After months in isolation, we’re all ready to see the people who matter most to us. But the last thing we want is to put anyone in harm’s way. Public health experts offer some advice on how to lessen the risk of these interactions.
Earlier this month, my mom finally asked the question I knew was coming: “So, when are we going to be able to see you?”
It’s a question as old as time, one that dates back to long before COVID-19 completely rocked our lives. And even during a global pandemic it came laden with its trademark guilt—the familiar discomfort of which I also found oddly comforting at this particular moment in history. It was refreshing to think that as mind-bogglingly life altering as the coronavirus pandemic has been, it can’t take away something as pure and enduring as a mother’s desire to see her children and grandchildren.
No sooner had I started to rattle off some options—like maybe staying in our own vacation rental, and doing socially distanced visits—I could already hear the resistance in her responses. She did not like the idea of me and my family staying somewhere other than my childhood home and that our encounters would be limited to seeing each other a couple times each day in an outdoor setting. Rituals are so important to her, and the kind of visit I was suggesting was a break from all tradition.
“What if we all get tested?” she asked. “I can’t hug my grandchildren?” she continued. “This is ridiculous,” she concluded in frustration. OK, I responded, let’s take things one step at a time. I told her I would gather some intel and that we would revisit the topic when we had some more information. But I assured her that we want to come visit and that the most important thing is that we are all safe.
My parents live in Southern California and my husband and I and our two small kids live in Northern California, which is within driving distance. The conversations get more complicated when the distances are longer and when you factor in flights and international travel. Not more than a few days prior to my discussion with my mom, I’d had a similar reunion-related conversation with my brother, who lives with his family in Romania and is planning to come with them to the United States over Christmas to visit us. It’s still many months away, but we are all already concerned about whether that visit will occur due to possible international travel restrictions or quarantine measures. Like so many families spread out around the world, we are wondering just how long it will really be until we see each other—we hope it will be a matter of months and not longer.
As soon as travel restrictions are lifted, 61 percent of us plan to visit family and friends, according a late April survey of 1,249 Americans commissioned by financial planning firm ValuePenguin. And I know I’m not alone in wondering what those in-person reunions will look like, whether we should be having them at all, and the best and safest ways to do so.
With this in mind, I reached out to some epidemiologists and medical experts for their take. Here’s what they had to say.
As you’re deciding whether to visit friends and family amid the ongoing coronavirus pandemic, the first thing to consider are the risks involved.
“With any trip that you plan or with any activity that you plan, there’s going to be a spectrum of risk—there are no things that are safe and things that are not safe. It is a spectrum,” says Kristin Bratton Nelson, an infectious disease epidemiologist at Emory University.
Evaluating that risk spectrum begins with the parties involved: Who is potentially planning to get together, and are any of those people in a higher risk category that would make them more likely to have serious complications if they were to contract COVID-19? Older adults (anyone 65 and older), people who live in a nursing home or long-term care facility, and people of any age with an underlying health condition that includes chronic kidney, lung, or liver disease, asthma, a severe heart condition, obesity, diabetes, or is immunocompromised are at higher risk for severe illness from COVID-19, according to the U.S. Centers for Disease Control and Prevention (CDC). People in these higher-risk categories are going to want to think about a possible visit in a different way than those who are not at higher risk.
“It doesn’t necessarily mean that you shouldn’t go visit. I think it makes it more important to identify ways that you can do it as safely as possible,” says Nelson.
If younger children are participating, it will be harder for them to practice proper social-distancing behavior—something else to consider, say experts. For some friends or family that might be a deal-breaker; for others, they may be willing to take the risk.
Another thing to consider when analyzing the potential risks is the level of coronavirus transmission both in the destination you are coming from and the one you are traveling to. If you are going to a coronavirus hot spot, the risks of becoming infected are greater, and if you are coming from one, the risks of spreading coronavirus to others is greater.
Before requesting time off or booking hotels or flights, you need to discuss whether everyone truly wants the visit to happen and how everyone envisions the visit playing out.
