Podcast: Preparing for winter and the holidays under the shadow of COVID-19

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Jim Dryden, host: Hello, and welcome to “Show Me the Science,” conversations about science and health with the people of Washington University School of Medicine in St. Louis, Missouri, the Show Me State. As we continue to look at Washington University’s response to the COVID-19 pandemic, we focus in this episode on something they used to frequently warn about on the hit TV show “Game of Thrones.”

clip: “I know this is hard for you. But winter is coming. We know what’s coming with it. We can’t face it alone.”

Dryden: It’s doubtful Jon Snow was anticipating a spike in cases of COVID-19. But health officials around the world have been doing just that. Throughout the U.S. and Europe, cases are spiking. As cold weather moves in, holidays approach, families wonder whether to gather, and college students approach the end of a semester and prepare to come home.

Andrew Janowski, MD: And so this could be one way that the virus spreads to the student. And then ultimately, they bring it back into the home. Even though everybody at home has been trying to do their best to prevent the spread of the virus, it’s really bringing these groups closely back together is a way that the virus is being spread. And so I would be concerned about a lot of these college students going back home over the holidays. And so that may be one discussion that is somewhat difficult to have, but maybe would be one way to keep a lot of our family members safer.

Dryden: That’s Andrew Janowski, a pediatric infectious diseases specialist. He says families need to talk through some difficult issues as the start of winter approaches. And he says 2020 may have to be the year we put holiday traditions on hold the way the rest of our lives have been put on hold. Though some things can’t be delayed like labor when a baby is due. Mati Hlatshwayo Davis is a doctor who treats COVID-19 patients, or at least she has since she returned from maternity leave. She says this year, she will spend the holidays with her mother, who is visiting from South Africa, but she only agreed to that after her mom agreed to quarantine.

Matifadza Hlatshwayo Davis, MD: My mama met Naniso Davis for the first time in September after she was born in May. She landed from South Africa, took every precaution on the long flights, and then quarantined for two weeks outside of our home, and then joined our family and has been helping us take care of our two babies since then.

Dryden: The holiday season at the start of winter is a traditional time to gather for meals and family celebrations as well as a time that college students return home from school. Janowski says those sorts of things are likely to increase risk for infection with the novel coronavirus. Fall and winter were always predicted as a time for a second wave. But Janowski says really, the first wave never ended.

Janowski: Thinking back to March and April and May, I think there was a lot of hope that it was going to be a first wave. But then the hope was that we would be able to suppress it. It would come down. And then we could keep it at low levels with all these kind of various ways to reduce the risk of transmission of the virus: social distancing, wearing masks, all these different aspects. I think we never really got past that first wave. And I think we just kind of plateaued at that point for really the rest of the summer. And then now, things are coming together again where now everybody’s moving inside again. People are trying to get back to normal, but we’re nowhere near it at this point. I just think that this is just a continuation of very much what kind of started in the spring and continued over the summer and now is kind of peaking again. So it’s still kind of all, kind of one kind of big wave at this point.

Dryden: As they used to say a lot on “Game of Thrones,” winter is coming, and the early part of winter brings holidays like Thanksgiving and brings with it questions like, “Do we gather with family?” Let’s start there. Is it safe to gather with your family this year?

Janowski: At this point, the biggest risk factor for transmission of the virus is close person-to-person contact. When we’re talking about being in close proximity and not wearing a mask, those are kind of two major risk factors of how this virus is being transmitted. And so when we’re talking about getting back together with our families, there are certainly risks associated with it. Certainly, I can indicate that this is certainly one of the higher risk activities, getting back together with a large group of people in a small space. But kind of everybody has to kind of consider what are their own dynamics in their home and their family and others that they may be visiting. Ultimately, I do think a lot of these activities over the holidays are going to bring significant risk. And it possibly could fuel further cases being spread across the country.

Dryden: In my family, we’ve been kicking around this, that maybe every household — there’s maybe like five or six households that will get together for Thanksgiving. Maybe everybody makes their own turkey. Then on Thanksgiving Day, we drop off side dishes on each other’s front porches, and then maybe we eat while we’re all on Zoom together. Something like that. I mean, I assume that would be much safer than having us all around the same table.

