Politics

You’ll be able to survive winter and never unfold Covid-19. Right here’s how.

Winter and the holidays can be hard times even in typical years: short days, cold winds, seasonal blues, and family stress, to name a few of the challenges many of us face. But the ongoing Covid-19 surge, with more than 100,000 new cases of the virus reported every day since November 5, is putting the hallmark activities that can help sustain us through the darker days — holiday gatherings, meals with friends, volunteering, or a visit to see Santa — in more dire limbo.

Despite being nine months into the pandemic, figuring out whether and how to approach a previously routine activity or event is still complicated and often stress-inducing. And the calculus seems to change with new case rates and evolving guidelines — and with our own fluctuating pandemic burnout.

The hard fact is that, especially with the surge in Covid-19 cases, “all activities are going to have some risk of being impinged upon by the virus,” says Amesh Adalja, a physician and faculty member of the Johns Hopkins University Bloomberg School of Public Health’s department of environmental health and engineering.

And doing things with people you know — but aren’t living with — can heighten that risk. Just because you know and love (or loathe) them, a family member or old acquaintance doesn’t have any lower risk of bringing or catching the virus than a stranger. And it will likely make you less careful than if you were interacting with a stranger.

A big part of the challenge in avoiding Covid-19 is that it spreads before people start showing symptoms. So you or anyone else can show up to a gathering feeling the picture of health only to spread the virus to those you come into close contact with.

We talked with epidemiologists and other health experts about the safest — and riskiest — ways to see others, keep kids busy, help out, and travel this winter during the pandemic.

This chart details the risk of people without symptoms spreading Covid-19 in different scenarios. Each scenario risk level is somewhat fluid, and there aren’t precise cutoffs for density of people or duration of contact. From the BMJ paper “Two metres or one: what is the evidence for physical distancing in Covid-19?”

Amanda Northrop/Vox

(Note: Activities are ranked relatively within each category, so a “moderate” risk in one category does not carry the same relative risk as “moderate” in another category.) Here is what they said.

See people from other households

Whether you usually celebrate Hanukkah, Christmas, Festivus, New Year’s, or a birthday this time of year, it’s likely that plans for a get-together will need to be adapted — if not scuttled altogether.

For one, having people from different households together is risky. But that’s, of course, what many of us are used to this time of year. In the Before Times, more than 85 percent of Americans planned to attend a gathering with extended family or friends for the holidays. And the average holiday meal included about 11 people. Now, in many states, that exceeds the limit allowed for private gatherings. (The maximum is 10 or fewer — sometimes as few as five — in many places, including Connecticut, Delaware, Idaho, Illinois, Kentucky, Maryland, Massachusetts, Mississippi, Nevada, New Mexico, New York, North Carolina, Ohio, Oregon, Texas, Washington, and Washington, DC, as well as some counties of West Virginia. And in some states — including Colorado, Hawaii, Illinois, Minnesota, Rhode Island, Vermont, Washington, and Wisconsin — many gatherings cannot include people from other households at all.)

In many places, “you shouldn’t do anything with people you aren’t actively living with [because] there’s so much virus spreading out in the community,” says Lisa Gralinski, an epidemiologist at the University of North Carolina Gillings School of Global Public Health. For example, an area with more than 5 percent of tests coming back positive indicates that there is undocumented community spread. Few areas in the country have test positivity rates below that. Even in those places, she says, “I would encourage people to be incredibly cautious.”

A map of the Covid-19 test positive rates in each state. A rate above 5 percent is considered too high.

German Lopez/Vox

As Krysia Lindan, an epidemiologist at the University of California San Francisco, notes in an email to Vox, it is especially important to “avoid multi-generational gatherings that include older adults and those with pre-disposing health conditions.”

Expected family time might need to be skipped this year. “This may be the year not to invite your young adult children to come home or, conversely, to visit your parents or grandparents,” Lindan writes. (Even if a college student is “distance-learning” near campus, “You may want to really check what they have been doing,” she says. “Transmission among people in colleges has been high.”)

