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

Winter and the holidays can be difficult even in typical years: short days, cold winds, and family stress, to name a few. But the continued US Covid-19 surge with More than 200,000 new virus cases have been reported daily since December 7th (about twice as many as a month ago). These are the main activities that support us – holiday gatherings, meals with friends, volunteering, or visiting Santa Clause worse limbo.

Even though the pandemic was more than nine months ago, figuring out whether and how to approach a previously routine event is still complicated. And the rationale seems to be shifting with new case rates and evolving guidelines – and with our own fluctuating pandemic burnout.

Experts are still analyzing the data on what role Thanksgiving played in the increase in Covid-19 cases and deaths. The hard fact remains, however, that with case rates this high, "all activities have some risk of being infected by the virus," said Amesh Adalja, doctor and faculty member of the Bloomberg School of Public Health at Johns Hopkins University's Department of Environmental Health and Engineering.

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

So this winter will be different, but it doesn't all have to be bad unless we are determined to see it that way. “Usually people find the holidays stressful, so this could possibly be the less stressful year. Just see what it feels like not to go to or host all of these parties, ”noted Krysia Lindan, an epidemiologist at the University of California at San Francisco, in an email to Vox. She calls it a year for "some experiments". For example, this year she had a picnic on the beach for Thanksgiving. Other experts suggest trying different activities, such as: Take a long-distance hike rather than gathering around a meal or party.

Much of the challenge is that Covid-19 spreads before people show symptoms. So everyone can feel the picture of health, only to inadvertently transmit the virus to those they come in close contact with.

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

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. (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.

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 at any other time in over 80 years. So there was no better time to find ways to help others.

Helping not only benefits others, it also has a positive effect on you. For example, thinking and helping others is a really important way to combat anxiety and stress, as well as a feeling of helplessness – all of these are ubiquitous these days.

"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.

Other experts agree, "I think people are hungry for ways to help one another," said Jodie Guest, vice chair of the epidemiology department at Emory University's Rollins School of Public Health.

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 deliveries or food deliveries for higher-risk community members.

The guest notes that this type 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 offer opportunities to donate time and help in a slightly safer environment 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, go to places you want to volunteer first and ask if they accept personal help and what precautions they are taking. 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.

See people from other households

Amanda Northrop / Vox

Whether you usually celebrate 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. Prior to the pandemic, more than 85 percent of Americans planned to attend a vacation get-together 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, Massachusetts, Mississippi, Nevada, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Texas , Virginia, Washington, and Washington, DC Certain states – including California, Colorado, Illinois, Minnesota, Rhode Island, Vermont, and Washington – do not allow other states to attend meetings Households in general.)

Even if your state allows gatherings (decisions that are often made for a variety of reasons, including transfer rates and also political and economic interests), there are good reasons to reconsider gatherings.

For example, in many places, "You shouldn't do anything with people you don't actively live with (because) the virus is spreading in the community," said Lisa Gralinski, an epidemiologist at the University of North Carolina Gillings School for Global Public Health . For example, an area where more than 5 percent of tests are positive shows that there is undocumented community dissemination. Only two states have test positivity rates below this as of mid-December. 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 as of December 16. A rate above 5 percent is considered too high.

German Lopez / Vox

As Lindane notes, it is particularly important to "avoid intergenerational gatherings attended by older adults and those with preparatory health conditions".

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.

The final warning from Covid-19 that others need to be reminded of is that this particular virus often spreads just before someone develops symptoms (as well as from people who do not develop symptoms at all). A good feeling therefore offers little to no degree of security.

With this in mind, here are reflections on the various meeting formats this season.

Safest: virtually

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.

"We want to be outside when we want to be together," says Guest. 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

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 of people sticking to safety protocols, and is more likely to revert to pre-pandemic socialization behaviors.

Riskier: indoors, distant and masked – or during testing and quarantines

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 the event 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, although a gathering could be organized with the best of plans – detached seats, open windows, masks, says Adalja. "Especially when it is a social get-together with friends or family where (people) feel comfortable."

If strict distancing is a challenge, one option is to get everyone tested and quarantined beforehand. It's not a perfect strategy, but it can reduce the risks a bit. 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. And tests are just a snapshot of a point in time and can even give negative results if someone is early on in the infection.

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 to quarantine as much as possible while waiting for results, 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, a long gathering, physical closeness – whether they are people cooking in a kitchen or at a table – limited wearing of masks and shouting ( it was a choice) eventually year) or sing (keep the holiday songs).

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

travel

Amanda Northrop / Vox

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. The CDC actually asked people to avoid travel.

Traveling right now can also get complicated pretty quickly, and not just because you have to pack extra masks and hand sanitizer.

Approximately 24 states and the District of Columbia have travel advisories or instructions with fines of up to $ 10,000 for violations that allow some or all of the individuals to investigate, quarantine, and / or submit official records if they enter the state Visiting longer than longer than 24 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 travel planner.) "Making sure you comply with regulations could be a logistical nightmare," Adalja said at a press conference in November.

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 increases the risk of this type of travel significantly, especially since "If you go on a road trip with a group of your friends, you are more likely to be exposed and less likely to be distant," says Adalia.

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 – wear your mask and wash and / or sanitize your hands. Some travelers these days choose to bring their own open air facilities on their car trips.

