How to Do the Holidays Safely This Year

“Wear a condom!”

Asking loved ones not to be together for the holidays is like asking teens not to have sex.  People will do it no matter what we say, so we should help them do it as safely as possible.  Let’s talk about COVID condom-equivalents!  Below are my thoughts, here at the end of August, about how we can make holiday gatherings hotbeds for communion and connection, rather than infection and transmission. These are my own recommendations and do not represent the advice or policies of my employer:

Talk About It Now

If your family is anything like mine, people have varying degrees of comfort and anxiety about COVID, and these levels may themselves oscillate and evolve over time.  Before we even talk about gathering for the holidays, we need to know how people feel and what they think about it all, as much as possible.  Talk to your nuclear family.  How important is it for each of you to be with extended family?  What trade-offs are people willing and not willing to make in order to do so?  What are the deal breakers?  What are the must-haves?  Starting these conversations today gives everybody time to reconcile differing opinions and make the most accommodating and collaborative plans.

Contact your extended families.  What’s everybody thinking?   Who’s on the same page?  For those who are not, what will need to happen?  How can we all work it out so that these holidays bring joy and connection, however we can get it, rather than more separation and loneliness?

Isolate for 14 days in advance

The most effective method for preventing infection and transmission is isolation. The incubation period for SARS-CoV-2 is 2 to 14 days. If we have no contacts outside of our household in that time, the chances of us getting infected, and then passing the virus onto others, is very low. I know this is not possible for many, but if we really want to be together safely, this is what we should aim for. Everybody who will be together in the extended family needs to minimize contact with people who will not be with us, in order for us not to spread the virus rapidly between us.

Merge Bubbles SAFELY

Once we have decided to gather, we should follow precautions obsessively:

  1. DO NO PARTICIPATE IF WE HAVE SYMPTOMS.
  2. Check temperature daily; stay away/isolate if over 100.0 degrees Fahrenheit.
  3. Wash hands and sanitize surfaces like our lives depend on it—20 seconds with soap and water, or enough 60+% ethanol-based hand sanitizer to take many seconds to dry, no exceptions, early and often.
  4. DO NOT share anything: utensils, drinking vessels, implements, etc.  When it doubt, throw it out and get a new/clean one.
  5. Minimize close contact–consider masks if close contact is prolonged.
  6. Optimize ventilation.
  7. Spread out whenever possible.
  8. Mask up if it helps us feel safer—especially if anyone was not able to isolate.  Respect one another’s decisions on this—be kind and generous.  Nothing ruins a gathering, holiday or otherwise, faster than snide comments and passive-aggression.

Know the Risks

So many statistics abound, and depending on our particular perspective on the pandemic, we will focus on certain facts more than others.  The bottom line is this:  Populational statistics are not easily applied to individuals.  Nothing can predict your or your family’s outcome if exposed.  Some things to keep in mind:

  1. None of us, not even veteran infectious diseases and public health expert Dr. Anthony Fauci, have seen a disease with such a spectacularly wide spectrum of illness—from asymptomatic to rapid multisystem organ failure and death, and everything in between.
  2. Any person, regardless of demographic, could have any course.
  3. There is no way to predict what any given individual will have, and virtually no way to influence it, other than preventing infection in the first place.  Maybe you can increase your vitamin D level and decrease your risk (talk to your doctor about it).  But unless you’re in the hospital (which means you are very sick), where remdesivir and dexamethasone may shorten your hospital course, there is nothing you can take or do to make you better.  You could be ill for many weeks with symptoms that involve your lungs, gut, brain/nervous system, heart, and blood vessels.  And all you will be able to do is wait it out.
  4. If you get infected, even if you recover, we still don’t know whether and what long term effects the virus and the disease will have on your body and/or your immune system.  It’s simply too new.
  5. The local positivity rate where we are can help us assess the risk we pose to others.  Where are we and our relatives coming from, and what does the pandemic look like t/here?  Find out here

Stay vigilant

Let’s say Thanksgiving goes well and nobody gets (too) sick in the weeks following.  Are we getting together again in December or over the New Year?  If so, we will all need to follow the same preparations and precautions before and during all gatherings to make it into 2021 unscathed.  The good news is, if we have already merged bubbles and we all steer clear of contacts outside of this new cohort, we may continue to commune safely all through the season.

