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. 

Gratitude Again

Office view 11-20-17

NaBloPoMo 2017: Field Notes from a Life in Medicine

I generally dislike cold, damp, cloudy weather.  I have survived this in Chicago the past 26 years, somehow, by grace.  Usually the second half of fall just feels dreary, wet, and lame to me.  And yet this season, on this drab day, I feel warm and happy inside more than last year.

Can’t say why, really.  Another year older and wiser, perhaps?  Maybe because the kids seem to have crossed some magical threshold on this side of which they seem suddenly much more mature and self-sufficient?  I’m entering my fourth year in my current practice, which is the magic number for really settling in, it seems.  With the patients I only see once a year, the third and fourth times bring a familiarity and rapport that can only come with time.  It’s like catching up with old friends.  I’m grateful for another year of watching my family grow and flourish.  I’m grateful for my work, and the immense personal and professional fulfillment it affords me.

Two years ago for my first NaBloPoMo, I wrote November Gratitude Shorts.  It was a spinoff from a Facebook trend in which my friends and I posted gratitude for something every day.  Writing a couple sentences a day was fun and easy; converting those ideas to full-fledged blog posts proved more daunting than I had anticipated.  It felt like a slog much of the time, though I did write some pieces that I’m still proud of.  Last year I felt more relaxed, less pressured to write profound things.  This year I’m actually having fun, though I can still only rarely make myself sit down to write before 10pm.  That will be the challenge next year.  I am grateful for the chance to practice my writing and share with a community of readers, writers, and friends.

I feel the holidays coming on, a little more acutely this year than last…  It’s been a tumultuous year, no doubt, in so many realms.  And yet we are all still here, relationships intact for the most part.  And many of us, happily or begrudgingly, have learned a little more about our biases, our emotional triggers, our friends’ and families’ hidden beliefs, and similarities and differences we did not know we had before.  The conversations continue, then maybe stop for a while.  Emotions heat up, cool down, heat up again—and hopefully the connections remain or even grow stronger.  I have hope that we can continue to do better, and I’m grateful that the trials of the past year have shown me what courage and resilience we have.  I am grateful for the holiday season every year, and the chance to reflect and advance.

A friend told me recently about marriage advice he received when he was young.  We get beyond infatuation and on to real love, he was told, through commitment.  This past year I have seen myriad examples of people making meaningful commitments—to their families, to their core values, to their ideals, their aspirations, their fellow humans.  The examples are everywhere, if we are open to seeing them.  I am grateful for the persistence of humanity, and for our innate drive to connect.

The holiday season is upon us, and truly, I wish us all peace, love, and joy.  I’m grateful to have so much to celebrate, so many to celebrate with, and so much to look forward to.  May you feel and be moved by all that holds you up, this season and for all seasons to come.

A Holiday Break

img_1083

Happy Holidays, friends!

December flies, does it not??  What is it today, the 18th?  Holy cow!  The kids are off for winter break, holiday greetings have overtaken snail mail (Yippeeeee!!), and now that NaBloPoMo has concluded, I am back to scrounging for blog post topics again.  How fascinating…

2016, what a long, strange, CRAZY trip!  The moments (periods?) of shock and disdain stand out, but there were also times of profound inspiration, learning, and connection.  2015 did not see any holiday greetings from us, a lapse after at least 15 consecutive years of not only composed letters with photos and personal notes on every one, but also often a craft of some sort.  I was just overwhelmed with other stuff to do, though now I can’t recall what all that stuff was.  This year I contemplated the annual year-in-review letter.  I have also proofed a bookmark on vistaprint.com.  But the mass-produced, conveyor belt greeting feels unsatisfying right now.

We have all witnessed the escalating anger, division, and destruction of relationships, both individual and between groups, these last 12 months (really, much longer?).  The emotional hijacking took me over for a while, too.  After all we’ve been through, I feel an urgent need to connect with friends and loved ones more intentionally, personally, and directly.  Many on my ‘list’ have known me most of my life, and I want to take time to write to them.  I used to write them all the time–I went to college with 100 postage stamps freshman year, and used them all.  I feel a need to tell people one by one this year how much they mean to me, how they have shaped the person I am today, what I admire about them, how I see them contributing to our world.  I want to encourage them, hold up their optimism and hope.  Most of all, I mean to reinforce my connections with them, so we may all help one another soldier forth in a world of increasing uncertainty.

We cannot control what others say or do.  But we can call out the hatred, illuminate and inform the ignorance, and stand up for core values of love, connection, inclusion, equality, compassion, and justice.  We can do this all the better if we support one another in action.  That support must be cultivated, tended, and protected.

So I’ll take a break from regular blogging for a while, to write by hand (with fun-colored gel pens on cute cards, and lots of stickers).  We’ll see if I break my tardy record for holiday greetings, St. Patrick’s Day…  I think it’s okay–never too late to make a meaningful connection.

Please share your intentions for the new year here, if you like–the community I have found here lifts me every time I open the window or the app.  Thank you for your engagement and encouragement, and Best Wishes to you all this season!