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You possibly can survive the winter and never unfold Covid-19. Right here's how.

Winter and the holidays can be tough times even in typical years: short days, cold winds, seasonal blues, and family stress, to name a few of the challenges many of us face. But the ongoing Covid-19 increase with As of November 5, more than 100,000 new cases of the virus have been reported daily, aiding the typical activities that can help keep the darker days – holiday gatherings, meals with friends, volunteering, or a visit to Santa Claus – in worse limbo .

Despite nine months into the pandemic, figuring out whether and how to approach a previously routine activity or event is still complicated and often stressful. And the rationale seems to be shifting with new case rates and evolving guidelines – and with our own fluctuating pandemic burnout.

The hard fact is that, especially with the rise in Covid-19 cases, "all activities have some risk of being infected by the virus," says Amesh Adalja, doctor and faculty member at Johns Hopkins University's Bloomberg School Public health environmental health and technology.

And doing things with people you know – but who you don't live with – can increase that risk. Just because you know and love (or loathe) them, a family member or old acquaintance is no less at risk of bringing or catching the virus than a stranger. And it will likely make you less cautious than if you were interacting with a stranger.

Much of the challenge in avoiding Covid-19 is that it spreads before people show symptoms. This is how you or anyone else can come to a gathering and feel the picture of health just to spread the virus to those you come in close contact with.

We spoke to epidemiologists and other health professionals about the safest, riskiest ways to see others, keep kids busy, help, and travel during the pandemic this winter.

This table shows the risk that people without symptoms will spread Covid-19 in different scenarios. The risk level of each scenario is somewhat fluid and there are no precise limits for the density of people or the duration of contact. From the BMJ paper "Two meters or one: What is the evidence of physical distancing in Covid-19?"

Amanda Northrop / Vox

(Note: Activities are relative in each category, so a "moderate" risk in one category does not have the same relative risk as "moderate" in another.) Here's what they said.

See people from other households

Regardless of whether you usually celebrate Hanukkah, Christmas, Festivus, New Years, or a birthday at this time of year, your meeting plans will likely need to be adjusted – if not entirely.

For one thing, it is risky to have people from different households together. But of course that's what many of us are used to at this time of year. Historically, more than 85 percent of Americans planned to attend a vacation gathering with extended families or friends. And the average holiday meal was about 11 people. In many states, this exceeds the limit for private gatherings. (The maximum is 10 or less – sometimes as low as five – in many locations including Connecticut, Delaware, Idaho, Illinois, Kentucky, Maryland, Massachusetts, Mississippi, Nevada, New Mexico, New York, North Carolina, Ohio, Oregon, Texas , Washington and Washington, DC and some West Virginia counties In some states – including Colorado, Hawaii, Illinois, Minnesota, Rhode Island, Vermont, Washington, and Wisconsin – many congregations may not include people from other countries Households in general.)

In many places, "don't do anything with people you don't actively live with (because) so many viruses are spreading in the community," said Lisa Gralinski, epidemiologist at the University of North Carolina Healthcare's Gillings School of Global. For example, an area where more than 5 percent of tests are positive shows that there is undocumented community dissemination. Few areas of the country have test positivity rates below this. Even in these places, she says, "I would encourage people to be incredibly careful."

A map of the positive Covid-19 test rates in each state. A quota over 5 percent is considered too high.

German Lopez / Vox

As Krysia Lindan, an epidemiologist at the University of California at San Francisco, stated in an email to Vox, "avoiding intergenerational gatherings involving older adults and those with health problems" is particularly important.

Expected family time may need to be skipped this year. "This could be the year when you don't invite your young adult children to come home or, conversely, to visit your parents or grandparents," writes Lindan. (Even if a student is doing "distance learning" near campus, "you may really want to check what they did," she says. "Inter-college transmission has been high.")

If you're still thinking about meeting in person, be it family or friends, virtually gather all potential guests together first to have an open and in-depth conversation about the risks, goals, and ground rules for the meeting and the people around it Remember Everyone Is Keri Althoff, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, discussed all of their exposures from the past two weeks to the event and advised at a press conference in November. This call should include naming a point person who will be notified if someone gets symptoms and / or positive tests in the two weeks following the event, and who will also call all other guests to let them know if they are quarantined and / or Must be treated tested, she said.

