How to have a holly, jolly, Covid-safe Christmas

[I am a UK-based infectious disease epidemiologist with specialism in new and emerging infections, and write regular “explainer” posts about the pandemic, of which this is the latest. There’s currently a lot of misinformation and misunderstanding swirling about the internet regarding COVID-19 — so please do remember to check someone’s credentials if they are posting about it. You can find my CV on LinkedIn (Georgia Ladbury). Usual disclaimer that I am writing in a personal capacity and my views don’t necessarily reflect those of my employer]

I thought it would be a good time to do another update now that the end of “lockdown2” is in sight and a festive five day superspreading event looms at the end of next month!

Lots of people have asked me about the planned relaxation of the rules over the Christmas period, whether it’s sensible, and whether it’s safe.

Here’s the thing: people have had a tremendously difficult year with a lot of stress and loneliness. Christmas has always been a great way to connect with loved ones and lift the mood in the middle of a dark, cold winter, and it’s no surprise that we feel we need that more than ever after the year we’ve had. The relaxation of the rules reflects that need, and recognizes that if strict rules were maintained over the period, people would probably break them anyway.

But here’s the other thing: to paraphrase Bob Geldof, Covid doesn’t know it’s Christmas — and if it did, it’d be rubbing its hands with glee. Covid thrives in situations where people are indoors in close company for long periods. A traditional family Christmas, with all the family gathered together under the tree, eating and laughing and arguing together from morning till night, is like a huge spangly-wrapped Christmas present for Covid, with a ribbon on top. The rules aren’t being relaxed because the situation is any safer. Rates are still very high; the risk of transmitting and getting coronavirus are still very high.

So, what to do? Here are some tips to see your loved ones safely this season and get that festive lift we all need, whilst helping make sure that the only thing we’re spreading round is good cheer rather than a fatal illness.

*ONLY SEE PEOPLE YOU FEEL YOU REALLY NEED TO

As ever, limiting your contacts is the best way to stop this virus spreading about. Choose to spend your Christmas with your nearest and dearest, the people who you absolutely couldn’t imagine being without during this time. You know who they are.

Even if you decide to bubble up with three households, it’s wise not to see everyone at the same time. Keep your groups small and uncrowded.

*SELF-ISOLATE BEFORE YOU GET TOGETHER

If you can effectively quarantine yourself before you mix with your loved ones, that will help reduce your risk of unwittingly passing on a virus along with your gifts. We know now that the window where an infected person sheds most virus (ie is most infectious) is typically two days before they show any symptoms, and the first three days of feeling ill. This means that it’s perfectly possible to be shedding loads of coronavirus and infecting people while you have absolutely no idea that you’re infected. In order to prevent this happening, it’s wise to isolate yourself at home in a mini self-imposed lockdown before you mix with your loved ones. The incubation period for the disease is two weeks, so ideally you’d isolate for a fortnight to bring your risk right down, if that’s not possible, even a week would help.

*MEET OUTDOORS AND AT DISTANCE WHEREVER POSSIBLE

Covid is not very good at spreading outdoors (for reasons I’ll come to later), and if you add distancing to that then the risk of spreading the virus is very, very low. Dig out your thermals and a good hat and coat, and get creative about how you spend time with your loved ones this Christmas. Have a stroll around town and admire the Christmas lights. Go on chilly countryside walks and crunch Jack Frost underfoot. Dust off your thermos and finesse your hot chocolate recipe. Perhaps Father Christmas will know to leave the presents underneath a magically decorated tree in your local woodland this year (he’s clever like that). A Christmas in fresh air will be different, but no less special.

*LIMIT THE TIME YOU SPEND WITH EACH OTHER

Probably an obvious one here, but the longer you spend with people outside of your household, the more likely you are to infect each other. If you’re meeting up with people not in your household, it’s best not to spend the entire day with them. Better to spend just part of the day together — enough to get that human contact we all crave — and then part ways. Above all, limit the time that you spend together indoors, for reasons I’ll go into next.

*IF INDOORS: VENTILATE — DISTANCE — WEAR MASKS

Ideally you want to spend as little time indoors as possible. In fact, it’s probably worth looking at the long-range weather forecast and deciding nearer the time what day to come together to celebrate; if it turns out the 25th is going to be hammering with rain but Boxing Day is blue skies and sunshine, shift your celebrations a day later. Still, though, there are some things that won’t work well outdoors, so here is what you can do to help reduce the risk for the indoors part.

Here comes the science bit: concentrate!

Covid is spread primarily by viral secretions from an infected person’s nose and mouth. Those secretions can take two forms: droplets or aerosols. What’s the difference between the two?

