What are the safe rules for gathering with family and friends?

As Canadians look forward to the Thanksgiving weekend, it seems the traditional turkey is being served with a side of confusion. With rates of COVID-19 on the rise in many places, public health officials are trying to provide up-to-date advice about how to gather safely. But even that can be inconsistent and confusing.

Dr. Lynora Saxinger is an infectious diseases expert in Edmonton and an associate professor of microbiology and immunology at the University of Alberta. She joins Dr. Brian  Goldman, host of the CBC podcast The Dose and the radio program White Coat, Black Art to provide some guidance and some food for thought as we move into fall and winter.  Here’s part of their conversation. 

In Ontario and Quebec, public health officials are asking us not to gather with anyone outside our own household this weekend. In fact, the Quebec government has asked the whole province to stay home, period. What’s your best advice on what we should be doing for Thanksgiving this year?

My thinking about this has changed over the last couple of weeks, as we’ve seen the numbers shift … to really flaring numbers. And so I’m taking a much more cautionary stance now.

At the moment, we’re seeing transmission from groups of people gathering indoors. And that is not a good Thanksgiving outcome for anybody, honestly.

So what are you doing for Thanksgiving?

I’m staying at home with my immediate family in my household bubble, if we’re using that terminology, and I will be making phone calls to family and friends. We might go out for a walk with another family after dinner. That’s about as ambitious as we’re going to get this year.

Dr. Lynora Saxinger, an infectious diseases expert in Edmonton, says she’ll be staying home with immediate family this Thanksgiving and other Canadians should consider doing the same. (Martin Weaver/CBC)

And what about gathering outside? How much would that reduce the risk?

Well, we still feel that outside gatherings are, you know, significantly safer than indoor gatherings. And when you look at outbreak investigations … the majority of them tend to be indoors related. 

To get even more granular about this, what about things like utensil sharing, and going upstairs to use the bathroom, even if you are meeting  outdoors? 

For shared utensils, there are some fairly easy ways to minimize the potential risk and that would be pre-plating. Like one person does the pre-plating rather than everyone grabbing a spoon and serving themselves. Or else [if] people only used their own utensils for serving food.

And then for bathrooms, I actually just think as long as people are washing their hands before they grab doorknobs, that kind of is in the realm of  … [manageable] risk. But you know, wiping down the high-touch surfaces and having wipes available for people after they use the facilities, I think, is also prudent and reasonable and not that difficult.  

How much does the risk vary depending on where you live at this point? 

Between the cities that are entering a resurgence, I think that the risk is pretty similar and that there are lots of places in Canada where [it is] fairly low risk. Even with that, though, it just takes one super-spreader event to really change the course in a community.

So even if you’re in a low-risk community, a big indoor gathering or a church supper or something like that still strikes me as being not something you should do, because it would just take one person who’s gone from a higher to low risk place, who has mild or annoying symptoms that they’re not even paying attention to, to potentially transmit to a whole bunch of people. 

On this week’s episode of White Coat, Black Art, we’re having a panel discussion on confusion and mixed messages. And it brings up a point that I want to ask you: Do we just wait for the provinces to tell us what to do? Or are there indicators that we can use to judge for ourselves that this is a time when I really need to stop gatherings and just really hunker down?

People have gotten desensitized to messaging. They’re not looking at the daily numbers as much, and you’ve just experienced life walking around. Things look a lot more normal. But just because you can do something by the provincial rules or the community rules doesn’t mean that you should do it.

We actually cannot go back to normal yet because we do not have any significant advances against this virus [such as a vaccine or treatment]. We’re tired of it and it’s not tired of us yet.

We have to just say, OK, we’re going to reduce our contact numbers, we’re going to really think critically about our networks, we’re going to do those physical basics and get back into the habit. We’re going to have to do the hard reset. 

This is a time when a lot of university and college students would ordinarily be coming home. What can parents and their returning students do to minimize the risks?

Wow, this is such a hard one, because you’re so excited to see them.

I actually think that if people are coming back from a campus situation, because we know that young people are much more likely to have essentially an inapparent infection, that you do kind of have to go with the quarantine at home. [You have to make] a real effort to reduce the shared communal space interactions, which is a real bummer. But going back to the old habits of interacting within the household could actually pose a risk, honestly.