Janowski: Yeah, definitely. And certainly, that’s one viable way to really kind of reduce some of these factors that fuel the spread of the virus. And so finding ways that we can still spend time together but still maintaining that social distancing and limiting the possibility of close contacts of situations particularly, when people aren’t wearing masks. So that would be one way that I think it would be doable, is that we can trade food amongst the various households and then having a family dinner still by Zoom. I think those are certainly viable. Certainly trying to keep the number of people down in these group sizes, I think, is another kind of important component to all of this.

Dryden: Another issue at this time of year is students coming home from college. They’ve been away. There have been infections and quarantines at many schools. If they want to — should they come home?

Janowski: Having these kids going back to home, that is certainly another way that the virus can be spread, and you can just imagine that you have a campus that has some amount of the virus being spread at any time when these students are considering going back home, and they may be going back to families and friends who are high risk for developing complications associated with the virus. And so this could be one way that the virus spreads to the student, and then ultimately, they bring it back into the home. Even though everybody at home has been trying to do their best to prevent the spread of the virus, it’s really bringing these groups closely back together as a way that the virus is being spread. And so I would be concerned about a lot of these college students going back home over the holidays. And so that may be one discussion that’s somewhat difficult to have, but maybe it would be one way to keep a lot of our family members safer.

Dryden: To stay safer, what do we do? I mean, dedicated bathrooms? I mean, should everybody wear a mask in the house for the first several days while the student is home? Do we try to restrict their visits with their friends over the holidays? How can you make it safe if it has to happen?

Janowski: So I think some of the ideas that you’re bringing up, Jim, are kind of the perfect ideas of how you can approach it. So really, limiting your exposure to any outside people that also could be a potential spreader of the virus is important. Wearing masks may be still helpful when you’re in a home. Of course, you’re going to be in a lot more close contact with your family members. And so it’s still going to be important to wash your hands and kind of all these other aspects. There still isn’t a perfect way to really kind of prevent the spread of the virus. That’s where the hope of the vaccine, and we’re still very much months away at this point. There is going to be some risk in bringing families back together. Not only do we have to consider how the virus is being spread, but then what are the consequences? And so I think that’s an important consideration, and it goes into why there is no one clear recommendation for all these situations. I think every family has to take a different approach.

Dryden: In terms of recommendations for certain family traditions, one family tradition that a lot of folks have is looking at lights over the holidays. And there are places in St. Louis, for instance, the zoo and the garden, where you can walk through a holiday light display. There’s other places you drive through light displays. I’m guessing staying in cars is probably a little safer. But do those sorts of experiences present danger, or are those the kinds of things that the families could do safely?

Janowski: I think for the most part, most of the holiday light displays are going to be fairly safe to visit over the holidays. Probably the safest would be being completely outside and just walking through them and being able to really kind of social distance yourself from any other people who aren’t in your social circle. There are some of these light displays where you may run into somebody who’s kind of managing it or some people who ask for donations at the end or beginning. Those are potential areas during these activities that could be associated with increased risk. But when we’re talking about, also, driving through some of these light displays, I would say it’s also fairly safe because, really, you’re just in your own enclosed environment within your own automobile.

Dryden: What about holiday traditions like church services?

Janowski: There’s been many outbreaks that have been associated with church gatherings. I know different church services have been taking different approaches. And depending on the number of people and the space involved, there are some of these church events that are somewhat safe to participate in, while there are others that are still relatively high-risk. I think the important factors are really trying to limit the number of people that are there and really allowing people to spread out and also trying to limit any kind of shared items, whether it is shared prayer books or any other items that could be potential source and then spread of the virus. But nonetheless, church events and other kind of religious ceremonies are still on the higher end of activities that are at increased risk for transmission of the virus.

Dryden: Lots of space in between family groups in the pews, maybe eliminating singing. I mean, do those sorts of things make it any safer, or is it just the problem of having a large number of people together indoors?

