En español | We don't need more proof of how dangerous the coronavirus is.
We know that more than 237,000 Americans had died of the disease as of early November, and 95 percent of COVID-19 deaths in the U.S. have occurred among people who were 50 or older. We know preexisting conditions such as obesity, heart disease, autoimmune diseases and type 2 diabetes make coronavirus infection even riskier. We know COVID-19 can cause blood clotting that can ravage your lungs and inflammation that can damage your heart and organs; a viral attack on your pancreas can even cause “COVID diabetes.” And infections can sometimes linger for months in so-called “long haulers.”
Yet we've isolated ourselves for more than eight months now, and the psychological toll of COVID is real. A study from early in the pandemic found “moderate” and “severe” depression symptoms had tripled.
Now the holidays are here, and we're missing our friends and loved ones more than ever. Can we safely celebrate the holidays and the end of a long, lousy year?
"We're not out of the woods with COVID-19,” says Michael G. Ison, M.D., infectious disease specialist at Northwestern Medicine in Illinois. “The virus is still there. It's still dangerous."
To help us cope with the coming holidays, we queried top experts about navigating the season safely and warmly.
1. A relative had COVID-19 several weeks ago. Can he or she still make me sick?
People who have had the virus generally stop spreading it 10 to 14 days after exhibiting symptoms. But the more we learn about the coronavirus, the more twists and turns we discover. For that reason, anyone who has contracted the virus, or thinks he's been exposed to it, should be cleared by a doctor before seeing anyone, says Sten Vermund, M.D., dean of the Yale School of Public Health.
That said, “those people are largely safe,” Vermund asserts. “ ‘Totally safe’ would be a slight exaggeration, but the functional reality is that a recovered coronavirus patient poses a minimal risk to others.”
2. I tested positive for COVID earlier this year. Does that mean I'm immune now?
Unfortunately, we don't yet know the answer to that. People who recover from the virus do have some level of acquired immunity, but it's difficult to know how much or for how long. Research is conflicting: A study of 1,100 COVID patients in the New England Journal of Medicine found that patients had no decline in antibodies four months after diagnosis. But a separate study found antibodies peaking 60 days after diagnosis and declining thereafter. And, of course, there have been a handful of widely reported cases of people contracting the virus more than once.
"When we look at immune responses, we look at how much antibody is in the blood,” Ison says. “With most viruses, that level goes down slowly over time, particularly with older people.” But the coronavirus is a whole new beast. “We've only known about this virus for about nine months,” Ison says. “Even for the earliest patients, all we can say is that immunity may last for nine months. Whether it lasts any longer, we can't know yet."
The severity of one's infection may determine subsequent antibody levels and how long they last. One study of COVID-19 patients in China who had zero symptoms found significantly lower antibody levels than in patients with symptoms. Common sense would point to asymptomatic people being more vulnerable to reinfection because of low or no antibodies. But we simply don't know enough about what antibody level is required to protect people from COVID-19.
3. Is catching the coronavirus linked to how much time we spend together?
The amount of exposure you have to the virus — both in terms of how sick another person is and how much time you spend with him or her — does appear to determine your risk, says Thomas Fekete, M.D., professor of microbiology and immunology at Temple University. That's why so many health care providers have gotten sick, especially at the start of the pandemic, when they had inadequate personal protective equipment.
While there are no established guidelines, Fekete suggests modeling how you handle indoor spaces on the policies in place at Temple's medical school: More than 15 minutes of exposure to another person is “meaningful,” while fewer than 15 minutes of exposure is less worrisome. “We're less concerned if someone rides an elevator with someone for 30 seconds than if he or she shares a small space with someone for an hour,” he says. “Our policy also mandates wearing a mask and eye protection. That said, there are no guarantees."
And that's what makes holiday gatherings so problematic. An infected person will throw off more virus when talking than when breathing — and more still when singing Christmas carols or shouting to be heard.
4. We've already had a bad outbreak in my town. Have we reached herd immunity?
As the pandemic has progressed, you may have heard about getting the U.S. population to a point where enough people have been exposed to the virus — either by infection or vaccine — that it's no longer a threat. This “herd immunity” is a real thing — the U.S. all but eradicated measles because an effective vaccine created herd immunity. Just don't expect this to happen soon with COVID-19.
