Should I Travel to See Family This Holiday Season? Dr. Tista Ghosh Helps You Think Through Questions to Ask Yourself

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With the holiday season just around the corner, many families are wondering how (if at all) they can travel and see family in a way that protects everyone from COVID-19. 

Dr. Tista Ghosh, a Grand Rounds senior medical director and CDC-trained epidemiologist, has been fielding these questions on a daily basis. She serves as a “virtual chief medical officer” for Fortune 500 companies across the country, helping their workers grapple with these plans along with regular day-to-day COVID-19 questions. 

Anna Medaris Miller of Insider connected with Dr. Ghosh last week to dive deeper into questions around holiday travel, safety and creative alternatives that families can consider this holiday season. 

Here’s how Dr. Ghosh recommends families evaluate their risk and think about the importance of their travel and family traditions during this holiday season. 

 

How do you decide if visiting is even worth the risk? 

There is no one universal answer to this question. Our care team helps our members think through the questions to ask yourself that will help you decide.

  • Are you high risk in any way?
  • Do you live with anyone with underlying conditions or who is in the at-risk age group?
  • Who are you visiting and what are their underlying conditions? What would potentially happen if they were to get covid? 
  • What are the mental health implications of making the trip? Or not doing this trip? You cannot underestimate the importance of this consideration. For many across the country, once the colder months set in, it will not be easy to gather outdoors. 
  • Are there ways to minimize risk if there are serious mental health implications? 
  • Can you bring heat lamps or other items to facilitate an enjoyable outdoor experience?
  • If meeting indoors, can you meet in a space where you can open windows, be more than 6 feet apart, and wear masks? Would it be possible to eat together virtually, and then meet in person, so masks can be kept on?

Remember, there is no zero-risk activity. Many doctors are doing virtual visits now or offering clinical phone consults to guide you in your decision making. If you’re a Grand Rounds member thinking through these questions, please call us at 1-800-929-0926.

 

If you’ve weighed the risks and plan to travel, how can you do so safely? What extra COVID-19 safety precautions should you take if visiting the elderly or immunocompromised? 

If you need to travel, do so at off-peak times. If you are flying, wear a mask that has 2-3 layers when going through the airport, and of course while you are on the aircraft for the duration of your flight. Consider wearing gloves so you’re touching less with your bare hands. Carry hand sanitizer. 

Some airlines are also doing social distancing better than others. Do your research in advance and bear in mind that the current scientific evidence indicates the virus spreads in these three ways: 

  1. Droplets come from people coughing or sneezing on you — they are larger particles that don’t travel very far before they are pulled down by gravity (typically not more than 6 feet). Physical distancing is key to preventing droplet spread. Try to make sure the airline you are flying isn’t jamming people next to each other. 
  2. Aerosols are smaller particles that are produced when talking or singing, and can travel far in poorly ventilated spaces (note: ventilation is good in airplanes). Keeping your mask on and not talking to your neighbor, while it may feel impolite, is a good practice to reduce aerosol spread.
  3. Contact spread occurs when coming into contact with surfaces that have virus on it, which can be mitigated with wipes and hand sanitizer.

If driving is an option, this is safer, although you should factor in gas station stops, overnight stays, etc. To reduce the risk while driving, wear a mask and gloves when going into gas stations, use hand sanitizer and practice good hand hygiene. As with any holiday season, perhaps even more so this year, there will be a lot of people driving across the country and staying in hotels. If you will be interacting with higher risk folks, staying at an AirBnB or VRBO standalone home or lobbyless lodging can help reduce your exposure. If it’s possible, consider reserving lodging 24 hours before you arrive to reduce any sort of viable virus lingering in the air or on surfaces. You can wipe down your surfaces upon arrival with disinfecting wipes and open all the windows to improve ventilation.

And even if you are able to take all of these precautions, there is still a certain level of risk you are taking on. If you can, quarantine before meeting your family or friends, do so. And try to meet them outdoors as much as possible, maintaining your distance in a well-ventilated area. 

 

Is 10 days still the standard quarantine time? Should we stay in one room for 10 days?

You will need to follow the recommendations of the local public health departments and authorities. This will vary with each location and may change after you’ve booked your trip. Check back in regularly and before you arrive at your location for the latest guidelines.

 

Do you have any tips in terms of making outdoor celebrations more bearable?

I’ve heard of some very creative solutions: gatherings around firepits, organizing get-togethers at parks, and changing the order of events during the celebration. Eating increases risk because it necessitates mask removal. So an alternative might involve each person cooking their own food and eating together over Zoom, then meeting before or after the meal in-person, in an outdoor or ventilated setting where they can wear masks. For example, eat turkey together via Zoom, but meet outside for a post-Thanksgiving walk together, where you can maintain mask use.

Or, if you are eating together, eat outdoors or in a place where you can create cross ventilation (to reduce aerosol spread) and maintain distance more than 6 ft apart (to reduce droplet spread). And keep the hand sanitizer handy (to reduce contact spread).

For families with children, I’ve had some patients successfully use picnic blankets as a way to maintain social distance. Set a rule, even with the little kids, that no one is allowed to get off their blanket. 

Depending on where you live, invest in shade structures or heat lamps now to make outdoor gatherings possible. Of course, that may not be enough, depending on where you live. Many families in cold climates are choosing to meet at a warmer location for winter holidays. Again, if traveling, consider booking your lodging 24 hours in advance of your arrival, so no one is in your space before you arrive.

 

Where does testing fit into all of this?

Access to timely testing and fast turnaround times can vary, depending on your location. Consider that you might not be positive right away, so getting tested right away might not necessarily cover you. If you receive a COVID-19 positive test result, it is likely a true positive. However a negative result may not mean much. For example, the rapid antigen tests can falsely negative up to 40% of the time (the PCR tests have less false negatives, but can still miss many people). Some individuals are re-testing 24 hours after their first rapid test to reduce the odds of a false negative. While this does not provide 100% assurance that you are COVID-19 negative, doing this is better than relying on one negative test alone. 

 

Is it really that much better to do a Zoom holiday? 

If possible, a virtual holiday meeting is the safest option. But if, mental health-wise, you really need to see your loved ones in-person, pick the warmer holiday that takes place earlier in the year. You’ll have a better chance of hosting activities outdoors, which reduces risk of spread.

 

You can read more on Dr. Tista Ghosh’s conversation with Anna Medaris Miller of Insider here, My grandfather died from the coronavirus, and I want to visit my newly widowed grandmother for Thanksgiving. Is that a bad idea?

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