“Be certain everyone involved understands all the risks and agrees before you travel,” says Dr. Hanh Le, senior director of medical affairs at medical information site Healthline. “Though you may be comfortable taking a flight to visit your elderly parents, they may be uncomfortable and frightened about the prospects. That’s added stress on them that should be avoided.”
It’s not just about the actual risks, but also the perceived risks. With regards to fears and concerns about how to stay safe and healthy during this pandemic, not everyone is on the same page within any given household, let alone two or more households. This is a process for everyone, and we’re all getting used to how to navigate the wide range of emotional and psychological responses people are having to the pandemic.
Compromise is key. We’re all going to have to become better at listening and understanding if we want our interactions to be as respectful and stress-free as possible. Establishing what everyone is comfortable with upfront before planning a visit will be crucial to the visit’s success. This is where a lot of the hard work needs to be done.
In “negotiating” with my mom about when to visit, one of the issues we have been grappling with is whether it’s better to visit very soon and use our time in lockdown as a period of time during which we have all lowered our risk of exposure by remaining mostly at home. The other option is to wait until there could be a further lowering of COVID-19 case numbers in our areas or additional developments, such as more widespread testing or possible treatments.
Depending on where you live, there may still be restrictions on nonessential travel that could limit your movements. For instance, the state of California’s plan for the gradual reopening of businesses following the March shelter-in-place order has entered Stage 2, which allows for the reopening of lower-risk workplaces such as retail (with curbside pickup). The resumption of nonessential travel (at least at the state level) does not enter the picture until Stage 4 (although some counties and cities have hospitality slated to be part of an earlier Stage 3 of their reopening plans). Given the statewide mandate, numerous counties and cities throughout California have issued guidance and notices reminding hotels and short-term rental owners that they cannot allow nonessential workers to book yet. Restrictions such as these, as well as quarantine measures in states such as Florida and Hawaii, could mean that waiting it out would offer greater flexibility and options for travel.
On how to best time your visit, public health experts don’t really have a set answer.
“There’s just so many factors at play that I don’t feel confident in projecting that, ‘Yes, it’s smarter to travel now because the risk is going to be lower now than it’s going to be in a few months,’” says Nelson. She notes that in theory, as restrictions loosen, we could start to see case numbers increase in some places, but that there are other developments like improved testing capabilities that could help mitigate any possible increases.
Dr. William Miller, an epidemiologist at Ohio State University, says that regardless of when you go, there are actions you can take before your trip to minimize the risks: “Try to be as safe as possible in the time leading up to the visit. Be very cautious about your own behaviors before you travel. And ask whomever you’re visiting to do the same.”
In recent weeks, access to coronavirus testing has increased. The U.S. Food and Drug Administration has authorized two viral COVID-19 tests (a nasal swab version and a saliva sample version), which test for current infection and typically provide the results within a few days.
“You may want to help assuage everyone’s concerns by getting COVID-19 testing done to confirm that everyone is negative for the novel coronavirus,” says Healthline’s Le.
Getting tested could provide an additional layer of risk reduction, but it’s definitely not foolproof. Le notes that the tests are not always accurate. A recent report found that more than one in five COVID-19 tests are false negatives—the results indicate the person is not infected even though they actually are. And even if you were found to be negative for COVID-19 before your trip, there is no guarantee that you won’t become exposed and infected during your travels.
Most experts agree that a negative test result doesn’t mean you should forego other precautions, such as social-distancing measures, hand washing, and mask wearing.
As with any interactions in these pandemic times, the fewer people you come into contact with, the lower the risk. The CDC reminds travelers to be vigilant about all of their encounters and touch points during their travels, whether they are driving, traveling by train or bus, or flying.
While air travel requires spending time in close proximity with other people, which can increase your risk of exposure, the CDC states that viruses and other germs don’t actually spread easily on flights because of how air is filtered on airplanes.
