COVID-19’s Resurgence Means Caution Must Outweigh Tradition

This op-ed by Dr. Leon Kraybill, chief of Penn Medicine Lancaster General Health’s geriatric division and post-acute care, and medical director at Luther Acres in Lititz, appeared in the Nov. 15 Sunday LNP.

The bad news: Lancaster County is clearly in a third wave of COVID-19 with rapidly rising infections, increasing hospitalizations and expanding nursing home illness. More COVID-19 related deaths are expected. Colder temperatures will drive us indoors, and in closer proximity to people infected with COVID-19. Approaching holidays tempt us to physically join our families at a time when we are all fatigued by COVID-19 precautions and desperately want to return to normal.

While many infected individuals recover from COVID-19 infection, some have prolonged complications. Like the old example of polio, you may recover from the infection but still have permanent damage to your body. This is not a passing common cold to be taken lightly.

The good news: We now know a lot more about COVID-19, how it is transmitted and how we can protect our families. There are proven and effective steps that each of us can take every day to significantly decrease our risk. Scientific studies on a COVID-19 vaccine are promising for eventual protection from this devastating infection, but it will be months until widely available.

The bottom line: The only way to protect yourself and your loved ones from COVID-19 illness and death is to take simple, known and proven precautions during every moment of every day.

Transmission Principles

COVID-19 is spread primarily from person to person, by virus particles present in our mouth, nose and lungs. The risk of infection increases by being close to another person, and by spending a longer time near them. The risk of infection decreases by covering our mouth, nose and eyes. Hands can transmit the virus, so hand-washing and hygiene are important.

COVID-19 is frightening because an infected and contagious individual may show no warning symptoms, but is still capable of passing on deadly disease to anyone. We cannot rely on recognizing symptoms to protect ourselves. We should assume that everyone is potentially infected and contagious.

These transmission principles lead to simple but challenging actions of protection.

 Protective Actions 

1. Distance and duration. Keeping at least a 6-foot distance from others significantly decreases infection. Minimizing the time spent closer than 6 feet is also protective.
2. Masking. Consistently covering your nose and mouth protects others, and now is shown to protect ourselves, providing up to 70% protection. The evidence is clear and no longer debatable.
3. Hand hygiene. Not touching your face is the best option. Thorough hand-washing or use of alcohol-based gel decreases the risk of infection when viral particles get on your hands.

Holidays are a time where we traditionally break all these rules. We gather in close proximity with people from other households and locations. We spend hours together. We take off our masks to eat. We laugh and cry, hug and kiss, shout and cough. Holidays are a recipe for personal, family and community COVID-19 disaster. Our homes are where 70% of COVID-19 transmission occurs.

There are no easy answers to this dilemma. Of course, we all yearn for these rituals of food and connection and community. It is so tempting to pretend for a day that we can let down our guard, act as if times were normal, and presume that because it is our family it will be OK.

Please make these decisions very carefully. Try to see the big picture of risk without letting the understandable wish for normalcy cloud the choices. For the immediate future in our community, most traditional family and social gatherings should not occur. Most families should significantly change their holiday meal plans. Most large- and medium-size social events should be canceled.

 Can any safe Gatherings Occur?

Here are some alternatives and suggestions:

• Substitute a family video conference call with an emcee to guide the call.
• Create a common menu for each household to prepare and enjoy at each home.
• Set up a video camera and screen at each household to enjoy the images and conversation from the other households while eating apart.
• Limit in-house attendees to your “pod” — the family or group of people you currently see regularly. Fewer households are better.
• Avoid inviting people who are at high risk of contracting disease based on job exposure, disregard of mask-wearing or physical distancing, or residence in “hot spot” areas.
• Deliver meals, in a no-contact fashion, to individuals at high risk of disease complications — the elderly, the immunocompromised, those with underlying medical conditions — so they can stay at home.
• Restrict the number of participants to what your space can safely hold with social distancing.
• Ask for an attendance agreement of COVID-19 precautions: a commitment to limit exposures for two weeks before the event, to use masks and practice physical distancing prior to and during the gathering, and to stay home if experiencing any symptoms of illness.
• Communicate expectations in the invitation, with words along these lines: “For this gathering, we will honor our health with consistent use of masks and physical distancing.”
• Use as large and open a room as possible, preferably outdoors. If indoors, ventilate the space well and keep the windows open in multiple rooms.
• Set up seating to maintain family pod separation — this is especially important during eating when masks are removed.
• Use masks when not eating. Avoid cheering, screaming or singing.
• Bring prepared food, to limit time in the kitchen.
• Avoid sharing and passing dishes.
• Limit alcohol, as it lowers use of appropriate precautions.
• Limit the amount of time together. Consider serving only dessert, for instance, or schedule only physically distanced outdoor social time.

There will eventually be a time when we can gather joyously in community to share food and fun. That time is not now. Now is the time to continue precautions that allow us to survive and enjoy future holiday meals.