In a few days, Carlos del Rio plans to fly from Atlanta to New York to celebrate Thanksgiving with relatives. He and his wife will stay for two weeks.
If that strikes you as reckless, think again. Del Rio — Doctor del Rio — is an infectious diseases specialist at the Emory University School of Medicine and a go-to source for wisdom on the pandemic. He knows what he’s doing. And he has weighed the risks and benefits.
This trip carries a powerful benefit: His daughter in New York is expecting her first baby shortly before Thanksgiving. Recognizing that nothing can be perfectly safe, del Rio’s family will endeavor to make things more safe. It will be a small gathering. Those traveling from out of state will get tested 72 hours before departure and again three to four days after arrival, as required by New York State.
Del Rio, of course, knows a negative test is no guarantee that a person isn’t infected, but he said, “Nothing in life is risk-free. Our role in life is to decrease risk, not to make life impossible.”
Similarly, Julia Marcus, an infectious disease epidemiologist at Harvard Medical School, cautioned against either-or absolutes. You do not face a stark choice between a dangerous 25-person party and a soul-crushing day alone at home. You have a multitude of middle paths to choose.
“If we tell people ‘do not gather for the holiday,’ then we’re missing the opportunity to give people risk mitigation strategies,” Marcus said. “None of this is about what’s safe or unsafe. There’s a spectrum of risk.”
Eleanor J. Murray, an epidemiologist at the Boston University School of Public Health, suggests contemplating your family’s usual Thanksgiving activities, selecting those that are most meaningful, and eliminating the traditions that have become chores. Maybe you never really liked those long turkey dinners — if so, COVID-19 can become your excuse to skip it. Once you’ve settled on the activities you treasure, assess the risks each poses, and plan a way to make it safer.
Think of the old Swiss cheese analogy. A single safety measure is like a slice of Swiss cheese. It has holes in it. Lay on a second slice and some of those holes will get covered up. A third slice will cover even more. The more slices you pile on, the closer you will get to a solid barrier.
Here are the slices of safety to consider:
The size of your gathering: The more people, the more likely one of your guests is infected and will spread the virus to others.
Keep your group small.
Think in terms of households, rather than individuals, Murray suggests. If you already live with 10 people, for example, then there’s no added risk in having those same 10 people gather for the holiday. But if your 10-person crowd involves five couples coming from far and wide, then the possibility that the virus will be introduced into your midst rises substantially.
Access to fresh air: Outdoors is always safer than indoors. If it’s warm enough where you’re gathering, spend the day outside, or as much of the day as you can. If that’s not doable, open as many windows and doors as you can. Open interior doors to allow air flow. Even opening a window in a room where no one is gathering will help.
Masks: No question, masks limit the virus’s ability to spread. They should be worn throughout the event, and are especially critical indoors.
But of course, you can’t wear a mask while eating. So get creative. Contemplate ways to limit the time people spend eating. Perhaps you don’t really need the traditional hours-long midday meal. Several small meals? Snacks on the deck and then everyone masks up and comes inside?
Distancing: To the extent your home layout permits, spread people out. Can you have several small tables? Or small gatherings in different rooms?
Quarantine: The Baylor College of Medicine has devised a method to "build your own holiday bubble” through a series of steps that everyone in your party would need to agree to. It includes a 14-day quarantine before gathering — that means going nowhere and seeing no one outside your immediate household. It can work, if everyone follows the strict rules.
Even if the Baylor program is not feasible, you can still lower your risk by having as little contact with others as you can manage in the days before the holiday.
Testing: It’s worth getting tested because if you get a positive result, you’ll know you need to stay home and isolate yourself. A negative test, however, doesn’t give you actionable information, Murray said.
If your test comes back negative, you may still be carrying the virus but at undetectable levels. Some people are infectious for as long as 14 days before a test will turn positive. And even if the test is accurate, you can become infected right after taking it.
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As you select your slices of safety, keep these factors in mind.
Your health and that of your family members: People with conditions that make severe COVID-19 infection more likely, such as heart disease, diabetes, obesity, and weakened immunity, should take the fewest risks.
Remember that your choices will affect everyone you come in contact with. If you decide that you’re willing to risk getting COVID-19 at a big bash because you’re young and healthy, keep in mind that you’re extending that risk to everyone you meet in the days afterward — a bus driver, a store clerk, your child’s teacher, your doctor, or your grandmother, and they could be much more vulnerable than you.
Location: Some places are more dangerous than others. “If the infection rate in your area starts to spike,” Murray said, “you’re going to want to change your plans.”
A website designed by Joshua Weitz at the Georgia Institute of Technology quantifies this risk. It calculates the chances that someone in a group will be infected in each county, based on the group’s size and the county’s infection levels.
For example, according to the website, in Suffolk County there is a 18 percent chance that an infected person will be in your midst if you have a gathering of 10 people. But if your group numbers 25, the chances the virus lurks among your guests rises to 39 percent. In contrast, in Dewey County, S.D., there’s a 91 percent risk that a COVID-positive person will present in a 10-person group.
The hazards of zero risk: To avoid all risk of catching the coronavirus, you can stay home and never go anywhere. That works. But it carries its own risks, especially if you live alone. Isolation, sadness — they can be as harmful as any virus.
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- The Baylor “build your own bubble” program: http://bit.ly/baylorbubble
- COVID-19 Event Risk Assessment Planning Tool, George Institute of Technology: http://bit.ly/groupsafety
- Advice from Boston University’s Epidemiology COVID-19 Response Corps: http://bit.ly/BUtips
- Tips from the Massachusetts Department of Public Health: http://bit.ly/DPHtips
- The US Centers for Disease Control and Prevention provides a hierarchy of risk: http://bit.ly/risky