If your Thanksgiving plans include a returning college student, a Harvard infectious disease expert suggests an addition to your holiday table — warm sweaters.
That’s because William Hanage advises families, especially those in milder climates like Georgia, to consider eating and holding festivities outdoors to reduce the risk of COVID-19. If that’s not possible, Hanage urges them to throw open a window to improve ventilation.
The Centers for Disease Control and Prevention last week predicted 260,000 to 282,000 coronavirus deaths by Dec. 5.
During a recent virtual discussion about the upcoming holidays and COVID-19 held by the Forum at Harvard T.H. Chan School of Public Health, Hanage was asked whether families should consider Plexiglas dividers at the Thanksgiving table. He recommended focusing on ventilating the room by opening a window 6 inches and employing fans to increase total airflow.
“It may be somewhat cold in the room, but this is an opportunity to get out those fall sweaters we all like to wear,” said Hanage, a Harvard associate professor of epidemiology and a faculty member in the Center for Communicable Disease Dynamics.
Hanage cited the benefits of outdoor events, pointing to a multifamily gathering over a few days where everyone became infected with COVID except one family. That family spent 10 hours one day and three the next with the others, but all outdoors.
Hanage explained why inside gatherings can turn into transmission clusters, citing the three C’s — closed spaces, close contact and crowding. “It’s fairly easy to see how those three can easily come all together when it comes to the holidays. Poorly ventilated indoor spaces are a risk for transmission. A further risk for transmission is eating," he said. "Putting this together, I’m afraid you can see the coming holidays have the potential to be a real problem.”
He suggested people get tested for COVID-19 if they plan indoor activities with family members but said a negative test doesn’t eliminate the need to wear a mask. It would also help to quarantine for 14 days before a family gathering. “We have to remember it is just not one thing,” he said. “Even though you have a lot of negative tests doesn’t mean the next test isn’t going to be positive.”
Colleges are encouraging students to undergo testing before returning home for the holidays, including the University of Georgia, which has a pre-Thanksgiving testing push underway.
“We are excited that so many members of our UGA community are taking advantage of the free surveillance testing being offered on our campus,” said Dr. Garth Russo, executive director of the University Health Center and chair of UGA’s Medical Oversight Task Force. “This is particularly important as we head toward the Thanksgiving holiday. If our students, faculty or staff are planning to be with loved ones, then for the health and welfare of all involved, they need to know if they are virus-free.”
UGA students and staff are advised to be tested on or before this Friday to get back their results before Thanksgiving.
With the state’s most ambitious campus testing program, Georgia Tech advised its students to undergo asymptomatic surveillance testing seven to 10 days before returning home for the holidays, and again one to two days before they leave campus for the break.
“Even if you aren’t in a high-risk population, we know the virus spreads easily, can circulate quickly, and could lead to severe health problems. Most importantly, we want you to be able to finish this semester and return home or travel safely during the semester break, reducing any risk of spread to loved ones and people you may come in contact with,” said Tech President Ángel Cabrera last week in a message to students.
Hanage said people must recognize how the virus spreads. “You hear that it is either incredibly dangerous to everybody or it’s not dangerous to anybody. Neither is true,” said Hanage. While it’s clear that young people under the age of 20 are much less likely to suffer severe disease, the risks are not zero, said Hanage. “And we are just beginning to learn about the long-term consequences of this.”
When you host multigenerational holiday events, older family members can pay a high price if infected by a child, grandchild, niece or nephew.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said his own adult children won’t be coming for Thanksgiving because they would be traveling from different states and are concerned about endangering him.
“You don’t want to be the Grinch who stole the holidays, but one family group or pod has to look at what the risk is in,” said Fauci in a recent livestream interview with the Journal of the American Medical Association. “If you have people like the elderly or individuals who are compromised because of underlying conditions, you want to take a couple steps back. Is it worth it for this year to bring these people together when you don’t know what the status of everybody in that pod you created is?
“These innocent family and friends gathering — six to eight people come together in someone’s home — you get one person who is asymptomatic and infected and then all of a sudden four to five people in that gathering are infected,” said Fauci. “To me, that is the exact scenario you are going to see in Thanksgiving.”
“People are more at risk by simply being older," said Hanage. "You can see this, indeed, if you look at the risk of death starting to increase for people in their mid-40s. If you are in your 50s and you contract COVID, your probability of dying is roughly speaking about 200 times the risk per year that you would die in a road traffic accident.
“One of the things that we know for a fact at the moment is that we often see the initial stages of these epidemic curves being driven by mild infections in adolescents and 20-somethings,” Hanage said.
Such cases are often unnoticed because the young are less likely to experience symptoms or seek testing. “But these individuals have the capacity to transmit to older, more at-risk individuals. That can happen despite people’s efforts,” said Hanage.
Consider invasive pneumococcal disease, which is caused by a bacteria called pneumococcus and can be deadly, especially to the elderly. Year after year, there is a spike in the disease among older people after the holidays, said Hanage.
"Older people get together with younger people over the holidays, and the younger people, who tend to be the core group for transmitting this bacteria, transmit it to their grandparents,” he said. “If you look at that in the context of a pandemic virus, that is a real matter for concern.”
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