The holidays are traditionally the busiest travel time of the year but, because of the pandemic, people are wary of making the trip to visit and stay with friends or family members who haven’t been part of their bubble for the past seven months.
How do you safely deal with kids coming home from college? With visiting elderly relatives? With flying, then joining another household?
To answer these questions and help you decide how to spend your holidays, I asked four health experts to weigh in:
· Rashid A. Chotani, MD, MPH, FRCPH, Medical Director, IEM, Epidemiologist/Infectious Disease Specialist and Medical Review Board, HealthCentral
· Dr. Ramprasad Gopalan, MD, infectious disease medicine, owner of First Class Medicine
· Dr. Georgine Nanos, board-certified physician and CEO of Kind Health Group, Encinitas, California
· Carol Winner, MPH, MSE, Public Health Expert and Founder of give space
We all want to spend time with family and friends during the holidays. How do you determine if it’s worth the risk?
Dr. Chotani: The entire population is exhausted of social distancing but the virus is still with us. Unanimously, all infectious disease experts believe, based on past experience and early observations in Europe and the U.S., that Covid 19 will surge during fall and winter. We know, based on experiences with other viruses such as influenza, that disease activity increases during the holiday season with the elderly getting exposed to young kids who have the disease. The same is believed to happen with Covid 19. More important is the fact that there are a lot of asymptomatic cases, especially among university students, so it might be a good time to observe stringent infection control measures at home if your kids are coming home. It would also be a good idea not to physically visit elderly relatives and to use Zoom, Skype or FaceTime instead. Risk will be determined by looking at the area where someone is coming from as well as the area they are visiting. Stay informed about Covid 19 numbers in both.
Dr. Gopalan: Consider the number of cases of COVID at your destination. If it is higher than the place you are traveling from, your risk is higher. If you have any vulnerable or immunocompromised people in your family, traveling will pose a higher danger to them. And if you are a person of high risk or high exposure, such as a healthcare provider, you need to take that into consideration if you have any vulnerable people at your destination. You should also check to see if there are any mandates for persons traveling from your area to the destination. Some quarantines are mandatory depending on where the traveler is coming from. If a mandated quarantine is 14 days but you’re only planning on being there for seven days, then you know it’s not worth it.
Dr. Nanos: Now that Covid 19 tests are widely available, I would recommend having everyone tested prior to reuniting to minimize that risk.
Ms. Winner: To stay safe this holiday season, give space. No one could argue that a gathering is worth even a one percent risk of losing a loved one. Carefully weigh who you are planning to visit, who might be visiting you and at what risk. We often hear people say that they are “just” going to their parents’ or sibling’s house for the holidays. We need to remind ourselves that we are not genetically protected from COVID 19; the same precautions we use to make decisions about visiting with friends should be used to make decisions about spending time with family.
If flying, especially on a long flight, what precautions should be taken?
Dr. Nanos: Besides wearing a high-quality mask, I would recommend bringing gloves and sanitizing wipes to wipe down everything you’re going to come into contact with before you sit down, including the extra tray tables near you, armrests, seatbelts, seat pockets, etc. Viruses can live on plastic and steel surfaces for up to three days.
Ms. Winner: A face shield can give you added protection for your eyes and block large droplets, but it still must be worn with a face mask to protect from small viral particulates. Wear your mask properly over your nose and mouth the entire time you are traveling. Choose a window seat if possible, as there will be less exposure from people walking up and down the aisles. Open and position your air vent between your face and the seat in front of you.
What extra precautions can be taken when using an airplane restroom?
Dr. Chotani: If possible, don’t use the bathroom but if you have to, make it short and wash your hands thoroughly with soap and water. Keep a small towel with you so you can dry your hands. After leaving the bathroom, use hand sanitizer.
Ms. Winner: You are safest when sitting in your seat. If you must use the restroom, take wipes with you to use to open and close the door and flush the toilet. Be sure to wash your hands thoroughly and use a paper towel to open the door on the way out, then discard.
Should people be tested when they reach their destination?
Dr. Gopalan: There is no reason for testing after travel unless you are symptomatic, in which case you likely contracted it prior to traveling. Even if you contracted COVID on the plane, it would not be positive on arrival at your destination. It would take three to five days to show symptoms and could extend all the way to 28 days — but the majority of infected persons will be symptomatic within 14 days.