If you’re still considering gathering in person, whether with family or friends, assemble all the potential guests virtually first to have an open and detailed conversation about the risks, goals, and ground rules for the get-together, reminding people that everyone is bringing all of their exposures from the previous two weeks to the event, Keri Althoff, an epidemiologist with the Johns Hopkins Bloomberg School of Public Health, advised in a November press briefing. This call should include naming a point person who will be notified if anyone starts getting symptoms and/or tests positive in the two weeks after the event and who will also call all the other guests to tell them if they need to quarantine and/or get tested, she said.

And there’s one more step to take after the gathering: Quarantine for at least 10 days (or a week if you get a negative test result). This will allow you or anyone else to detect any cases of Covid-19 that might have resulted from the gathering and not spread them back out into the community.

Here are considerations for different formats of gatherings this season:

Safest: Virtual

Amanda Northrop/Vox

It’s hard to pass the dessert when you’re celebrating on Zoom. But it’s also impossible to pass Covid-19.

Althoff said that although she loves visiting her “ginormous” family in Iowa, she won’t be seeing them in person this year. Instead, she is planning to partake in video toasts and virtual game nights with family and friends.

Other ideas include having everyone make the same food or drink to enjoy during the call or playing a game of charades — or even enlisting kids to provide entertainment.

Next safest: Small, short, outdoors, distanced, and masked — hold the food and drink

For some, seeing others in person is not something they are willing to hold off on until there is widespread vaccination. So the safest way to do this is by keeping gatherings small, brief, outdoors, distanced, and continuously masked — which means no food and drink.

“Outside is where we want to be if we want to be together,” says Jodie Guest, vice-chair of the department of epidemiology at Emory University’s Rollins School of Public Health. She also recommends keeping it under a total of 10 people — with only one or (if your area permits it) two other households — and keeping everyone separated by household pod.

One caution this time of year is to be mindful of outdoor heaters. They can help extend the outdoor season, but if too many people are crowded around them, that could increase the risk of disease spread. As Guest notes, she bought two heaters for her porch: one for her household and the other, spaced far away, for one couple they see regularly, outdoors.

Moderate risk: Outdoor meal

Amanda Northrop/Vox

If eating and/or drinking are non-negotiable, “Consider having tables spaced around outside and people within bubbles or family units seated together,” Lindan writes.

Guest adds that everyone should be masked when they’re not eating or drinking. People should also be mindful of alcohol consumption, she says, as it reduces inhibitions, making people less likely to stick with safety protocols and more likely to revert to pre-pandemic socializing behaviors.

Riskier: Indoors, distanced, and masked — but testing and quarantining can help

Amanda Northrop/Vox

If you decide having people together indoors is the only option, there are several things you can do to decrease the risk of turning your event into a Covid-19 outbreak. Most of the usual advice applies: Ensure people keep their masks on at all times and remain physically distant. Keeping households in different areas “is not perfect,” says Gralinski, “but it’s better than completely intermingling and being right next to each other.”

Keep it short, and limit the number of people attending. And increase air circulation by opening windows, turning on fans, and cranking on the central AC or heat, Althoff said.

But be forewarned that although a gathering might be set up with the best of plans — distanced seats, open windows, masks — indoor risk is higher than outdoor risk, says Adalja. “Especially if it’s a social gathering with friends or family that [people] feel comfortable around.”

Another option is to have everyone test and quarantine beforehand. Here’s how:

Test: Have everyone get a Covid-19 test before the gathering — and if anyone is traveling, they should test before they make the trip.

Quarantine after testing and before seeing others: This means households should avoid contact with others, including not going to the grocery store, work, or school in person. “Once you test, you need to quarantine as much as possible,” Guest says, so that you don’t then contract the virus in the interim. The CDC is recommending that people traveling should quarantine for at least a week upon arrival — as well as testing again three to five days after traveling.