Janowski: Yeah, I think the primary components that really kind of fuel the risk in a lot of these religious ceremonies is, first, that you’re moving indoors, and then you may be in an enclosed space, in which you’re in very close proximity to many other people. One of the interesting studies was back early from the start of the pandemic, where they looked at this choir group in Washington state. And what they saw was that there’s a significant outbreak associated with these choir members. And what they really kind of traced it back to was the singing part of the choir events. And so it may not just be just close proximity that you’re coming into people, but you also have to consider the risk of closely talking to somebody, singing. And so these are other ways that various secretions are being spread. And it’s those secretions that contain the virus, and it’s how you’re being infected with it.

Dryden: Church, it reminds me of a story about myself because a couple of weeks ago, I attended a family funeral. I’m guessing there were maybe 50 people, and it’s exactly those types of family events — funerals, weddings, birthday parties, bar mitzvahs — that can really be dangerous. Is that correct?

Janowski: Yes, exactly. And this really comes into play when we’re talking about eating and drinking. Those are the type of situations where you’re just obligated to take off your mask. And so that’s really when you’re being at greater risk of being exposed to the virus being spread from others nearby. And then you talk about these situations where again, you’re indoors, in close proximity, that just increases the risk even more at that point. And so that’s why a lot of different analyses of what are the risky activities in which this virus is being spread, it’s being traced back to restaurants and bars.

Dryden: Those tend to be popular places during the holiday season. But Janowski says they are places to avoid during this holiday season and throughout the winter. Although he says carryout and curbside service is OK, as has been the case since the start of the pandemic. And since the pandemic started, a second wave has been predicted. But Mati Hlatshwayo Davis says she’s disappointed things ever got this bad.

Hlatshwayo Davis: You start off by just feeling like we live in the United States, right? So we’re clearly going to put all the best minds together. We clearly have the leadership and the resource capacity to get on top of this within a reasonable time. And so even though in the beginning, we were in dire straits as far as resources specifically — I think about testing; I think about conversations we were having around PPE — but had we had standardized and consistent messaging, we should be in a better place than we are now. The capacity is there. I just worry that we’ve put ourselves in a position where it’s going to be harder to engage the community in the way we need to because they’re tired, quite frankly.

Dryden: Are you tired as a health-care worker that we’re not in a better place? When you get up in the morning, do you think, “Oh, here we go again?”

Hlatshwayo Davis: I mean, Jim, I’m exhausted. I’m exhausted, right? But we’re all exhausted. Anyone who does this work is exhausted because it’s all-encompassing, right? We do this at work. We do this at home. Am I exhausted? Yes, absolutely. Am I still happy and passionate to do it? Absolutely, because I come at this wearing multiple hats. I’m a physician. I’m a researcher and public health expert. But I’m a mom. I’m someone’s daughter. I’m a wife. And so we’ve had to live. I think part of the reality of this pandemic fatigue is having to live with all of these emotions at the same time for a long stretch of time. But yeah, I gave you the long version. Short term, yes.

Dryden: And you have seen this from both sides, both as an infectious diseases specialist and as a person who had a baby during the pandemic. And I wonder about pregnant women, young mothers. Do you need to take special precautions both for themselves and for their babies during this time?

Hlatshwayo Davis: Being in a pandemic whilst pregnant was certainly a unique experience. When I was pregnant, things were very new. So a lot of the information and data around how this impacts pregnant women was not well understood. What that experience was like for me was extraordinarily scary because, like I said, the data was just not conclusive about what that risk looked like for me and for my unborn child. My husband and I — I’m very fortunate I have a present and capable partner, but we were alone. We couldn’t have family with us. You’re having a newborn breastfeed every two hours. People don’t talk about some of the other things that happen there. My child was not breastfeeding well, which caused a lot of a lot of stress and strain and anxiety. And we had a 4-year-old that we had to also take care of. And I’ll tell you, it was one of the most difficult things I’ve ever done in my life. But again, I’m telling this story from a place of having so much. So imagine what that’s like for folks who don’t have as much as I have, and I’m doing, have been doing, the exact same thing.

Dryden: As we’re heading toward holidays, when I think of holiday gatherings that I’ve attended over the years where there was a new baby there, especially during a pandemic, if you’re going to be in contact with family members, passing around the baby doesn’t seem like a good idea.