Dr. Nanos: It’s probably better to have everyone tested before they gather together. If they are testing themselves for fear of exposure while traveling it will probably take at least four to five days to get a positive test result. Best to test before and take precautions during travel.
Ms. Winner: If someone is visiting family and friends for just a few days, they will be heading home by the time they might get a test result that would be accurate. In this case, it is best to protect everyone by social distancing and wearing masks. If someone has traveled and is expecting to stay for an extended period of time, a test would be prudent, particularly when a two-week quarantine is more than inconvenient. Know that a test or quarantine period may be required by the state you are visiting. For example, Hawaii will soon be requiring proof that you have had a negative test, or require you to commit to a two-week quarantine with steep penalties up to $5,000 and/or a year imprisonment.
Which test should they take?
All four doctors: The RT-PCR is the gold standard. The Abbott rapid antigen test is an acceptable alternative but harder to come by. Beware of the many fakes out there.
When should travelers quarantine?
Dr. Chotani: It is always good to quarantine after traveling, especially when returning from a college campus. If they get tested and are negative, quarantine is not required but precautions are necessary as the virus has an incubation period. If someone does test positive, quarantine for 14 days and follow CDC guidelines.
Dr. Gopalan: A negative test, along with being asymptomatic, means you do not have to quarantine. If you are positive, you should quarantine for a minimum of two weeks and until you are asymptomatic for a minimum of 24 hours.
Dr. Nanos: If you’re going to see an older or chronically ill family member, you might behave differently than if you’re going to see a younger group of individuals. If you test negative but had a high risk exposure – coming into close contact with a confirmed case of Covid 19 – you should probably quarantine. If you are positive, quarantine for a minimum of 10 days and until symptoms have resolved.
Since it takes time to become a bubble, are there precautions that should still be taken in the house and when kids home from college want to visit friends?
All four doctors: Frequent hand washing is the most important thing everyone should do. Keep wiping down surfaces and avoid touching your face. Wear masks and social distance when leaving the house, and stay outside when visiting with friends when possible. If they go inside someone’s house, they should keep their mask on and use hand sanitizer when they leave. They should also keep a mask on during golf when they’re standing near other people and when they play doubles tennis. Singles tennis is fine because players are naturally social distanced.
Which masks are best? Are gaiters, which a lot of younger people like to wear, effective?
Dr. Chotani: Any type of mask is better than no mask. But the best, in order of effectiveness, are N99, N95 or kN95, surgical, cloth mask (double layer with a filter), regular cloth mask, bandanna, then gaiter mask. It is important to understand how to use the mask and how to manage it. Unfortunately, gaiter masks have not demonstrated effectiveness.
Dr. Gopalan: Standard level of protection includes triple layer cotton masks or surgical masks, with the most superior being the N95 masks.
Dr. Nanos: Of the effective masks, the one you feel most comfortable wearing on your face for a long time and are likely to wear without many adjustments is the one that is going to be best for you.
Ms. Winner: You do not need an expensive mask. A simple two-layer, natural fiber (such as cotton) mask that fits properly by covering your mouth and nose and snuggly on the sides of your face should suffice. Having more than one mask is necessary for back-up. Keep in mind, if you are traveling by air, you may be required to disembark the airplane wearing a clean mask. Gaiter masks are often one layer and made of synthetic material, so more research is being conducted to determine which ones are safe.
Is there anything else you want travelers to know?
Dr. Chotani: The virus is still with us so wear a mask and observe social distancing and hand hygiene. Things will get better, but we all have to work together. With the expected surge we will have more cases and deaths. However, we can reduce the damage to our families, communities and nation by following common sense measures.
Dr. Gopalan: The risk of acquiring COVID is higher while traveling to and from your home, rideshares, inside the airport, the check in process, the waiting areas, etc. than on the actual airplane. The filtration systems on the plane are effective and the risk of being exposed inside the plane is lower than outside, unless of course there is droplet exposure from someone in your immediate area. Wear your mask.
Dr. Nanos: Don’t forget to get a flu shot!
Ms. Winner: Wash your hands. We have recently learned that COVID19 can live on your skin for up to nine hours without hand washing. And remember that regular testing does not replace social distancing and wearing masks. We’ve seen the most illuminating example of that from the White House over the past week.