After the meeting, there is one more step to take: quarantine for at least 10 days (or a week if you get a negative test result). This will allow you or anyone else to spot cases of Covid-19 that may have emerged from the gathering and not re-spread it to the community.

Here are considerations for different formats of gatherings this season:

Safest: virtually

Amanda Northrop / Vox

It's hard to pass dessert when you're partying on Zoom. But it is also impossible to pass Covid-19.

Althoff said that while she loves visiting her "ginormous" family in Iowa, she won't see them in person this year. Instead, she plans to attend video toasts and virtual game nights with family and friends.

Other ideas are for everyone to prepare the same food or drink to enjoy while on the call, or play a charade game – or even get kids involved in entertainment.

Safest: Small, short, outdoors, aloof and masked – keep eating and drinking

For some, it is unwilling to see others in person until there is widespread vaccination. The safest way to do this is to keep the gatherings small, short, outdoors, detached, and continuously masked – which means you don't have to eat or drink anything.

"When we want to be together, we want to be outside," says Jodie Guest, vice chair of the epidemiology department at Emory University's Rollins School of Public Health. She also recommends keeping it under 10 people in total – with just one or (if your region allows) two other households – and keeping them all separated by a household capsule.

A warning at this time of year is to watch out for outside heating. They can help extend the outdoor season. However, if too many people crowd around them, it can increase the risk of the disease spreading. As Guest notes, she bought two heaters for her porch: one for her household and the other, far apart, for a couple they regularly see outdoors.

Moderate risk: eating outdoors

Amanda Northrop / Vox

If food and / or drink are non-negotiable, "you should have tables outside and people in blisters or family units together," writes Lindan.

The guest adds that everyone should be masked when not eating or drinking. People should also watch out for alcohol consumption, as it reduces inhibitions, reduces the likelihood that people will adhere to safety protocols, and is more likely to revert to pre-pandemic socialization behaviors.

Riskier: Indoors, aloof and masked – but testing and quarantine can help

Amanda Northrop / Vox

If you choose to have people together indoors, there are several things you can do to reduce the risk of your event becoming a Covid-19 outbreak. Most of the usual pieces of advice apply: make sure people always wear their masks and stay away physically. Keeping households in different areas "is not perfect," says Gralinski, "but it's better than mixing completely and being right next to each other."

Keep it short and limit the number of participants. And increase air circulation by opening windows, turning on fans, and turning on the central air conditioning or heating, Althoff said.

But be warned that the risk is higher indoors than outdoors, says Adalja, although a gathering could be organized with the best plans – detached seats, open windows, masks. "Especially when it is a social get-together with friends or family where (people) feel comfortable."

Another option is to have them all tested and quarantined beforehand. Here's how:

Test: Have everyone do a Covid-19 test before the meeting – and if someone is traveling, they should test before the trip.

Quarantine after testing and before visiting others: This means households should avoid contact with others, even if they are not going to the grocery store, work or school in person. "Once you've tested, you need to quarantine as much as possible," says Guest, so that you don't get infected with the virus in the meantime. The CDC recommends that travelers be quarantined for at least a week upon arrival – and retested three to five days after the trip.

Now, if everyone is negative, the gathering could continue with a little less concern about the spread of Covid-19.

Adalja recommends doing some research for testing first. There are delays in returning results in many places, and the American Clinical Laboratory Association warns of an increased strain on testing capacity and a lack of testing equipment before the holidays.

As Adalja points out, "the test results are not falsified – just look at the White House," where senior officials are regularly tested but there have still been numerous outbreaks.

If someone is unable to effectively quarantine upon arrival (e.g. a young adult coming home to their parents' house and unable to be completely separated from other household members), the next best option is to at least get everyone tested and try quarantine as possible until the results are in, says Lindane.

Most Risky: Indoors with little or no precautions

A normal meal indoors with people outside of your household is at a significantly increased risk of transmitting the virus. Other things that further increase the risk include large numbers of people, multiple households, long gatherings, physical closeness – whether they are people cooking together in a kitchen or at a table – limited wearing of masks and screaming (it was finally an election year) or sing (who keep Christmas carols).