Droplets are kind of large and spluttery; they’re pretty heavy in respiratory terms. Think of droplets like a shower — you turn the shower on, and the large drops of water fall to the ground. If you stand at a distance from the shower, you won’t get wet. In a similar way, Covid-infected droplets expelled from an someone’s nose or mouth fall to the ground quite close to them. That’s why social distancing helps to prevent transmission — because the Covid infected droplets don’t reach you.

Increasingly, though, it’s recognized that aerosols play some role in the transmission of Covid-19. Think of aerosols like a fine mist — tiny drops of water suspended in the air. You can’t see them, you can’t avoid them, they hang around in the air for ages. This means that if you’re indoors, distancing alone will not keep you safe, as the aerosols build up and stick around, potentially for hours. If an infected person has unwittingly breathed out some aerosols into a room, and you then go in the vicinity of those aerosols (even if that person has long since moved elsewhere and you maintain a >2m distance from them), you could potentially inhale those virus particles and get infected.

The key to mitigate this risk is VENTILATION. Ventilation is likely the key to why Covid transmission barely ever happens outdoors, as aerosols are immediately dissipated and don’t get the chance to hang around and infect people. What you want is for fresh air to be circulating around the room in which you’re gathered. The circulation part is important — so don’t just open one window at the end of the room, open windows or doors at opposite ends of a room, and at the top and bottom of your house, so you get air passing through. If it gets chilly, you can mitigate by closing the windows for a bit while it warms up, and then open them up again — this will at least help with preventing the build-up of aerosols. But, best to keep them open as much as possible. Another good reason to wear thermals.

Aerosol transmission means that there’s no guaranteed “safe” distance when it comes to being indoors. However, because Covid is also spread through droplets, it’s still very important to main a >2m distance wherever possible. So, while hugs and kisses may be allowed within the guidelines, they are still not advisable — and especially so with elderly or vulnerable people. If you’re going to gather round a table, make it a long table, distance people from different households, and try to avoid people from different households sitting directly opposite each other (as they would be breathing into each other’s faces, which is undesirable).

Wearing masks will help reduce the risk of spreading droplets and aerosols even further, so if it’s practical to do so (e.g. you’re not eating Christmas dinner), mask up.

*KEEP EXCEPTIONALLY GOOD HYGIENE

Wash/sanitise hands frequently; don’t share crockery, glasses or cutlery; disinfect “high touch” points (e.g. door handles) often; and use separate toilets for separate households if that’s an option.

*BE PEACEFUL AND SERENE

The season of good cheer traditionally brings with it a lot of carols, karaoke, and humdinger family rows to rival the EastEnders Christmas special. Unfortunately, all of these things increase the number of droplets coming out of your mouth and how far they travel, so they’re not a good idea. Save the Céline Dion renditions to next year, lower the background cheesy Christmas song playlist so nobody has to raise their voices to hear each other, and hold your tongue if you feel your prodigal sibling has been unfairly honoured with a disproportionate number of roast potatoes.

*LAY OFF THE EGGNOG

Alcohol makes us feel relaxed, invincible, and more inclined to soften and take risks — especially if we’re already in the comfort of our own home. Having a safe Christmas unfortunately does require that we all stay on our guard, so step away from the Baileys and the mulled wine and the eggnog and the whiskey and the bellinis and whatever other favoured festive tipples you usually enjoy.

*DO ALL OF THE ABOVE. ALL OF IT.

There’s no one sole measure you can take that can reduce your risk of spreading or getting Covid, sadly. If there were, the whole world would be doing it by now and the pandemic would be largely solved. Reducing your risk means following all of the above, as far as you possibly can for each.

*CONSIDER POSTPONING

If you read all of the above and think “Geeeeeeeeeeeeeeeez, this just sounds awful, I’d rather spend Christmas with Ebeneezer Scrooge” — then consider whether it’s just worth putting off the celebratory gatherings for a bit. Australians have Christmas in summer every year, and it doesn’t do any harm. If you really would be miserable having a pared-down Christmas, hold off festivities until later in 2021, by which time with any luck, Covid rates will be lower, and our most vulnerable will have been vaccinated. Goodness knows it’ll be time to celebrate when that time comes.

…..

That’s it, folks! A Covid-safe 2020 Christmas sure will be a strange and slightly subdued affair, but please do take some time to remember the thousands of families who will have an empty chair at the table precisely because the virus has taken their loved ones. How we all choose to behave over the coming weeks will directly affect how many more thousands of empty chairs there will be this time next year.

In short: let’s aim to have a unique Christmas to remember, rather than a bogstandard Christmas we will live to regret.

Take care, all; keep safe and enjoy your festivities, however they pan out.

[And apologies to all those who missed out on Passover, Eid, Diwali and all the many other celebrations that have been cancelled this year]

I’m an infectious disease epidemiologist with special interest in zoonoses, new & emerging infectious, One Health, and interdisciplinary public health research