Thanksgiving 2020: Don’t Let Your Guard Down

With COVID-19 spreading more rapidly and Thanksgiving coming up, many of our clients have asked us about testing and quarantining, and whether some combination of the two could make a holiday celebration safer.

We are doing a lot of COVID-19 testing – PCR, antigen, as well as antibody testing – at our Bryn Mawr office as well as at clients’ homes and businesses. There are lots of questions about which test is the right test, and when and how it should be done.

In order to assess your level of risk, it’s important to take a look at how prevalent the virus is where you live. Unfortunately, Pennsylvania and New Jersey are setting records for daily counts of coronavirus infections. The first week of November, the U.S. topped 100,000 new cases in a day for the first time. With this important holiday coming up, it seems to be an appropriate time to answer questions about SARS-CoV-2 testing, when to get tested, and how long to quarantine after being exposed to a person with the virus.

If it were up to the Centers for Disease Control and Prevention, all of your family members would celebrate the holiday in their own homes, spending time with distant relatives through a “virtual dinner.”

So, where does this leave your Thanksgiving plans?

This really depends on your health and risk factors. This is why we have been working to optimize our clients’ health since the start of the pandemic. So, let’s risk stratify, since that’s vital to making recommendations.

Is there a safe way to celebrate Thanksgiving if you’re considered high risk?

Public health officials recommend avoiding holiday gatherings if you’re high risk. Consider having virtual Thanksgiving and “Friendsgiving” celebrations with your wider circle. You can schedule a Zoom toast to share the day or send a moment of gratitude. You could share the same recipes in your separate homes, or maybe send a home care package themed to the holiday. This year, we just need to get creative and be intentional.

Say you’re not high risk, and you’re planning on getting together with family or friends. How to do it right?

As per the CDC, any gathering with people outside of your own household is considered a moderate-to-high risk activity, even if you follow the agency’s guidelines for how to host gatherings or cookouts. Outdoor gatherings have the least risk, but the CDC still recommends wearing masks whenever possible. It also recommends arranging tables and chairs to keep groups of individuals from the same household at least 6 feet away from other family groups.

Unfortunately, typical Thanksgiving Day weather in a lot of the country, and especially in our region, makes outdoor dining difficult or impossible. If the weather is not conducive to bundling up and being outside, keep the windows open since the coronavirus spreads much more easily in indoor spaces with poor ventilation.

The next safest way to do Thanksgiving this year is to keep it inside your pandemic bubble. However, Thanksgiving is an important holiday and if you’re dead set on celebrating the holiday with people who are outside your bubble, consider these things to keep you and your close ones safer:

If you are determined to celebrate any holiday with individuals outside your household, you should think of it as a temporary social bubble. This involves having all would-be attendees take a PCR COVID-19 test, and then drive to the gathering in private vehicles without having contact with others along the way.

The first advice is to keep your gatherings small. It makes sense to check the rules for gatherings in your county.

So, you’re traveling and seeing others outside your bubble, and want to keep family safe? What type of test should you get, and when?

The most common and reliable tests are molecular tests, also known as PCR tests. We are able to swab our patients and have results back the next day. These are the kind that are required for air travel.

In case you have been exposed, a common question is how long after exposure is it best to test. The answer is that the tests are most sensitive five to eight days after exposure. A recent study published in the Annals of Internal Medicine demonstrated that in the four days before symptoms appear, the chances of a false negative result range from 100% the day after contracting the virus to 67% on Day 4 after contracting the virus.

Antigen tests are becoming more common. These are rapid tests that produce the result about 10 minutes later. These are the COVID-19 equivalents of home-pregnancy or rapid strep tests. As with all rapid tests, there’s a trade-off between speed and accuracy. In addition, these tests were never intended to reliably detect infection in asymptomatic individuals.

When used as quick diagnostic tools for people with recent onset of COVID-19 symptoms, positive results on antigen tests are almost always accurate. This allows people with symptoms who test positive to be isolated quickly, before they can infect others. But even when a person has a viral load high enough to produce symptoms of illness, antigen tests often have a false-negative rate of 10% or more. When these rapid antigen tests are done on an asymptomatic person, the likelihood of having a false negative is even higher.

These are not the odds you want to have when your family’s safety is on the line.

Everyone wants a test to be cheap, accurate, and fast, but it’s not feasible to have a combination of all three, at least not at this time. Some reports put the false-negative results for rapid antigen tests at 50%, whereas false negatives for PCR tests are far lower.

Antibody tests check for IgG and IgM antibodies, telling you about past exposure. Theoretically, having IgM antibodies should tell you about current infection, but sensitivity for this is in the 80s.

After many months of separation, it’s incredibly tempting to let down your guard to see the people you love. Many of us are feeling real pressure to do something – anything – to make our lives feel “normal” again. But remember to balance temptation with precautions and ground rules. Whether you choose a bubble or a Zoom holiday, you and your family can still be thankful – for your health and safety.