Now, if everyone is negative, the gathering could proceed with slightly less worry about spreading Covid-19.

Adalja recommends doing some research on testing first. Many places are facing delays returning results, and the American Clinical Laboratory Association has warned of increased stress on testing capacity and shortages of testing equipment ahead of the holidays.

Also, as Adalja points out, “Test results are not ironclad — just look at the White House,” where top-level officials are tested regularly but there have still been numerous outbreaks.

If someone is unable to effectively quarantine upon arrival (say, a young adult who comes home to their parents’ house and is unable to remain entirely separate from other household members), the next best option is to at least get everyone tested and attempt as much of a quarantine as possible while awaiting results, says Lindan.

Riskiest: Indoors with few or no precautions

A standard, sit-down indoor meal with anyone outside of your household presents a substantially increased risk of transmitting the virus. Other things that further increase the risk include a large number of people, multiple households, a lengthy gathering, physical closeness — whether that’s people packed into a kitchen cooking together or around a table — limited mask-wearing, and shouting (it was an election year, after all) or singing (hold the holiday songs).

“I would just avoid large gatherings indoors at all costs,” Lindan says. “I know it’s really hard.”

Keep kids occupied

Outside, outside, and mostly outside is what experts say as a general rule for kid activities this winter. To that end, if you live in a colder climate, it’s an important year to make sure you have warm outdoor gear that fits your kids well.

That said, there are some caveats to this guidance. Not all outdoor activities are created equal, and there could be some indoor ones that, if done responsibly, could carry slightly less risk. It’s also important to remember that “the virus survives longer in the winter due to the lower temperature and lower humidity, resulting in increased risk of transmission in winter compared to summer,” Dean Blumberg, chief of pediatric infectious disease at the UC Davis Children’s Hospital, writes in an email to Vox.

Safest: Activity with only household members

Of course, the activities that carry the lowest risk of Covid-19 for kids are the same as adults: avoiding exposure to anyone outside the household, whether it’s indoors or out.

This could mean there’s more screen time this winter — including those video calls with family and friends. Or time offline doing crafts (particularly to give to people you cannot see in person) or house projects, such as cleaning out old toys and clothing to donate. Or bundling up for outdoor activities away from other households, such as exploring quiet parks, hiking, biking, or sledding.

Moderate: Quiet indoor activity with masks and distancing

What about all of those museums and movie theaters that were key — especially during long school breaks — in Before Times? “If you’re going to a kids museum where you’re restricting the number of people, and everybody’s wearing a mask and hand-washing, and they have good air filtration, that’s probably okay,” Lindan says.

Adalja agrees. Even though a museum is indoors, “if they’re distanced and wearing masks, that becomes an obstacle that’s harder for the virus to overcome.”

That said, some experts caution that other indoor activities — even though they might seem to have similar precautions — carry higher risk, especially if local case numbers are high. “If there is increased transmission in your community, then an indoor activity like a movie theater is risky,” noted Blumberg. “There may be compromising of social distancing in common areas, such as corridors and bathrooms, and people may not be masking at all times as they sip their soda or snack.”

Riskier: Busy outdoor activity with intermittent distancing and masking

According to the experts we spoke with, a busy playground might bring higher risk of Covid-19 transmission than a quiet indoor activity in which all of the best protocols are being followed.

For example, “playgrounds — those are not ever going to be without risk,” Adalja says. Not all kids are diligent about wearing their masks, surfaces are very high-touch, and it’s essentially impossible to keep children physically distanced. “That’s a risk where you have to make an individual risk calculation,” he says.

Also, outdoor sports in which kids come into contact with one another increase the risk of transmission, as could crowded outdoor events or activities, especially those where people do not always have their masks on (such as for eating or drinking).

Riskiest: Close activities indoors with others

Families are all having to make the best decisions for themselves. And keeping kids isolated from others, especially on school breaks or when schools are remote, is not always feasible.

