Social media is flooded with frustrated comments from people complaining that the government is trying to dictate how Americans are allowed to spend their Thanksgiving holiday.
They are clearly frustrated -- but they are mistaken: The reality is that exhausted health care workers, public health officials and public administrators are at wits' end as they call for personal action to stop the spread of Covid-19 in the absence of federal political will. The US has already seen more than 12.4 million cases and 259,000 deaths. Something must change because this trajectory is unsustainable.
But for those who are used to getting together with family members and friends -- basically merging several households for the day -- the idea that Thanksgiving, like almost everything else in this cursed year, should be different, is too much to bear.
It started with warnings from Dr Anthony Fauci that people should 'bite the bullet' and cancel plans for mixing households at Thanksgiving. This recommendation was given on October 14, at a time when Covid-19 cases were on the rise in the US, with tens of thousands of new cases daily. Since then, the numbers have risen yet higher with new daily cases topping 185,000 last week.
Now, countless public health officials have backed up Fauci's urgent Thanksgiving prescription. I wholeheartedly agree. However, I recognize that many will not heed this advice and will still choose to gather. For those families, it is important to take precautionary steps to minimize the risk of viral spread as much as possible.
I will explain these in a moment, but first let me explain why we shouldn't gather and why I'm taking an alternative approach to Thanksgiving.
We are now at a critical point in the trajectory of the pandemic in the US. When infections in the local community escalate, the typical response is for an increasing number of people to voluntarily modify their behavior and shift toward lower risk activities. At the same time, local and state governments often begin to enact stricter mitigation measures. Together, these two factors can bend the infection curve and curb the outbreak.
Throughout this pandemic we have seen waves of infection. First the states in the northern cities crested and fell, then the southern states, followed by small towns, many of which were in the Midwest. As each area flared with infections, resources from around the nation -- including doctors and nurses -- flooded to those areas to assist the sick. But now infections are rising everywhere in the country, beds in hospitals are filling up rapidly, and the health care workforce is exhausted and depleted. Doctors and nurses from one area of the country simply cannot travel to another part of the country to assist because they are needed where they live.
Additionally, over the course of the pandemic, we have seen this virus spread in close quarters: in nursing homes, hospitals, social gatherings and households. In Massachusetts 86% of the new infections associated with outbreak clusters occurred inside households. One person would get infected and come home and infect their family.
Yet, despite what we know about this, many people are planning to travel this week and celebrate with other households. They seem willing and excited to celebrate the holiday by a return to normality -- even if just for a Thanksgiving meal.
And this is where the magnitude of the problem reveals itself. Public health resources are not necessarily overwhelmed when infections are geographically dispersed, occur over time, or are focused in the young who tend not to get as sick. But when infections are everywhere and we are collectively gathering multiple generations in our household, we will be synchronizing a wave of new infections in our communities and we run the real risk of completely overwhelming our hospitals.
What does it mean to overwhelm our hospitals?
Hospital care may need to be rationed in the weeks following Thanksgiving because there simply will not be enough beds or staff to treat the number of people who need treatment for Covid-19.
This feeling of an impending crisis is a weight we can all recognize, but it is felt the most by those who work in health care. Yet, all of us have the same primal need for companionship with family and friends.
So, if you choose to host a Thanksgiving gathering that includes more than one household or attend a celebration of the holiday at another house, know there is nothing you can do to eliminate the risk of spreading or contracting Covid-19. There are, however, things you can do to minimize the risk:
Leading up to Thanksgiving
Minimize the number of households you interact with: Each additional household brings added risk which grows with the number of people in that household.
Reduce interactions: Ask your guests to reduce their interactions in the days leading up to Thanksgiving. The fewer interactions they have, the lower the likelihood of them being infected. The same goes for your own household.
Get a test: Getting tested after 5-7 days of low-risk activities and then isolating between the time you take the test and your Thanksgiving gathering is a good way to lower the risk of bringing an infection to the dinner table -- though this advice is perhaps more useful going forward to other gatherings, as the Thanksgiving holiday is nearly upon us.
Maximize outdoor air: If the weather behaves, keep the meal outdoors. This is not likely realistic in many parts of the country, but windows and doors can be kept open as wide as the weather allows if you are inside. The goal is to not rebreathe someone else's air.
Time: Duration of exposure is an often overlooked risk factor. The longer you are around an infected person, the greater the risk of infection. There is no magic number when it comes to time, infection could occur with a brief exposure, but the risks of inhaling enough virus to establish an infection increases the longer you are in the company of an infected person.
Keep the meal short! This will also be one meal where if the kids ask if they can eat in the playroom, the answer should be yes.
Distance: Wearing masks indoors throughout the gathering may not be a realistic expectation. In the absence of masks, keep your distance; 6 feet is good, 10 feet is better.
Don't Share: Don't share serving food, glassware or cutlery. These surfaces go directly in your mouth and make it really easy for the virus to find a new home.
Our responsibility to minimize the risk of viral spread doesn't end when the day is done. If you choose to gather, you also should keep your interactions low in the days after Thanksgiving. If possible, get tested again the following week.
No one wants to be infected or to infect their family and friends. But when an abstinence-only approach to Thanksgiving is being pushed by so many, and the country is so ideologically fractured, the messaging is -- unfortunately -- bound to fail for too many people. We really shouldn't be mixing households for Thanksgiving, but if you do, please consider incorporating steps to make it safer.