"I would just avoid large indoor gatherings at all costs," says Lindane. "I know it's really hard."

Keep kids busy

Outside, outside and mostly outside, experts generally say this winter that these are activities for children. Therefore, if you live in a colder climate, making sure you have warm outdoor gear that is a good fit for your children is an important year.

Even so, there are a few caveats about this guide. Not all outdoor activities are created equal, and there may be some indoor activities that, if done responsibly, may be slightly less risky. It's also important to remember that "the virus survives longer in winter due to the lower temperature and humidity, which increases the risk of transmission in winter compared to summer," said Dean Blumberg, chief of pediatric infectious disease at UC Davis Children & # 39 ; s Hospital, wrote in an email to Vox.

Safest: Activity only with household members

Of course, the activities that are least at risk of Covid-19 for children are the same as adults: avoid exposure to anyone outside the household, whether indoors or outdoors.

This could mean more screen time – including this one – this winter Video calls with family and friends. Or tinkering time offline (especially to give something to people you can't see in person) or doing house projects like cleaning old toys and clothes to donate. Or pool yourself for outdoor activities outside of other households, such as exploring quiet parks, hiking, biking or tobogganing.

Moderate: Calm indoor activity with masks and distancing

What about all the museums and cinemas that played a key role in Before Times, especially during long school holidays? "If you go to a children's museum where you limit the number of people and they all wear masks and wash their hands and they have good air filtration, that's probably fine," Lindane says.

Adalja agrees. Also, if there is a museum in the house, "if they are distant and wearing masks, it becomes an obstacle that is harder for the virus to overcome."

However, some experts warn that other indoor activities – even if they seem to take similar precautions – carry a higher risk, especially when the local case numbers are high. "If your community has increased broadcasting, an indoor activity like a movie theater is risky," noted Blumberg. "Social distancing can be compromised in public areas like corridors and bathrooms, and people may not always mask themselves when sipping their soda or snack."

Riskier: Busy outdoor activities with temporary distancing and masking

According to the experts we spoke to, a busy playground can bring you a higher risk of spreading Covid-19 than a quiet indoor activity that follows the best protocols.

For example, “Playgrounds – these will never be without risk,” says Adalja. Not all children wear their masks diligently, the surfaces are very sensitive to touch, and it is essentially impossible to keep children physically at a distance. "That is a risk that you have to do an individual risk calculation for," he says.

Outdoor sports in which children come into contact also increase the risk of transmission. As well as crowded events or outdoor activities, especially those where people don't always wear their masks (e.g. to eat or drink).

Riskiest: Include indoor activities with others

All families must make the best choices for themselves. And keeping children isolated from others, especially during school holidays or in remote schools, isn't always feasible.

Adalja suggests a few things that families can do to reduce the risk in these situations. Continue to avoid overcrowded indoor spaces where you come into contact with other households. Instead, work with another family or two (if your region allows it) to start one small group of children for personal visits to ensure everyone is familiar with the risks and behaviors of each household – and to emphasize hand washing.

"The whole thing is about weighing risks and benefits," he says. “Playing children is crucial for psychosocial development. It's a balancing act. “A high level of community broadcast can set these standards and make personal activities with friends too risky for many. And every time group visits take place outdoors, it can lower the risk.

Help others

As a result of the pandemic, millions of people in the US are struggling to get enough food on the table for themselves and their families. More people need help this winter than ever before in over 80 years. So there was no better time to find ways to help others.

Thinking about and helping others is a really important way to combat anxiety and stress, as well as a feeling of helplessness – all of which are pervasive right now.

"It is always good to volunteer and this could ease the sadness of not being able to see family and friends like in previous years," writes Lindan.

The guest agrees: "I think people are hungry for ways to help one another."

The safest way to do this is to give money

Charities can often stretch donated money further than donated goods. Therefore, financial contributions are not only helpful, but also non-transferable for Covid-19. Established charity review websites like GuideStar or Charity Navigator can let you know how much of your contribution will go straight to the cause.

Next safest: contactless help

The next surefire way to help this season is through contactless volunteering or donation. This can be a formal, organized effort, such as bringing groceries to a local pantry, or it can be a personal effort, such as arranging grocery or meal deliveries for members of the higher risk community.