Hlatshwayo Davis: Excellent, excellent question. When we are going through tough times, we focus on family. We focus on traditions. We focus on connection. And I think that’s what’s been so difficult and somewhat barbaric about this pandemic is how much it stripped us of those safety blankets, right? I can only speak to my experience, and what I’ll tell you is I have the most supportive obstetrician ever. And what he did for me is, I came to him with all these questions: What do we do with the baby? What do we do with family? Family are going to be so upset with us that they can’t come. Should we just let them, and how do we manage that? And he looked at me, and he said, “Absolutely not. And what you do is make me the bad guy. I’m going to tell you exactly what we’re recommending right now for the safety of your baby, first, and for your safety, and you make me the bad guy.” So my advice to anyone is, whoever is managing and directing your care, you should be having these conversations early so that you can start planning and warning your family about whatever restrictions need to be in place, and you need to get everyone on the same page. What we love about babies is that they are babies, and we put babies first, right? And as upset and as disappointed as people will be, I think making sure that the baby’s health is the priority will put most people in a collaborative and supportive place. And reminding people that this is – it feels like it’s gone on forever. But this is just for a short time. The end is nigh. We will get through this. When I speak to people about holiday traditions, there’s things we can’t do. It was devastating to have to make the call to tell our parents, a month out of the baby coming that, unfortunately, not only can you not be here for her birth, but you’re probably not going to meet her for a little bit into her life. It was terrible. I felt like I was a 24-hour reality TV show as much as I was on FaceTime and all kinds of apps to make sure the grandparents saw their grandbabies. But that’s what we committed to. Make sure they got to see her stinkingly cute, fat face every day if we could. And once we got through that period, we started to discuss what’s the plan forward to be able to get them here safely. Not only for the baby’s health, but because grandparents specifically fall into that older category that can really get sick. And understanding, my husband and I are physicians. So after maternity leave, we’re back at work on the front lines, and we don’t want to be the ones to put them in a bad position.

Dryden: How can that be done safely?

Hlatshwayo Davis: Yeah. So what we know is that coronavirus has disproportionately affected the older segment of our communities as well as Black and brown communities. And so we talked about a plan where we know we’re being as safe as we can be at work. We talked to them about the risks that they still had, being of their age group and knowing what we do for a living. And we couldn’t keep them away. And so they had to commit to a two-week quarantine. And both sets of grandparents did it. And when I tell you, I don’t have the sort of sit-at-home-everyday kind of grandparents. I mean, my husband and I’s parents are some of the most active people that I know. This was a big sacrifice for them and enormously difficult. My mom is a single parent, so she doesn’t have a partner that can be with her, and she had been alone since March in Johannesburg. Their shelter-in-place was a lot stricter. This was a really tough challenge for her. But they did it. They did it for us knowing we needed help when we went back to work, and they did it out of love for their grandbaby. So my mama met Naniso Davis for the first time in September after she was born in May. She landed from South Africa, took every precaution on the long flight and then quarantined. We’re very fortunate to be able to provide a safe space for her to quarantine for two weeks. And then joined our family, and has been helping us take care of our two babies since then. Every family is not made the same. What is true for my family is not true for the family next door or down the street. We get nowhere venting our frustrations through talk of blame. So when we don’t see people masking, when we don’t see people doing what we think they should be doing, let’s just really be thoughtful about how we engage people and have healthy conversations to get our communities where we’d like to see them.

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Dryden: Mati Hlatshwayo Davis, as an infectious diseases specialist, is particularly interested in the intersection of SARS COV-2 and influenza, another virus that rears its head in winter. We will discuss that relationship with her in a future episode of “Show Me the Science.” Until then, she and Andrew Janowski both say that many of our holiday traditions may be dangerous in this pandemic year. So it’s important for friends and families to have potentially difficult conversations about how to celebrate as safely as possible. “Show Me the Science” is a production of the Office of Medical Public Affairs at Washington University School of Medicine in St. Louis. The goal of this project is to keep you informed and maybe teach you some things that will give you hope. Thank you for tuning in. I’m Jim Dryden. Stay safe.