Autumn is here, and with it are colder temperatures and the approaching holiday season. COVID-19 infections are skyrocketing across the US and local hospitals are reaching capacity, with local experts predicting their systems will be full in the next 2-3 weeks due to high rates of COVID-19 admissions. Here are some tips to make this fall a safe and healthy one.

Avoid indoor dining - The riskiest scenario is when you are in a group setting indoors without a mask. This is exactly the scenario in a restaurant. In a large public health study, people who developed COVID-19 were twice as likely to have dined at restaurants as their peers who did not get infected. Simply putting the tables 6 feet apart is not enough to protect from infection. Studies have shown detectable virus in the air up to 15 feet away from a person with COVID. If you think about the virus as smoke, you can understand how it can drift around an enclosed space and put even people who are at a distance at risk. The people at your table are the highest risk to you. Most tables are not 6 feet across, and aerosol studies from Japan show significant droplet contamination from your companions at a dinner table. If you don’t live with a person, you should not dine at the same table with them, particularly indoors.

Socialize with your mask on - We all crave a human connection. We are exhausted from this pandemic and socially isolated. Seeing friends in person can really help put the enjoyment back in life, but an event will only be remembered fondly if no one ends up in the hospital. Break out your fire pit or patio heater, bring out blankets to keep everyone cozy. Keep your masks on, and keep your distance. Food and drink encourage people to be unmasked, so be creative and play a game instead or project a movie on the wall of your garage. If you have to be indoors, keep your masks on all the time and place a HEPA-filter air purifier in the room to reduce lingering virus in the air that can be a source of infection. Keep it small. Socialize only with people who are not behaving in a risky fashion. Keep doors and windows open to allow airflow indoors.

Thanksgiving and Halloween will have to change - Forget the masked indoor party for Halloween. Put out paper bags of treats for your little neighborhood guests. Have a parade in the street or a pumpkin-carving competition.

You cannot bring together 30 people from around the country safely for a holiday meal. Save the big family dinner for when a vaccine is available. Here are some creative smaller solutions to keep people safe. I am ranking these in order from most safe to least safe.

• Most safe: Try a zoom family dinner: Have the 4 or 5 families you usually celebrate with eat in their own homes with a laptop on the table to allow for cross family conversations.
• Less safe: Have your dinner outdoors - a garage with the door open is much safer than a dining room. Forget the giant banquet table. Each household should be at a table by themselves and should be spaced at least 6 feet from another table.
• Least safe: Keep the dinner to those in your “quarantine bubble.” If you are already together regularly before the holiday and are avoiding risky behaviors (no in-person school children, no people working in person in settings without consistent mask wearing, no people who are attending indoor group fitness without mask, or those who socialize without masks) you can have a small (under 10 people) gathering. The way to avoid a super-spreader event is for everyone to lock down on all activities for the 2 weeks before the holiday and get tested before coming. Keep your masks on unless eating! Remember, the people next to you hold the highest risk for infecting you, so you should only sit next to people in your household.
• Don’t even think about it: Traditional Thanksgiving dinner is not on the table. I had to cancel our huge family gathering for 25 people for the first time in my lifetime. Holidays are about the people you love, and the short-term gain of being together is not worth the heart ache of infecting a loved one with a potentially fatal illness. Be strong, together we can get through this.   

• Do not travel if at all sick or if recently exposed to anyone ill.
• Wear a mask and face shield/glasses at all times during the flight, and do not eat or drink anything.
• Wash your hands often and wipe down adjacent surfaces; avoid hand contact with your face.
• Choose an airline that eliminates the middle seat.
• Sit at a window seat which minimizes close contact with others.
• Be especially careful to socially distance when boarding and deplaning.

Remember that risk does not begin and end with the flight itself—you should consider the risk of your community and the destination along with airport time, your own risk for severe illness with COVID-19, and the risk of vulnerable members of your household and those at your destination.

For these reasons, we recommend postponing nonessential travel at this time. But if you must travel, do your best to travel thoughtfully, safely and with attention to safety of others.

How do I vote safely in person? The expected large turnout for this year’s election on November 3 in the midst of the pandemic makes voting in person a bit problematic given the expected crowds and long lines. If you qualify, we recommend voting absentee in person at a nearby location if you have not sent in your absentee ballot at this time. Our experience suggests this is an efficient system that allows greater flexibility for voting. Whether you do this or vote on November 3, here are our recommendations:

• Vote at off-peak hours to minimize time spent in line, particularly indoors. Use this interactive map to see wait times at nearby locations.
  
• Wear your mask properly and social distance, standing at least 6 feet from others.
• Practice good hand hygiene and avoid touching your face.
• Bring your own black pen.
• Know what’s on the ballot and how you will be voting to minimize actual voting time.

These simple guidelines will help minimize the possibilities of contracting COVID while voting in person.

Are you seeing patients? Yes we are! Do not neglect your health out of fear of contracting COVID. Reports suggest that non-COVID hospitalizations remain near 50% of their usual levels, and doctor’s visits are down 20%. COVID will be with us for a while. We do not want preventative health issues, screenings for cancer, monitoring of medical issues, and health updates to fall victim to this fear. If you have not had a physical exam in the past year, please set one up. The office has gone to great lengths to reduce COVID risks, including minimizing foot traffic and time spent in the office, HEPA filters in every room, full masking at all times of staff and patients, and seeing patients with respiratory illnesses outside in their vehicle. Please call the office to set up your annual exam if due!