I may update this post as the holidays get closer. Maybe everything will get better and we will have much less to worry about… I seriously doubt it. The best thing that could happen is that we all draw closer, physically and/or otherwise, to take care of each other and appreciate all that we have; that we live more mindfully, kindly, and inclusively in all domains; that we pull together in every way and keep each other safe and healthy.

What will be your COVID condom-equivalents this holiday season?  How willing are you to wear them every time, no question, without fail, to protect yourself and your loved ones?

***

Coda:  On Testing

Below is a draft of information I have written for patients.  It reviews what constitutes an exposure, and guides decision making about testing.  Bottom line:  Negative testing does NOT guarantee the absence of infection or risk of transmission.  Know what the information means and how to use it before getting tested.  These are also my own recommendations and do not represent the advice or policies of my employer:

Definition and Degree of Exposure

Known exposure

–You spent more than 15 minutes within 6 feet of someone who was symptomatic with COVID-19 illness and/or tested positive ​within the two weeks prior or 48 hours after the time you were with them.

Possible exposure

–Same situation as above, but you and/or the other person were masked​.  ​Some would still consider this an exposure​, others would not.  If you were both masked for the entire encounter, the risk of transmission ​is significantly lower.

— You spent less than 15 minutes unmasked with someone who was symptomatic or tested positive within the two weeks prior to or 48 hours after the time you were with them.

–You attended a large gathering, flew on an airplane, rode a train, etc. where someone in the vicinity recently or subsequently tested positive. The risk in this situation is higher if anyone was unmasked and/or if it was indoors and/or in a small, poorly ventilated space. Avoid these activities if possible.

–Prolonged outdoor contact, unmasked, inconsistently distanced at 6 feet or more, eg outdoor dining.

Not an exposure

–Outdoors, consistently masked and/or distanced from other people at least 6 feet apart

Statistics of Infection

–Incubation period is 2-14 days

–Average time to symptom onset is 5 days

–By 10-11 days, 90% of infected people will have developed symptoms

–Viral load peaks 1-2 days before and after symptom onset—this is when the test is most likely to be accurate

Reasons for Testing

–Required for return to work/school, participation in structured activity, etc.

–Known exposure

–Symptoms:

  • fever
  • cough
  • any new shortness of breath or difficulty breathing
  • chills
  • shaking with chills
  • muscle pain or body aches
  • headache
  • sore throat
  • new loss of taste or smell
  • diarrhea
  • nausea or vomiting
  • congestion or runny nose
  • fatigue

–I do not recommend testing in the absence of symptoms, exposures, or a requirement. 

Timing of Testing

–After a known or possible exposure, the best thing to do is self-isolate ​for 14 days.

–If you develop symptoms, seek testing.

–If you do not develop symptoms, consider testing around day 5-10 and continue to isolate

–Check the turnaround time at your designated testing site.  Results can take anywhere from hours to weeks.  Note that if a result is reported many days after the test date, that result may not reflect real time infection status.  Thus testing may not be useful and 14 day self-isolation is the best course of action.

​-A negative test does NOT ‘clear’ you. Testing can be negative in up to 30% of people who have symptoms, and may be higher in those who are asymptomatic or early in infection. Therefore, you MUST continue to isolate for a full 14 days after a known exposure, even if you test negative. 

Why Identity Matters

“You have a Chinese face,” my mom said to me.  I was ten years old, maybe twelve.  I can’t remember how it came up.  But the message was twofold and clear:  1. What makes you different from almost everybody around you is visible.  You cannot hide it, you cannot escape it.  2. People will judge you for it, so like it or not, to them, you represent us—your family, your ethnicity, all people who look like you.