Adalja suggests some things families can do to lower the risk in these situations. Continue to avoid any crowded indoor spaces where you will come into contact with other households. Instead, work with another family or two (if permitted in your locality) to establish a small group of children for in-person visits, ensuring everyone is comfortable with each household’s risks and behavior — and stressing hand-washing.

“The whole thing is about weighing risks and benefits,” he says. “Children playing is crucial for psychosocial development. It is a balancing act.” But high levels of community transmission can tip those scales and make in-person activities with friends too risky for many. And any time group visits can be outdoors, that will help lower the risk.

Helping others out

As a result of the pandemic, millions of people in the US are struggling to put enough food on the table for themselves and their families. More people need help this winter than perhaps any other time in the past 80-plus years. So there has been no better time to find ways to help others.

Thinking about and helping others is a really important way to combat anxiety and stress and a feeling of helplessness — all of which are currently pervasive.

“It’s always good to volunteer, and doing so might lighten the sadness of not being able to see family and friends as in years past,” Lindan writes.

Guest agrees: “I do think people are hungry for ways to help each other right now.”

Safest: Give money

Charitable organizations can often stretch donated money further than donated goods. So financial contributions are especially helpful, in addition to being Covid-19 transmission-free. Established charity-rating sites, such as GuideStar or Charity Navigator, can tell you how much of your contribution will go directly to the cause.

Next safest: No-contact help

The next safest way to help out this season is through contact-free volunteering or donations. This could be a formal, organized effort, like contributing food to a local pantry, or it could be personal efforts, like arranging grocery or meal deliveries for higher-risk community members.

Guest notes that these kinds of efforts can also safely be turned into a shared experience of sorts — such as organizing a coat or blanket drive with friends, family, or neighbors. (She suggests quarantining the donated goods for three days before you touch them.)

Moderate: Helping out in-person with a few others

There are many organizations that rely heavily on behind-the-scenes volunteers. Food pantries or clothing and household goods distribution centers might offer opportunities to donate time and help in a slightly safer environment than, say, serving meals. Before you go, find out how many other people you will be working with, if they require masks, and how long you will be expected to work (shorter shifts are better for limiting exposure).

You shouldn’t have to look far for opportunities to contribute this way in your area, says Guest: Since the start of the pandemic, “the need for volunteers has only gotten bigger.”

Riskier: Volunteering in-person with larger numbers of people

If you want to do more personal work, first check in with places where you might want to volunteer and ask if they are accepting in-person help and what precautions they are taking. For instance, if you want to serve meals, ask how many people they allow in at any time, if people are required to have masks, how often the organization cleans the area, and whether you will be the only one touching serving utensils, Guest notes.

“You should continue to use the same precautions as always when in a group setting — masks, even face shields, hand-washing, and distancing to the extent possible,” Lindan writes.

Riskiest: Volunteering in congregate living settings

The highest-risk ways to give back this year are those where you volunteer in person in a place where lots of people live, whether that’s a homeless shelter or an assisted living facility. Each carries different risks in terms of acquiring the virus or passing it along. But, as Guest notes, most of these places are being quite careful in terms of their protocol around any outside people (and whether they allow them at all). Even so, it’s still good to check on their practices first. You can also ask if there are other ways your time or money could be even more valuable to them than serving in person.

Travel

Traveling during the holidays is usually a little hellish: crowded planes, overheated trains, and gridlocked automobiles. But this year, the specter of Covid-19 makes it that much more daunting.

“Given the rise in cases throughout many parts of the US, the best advice is to avoid travel at this time,” Lindan writes. (By staying home, she adds, there’s also a bonus of preventing a lot of excess carbon emissions this year.) The CDC has, in fact, asked people to avoid travel.

Travel right now can also get pretty complicated pretty quickly, and not just because you need to pack extra masks and hand sanitizer (and double that if traveling with kids).

