The pandemic has altered traditions and celebrations worldwide. A lot of people are struggling with the notion of a very different sort of Thanksgiving. The CDC says "postponing planned travel and staying home is the best way to protect yourself and others this year." The agency suggests either virtual gatherings, or celebrations with only the members of your own household.
Dr. Asaf Bitton of Brigham and Women's Hospital, a primary care physician and public health leader, wrote for WBUR early in the pandemic about the need to thwart the spread by resisting the natural temptation to mingle.
With Thanksgiving just a few days away, and coronavirus cases surging, Bitton joined WBUR's Weekend Edition to help people navigate their way through a fraught season of decisions. Below are his remarks, lightly edited for clarity:
On his single most important piece of health guidance for Thanksgiving 2020:
The most essential advice is really to scale back those plans and really to stay within your household. It's critically important, given the rise [in cases] that we're seeing, that we have minimal to non household mixing, especially indoors.
On how to cope with the idea of missing a quintessential Thanksgiving experience:
This has not been the year that I think any of us might have imagined, and the way that I approach this is really by actually naming and holding that loss out in front and and agreeing that it really stinks and that that it's really disappointing. You know, sometimes in medicine and public health, there's a tendency to browbeat or to shame or to sort of throw a bunch of statistics on the wall and to ignore normal human inclinations, behaviors, wants, needs. I don't think that's going to work here. I think we need to hold that there's a loss that we are facing together — the obvious health loss and the disaster that we've seen, but also those day-to-day losses of normal life, normal year-round sequences of events and things that we hold so dearly.
So we name it, we mourn it, and then we say, look, this looks like a transient phenomenon. There is a light at the end of the tunnel. The vaccines are coming. They look even more effective than we thought they did. And so the core features of our response, to keep ourselves in our communities and our families safe, have to hold us till that six or nine months until the vaccines are widely deployed. And when we ensconce it in that naming, that empathic response, that holding of loss, but that sort of light at the end of the tunnel, then it becomes a more productive conversation.
On how people can make decisions about a pandemic Thanksgiving when some details don't match up between advice from different voices of authority:
I think simplicity...[is] key here. I mean, we can parse the differential between the guidances and we can go back and forth and we can even together as communities engage in some magical thinking. But the reality is this: mixing households in an indoor environment without masks is pretty much one of the most unsafe things we can do right now.
Now, if people really need or feel that they they really need to have some commemoration of this holiday, then it's a matter of harm reduction and ways to mitigate risk. And so I would say in that case, it's not about the numbers inside the household. It's about can you have a distanced-based event outside? With separate utensils and being really mindful and careful about keeping your space in between people? That's a compromise that some people may want to look toward.
But the idea that, "Well, we'll mix two households together and that's only nine people total!"-- I think that's just not going to cut it at this time when we know that that increases risk so much....This is really perhaps less about legislating or ... making regulations around not having households mix, and more about a renewed social compact together to keep each other safe by doing the right thing.
On the concept of testing as a way to do an end-run around the no-mixed-household guidance:
[There are] dangerous misconceptions about testing. I love testing.... But the story with testing is the following: testing by itself will miss potential cases of infection in the three-to-five day window before the actual test itself. So if a person hasn't been fully quarantining — and by quarantining, I mean not having interaction with other humans outside their pod — then...a negative test on that given day before Thanksgiving might give a false sense of security. It might actually hide the fact that they're in fact infectious and could infect the people in that indoor household where everyone's not wearing masks.... Please don't be under the impression that a negative test on Wednesday before Thanksgiving is enough to give you the sense of security that you wish to have.
On how to overcome the impulse to succumb to vigilance fatigue:
What we give up moment to moment, what we give up for Thanksgiving? It all adds up in terms of averted suffering and averted cases and averted reverberations across our community. And maybe that's a way for people to think about this loss of the Thanksgiving that they knew, or that they had hoped for. You may never be able to exactly know all the people that don't get sick because you and so many others made the best choice. But you can know in aggregate that that is a definable and large group of people — if we can all hold steady.
On avoiding the danger of believing the science but also believing oneself to be an exception:
The thing about COVID is that those...virus particles with 15 genes, to the extent that they have any volitional will, they want you to think that you're the exception. They feast on your exceptionality. Because it takes just that moment of lacking the will or lacking the stamina to do what you already know is right, for you to get infected. And ...now that people kind of have become almost numb to the pandemic — that you can sometimes get away with that indoor gathering or that time not wearing a mask — it almost breeds a sense of invulnerability. But unfortunately, that's not how the biology and the physics of this work. Your luck can only hold up for so long. And that is why we come back to the fact that there's no reason to believe biologically or medically that anybody really is the exception. This is an incredibly infectious virus and it's in some ways waiting for you to let your guard down and believe in your own exceptionality. And so...especially since we have the light at the end of the tunnel with these vaccines and with better testing...for now, you know, not believing in your own exceptionality perhaps is the best way to go forward.
On embracing the challenge of bundling up to spend time outdoors instead of indoors this Thanksgiving:
You know, I grew up part of my life in Minnesota, which has a large Scandinavian heritage population. And the famous saying, I believe from Norway, is that "there is no bad weather, there's only bad clothing." And so I think that we in New England can sort of take some of that to heart.
On how to create a better 2020 Thanksgiving with the public health seal of approval:
It's not going to be the Thanksgiving you'd wanted it to be, so it's not going to be indoors with other families. That means it could be on Zoom with people you love. If the weather cooperates, and you're willing to wear masks and distance, it can be outside carefully.... But above all else, the simplest thing and the best thing to do is just make it a different Thanksgiving, a quieter Thanksgiving, a smaller Thanksgiving this year so that we can get to next year and have the big celebrations that we're all hoping for.
This segment aired on November 22, 2020.