A road trip may seem like the safest bet due to the fact that you are contained within a single vehicle, but the agency warns that you should still be mindful about opportunities for exposure during the drive. Those can include getting gas, stopping at restaurants, and using restroom facilities. Wash your hands after you have been in a public place, wear face masks in public, and opt for to-go or drive-through food services if you can.
If your travel exposes you to other people, be sure to take that into consideration with respect to the safety precautions you take upon arrival. If your trip requires a flight, you might want to factor in additional safety measures such as a quarantine once you arrive at your destination or limiting your encounters with friends or family to physically distanced visits, advises Le. (Check out AFAR’s list of what countries are allowing travelers, and if they’re requiring quarantine.)
When it comes to how to safely socialize, Miller has a good set of rules. “Remember: time, space, people, place,” he says.
“Time” relates to how long you’ll be spending with someone in close proximity (less time means less risk). “Space” refers to maintaining six feet of distance. “People” means you should be aware of the recent exposures of the people you’ll be with, and “place” indicates that outdoors is better than indoors.
“Plan for lots of outdoor activities if possible,” says Miller.
Along those lines, Nelson adds that having a big gathering of people inside your home is probably not a good idea. But if you can hang out in the yard, have a small outdoor barbecue, go for a hike, have dinner on a restaurant patio, or do anything outside or in a well-ventilated area, those are lower risk interactions.
“I think that’s a reasonable way to reduce risk and still socialize, scratch the itch and be around the people you want to see that you love,” she says.
Public health experts agree that no matter what, smaller gatherings are better. And in fact, in some municipalities throughout the country, there are restrictions limiting group sizes to up to 10 people. For that reason, as we consider these get-togethers, it is probably better to think about them in smaller, bite-size chunks rather than as a coming together of everyone in your crew. This is not the year for the massive reunion.
Staying in someone’s home increases the opportunity for virus transmission, according to public health experts. If you or the people you plan to stay with are in a higher-risk category, you may want to consider staying elsewhere and having outdoor socializations.
“Staying in someone’s house you are guaranteed to exchange whatever sort of germs you have,” says Nelson.
But, she added, if you plan on spending a lot of time visiting someone in their house, then staying in a hotel won’t really help—it’s the combination of staying elsewhere and outdoor socializations that will minimize risk.
As we consider travel experiences beyond our immediate environs to see some of the people who matter most to us, it’s important to revisit some of the CDC’s critical reminders about health and safety during the coronavirus pandemic.
The agency emphasizes that we should not travel if we are sick. This one may seem obvious, but it also bears repeating. All of the precautions we are becoming accustomed to in our daily lives apply to travel as well. Wearing a mask is recommended for all settings where six feet of distance cannot be established between people. When you can maintain that six feet of distance between others, you should.
Pack ample hand sanitizer for when soap and water aren’t readily available, and bring plenty of food and water with you in case restaurants along the way are closed. If you are going to stay at a hotel or other accommodation, the CDC offers guidelines on how to best clean and disinfect surfaces to improve the safety of the stay.
As we learn to live with the coronavirus pandemic, risk assessment is becoming an integral part of our daily lives—whether we like it or not. The decisions we will make in the coming days, weeks, and months about how and whether to see our friends and family are no different.
Says Nelson: “Telling people the only way to do this is to abandon all social contact, that’s just not effective. Humans thrive on social contact. We have to see other people, we have to engage with family and friends. As epidemiologists, as public health practitioners, we need to provide people with safe ways to do that.”
If seeing your family is something you need for your sanity and you can reduce the risks to a level everyone is comfortable with, Nelson says the benefits might outweigh the risks. For some, they might not. Ultimately, the decision is our own.
If you’re wondering where things netted out between me and my mom, I stood firm on the vacation rental idea and my parents have promised not to (openly) resent my decision. The most important thing, we all agreed, is that we are eager to see each other and that we will definitely do so soon: We have our sights set on the end of June, while our two young kids are still home from preschool and daycare. As for my brother, time will tell.
This article was originally published by AFAR here.
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