More than 20 states now have travel advisories or orders — carrying fines of up to $10,000 for violating them — for some or all people to test, quarantine, and/or submit official paperwork if they will be visiting the state for more than 24 hours (i.e., not just traveling through). So that usual week-long visit to see family in California, New York, or Chicago, for example, isn’t going to be as feasible. (Specific guidance is also available through the CDC’s travel planner.) “It might be a logistical nightmare to make sure you’re in compliance,” Adalja said in a press briefing earlier this month.

In addition to state or city guidelines for travel, many employers, schools, and day cares are issuing rules about travel, so Althoff advised reviewing those as well. “Be ready to accept abrupt changes to your travel plans.”

If you must travel this winter, there are ways to reduce your risk of catching or spreading the virus. Much of it depends on how you travel.

Safer: Self-contained car trip with your household

In this case, while you’re in the car, you’re just with your pod. But the key is to make it household members only. Expanding the roster to other people vastly increases the risk of this mode of travel, especially since “If you’re taking a road trip with a bunch of your friends, you’re more likely to be unmasked, and you’re less likely to distance,” Adalja says.

Things to consider along the way: where you’ll eat, where you’ll sleep, and where you’ll make pit stops.

Short pit stops to use a public bathroom should be okay, says Guest — just wear your mask and wash and/or sanitize your hands. Some travelers are choosing to bring their own open-air facilities on car trips these days.

“The safest is going to be being self-contained as much as possible,” Gralinski says. For sleeping, that might mean renting a dwelling that you have entirely to yourself to stay in “and bringing as many supplies as you possibly can.” The idea is to minimize contact with others, which includes limiting trips to a local grocery store. For additional food, curbside pickup and drive-through are safest.

What about hotels? A recent study in Nature, based on cellphone data of 98 million people in large cities, found that this spring, hotels and motels were fairly large drivers of Covid-19 spread — just below restaurants, gyms, and cafes. (Their data, though, is from March 1 to May 2, a period during which mask mandates and other Covid-19-prevention protocols were just starting.)

Adalja says these days hotels are taking many more precautions and should be fairly safe so long as you’re careful. “It’s not the hotel itself, it’s what you do in the hotel,” he says. So wear a face covering, wash your hands, and avoid other people (for example, skip the elevator, restaurant, bar, and lobby common areas).

For her part, Gralinski said she still avoids hotels. For a late-October vacation she and her husband took, they rented a camper to travel in. “We had our own bedroom, our own bathroom, got curbside takeout; we were pretty self-sufficient,” she says. They would park in the driveways of friends’ houses and see them safely from a distance outdoors. Even though it was cold, it worked. “We got to see friends, and it was amazing.”

Moderate risk: Airplane

We still don’t have definitive data on the safety of air travel right now. Many of the studies that looked at airplane risk — which did show cases of transmission — were carried out before masks were required.

Increasing the safety is the fact that masks are now mandated, and planes have very high rates of air circulation — replacing the full air of the cabin with clean air about 20 to 30 times per hour, thus hopefully removing more virus from air you might be breathing. “The data does show that airline travel is fairly safe right now if people are wearing face coverings,” Adalja says.

But there are other downsides to flying, and they mostly have to do with other people. Namely, you’re in close proximity to a lot of them — even with middle seats empty, as they remain on some, but not all, airlines — and you’re largely at the mercy of their choices. Do they keep their mask on for the entire flight, or have it off for long stretches?

Another thing to be mindful of in air travel is that it involves a lot more than just sitting on a plane. ”It’s the whole experience,” Althoff says, including airport shuttles, lines, lots of high-touch surfaces, and people mingling from all over the country, including areas with very high rates of transmission. If you’re going to be in an airport, she advises to “practice your statement about how you will remind a stranger to maintain a distance.”

Also, be prepared to remind people about masks. In airports and even in airplanes, “insouciant mask-wearing — by having them dangle from earlobes or positioned under the nose — still seems to happen,” Lindan says. “Don’t be afraid to ask people to put on their masks when in the airport.”

