Let’s Talk Turkey
MEDICAL AND MENTAL HEALTH UPDATE
With Thanksgiving on the horizon, college kids migrating home, and our desire to gather with family at odds with the surging COVID numbers, we need to plan ahead.
How can we stay safe AND sane at the holidays? Must we choose between our physical and mental health for the sake of turkey and stuffing?
Let’s take a real-life question that a patient asked me last week:
“Dr. McBride, I was wondering what you would advise our daughter and us to do after she flies home from college in California. We are unsure how long she should quarantine for, and then when she should get tested, and if she should get tested on multiple days? She hasn't shown symptoms and gets tested twice a week at school, but she'll be in the airport and on a commercial flight cross-country so obviously that will be a risk.”
My reply? It’s not about telling my patient what to do; it’s about explaining relative risk to help the family make an informed decision.
Recall that even PRE-pandemic, we made decisions every day. Take a rainy Monday morning, for example. You’d ask yourself “Should I drive my car into work to avoid getting wet while walking to the subway—but risk getting road rage in traffic? Or should I take public transit to save time and money and reduce my carbon footprint—but risk ruining my new pumps?” Whether or not you knew it, your brain was honing your RISK/BENEFIT ANALYSIS skills, and it’s time now to unleash them.
Indeed, a similar decision-making rubric applies to the COVID era:
Understand the facts.
Assess the risks inherent in your question, the available tools to mitigate them, and the reality of employing those tools.
Assess the benefits inherent in your question and their relative importance to you.
Make a decision.
Live with it. (Enjoy the benefits, own the consequences, and don’t blame the weatherman when it rains.)
Step one: Remember the FACTS about COVID-19.
We know that the risk for transmitting coronavirus can’t be fully eliminated when interacting with other people. We know that approximately half of people infected with coronavirus are asymptomatic or pre-symptomatic.
We know that many college campuses have been hotbeds for COVID-19—but that some schools are beautifully tacking down risk by mandating masks, enforcing strict social distancing, offering remote classes, and providing surveillance testing.
We know that airline travel poses risk—but not as much as we previously thought. The latest data suggest that the risk for catching coronavirus on a plane is low if we wear a mask. Indeed the ventilation systems on planes seem to pretty well prevent transmission via aerosols. HOWEVER, the data do not account for an unmasked, coffee-slurping, droplet-emitting Chatty Cathy passenger seated beside you.
We know that coronavirus tests cannot detect an infection until at least 4-5 days after exposure, that they aren’t 100% accurate, and they don’t predict the future.
Recall that the COVID PCR tests can help answer the question: “Do I have any bits of coronavirus in my nose right now?” The COVID antigen tests can help answer the question: “Do I have infectious levels of virus in my nose right now?”
We know that it can take up to 14 days for infection to occur after an exposure (hence the recommended 14-day quarantine after a known exposure).
We know that the current surge in COVID cases around the country is largely due to (relatively small!) family gatherings and household transmission. We know that the LEAST SAFE place to be right now is a poorly-ventilated indoor space, closer than six feet from other people, and unmasked. (Think: households and indoor gatherings.)
We also know that we tend to underestimate the risk of getting COVID from people we know and love. Just because aunt Emily knit you a scarf and always remembers your birthday doesn’t mean she can’t transmit COVID and unwittingly infect you—and vice versa!
Step two: Think about MITIGATING RISK and the REALITIES of doing so.
Let’s go back to my patient’s case. Unless her daughter has been living in complete isolation at college, her chance of carrying coronavirus without symptoms even before she leaves her dorm room is not zero.
So for optimal safety, she could stay put in California and celebrate Thanksgiving via Zoom.
Alternatively, she could strictly quarantine for 14 days in advance of travel in order to minimize the risk of bringing coronavirus with her on the plane. She could take a COVID test a day or so before departure “just to see,” understanding the limitations of the tests (above).
She could drive herself to the airport to limit infection risk to and from an Uber driver or bus passenger. If she does take public transportation, she should, of course, wear a mask, distance from other passengers, and carry hand sanitizer.
She could call the airline to ensure that middle seats are not filled—in order to distance from other passengers. In addition to wearing a mask at all times, she could also wear a face shield on the plane to help prevent inhaling Chatty Cathy’s respiratory droplets.
Upon arrival home, she could isolate from her family for the five-day incubation period (the time from exposure to infection), take a COVID PCR test on day five, and, if negative, somewhat liberalize her interactions with family with the understanding that a) she still could have been infected on the plane (or elsewhere) and b) that it can take up to 14 days to become infected—with or without symptoms. She could offset the risk of infecting others by wearing a mask indoors, distancing six feet from others, and spending time outdoors whenever possible.
She could air-hug aunt Emily and distance herself at least six feet from others when eating. If indoors, she could sit by an open window, distance even further than six feet while eating, and keep her mask on at all other times.
She could take another PCR test at day 14 and, if negative, feel pretty good that she hadn’t gotten COVID from the plane—but of course could have become infected from aunt Emily or anyone at Thanksgiving who was unmasked, up close, and indoors with her for a total of 15 minutes over 24 hours.
PHEW!!!!! That sounds exhausting, right?
But perhaps more importantly, is it realistic to think a college student will adhere to these rules? Is it realistic for ANYONE—college-age or otherwise—to fully distance from family once LOVE is in the air, the weather forces people indoors, and the hot toddies are flowing?
This is when we need a reality check, a contingency plan, and the fortitude to have tough conversations with family. Even the best laid plans can easily fall apart in the moment!
Step three: Assess the BENEFITS of holiday togetherness.
This calculation is going to be different for all of us. For some of us, Thanksgiving is the highlight of the year and a rare chance to see loved ones. Family gatherings can be the antidote for loneliness and isolation. But some of us may be too worried about our underlying health conditions that the fear of getting COVID may prevent us from fully enjoying the holiday. And for others of us, the risk of witnessing grossly divergent COVID practices among family members is enough to make take-out and TV alone seem the sanest option this year.
The social and emotional benefits of the holidays are unique for all of us. Things will be quite different this year. I recommend carefully considering the realities of the pandemic, your unique medical and mental health needs, your family situation, and the likelihood of a FOOD FIGHT breaking out before booking your trip.
Step four: MAKE YOUR DECISION on how best to manage your holiday.
Whether you decide on Thanksgiving via Zoom, a small outdoor feast by a fire pit, or an indoor masked gathering with testing in advance, it’s time to put a stake in the ground.
Step five: LIVE WITH your decision.
Do your best not to second-guess yourself. Know that every decision carries some physical and/or emotional risk. And whatever you do, remember that the MOSHPIT rules apply, wherever you go and whatever you do!
Got more questions about travel and the holidays? Bring them to me and Dr. Ackerly tonight at 8 pm on www.facebook.com/drlucymcbride for our 8th Facebook Live Q & A on this very subject!
And last, we need a GOOD LAUGH. Please mark your calendars for Wednesday, October 28 at 7 pm. I’ll be talking with award-winning Washington Post humorist and author Alexandra Petri about humor as medicine and food for the soul. Click HERE to register for the event. I’ll see you there!
I will check in later this week. Until then, be well.