Dr. Robin’s Covid-19 Updates

Should I Hold Thanksgiving During Covid?

Five Data-Driven Ideas to Help You Decide

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Photo by Element5 Digital on Unsplash

Thanksgiving this year in our Age of Covid is not just a meal, it needs to be a science-based data-driven carefully-calculated risk proposition made in the context of rising cases and hospitalizations in most of the country.

Here’s a big thing we’ve learned in the 2020 Giant Science Fair of Covid: eating inside unmasked is one of the riskiest things we can do. Why?

Because meals are where you take off your mask and talk for prolonged periods.

You take off your mask to eat, to drink, to sip. You share a meal to talk, tell secrets, announce, argue, gossip, flirt, yell, convince, and chat and chat and chat.

And what do you do at Thanksgiving? All of the above.

And who do you do it with? People you love who gather from far and wide to cook in the kitchen and fight over the Xbox and eat for hours and tackle each other in the yard and tickle on the couch and laugh out loud with the kids and yell at the football game on the television. All risky business, I’m sad to say.

So basically Thanksgiving is like “The Children’s Illustrated Guide To A Super Spreader Event.”

Is there any way to do this safely? Let’s use some science to try and figure this out.

But first. How much risk are you willing to take?

All of us have to figure out how much risk we can handle. We can’t be 100% safe unless we sit by ourselves in the basement with a Lean Cuisine box. But we don’t also want to be 100% unsafe with six dozen friends and family from across the country eating an unmasked six hour meal in our wee kitchen. What’s your number?

Once your figure that out, here is a four-pronged approach to using science to decide what to do about Thanksgiving.

One: Is there a way to make Thanksgiving completely safe? Answer: No

a) But what if I ask my family if they’re having any symptoms? Not a guarantee since 40–45% of people are asymptomatic when contagious.

b) But what if I take everybody’s temperature? Thermometers are basically theater. Many people with full-blown Covid never have a fever. Asymptomatic Covid-positive people by definition don’t have a fever. Having a normal temperature is no guarantee that someone isn’t infected. (Although if it turns out Aunt Petunia is indeed running 101.2 “but I always run hot,” get her the heck out of there!).

c) But what if I have everybody tested? There is no “testing date” that will guarantee no one is contagious when they arrive.

Two: Can eating outside make Thanksgiving safer? Answer: Yes, but it depends on distancing and family dynamics.

First off, don’t forget you want to avoid frostbite as well as Covid.

Outside is definitely better than inside. Garages with excellent ventilation and wide open bays might be okay (this is a data-free zone).

Dining outside clearly helps with the most hazardous part of Thanksgiving — eating — which this year means “Unmasked Mouths Spewing Droplets.”

Even outside, you need to keep everybody’s mouths at least six feet away from everybody else’s mouths. This means chairs placed across from each other at a narrow table may not be far enough apart.

But it’s tough to stay far apart and still keep up the chatter and the gossip, and it may be close to hopeless to keep your people safe if Uncle Maskless likes to argue loudly or Aunt Petunia (who you know is going to sneak in her own personal stash of Chardonnay) starts to sing.

Three: Can using Maximally Excellent Covid Hygiene while traveling (masks, distancing, hand washing, minimizing exposure time, maximizing good ventilation) make Thanksgiving safer? Answer: Maybe, if you’re consistently mindful

The goal during travel is not just to wear a good mask on the plane but to minimize prolonged exposure to other People with Mouths and Noses throughout the entire trip. So you also need to be Good With The Covid Hygiene when:

taking an Uber

walking through the airport

talking to the ticket agent

lined up for TSA

waiting in the boarding line

deplaning

being in a crowd on the escalator

waiting at baggage claim

riding in the car rental van

waiting in the indoor line at Avis

talking to the car rental clerk

checking into the hotel (or Aunt Petunia’s house)

getting ice from room service (or Uncle Maskless)

and — very important — whenever there’s a travel snafu: cancelled flights, tarmac waits, flat tires, etc etc etc

And it doesn’t necessarily help to take Amtrak or a bus — same hazards, longer exposures.

Four: Are there other data-driven ways to make Thanksgiving safer? Answer: Yes. Not 100% safe but safer. These adjustments can help:

  • THE MOST IMPORTANT (and mostly impossible) thing: If everybody can seriously stay home from Nov 12 til Nov 26 (no work, no school, no shopping, no indoor food/drink, no gym, no social interactions), these pre-quarantined people will be safer guests
  • Nobody comes over if they have even one little symptom (not Aunt Petunia’s dry cough, not Uncle Maskless’ allergies: NOTHING)
  • Limiting the number of invitees
  • The more distancing the better. Space chairs out wherever sitting takes place.
  • Use the biggest spaces you have
  • Try to minimize close congregating by keeping kitchen prep time to a minimum; maybe this is the year for take-out or prepared foods.
  • Spend as much time outside as possible
  • Keep the sit-down mealtime short
  • All travel with the Best Covid Hygiene imaginable
  • Definitely safer if everybody wears masks 100% of the time they’re not eating. Just this year!

Five: When does the data say we seriously consider cancelling in-person Thanksgiving?

The CDC has updated categories of people at the highest risk of getting severe Covid. These include friends and family who:

  • Have chronic issues with hearts or lungs or kidneys
  • Have cancer
  • Are older (every decade is higher risk)
  • Have Type 2 diabetes, had a lung/kidney/heart transplant, has sickle cell disease
  • Have a BMI of >30
  • Are current smokers

If your loved ones fall into these categories, you may really truly want to think about a Zoomed Thanksgiving.

So, science-based decision time.

Can you picture a radically altered Thanksgiving? The kind where you:

  • limit the guest list and shorten the day
  • ask people to quarantine from Nov 12 til Nov 26
  • are confident everyone will travel with Maximum Covid Hygiene
  • spend nights elsewhere and days in masks
  • let go of traditions involving close contact with Mouths and Noses
  • eat far from each other
  • don’t yell at anybody, even about the election
  • find yourself calling your guests every other day from Nov 26 to Dec 10 to make sure everybody is okay through the post-Thanksgiving incubation period
  • and then start thinking about the December holidays and starting this all again.

For me personally, it’s a no go. I’ve decided my Covid-impacted 2020 is not going to include a big fly-them-in, groaning-table Thanksgiving. I’m going to keep it tiny.

Hard stuff.

For me personally, history helps. This week I’ve been reading about WWII Thanksgivings with stories of frantic housewives searching high and low for black market turkeys, sometimes having to stoop to serving chicken or duck (which was, at the time, devastating).

And stories about the Uncle Monocles who couldn’t come because of gas rationing and the Great Aunt Petunias forced to stay home because they couldn’t find rationed tires for their Fords. And all those lovely young women drawing lines on their calves to fake the nylons they couldn’t buy for the length of the war. And all those lovely young men who couldn’t spend Thanksgiving in North Attleboro because they were stationed in North Africa.

It also helps me that the speed of our accumulated science gives me confidence our next Thanksgiving will be more normal — maybe we won’t even need to wear masks! But most importantly I want 2021’s meal to be with all my loved ones gathered once again around the table, and with nobody who became ill at my Thanksgiving the year before.

{Robin Schoenthaler, MD is a Boston-based cancer doctor who has been writing straightforward fact-based no-blame-no-rumors-all-science-all-the-time essays about Covid-19 since March 2020.}

Written by

Radiation Oncologist at Massachusetts General Hospital/Emerson Hospital. Writer. Teller. Mom. Currently Covid-Obsessed. www.DrRobin.org, @robinshome

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