First things first. Get your flu shot.
Last winter, only about 45 percent of all Americans got their seasonal influenza immunization, which means that even in the pre-novel-coronavirus times, we were failing at preventive health promotion in the United States. Though we are all worried about Covid-19 in 2020, influenza is a deadly disease, and in serious flu seasons our hospitals fill up quickly with patients needing care. Now, as either the physicist Niels Bohr or New York Yankee Yogi Berra said, it’s difficult to make predictions, especially about the future. But these next six months may be more dangerous than the past several we’ve experienced. Many epidemiologists and public health experts are expecting a resurgence in SARS-Cov-2 infections this winter as we head indoors, where we run a greater risk than in the outdoor activities we all enjoyed this summer.
While some are suggesting our social distancing efforts may slow the spread of the flu this season, the prospect of influenza adding to our coronavirus troubles is nothing to be complacent about. Getting a flu shot is good for you and for your community. You can be protected against influenza, removing yourself as a source of flu transmission, and you’ll reduce the burden on emergency rooms and hospitals where you live. In addition, if you’re immunized, it may give your doctors important information if you come down with a flu-like illness, helping them to distinguish between diagnoses, such as influenza and Covid-19, when time is of the essence.
Going into the fall, though we are all weary of social distancing, mask-wearing, handwashing, and the other measures we’re doing to keep ourselves, our friends, and families safe, we’re going to have to keep up the good work. Though President Trump keeps crowing about a vaccine before Election Day, we’re unlikely to see one by then. Even if we do, it will take months and months to immunize all Americans against SARS-Cov-2.
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So we’re stuck with our risk-reduction protocols, where we try to minimize the situations and settings in which transmission of SARS-Cov-2 is most likely, in what Julia Marcus and others have called a harm-reduction approach to Covid-19. However, the impending cold weather and the holidays, from Thanksgiving to Christmas, Hannukah, Kwanza, and New Year’s Eve, coming up could put us all at higher risk than we’ve been in than months: indoors, with the windows closed, in close physical proximity to our extended families, around a table without masks, sharing food and utensils, cups, potentially giving a gift even less wanted than that reindeer sweater from your Aunt Tilly: a family outbreak of Covid-19. This summer numerous outbreaks of the virus were tied to family events, large and small. Winter will just exacerbate these risks.
Is 2020 the year without the holidays? For some it will be. In addition to the general transmission risks I described above, those with elderly, sick, or immunocompromised relatives may not want to further risk the health and safety of their loved ones by visiting with them. Those of us with underlying conditions may also not want to take the risk of acquiring Covid-19 by going to a family gathering. These will be tough choices, and I don’t look forward to the conversation with my 86-year-old mother telling her I think it’s best that we all stay apart for the holidays. Though the winter heightens risk in many ways, there are local considerations that come into play in our decisions. Some states have their local epidemics under relative control with cases low and staying low; others have cases at high levels and staying high. Knowing what is happening epidemiologically in your community is an important part of decision-making for each of us.
Even with the elevated risk of SARS-CoV-2 transmission this winter, along with our perennial risk of flu, there are ways to minimize risk for the holidays, but they take some planning. Getting tested for Covid-19 shortly before you embark upon your holiday journey would be critical—as would quarantining yourself for 14 days before the big event. On the way to the old homestead, you should try to minimize transmission risk with proper mask-wearing, regular handwashing, and avoiding crowds (drive, don’t fly). Once you’ve arrived, if windows can be open, masks can be worn and six feet of distance kept between you and your extended family, you’ve gone a long way to minimizing risk within what is possible to do. However, in my family, if we wanted to do a “normal” Christmas, we’d have two twins home from college, several health care workers who’ve been on the front lines, two of us living with HIV, and an elderly matriarch among us, with little ability to maintain social distance and the essence of the gathering relying on lots of shouting and gesticulating (think of a suburban, goyische, Italian-American version of the scene from Annie Hall with Alvy Singer’s family under the roller coaster on Coney Island). It’s not a situation I consider safe for anyone at the moment.
The pandemic continues to throw our lives into chaos. Even after the election, even if Trump loses, and then steps down in an orderly transition of government—two big ifs—it’s going to be months and months until we’re back to normal, if normal ever returns to us. We’ve likely got to admit, in Willa Cather’s phrase just under a hundred years ago, that “the world broke in two” in 2020.
There are simply moments in history that create a rupture with the past. We can face the future and take it as a challenge to be met, that of building a better world, where the politics that left us in such peril are replaced by something new. That would be a holiday gift worth waiting for. I miss my family and my friends, but what I long for more than anything is a chance to get these next few months and years right, to lay the foundation for addressing the health needs of communities we’ve long ignored, and for us to address the health and environmental threats that just keep coming with a new seriousness of national purpose.