The guest notes that this kind of effort can also be safely turned into some kind of shared experience – for example, organizing a coat or blanket trip with friends, family or neighbors. (She suggests quarantining the donated goods for three days before touching them.)

Moderate: Help out personally with a few others

There are many organizations that rely heavily on volunteers behind the scenes. Grocery pantries or clothing and housewares distribution centers may provide an opportunity to donate time and help in a slightly safer setting than serving meals, for example. Before you go, find out how many other people you will be working with, whether they will need masks, and how long you are likely to be working (shorter shifts are better to limit exposure).

You shouldn't have to look long for ways to make a contribution in your region in this way, says Gast: Since the beginning of the pandemic, the need for volunteers has only increased.

Riskier: volunteering with a larger number of people

If you want to do more personal work, first go to places you want to volunteer and ask if they accept personal help and what precautions they take. For example, if you want to serve meals, ask how many people they allow at any given time, if people need masks, how often the organization cleans the area, and if you are the only one touching the serving utensils, guest notes.

"You should continue to take the same precautions as you always do when you're in a group – masks, even face shields, hand washing, and distancing where possible," Lindane writes.

Most risky: volunteering in shared apartments

The riskiest ways to give something back this year are by volunteering in person in a place that has a lot of people, whether it is a homeless shelter or an assisted living facility. Everyone carries different risks of acquiring or spreading the virus. As the guest notes, most of these places are very careful about their protocol towards outside people (and whether they even allow it). Even so, it's still good to review their practices first. You may also ask if there are other ways that your time or money could be more valuable to them than serving in person.

travel

Traveling on vacation is usually a bit of hell: crowded planes, overheated trains, and stuck cars. But this year the specter of Covid-19 makes it all the more daunting.

"With cases increasing in many parts of the US, the best advice at this time is to avoid travel," Lindane writes. (Staying at home also has a bonus in preventing a lot of excessive carbon emissions this year.) The CDC actually asked people to avoid travel.

Traveling right now can also get pretty complicated pretty quickly. Not just because you have to pack extra masks and hand sanitizer (and double that if you're traveling with kids).

Meanwhile, more than 20 states have issued travel warnings or assignments – fined up to $ 10,000 for violations – so that some or all of the people can review, quarantine, and / or file official records if they have been in the state for more than 24 hours Visiting hours (ie not just passing through). So that usual week-long visit to a family in California, New York or Chicago won't be so feasible. (Specific instructions are also available through the CDC's Trip Planner.) "It could be a logistical nightmare to make sure you comply," Adalja said at a news conference earlier this month.

In addition to state or city travel guidelines, many employers, schools, and day care centers have rules governing travel. Althoff therefore recommended checking these as well. "Be ready to accept abrupt changes to your travel plans."

If you have to travel this winter there are ways to reduce your risk of catching or spreading the virus. Much of it depends on how you travel.

Safer: self-contained cA trip with your household

In this case, you are only traveling with your pod in the car. But the key is to make it household members only. Expanding the roster to include other people greatly increases the risk of this type of travel, especially since "If you are on a road trip with a group of your friends, you are more likely to be exposed and less likely to be at a distance," says Adalja.

Things to consider along the way: where to eat, where to sleep, and where to make pit stops.

Brief pit stops to use a public bathroom should be fine, says Guest – just wear your mask and wash and / or sanitize your hands. Though some bring their own open air facilities on car trips these days.

"It will be safest to be as self-contained as possible," says Gralinski. For sleeping, this could mean renting an apartment where you have to be all to yourself to “bring as many supplies as possible”. The idea is to minimize contact with others, including limiting trips to a local grocery store. Roadside pickup and drive through are safest for additional food.

What about hotels? A recent study in Nature, based on cell phone data from 98 million people in major cities, found that hotels and motels were pretty big drivers of the spread of Covid-19 this spring – right below restaurants, gyms and cafes. (Although their data is from March 1 to May 2, mask mandates and other Covid-19 prevention protocols have only just begun.)