That was it—straightforward truth, unvarnished.  And I understood immediately.  There was a gravity, an importance to her expression.  It was not meant to apply pressure or expectation; Ma was simply teaching me about reality so I would be prepared to meet it when I left home, whether it was at the mall or farther out in the world.  And I felt equipped to meet the challenge.  We lived in an affluent suburb.  My parents are both educated professionals.  They are still leaders in the Chinese community, heading initiatives to liaise with “Americans” in business, government, and news media.  Growing up I was known as the ‘smart’ kid—I fit the Asian nerd stereotype.  And people were impressed that I was also bilingual, could paint classical Chinese art and perform classical Chinese dance, and also play volleyball and win at statewide speech tournaments.  I thought I represented well.

I brought my Chinese-American identity with me to college, where I estimate about 20% of my fellow undergrads were Asian.  In medical school, residency, and now in practice, there are still proportionally more Asians than in the general population—we are an overrepresented minority group among physicians.  But we are still a minority, occupying proportionally few seats in medical and academic leadership. 

Once again I find myself in this strange, middle, white-adjacent space, considering how I can and should use my unique identity for the greater good.  How does an anti-racist message land differently/better/worse when I express it?  How do my white colleagues hear me differently/better/worse from/than my Black and other underrepresented minority colleagues?  Do I have a bridge role to play here?  Or should I keep my head down and my mouth shut (this is unlikely)?

Someone told me recently that our racial (and other) identities do not matter at work.  We should just think of ourselves as doctors, teachers, engineers, CEOs.  I respectfully and vehemently disagree.  If I were ‘just a doctor’ I would not be the only one fluent enough in Mandarin to care for non-English speaking Chinese patients without a translator.  If my Black colleagues were ‘just doctors,’ they would not inspire young Black kids to become doctors themselves.  If women physicians and surgeons were ‘just doctors,’ there would not be so many women physician groups all over social media, where countless of us seek reassurance that we are not insane, weak, and otherwise broken for all of the horrible, unbelievable-yet-totally-believable discriminatory experiences we endure at work in 2020.  And so many of us would not have our own stories of women in medicine who went in front and inspired us, encouraged us, and gave us the wherewithal to follow. 

Medical culture slowly evolves to see and treat patients as whole people, not just sets of diagnoses.  When will we come around to seeing ourselves and our colleagues also as whole people, interconnected, inseparable, and in need of full integration, inside and out?

* * * * *

The two articles below describe well how our ‘identity blind,’ assimilation-centered work cultures harm our Black colleagues, especially now.  Please take a few minutes to read each, and really try to put yourself in the writers’ shoes.  For us, taking this perspective is a choice; not so for them.

Maintaining Professionalism In The Age of Black Death Is… A Lot  by Shenequa Golding

I just witnessed the lynching of a black man, but don’t worry Ted, I’ll have those deliverables to you end of day.

…If I am to perform my duties for 40 hours a week, it’s asinine to assume that the life I live outside of those 40 hours won’t rear its head. Whether I’m a sleep deprived single mother of two or a struggling college student who really needs this internship to graduate, the belief that only the part of me that fattens your bottom line is allowed in the workplace, is stifling.

This is magnified for young black professionals who are recruited for their culture, but told, in so many words, that their blackness and the struggles that come with it are to be left at the door.

 …Forgive us if our work isn’t up to par, we just saw a lynching. Pardon us if we’re quiet in the Zoom meetings, we’re wondering if we’ll be the next hashtag. Spare some grace if we’re not at the company happy hour, because the hour of joy that most adults look forward to has been stolen from us due to the recent string of black death.

We’re biting our tongues, swallowing our rage and fighting back tears to remain professional because expressing that hurt caused by witnessing black death is considered more unprofessional, than black men and women actually being killed.

So if you can, please, be mindful. Your black employees are dealing with a lot.

7 Things That Need To Be Said About Black Trauma In Predominantly White Workplaces  by Samantha E. Willams

You know what’s worse than America treating racism like a new album that just came out? People moving on like nothing ever happened.