"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 November study in Nature, based on cell phone data from 98 million people in major cities, found hotels and motels were pretty big drivers of the spread of Covid-19 this spring – right below restaurants, gyms, and cafes. (However, your data is from March 1st to May 2nd, a period when 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 an autumn vacation that she and her husband were on, they rented an RV to travel inside. “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. "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 for 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," says Althoff, including airport transfers, lines, and more 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. If possible, avoid a food and drink flight. "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

Train travel is even less explored than air 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.

These are all steps Amtrak has taken, along with improved cleaning and other measures. Trains also have the advantage of generally having fewer passengers per square foot than planes and that you may be better able to get away from someone who doesn't follow the rules or appears sick. (Amtrak also offers private rooms on some trains.)

However, experts we spoke to suggested it could still be a little riskier than air travel. This is in part because long-distance train journeys are more likely to be longer than a typical domestic flight, increasing your contact time with others. Wagons also don't have quite the same rate of air exchange as an aircraft cabin – Amtrak promises to provide clean air exchange 12 to 15 times an hour.

As with airports, there are train stations to deal with – and regulations may be even less enforced as they tend to be more open to the public (rather than having most of the airport space behind the TSA checkpoint screening) .

Most risky: long-distance bus

We also don't have a lot of solid scientific information on the risk of Covid-19 transmission in long-haul buses. However, previous research suggests that this type of travel could be riskier than planes or trains, especially if people don't take the right precautions. A case study showed how a single sick passenger on a bus in China infected 23 out of 67 others on a journey that took less than an hour. It is noteworthy, however, that at this widespread event, which took place in January 2020, none of the passengers were wearing masks and the bus was circulating air.

Bus companies in the US have updated security protocols to reduce the spread of the virus. Greyhound, for example, needs face masks, has improved the cleaning and disinfection of its buses, replaces bus air around 12 times an hour and “encourages” passengers to physically distance themselves.

However, epidemiologists are currently more cautious about bus trips than other modes of transport. "On long journeys, it may be more difficult to store the mask and it is unlikely to be as enforced as on an airplane," says Adalja.

Keep kids busy

Amanda Northrop / Vox

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, writes in an email to Vox.

Safest: Activity only with household members

The activities with the lowest risk of Covid-19 for children are the same as for adults: avoid exposure to people 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 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, cycling or sledding.

Moderate: calm indoor activity with masks and distancing

What about all the museums and cinemas that played a key role in the past, 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," says Lindane.

Adalja agrees. Even if there is a museum in the house, "if they are distant and wear 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. "In öffentlichen Bereichen wie Korridoren und Badezimmern kann es zu Kompromissen bei der sozialen Distanzierung kommen, und die Menschen maskieren sich möglicherweise nicht immer, wenn sie an ihrem Soda oder Snack nippen."

Riskanter: Beschäftigte Outdoor-Aktivitäten mit zeitweiliger Distanzierung und Maskierung

Laut den Experten, mit denen wir gesprochen haben, kann ein belebter Spielplatz ein höheres Risiko für die Übertragung von Covid-19 mit sich bringen als eine ruhige Aktivität in Innenräumen, bei der die besten Protokolle befolgt werden.

Zum Beispiel „Spielplätze – diese werden niemals ohne Risiko sein“, sagt Adalja. Nicht alle Kinder tragen ihre Masken fleißig, die Oberflächen sind sehr berührungsempfindlich und es ist im Wesentlichen unmöglich, Kinder körperlich auf Distanz zu halten. "Das ist ein Risiko, bei dem Sie eine individuelle Risikokalkulation durchführen müssen", sagt er.

Sportarten im Freien, bei denen Kinder miteinander in Kontakt kommen, erhöhen das Übertragungsrisiko, ebenso wie überfüllte Veranstaltungen oder Aktivitäten im Freien, insbesondere solche, bei denen Menschen nicht immer ihre Masken tragen (z. B. zum Essen oder Trinken).

Am riskantesten: Schließen Sie Aktivitäten in Innenräumen mit anderen

Alle Familien müssen die besten Entscheidungen für sich selbst treffen. Und Kinder von anderen isoliert zu halten, insbesondere in den Schulferien oder in abgelegenen Schulen, ist nicht immer machbar.

Adalja schlägt einige Dinge vor, die Familien tun können, um das Risiko in diesen Situationen zu senken. Vermeiden Sie weiterhin überfüllte Innenräume, in denen Sie mit anderen Haushalten in Kontakt kommen. Arbeiten Sie stattdessen mit einer oder zwei anderen Familien zusammen (sofern dies in Ihrer Region zulässig ist), um eine zu gründen kleine, geschlossene Gruppe von Kindern für persönliche Besuche, um sicherzustellen, dass jeder mit den Risiken und dem Verhalten jedes Haushalts vertraut ist, und auf Händewaschen bestehen.

"Bei der ganzen Sache geht es darum, Risiken und Nutzen abzuwägen", sagt er. „Kinder spielen ist entscheidend für die psychosoziale Entwicklung. Es ist ein Balanceakt. “ Ein hohes Maß an Community-Übertragung kann diese Maßstäbe setzen und persönliche Aktivitäten mit Freunden für viele zu riskant machen. Und jedes Mal, wenn Gruppenbesuche im Freien stattfinden, kann dies das Risiko senken.

Ein Ruf nach einer neuen Perspektive

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.

Katherine Harmon Courage ist freiberufliche Wissenschaftsjournalistin und Autorin von Cultured and and Octopus! Finden Sie sie auf Twitter unter @KHCourage.

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