According to Adalja, hotels these days take a lot more precautionary measures and should be pretty safe as long as you are careful. "It's not the hotel itself, it's what you do in the hotel," he says. So wear face covering, wash your hands, and avoid other people (e.g., skip the elevator, restaurant, bar, and lobby public areas).

For her part, Gralinski said she still avoids hotels. For a late October vacation that she and her husband were on, they rented an RV to travel in. “We had our own bedroom, our own bathroom, and were taken out by the roadside. We were pretty self-sufficient, ”she says. They parked in the driveways of friends' homes and saw them safely in the open from a distance. Even though it was cold, it worked. "We saw friends and it was amazing."

Moderate risk: airplane

We do not currently have any final data on air traffic safety. Many of the studies that looked at aircraft risk and showed transmission cases were done before masks were required.

Increasing security is the fact that masks are now mandatory and airplanes have a very high rate of air circulation. They replace full cabin air with clean air about 20 to 30 times an hour, hopefully removing more viruses from the air you may be breathing. "The data shows that air travel is currently fairly safe with people wearing face covers," says Adalja.

But flying has other disadvantages, most of which have to do with other people. You are in close proximity to many of them – even if the center seats are empty as they remain with some, but not all, airlines – and you are largely at the mercy of your decisions. Do you keep your mask on during the entire flight or have you taken it off for long distances?

Another thing to keep in mind about air travel is that it's about a lot more than just sitting on a plane. “It's the whole experience,” Althoff said, including airport shuttles, lines, many High-touch interfaces and people from all over the country, including areas with very high transfer rates. If you are going to be at an airport, she advises "practicing your testimony on reminding a stranger to keep your distance".

Also, be ready to remind people of masks. At airports and even on airplanes, it still seems to happen that "inadequate masks are worn – by dangling them from the earlobes or positioning them under the nose," says Lindane. "Don't be afraid to ask people to put on their masks when they're at the airport."

How can you lower your risk in doing this? decide to fly? In addition to wearing a good mask, wear eye protection like sunglasses, goggles, goggles, or a face shield (with a mask), says Guest. You can also check for snacks or drinks on a flight. This used to be a benefit, but these things now increase the chances of virus transmission as people remove their masks to eat or drink. Therefore, if possible, you should avoid a flight with food and drink. "If you have to eat or drink something on the plane, do so when other people are not eating," writes Lindan. "Leave your mask on and only lift it to put food or drink in your mouth."

Somewhat riskier: train

Even less research has been done on train travel. A study of passenger trains in China relatively early in the pandemic – mid-December 2019 to early March 2020 – found that Covid-19 spread to nearby passengers fairly easily on these trips, especially if people were in close proximity for more than three hours found. Based on these results, published in the summer, the authors suggested that physical distancing, mask wearing, and improved air filtration would reduce the rate of spread on trains.

Dies sind alles Schritte, die Amtrak eingeleitet hat, zusammen mit einer verbesserten Reinigung und anderen Maßnahmen. Züge haben auch den Vorteil, dass sie im Allgemeinen weniger Passagiere pro Quadratfuß als Flugzeuge haben und dass Sie möglicherweise besser von jemandem wegkommen können, der sich nicht an die Regeln hält oder krank erscheint. (Amtrak bietet in einigen Zügen auch Privatzimmer an.)

Experten, mit denen wir gesprochen haben, schlugen jedoch vor, dass es immer noch etwas riskanter sein könnte als Flugreisen. Dies liegt zum Teil daran, dass Fernzugfahrten mit größerer Wahrscheinlichkeit länger sind als ein typischer Inlandsflug, wodurch sich Ihre Kontaktzeit für andere erhöht. Waggons haben auch nicht ganz die gleiche Luftaustauschrate wie eine Flugzeugkabine – Amtrak verspricht 12 bis 15 Mal pro Stunde einen sauberen Luftaustausch.

Wie auf Flughäfen gibt es auch Bahnhöfe, mit denen man sich auseinandersetzen muss – und die Vorschriften werden möglicherweise noch weniger durchgesetzt, da sie in der Regel offener für die Öffentlichkeit sind (anstatt dass der Großteil des Flughafenraums hinter dem TSA-Checkpoint-Screening liegt).

