Make sure COVID doesn’t come home for holidays

Weddings, funerals and church choirs have turned into COVID-19 transmission clusters because they often involve closed spaces, close contact and crowding. Similar conditions can exist at holiday events, including Thanksgiving. (Andrew Rush / Pittsburgh Post-Gazette / TNS)

Infectious disease expert advises celebrating outdoors when possible and opening windows inside

If your Thanksgiving plans include a returning college student, a Harvard infectious disease expert suggests an addition to your holiday table — warm sweaters.

That’s because William Hanage advises families, especially those in milder climates, to consider eating and holding festivities outdoors to reduce the risk of COVID-19. If that’s not possible, Hanage urges them to throw open a window to improve ventilation.

During a virtual discussion about the upcoming holidays and COVID-19 held by the Forum at Harvard T.H. Chan School of Public Health, a listener asked Hanage whether families should consider Plexiglas dividers at the Thanksgiving table. He recommended focusing on ventilating the room by opening a window 6 inches and employing fans to increase total airflow. (See here how the U.S. Environmental Protection Agency advises deploying fans.)

“It may be somewhat cold in the room, but this is an opportunity to get out those fall sweaters we all like to wear,” said Hanage, a Harvard associate professor of epidemiology and a faculty member in the Center for Communicable Disease Dynamics.

He also suggested people get tested for COVID-19 if they plan indoor activities with family members but said a negative test doesn’t eliminate the need to wear a mask. It would also help to quarantine for 14 days before a family gathering. “We have to remember it is just not one thing,” he said. “Even though you have a lot of negative tests doesn’t mean the next test isn’t going to be positive."

Hanage cited the benefits of outdoor events, pointing to a multifamily gathering over a few days where everyone became infected with COVID except one family. That family spent 10 hours one day and three the next with the others, but all outdoors.

The number of new COVID-19 cases is increasing nationally by 50,000 a day, with 20 states, largely in the West and Midwest, reporting record cases in the last few days. Health experts worry this could be a preview of a fall and winter surge as cold weather forces people indoors, where transmission is higher.

Explore‘Bite the bullet’ and stay home this Thanksgiving, Fauci says

Hanage explained why inside gatherings can turn into transmission clusters, citing the three C’s — closed spaces, close contact and crowding. “It’s fairly easy to see how those three can easily come all together when it comes to the holidays,” said Hanage. “Poorly ventilated indoor spaces are a risk for transmission. A further risk for transmission is eating. Putting this together, I’m afraid you can see the coming holidays have the potential to be a real problem.”

Hanage said it is critical for people to recognize how the virus spreads. “You hear that it is either incredibly dangerous to everybody or it’s not dangerous to anybody. Neither is true,” said Hanage.

While it’s clear that young people under the age of 20 are much less likely to suffer severe disease, the risks are not zero, said Hanage. “And we are just beginning to learn about the long-term consequences of this.”

More importantly, when you host multigenerational holiday events, older family members can pay a high price if infected by a grandson or niece.

On Wednesday, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told CBS News his three adult children won’t be coming home for Thanksgiving because they live in different states and are worried about flying. “They themselves, because of their concern for me and my age, have decided they’re not going to come home for Thanksgiving, even though all three of them want very much to come home for Thanksgiving,” said Fauci.

“People are more at risk by simply being older," said Hanage. "You can see this, indeed, if you look at the risk of death starting to increase for people in their mid-40s. If you are in your 50s and you contract COVID, your probability of dying is roughly speaking about 200 times the risk per year that you would die in a road traffic accident,” he said.

“One of the things that we know for a fact at the moment is that we often see the initial stages of these epidemic curves being driven by mild infections in adolescents and 20-somethings,” Hanage said. Such cases are often unnoticed because the young are less likely to experience symptoms or seek testing. “But these individuals have the capacity to transmit to older, more at-risk individuals. That can happen despite people’s efforts,” said Hanage.

Consider invasive pneumococcal disease, which is caused by a bacteria called pneumococcus and can be deadly, especially for the elderly. Year after year, there is a spike in the disease among older people after the holidays, said Hanage.

"That’s because of the fact that older people get together with younger people over the holidays, and the younger people, who tend to be the core group for transmitting this bacteria, transmit it to their grandparents,” he said. “If you look at that in the context of a pandemic virus, that is a real matter for concern.”

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