Today I wanted to pause while COVID-19 is surging in the world and find joy this year. I know that’s hard given the horrific losses of life and stability this pandemic has caused, but I do want to take this time in the holiday season to focus on what we have and can safely do this year. I’m writing this on the third Sunday of Advent. In my religious tradition, that is the Sunday we focus on Joy. I wanted to celebrate today the joys of having a Cozy COVID Christmas and what the science seems to be telling us about how we can celebrate our respective holidays while minimizing the risk to our loved ones and community.
First, it is important to share my perspective, which is that of an ICU doctor who has taken care of too many people who have not survived this pandemic. The loss from COVID19 is staggering. At the time I am writing this, we have 71.8 million global cases, 1.6 million deaths worldwide, and almost 300,000 deaths in the United States. In my state of Oregon, over 1,100 people have died and many more of my fellow Oregonians have recovered from COVID19, but do not know what long-term effects they may face. Heartbreakingly, this is devastating already disadvantaged communities to a greater degree than the general population. There is every indication that the numbers of dead and affected are going to accelerate in the short term, despite the hope that the new vaccines bring. We have children who have been orphaned in our country by COVID-19. We have so many people who have lost family members, and I have even cared for people who have been hospitalized along with other family members, struggling in isolation in different parts of the hospital. The most haunting and horrible part of this illness has been the cruelty of the solitary death. Prior to COVID19 and its safety restrictions, if we knew someone was dying or likely to die despite our best efforts, family and friends would come surround the bed in a vigil- sharing memories and stories among themselves and with those of us on the healthcare team caring for their loved ones. It made a bitter moment bittersweet. This year there is so much bitterness as the ability to have family present in the same way has been taken from us. The patient is often more confused and alone. The family may be outside in a car, or calling in frantically, wild with understandable grief, and will suffer for a long time from the inability to be truly present at this moment of passing. It has been hard to be in the ICU during this time. Every time I leave the hospital after caring for my critically-ill patients, I pull into the garage, go to the room we have designated for Mami’s hospital items, change my clothes and follow my decontamination ritual, and then hug my children and greet my husband, and try to take a moment to recognize with deep gratitude that my family is healthy and whole.
All the grief and darkness can be overwhelming. But in my faith tradition, this is also the season where we focus on hope coming in the darkness. I know that many faiths have similar values in their winter holidays, in which we recognize how vital hope is despite the call of despair. I will focus on three potential gifts from this pandemic. The first is a gift of time. The second is the embrace of new technology. The third is the protective gift of the outdoors.
In my home with two full-time working parents and three children, I know we are not alone feeling like the holidays can be an extra busy time thrown on top of a schedule that barely has enough room in it. The first gift of this extra time COVID has forced upon us has been a very valid reason to jettison the frantic schedule, and spend more time with our families in a sustained way. We can take time to read that extra book, play a game, bake, and build memories that will last. Travel and mixing of households is risky for COVID19 spread, so spending a simple and small holiday this year can be embraced as an opportunity prior to the likely resumption of busier holidays in the years to come.
In a second gift, there is the normalization of using video technology to safely communicate. This pandemic has crashed the entire world onto video conferencing platforms, and it no longer seems odd to talk to someone on the other end of the country or world whereas before they may not have been “in the area.” Now we are video conferencing with people across town or in the same office, so though we are all more physically distanced from each other, many of us are now often in touch with those with whom we had not been as much prior. As a physician, I have been gratified by the rapid uptake in telehealth, which I think will benefit many of my patients.
The third gift has been the seeming safety of the outdoors compared to indoors. COVID19 has been a virus that is so insidious in its long pre-symptomatic phase and capacity to spread through the simple intimate moments of conversation, of laughter and singing. It is precisely the kind of gatherings that we traditionally long to have at the holidays that make COVID-19 most likely to spread. Outbreak investigations have shown the dangers of indoor spaces over and over again. There is the dramatic example of a choir In Washington State- in which one person with covid-19 attended a choir practice with 61 people. 53 cases were identified of covid-19 following this. Three of the 53 people who became ill went to the hospital and two of them died.
Another publication highlighted the danger of indoor dining, with a person infected after 5 minutes from someone sitting over 20 feet away. This makes the idea of the kind of indoor gatherings and religious celebrations many of us would want to have in this time unsafe. Further exploration has shown the importance of lack of ventilation, of close contacts, and indoor spaces for allowing both droplet and aerosol spread of the virus. It appears that spending more time outside is much safer, especially when combined with masking and distancing.
So how can we spend time with our loved ones, especially vulnerable individuals such as grandparents, those with diabetes or hypertension, immunosuppression or other potential risks for severe and potentially deadly COVID infection? The answers are still emerging, but this is what I have done in our lives with the data so far for this holiday season. Though we of course had hoped for a large family gathering at Thanksgiving, our individual households elected not to mingle indoors. I had a delicious meal with my husband and kids, and then we went for a walk in a lovely wooded park with my parents. All wore masks, but were able to enjoy a crisp Fall afternoon together. My parents will go on other masked walks with us and the children, or meet up with us at a park, and we enjoy our in-person time and conversation. I have purchased an electric heat lamp for our back porch, and have invited loved ones over outdoors with masking and distancing as well, and even occasionally sipping hot beverages safely. None of this comes with zero risk, but the risk of transmission outdoors is far lower than indoors, and when coupled with distancing and masks, becomes acceptable.
This is obviously not as satisfying as our usual family holidays, in which we pile more people into a house than fit comfortably, enjoy the chaos and noise of children running all over and the sweetness of multiple generations under the same roof. However, the collective love and respect we are all showing by physically distancing during the holidays is a gift we give to our families and communities. That gift will mean that there will be more of us around to celebrate the holidays next year.
I’m working ICU nights over Christmas this year. I sincerely hope I don’t see you or any of your loved ones in my professional capacity. I wish you a wonderful holiday season, sharing the gift of safety and finding joy in dark times.
Things you can do:
1- Follow health authority guidelines for pandemic safety– CDC guidelines here
2- Get outdoors if you can
3- Donate to your local foodbank
4- Get your flu shot
5- Join or donate to the Air Health Our Health Fight For Air Climb to benefit the American Lung Association and their lifesaving COVID19 research and more
References:
CDC Choir Practice Analysis– May 2020 MMWR
CDC How COVID19 Spreads- October 2020 update