Am riskantesten: Langstreckenbus

Wir haben auch nicht viele solide wissenschaftliche Informationen über das Risiko einer Covid-19-Übertragung in Langstreckenbussen. Frühere Untersuchungen deuten jedoch darauf hin, dass diese Art des Reisens riskanter sein könnte als Flugzeuge oder Züge, insbesondere wenn die Menschen nicht die richtigen Vorsichtsmaßnahmen treffen. Eine Fallstudie zeigte, wie ein einzelner kranker Passagier in einem Bus in China 23 von 67 anderen auf einer Fahrt infizierte, die weniger als eine Stunde dauerte. Bemerkenswert ist jedoch, dass bei diesem weit verbreiteten Ereignis, das im Januar 2020 stattfand, keiner der Passagiere Masken trug und der Bus Luft umwälzte.

Busunternehmen in den USA haben die Sicherheitsprotokolle aktualisiert, um die Verbreitung des Virus zu verringern. Windhund zum Beispiel benötigt Gesichtsmasken, hat die Reinigung und Desinfektion seiner Busse verbessert, ersetzt die Busluft etwa 12 Mal pro Stunde und „ermutigt“ die Fahrgäste, sich physisch zu distanzieren.

Epidemiologen sind jedoch derzeit noch vorsichtiger gegenüber Busfahrten gegenüber anderen Verkehrsträgern. "Bei einer längeren Fahrt ist es möglicherweise schwieriger, die Maske aufzubewahren, und sie ist wahrscheinlich nicht so erzwungen wie in einem Flugzeug", sagt Adalja.

Ein experimenteller Winter – und eine neue Perspektive

Amanda Northrop / Vox

Dieser Winter wird anders sein. Aber es muss nicht alles schlecht sein, es sei denn, wir sind entschlossen, es so zu sehen. „Normalerweise empfinden die Menschen die Feiertage als stressig, daher könnte dies möglicherweise das Jahr mit weniger Stress sein. Sehen Sie einfach, wie es sich anfühlt, nicht zu all diesen Partys zu gehen oder sie auszurichten“, schreibt Lindan. Sie nennt es ein Jahr für "einige Experimente". Sie hatte ein Picknick am Strand zum Erntedankfest. Der Gast schlägt vor, eine Fernwanderung mit seinen Lieben anstelle einer typischen Mahlzeit oder Party zu unternehmen.

Wir haben durch unser Handeln die Möglichkeit, einen echten Einfluss auf die Ausbreitung der Pandemie zu haben – nicht nur in unseren eigenen Kreisen, sondern in der breiteren Gemeinschaft. Dies hat wichtige Auswirkungen auf die Gerechtigkeit und Gerechtigkeit der Gesundheit, da das Virus bei seiner Ausbreitung mit größerer Wahrscheinlichkeit wichtige Arbeitnehmer, ihre Familien und farbige Menschen trifft und ihnen größeren Schaden zufügt.

"Unsere Epidemie wird nur zurückgehen, wenn die Menschen die entsprechenden Vorsichtsmaßnahmen treffen", schreibt Lindan an Vox. "Das Problem ist, dass wir einfach nicht das tun wollen, was wir tun müssen."

Dieser Winter wird also Akzeptanz, Ausdauer und Perspektive erfordern.

Wie relativieren Epidemiologen diese schwierige Saison für sich? Zum einen, indem wir „anerkennen, dass dies schwierig ist und dass die Feiertage 2020 ganz anders aussehen werden“, sagt Guest. „Wir müssen jetzt vorsichtig sein und uns gegenseitig schützen, damit alle da sind, die uns wichtig sind, wenn wir (in Zukunft) zusammenkommen. Es ist wichtig, dies zu berücksichtigen, damit sich diese Opfer jetzt als wertvoll erweisen. "

Lindan stimmt zu. "In den Ferien ist es wirklich schwierig. Wir wollen unsere Familie und Freunde sehen, und es ist eine wirklich schwierige Aufgabe, nicht so lange so zu leben. Aber es ist ein kleiner Preis für den langfristigen Nutzen. "

Und wie Althoff uns erinnert: "Wir werden für kommende Generationen Geschichten aus diesen Feiertagen erzählen." Es liegt weitgehend in unserer Kontrolle, sie zu den richtigen zu machen.

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