are an anomaly. And the more precautions everyone takes, the sooner we can get back to celebrating "as normal,"—nosy questions from your relatives and all.
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