"Herd immunity requires somewhere in the neighborhood of 60 to 70 percent of the population having immunity,” Ison says. “The epidemiology studies have gone on to tell us that even in the worst areas like New York, it's in the 20 percent range, and in most areas in the 3 to 10 percent range."
A COVID-19 vaccine could change that, but again, we're nowhere near that point. “As we've seen with other viruses, if people don't get the vaccine, we get outbreaks,” he says. “So herd immunity not only takes an effective vaccine, but a willingness to get that vaccine."
5. If I do host a holiday gathering, are there any rules I should put in place for my family?
Here's a good one: Nobody gets to come to dinner unless he or she has had a flu shot. The reasons go far beyond the usual in 2020. Flu and COVID-19 symptoms are similar, so if you become ill with the flu, it could necessitate a trip to the doctor or even the hospital, which puts you at additional risk. And yes, it's possible to get both, either one after the other, or simultaneously, Vermund says. Just imagine getting COVID after your lungs have already been dealing with the flu.
Vermund puts it bluntly: “It is essential for people to get the influenza vaccine. And I mean everybody: children, pregnant women, young adults, middle age, older adults, seniors, everyone."
6. My whole family is in excellent health. Does COVID-19 really pose a threat to us?
The fact is, researchers cannot predict how sick any one person will get if infected by the coronavirus. Recent research out of Stanford suggests that patients with more severe COVID-19 symptoms tend to have higher levels of certain inflammatory molecules in their blood. This could help experts predict severity in the years to come. But right now?
"None of us are clear [about] what's going to happen,” Fekete says. Which means even if you're a “healthy” person, getting COVID-19 is a risk to yourself and everyone else.
"In the best of all worlds, [precautions] would reduce the impact of coronavirus, but also other respiratory viruses. If that's the outcome, I think people will be relatively OK over the winter months,” Fekete argues. “Having said that, I'm expecting to see significant outbreaks in certain populations, such as nursing homes and adult living facilities, and also in immunosuppressed people."
"We've had some terrible ageism creeping into politics and medicine,” Vermund says. “There are people who have an attitude, like, ‘Why should I suffer just to protect the elderly?’ And that's a very unfortunate turn in American society."
What can you do? Watch out for you and yours, of course, but set a strong example for others you know who may not be as enthusiastic as you are to prevent virus spread.
7. Are our holiday traditions ruined?
After more than six months of distancing and isolation, the pressure to gather for Thanksgiving and other holidays will be massive. But this is just one year, and it would be tragic to get even one family member or friend (or yourself!) sick. Remember: An August wedding in Maine was linked to 178 COVID cases and eight deaths — and none of those who died even attended the event.
"Thanksgiving is one of my favorite holidays, but this year it can't be done safely in the usual sense,” Ison says. “We won't just have COVID-19. We'll have the flu and other respiratory viruses as well. So it has the potential to be a perfect storm, and we can't let our guard down. We'll have to get creative with the holidays, which will require more virtual visits."
The good news: It's temporary. “We're not condemning people to a lifetime of this,” Vermund says. “I do have a great deal of optimism for 2021 because we've got more than 400 clinical trials of new antiviral drugs, new biologic agents like monoclonal antibodies, and different steroid strategies. We've got 10 vaccines now in phase 3 clinical trials, which is absolutely remarkable. And we can avoid circulating the virus. So I'm just trying to remind people that 2020 is not 2021. We probably can be closer to normal by the end of next year.”
Holiday Gathering Safety Checklist
- Make the most of the situation: Order or make personalized masks for everyone!
- If weather permits, go outdoors. If not, ventilate the room as best you can.
- Keep people circulating to limit extended exposures between individuals.
- Embrace aggressive hygiene: Have soap at every sink, hand gel in every room.
- Lean on technology. A Zoom dinner may not be ideal, but it can be fun.
- Respect those who choose not to attend or ask you to stay distant and not touch.
- Avoid unnecessary mass transit. If flying, be ultra-cautious and keep distant from strangers the best you can.
- If you're sick, stay home. We'll see you next year!