Over the last few weeks, you’ve probably noticed most of your white colleagues have abandoned their outrage over George Floyd and Breonna Taylor, trading it in to enjoy summer’s finest things — sailing, bonfires and lake house getaways. But not us. Those tough and uncomfortable conversations everyone boasted about having have slowed (maybe even stopped), and once again Black trauma in the workplace has been placed back in the hands of Black employees. While I wish I could say everything about this is new or shocking, the truth is we’ve been here before.

…The day was July 7, 2016…  That morning I did all the things one does to “maintain professionalism” because let’s be real, as Black professionals we often feel like we can’t be caught slipping (aka displaying feelings). But when putting my best face forward failed, my colleague asked what was wrong? I explained my stoicism was due to Sterling’s and Castile’s death, which was ultimately the result of the racism and systemic oppression that plagues our country, constantly making Black people a target.

What came next was disappointing but not surprising. Her response was, “Well, did you know him?” In that moment, just as it had in others, it became clear that Black trauma had no place, no weight of relevance in white workplaces. This wouldn’t be the last time Black trauma was ignored, displaced or misunderstood.

 

Witnessing

So much suffering, friends—everywhere, all the time, every day.  It’s overwhelming. 

Our current circumstances feel like the most distressing case of sensory overload I have ever experienced:  intense, prolonged, and complicated.  Paradoxically, I also often feel like my head and heart could explode from sheer hopefulness—at no other time in my life have I felt so much potential for meaningful, positive collective change.  We stand on the knife edge of a continental divide of sorts, simultaneously overlooking the worst and best extremes of humanity.

People. Are. Losing it. 

Patients with underlying anxiety and depression are increasingly agitated and even combative, at home and in the clinic.  They threaten themselves and/or office staff, sometimes with mortal results.  Lifelong friendships are ending from irreconcilable differences over politics, ideology, and disagreements over social distancing and masking, among other things.  People lash out in rage at the slightest, often innocent provocations.  We doom scroll on social media, amplifying and reverberating (mis)information in our echo chambers, driving ourselves to the cliff’s edge of sanity with fear, fury, and hatred.

I watch it unfold before my eyes, escalating in the past few weeks.  I have joked for a while that the world may end in my lifetime; now it feels less and less like a joke. 

How we do process it all?  How do we get through?

Physicians, therapists, nurses, and many other professionals make a living watching and listening to people through their suffering.  Often we cannot cure people’s problems; sometimes it feels like we can’t even help.  But the truth is we can always help—all of us.

By simply being present to someone in pain, we help.   By not looking or running away, by sitting and facing them full on, we help.  By allowing, even embracing our own discomfort, and holding safe, quiet space for another’s suffering, we help.  We know this because when we suffer, the loving presence of others is what heals us first.

I cannot take away your depression or anxiety.  I cannot create a stronger social support network for you.  I cannot get you a job, bring back your deceased loved one, make the pandemic go away, or stop the next police officer from profiling your son by his skin color.  But I can sit with you in your grief.  I can stand in solidarity with you and advocate for our common cause.  Most importantly, I can take good care of myself so I can keep showing up for you and all those who may need to lean on me from time to time.  I have those who let me lean on them sometimes, too, and I make sure to thank them often.

To witness means to see.  The best witnesses make us feel seen, heard, understood, accepted, and loved, no matter what.  This is what we can do for one another right now.  It is the highest calling of humanity, to take care of each and every other as ourselves.  It is an infinite rather than a finite calculation.  Love shared is multiplied, not divided.  Caring for you feeds me too, whereas disconnecting from you costs me more than I know, and diminishes us all.

“Although the tale of human experience is certainly universal, it contains unique elements for each us and we continue the art of storytelling, both verbally and nonverbally, each and every day. While some stories are sweeter than others, all long for the benefit and necessity of a witness, for a witness assures us that our stories are heard, contained, and transcend time; for it can be said that one is never truly forgotten when one is shared and carried in the hearts of others.” –Kristi Pikiewicz, PhD

The only way out is through. The best way through is together.