University and college students should consider staying on campus this Thanksgiving or going into quarantine if they are home for the holiday. (Julia Wall/The News & Observer/The Associated Press)

Are there some places when we should just be telling our university and college-age kids to just stay at the university or college? 

That should be definitely on the table. And I mean, every family is different. If you have a household bubble that includes people who are at higher risk, I think that those families might really look at saying, ‘Hey, we’re gonna do a lot of Facetiming over Thanksgiving and I’m sending you a care package.’

But if they are going to be coming home, masking within the house, handwashing, distancing and kind of avoiding the shared airspace actually does reduce household transmission a lot. 

Should we even be seeing our older parents and grandparents right now? 

Age alone confers a huge extra risk of severe infection and mortality. I actually think virtual contact is by far the safe option. In places that are not having cases, managing contacts very, very judiciously, might be kind of reasonable.

But those [long-term care] home settings are extremely fragile. And already, we’re seeing outbreaks in multiple care homes all over the country again. 

On a personal level, [while] not downplaying the risk of isolation, when things are ramping up and there’s a lot of unknowns about how much transmission we’re seeing, I have gone to visit my own older parent [before] and I would not do that right now. It would not be an appropriate time to do that. [We use] Facetime again. 

Unless they live in a long-term care facility and you’re deemed one of their essential family caregivers?

Yeah, and then the risk reduction measures become super important [including wearing masks.]

One thing that keeps on striking me, whether it’s visiting elderly people or going into work or just running out to the store, is that Canadians tend to be hardy, stoic people. We’re really used to ignoring minimal symptoms [like a sore throat, runny nose, etc.]. We have to retrain ourselves on that because that’s actually proving to be an issue. 

Visiting through a window, or virtually, with a vulnerable senior may be your safest bet this Thanksgiving. (Submitted by Loralee Wettlaufer)

Part of the hard reset, I think, might be people kind of getting into the mode of doing a little “all-system check” in their own head. Like “how am I really feeling? Do I think something might be going on?” and then modifying your activities and looking to see if you qualify for testing in your local area, because that actually could end up being deadly to somebody.

We’ve heard the Prime Minister say that Thanksgiving might not be what we wanted this year. But he did say we had a shot at Christmas. And I’m asking you now, how realistic is it that we can see more of our loved ones by then?

I think that if we really buckle down over Thanksgiving and the ensuing weeks, and kind of try to figure out exactly what is OK and what is not OK in the fall of 2020, Christmas might look more possible in a lot of areas.

The data from [COVID-19] resurgences elsewhere … tells us that early actions when things are taking off make a huge difference … and so some decisive action right now might make Christmas look a lot more possible. 

 I do think that there’s some clear things that look like they’re just not a good idea right now, [such as] indoor dining — we’ve seen U.S. data that tells us that’s a risk and we can still support our restaurants by ordering out.

I think that getting a little bit more refined and clear on the gathering sizes would be good. And … the communication around bubbles and networks, I think, has gotten really diluted. I think the messaging needs to be untangled. 

So let’s untangle that.  Certainly the sense in Ontario is that we have to burst our social bubbles. What are your thoughts?

[Social bubbles are] an area where we saw a lot of creep of what’s OK and what’s not OK. People feel more confident doing something when they’ve been doing it and nothing bad has happened yet. Even though every time that you have an interaction, it’s a new dice roll, and the person that you’re interacting with could have COVID. 

Since we are living different COVID realities depending on where we live in Canada, what’s your best broad-strokes advice on what factors we need to consider when deciding whether to gather with others?

Because we’re all facing possible upsurges, even if we’re not in one, we [need to] reset and look at the number of people we’re thinking of being in contact with and minimizing it, quite strictly — most strictly in places with outbreaks, to just your own household. 

If we feel that it is worth the risk of face-to face socializing, we distance. We handwash, we mask, we maximize outdoor ventilation. 

Every week that goes by, there is new knowledge about what’s OK and what’s not OK. And this fall could actually set us up for a possible better holiday season at the end of the year. And boy, will we be happy to see the end of this year. 

Q&A has been edited for length and clarity. Written by Dawna Dingwall.  Interview produced by Nicole Ireland, Dawna Dingwall and Dr. Brian Goldman. 


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