How can you lower your risk if you do decide to fly? Wear not only a good mask but also eye protection, such as sunglasses, safety glasses, goggles, or a face shield (with a mask), says Guest. Also, you can check to see if a flight will serve snacks or beverages. This used to be a perk, but these things now up the odds of virus transmission as people remove their masks to eat or drink, so you might want to avoid a flight with food and drink services if possible. “If you need to eat or drink something on a plane, do so when other people are not eating,” Lindan writes. “Keep your mask on, and only lift it up to insert food or drink into your mouth.”

Slightly riskier: Train

There has been even less research on train travel. A study from passenger trains in China relatively early in the pandemic — mid-December 2019 through early March 2020 — found Covid-19 spread fairly easily to nearby passengers on these trips, especially if people were in close proximity for more than three hours. Based on these findings, which were published over the summer, the authors suggested physical distancing, mask-wearing, and improved air filtration would lower the rate of spread on trains.

These are all steps Amtrak has instituted, along with enhanced cleaning and other measures. Trains also have the advantage of generally having fewer passengers per square foot than planes, and you might be more able to get away from someone who is not following the rules or appears ill. (Amtrak also offers private rooms on some trains.)

However, experts we spoke with suggested it might still be slightly riskier than air travel. This is in part because distance train trips are more likely to be longer than a typical domestic flight, increasing your exposure time to others. Train cars also don’t quite have the same rate of air replacement as an airplane cabin — Amtrak is promising clean air exchange 12 to 15 times an hour.

Like airports, there are also train stations to contend with — and there might be even less enforcement of rules, as they are typically more open to the public (rather than the majority of airport space being behind TSA checkpoint screening).

Riskiest: Long-haul bus

We also don’t have a lot of solid scientific information about the risk of Covid-19 transmission on long-haul buses. But early research suggests this mode of travel could be riskier than planes or trains, especially when people aren’t taking proper precautions. One case study showed how a single sick passenger on a bus in China infected 23 of 67 others on a drive that was less than an hour. Of note, though, is that in this superspreading event, which occurred in January 2020, none of the passengers were wearing masks, and the bus was recirculating air.

Bus companies in the US have updated safety protocols to help reduce spread of the virus. Greyhound, for example, requires face masks, has upped cleaning and sanitizing of its buses, replaces the bus air about 12 times per hour, and is “encouraging” passengers to physically distance.

Epidemiologists, however, are still warier of bus travel over other modes of transport right now. “It might be harder on a longer ride to keep your mask on, and it’s probably not as enforced as it is on an airplane,” Adalja says.

An experimental winter — and a new perspective

Amanda Northrop/Vox

This winter is going to be different. But it doesn’t have to be all bad unless we are determined to think of it that way. “Usually people find the holidays stressful, so this could potentially be the year with less stress — just see what it feels like not to go to or host all those parties,” Lindan writes. She calls it a year for “some experimentation.” She had a picnic on the beach for Thanksgiving. Guest suggests trying a distanced hike with loved ones instead of a typical meal or party.

We have an opportunity, through our actions, to make a real impact on the spread of the pandemic — not just among our own circles but in the broader community. This has important implications for health justice and equity because when the virus spreads, it is more likely to hit and cause greater harm to essential workers, their families, and people of color.

“Our epidemic is only going to recede if people take the appropriate precautions,” Lindan writes to Vox. “The problem is that we just do not want to do what we have to do.”

So this winter will take some acceptance, perseverance, and perspective.

How are epidemiologists putting this difficult season into perspective for themselves? For one, by “acknowledging that this is hard and that the holidays of 2020 are going to look much different,” Guest says. “We need to be cautious and protect each other now so that when we do get together [in the future] everyone we care about is there. It’s important to keep that in mind so that these sacrifices now feel like they’re worth it.”

Lindan agrees. “It’s really difficult over the holidays. We want to see our family and friends, and it’s a really difficult task not to after living this way for so long. But it’s a small price to pay for the long-term benefit.”

And as Althoff reminds us, “we will be telling stories from these holidays for generations to come.” It’s largely in our control to make them the right ones.

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