Family travel plan: Keep virus in check
3 top health experts weigh in on vacation strategies
On Orange Skies Day, we turned to Southwest Airlines for salvation.
It was time, my husband and I decided, to book a flight — to flee smoky air and bring the baby, closing in on her first birthday, to visit East Coast grandparents who desperately wanted to see her beyond the confines of an iPad screen.
So on Sept. 9, we sketched the outlines of a coronavirus travel plan for late October: We would fly in before the holiday crush; we would stay long enough to quarantine on arrival; we would get tested before moving in with family; and we would be extremely cautious without driving everyone crazy. There would still be a risk of being infected with coronavirus, of course, but we would whittle it down to an acceptable level.
As the holidays approach, millions of people like us are weighing their own travel plans. They’re googling airplane transmission risks and imagining socially distant Thanksgiving dinners. They’re deciding whether to fly or drive or stay home entirely, trying to devise a way to be together when the safest thing is to stay apart.
If there were any doubt about that, a joint statement from Bay
Area health officers last week made it clear: “Traveling outside the Bay Area will increase your chance of getting infected and spreading the virus to others after your return.”
“We’re going to see a bump,” said UCSF infectious disease expert Dr. Peter ChinHong, of how holiday travel will impact COVID19 case rates in the Bay Area. “The question is how much.”
But for many people, the pull of stuffing, sweet potatoes and longheld traditions will be strong, and the benefits of visiting longmissed family will be real. Dr. Monica Gandhi, a UCSF infectious disease expert, says she’s worried about a potential holiday spike, but she’s also concerned about the
“profound mental health impact of depression and mental illness. I think we have to have a more balanced discussion.”
Trying to achieve a balance, it turns out, is not easy. Even with a detailed strategy, amenable relatives ( who firmly believe in science) and the privilege to pay for accommodations, my family had a hard time staying true to our plan.
We got on a plane — then things got complicated.
I asked ChinHong, Gandhi and Dr. Robert Wachter, chair of the Department of Medicine at UCSF, to weigh in on our experience. What did we get right? What did we get wrong? What would they suggest for anyone considering holiday visits?
The trip
My husband and I hail from the East Coast, so heading home meant flying crosscountry with an infant too young to mask. We chose an earlymorning nonstop departure on Southwest Airlines, hoping it would be less crowded than later flights and because ( at the time) the airline guaranteed vacant middle seats.
Wachter: It’s a tradeoff. The direct part sounds good in that you don’t have to brave the airport twice. On the other hand, no one can sit there for six hours with their mask on and not eat. I see direct versus not direct as probably neutral, you could frame that either way.
Our first dilemma was how to get to the airport. It was pay for two weeks of parking or get into a Lyft — our first time riding in someone else’s car since the pandemic began. We went for it. If we were already getting on a crosscountry flight, we figured, what’s a 20minute drive to get there? We pulled on surgical masks over N95s, insisted on handling our own bags and asked our driver to lower the windows despite the morning chill.
ChinHong: I think it’s an OK idea, particularly if you’re wearing masks and crack the window open so you’re going to have ventilation. If you took your car to the airport, you’d have to take the shuttle bus, which you’d have less control over. The name of the game is controlling your environment. ( Taking a Lyft was) more controlled than the uncertainty of the shuttle bus.
Wachter: I would do more than crack the windows, I would keep them wide open. When I did the same thing, I wore an N95 mask from work and a face shield and had the windows wide open. I wouldn’t get in if the driver wasn’t masked. If you do all that, the risk of car ride was essentially zero.
At the airport, controlling our environment was substantially harder. We dodged other travelers, sanitized liberally and generally stayed on high alert, scanning for anyone maskless or whose face covering was beneath their nose.
By comparison, the flight itself was a relief. We blasted the air coming from the vents above our seats, cleaned everything in reach with alcohol wipes and kept our masks on except for a quick sip or snack. The passengers around us seemed to be following protocols, too, and flight attendants made clear they would enforce the rules.
ChinHong: Over time, we’ve understood that, scientifically, a lot of air exchange in airplanes is better than most houses and office buildings. The second thing is we haven’t had any convincing reports of outbreaks on an airline in the United States. The sky never fell.
The accommodations
After arriving, we spent our first week in town quarantining at an Airbnb.
Paying to rent a stranger’s condo when my husband’s childhood home was 15 minutes away felt ridiculous, but also like the only possible choice. My motherinlaw and my parents, who had driven into town to see us, are in their 70s and at higher risk of complications from the coronavirus. So we all stayed separately — my folks in their own Airbnb — while we waited for symptoms to show up and to get tested. Barring a positive result, we would spend the second week together under one roof.
ChinHong: A lot of people don’t have the luxury of time to quarantine for two weeks. That’s the gold standard of recommendations from the CDC. I think your strategy sounds great.
Gandhi: I personally, in your situation, would have been close right away. ... ( If you were negative when you left and traveling from a low-prevalence region) it would make me feel like it was a profoundly low chance for you to have acquired it in the eight hours ( of travel).
While we crashed at the rental, we met for dinner each night on my motherinlaw’s wide front porch: two separate tables 6plus feet apart, paper plates and plastic glasses, my motherinlaw shuttling food while we stayed outside and scolded our parents to keep their masks on. For that whole first week there were no hugs, no helping, no getting too close. No holding the baby for the grandparents.
“Next week,” we repeated like a mantra.
But when you’ve traveled so far to be together, staying apart is hard.
The testing
A key part of our strategy was getting tested: In the Bay Area before we flew, and again five days after we arrived, when an infection from the flight was more likely to register.
Pretravel testing went smoothly. But getting tested in Maryland proved much harder. Some sites were for residents only and required a Maryland ID. Private hospitals were accessible only to patients innetwork. Other options said results might take up to five days, which would stretch our quarantine time almost to the end of our visit. Our best option seemed to be an urgent care clinic that offered rapid testing, where patients would line up before opening to snag one of the 25 daily test allotments.
ChinHong: That’s dumb and inefficient. It’s ridiculous. It actually enrages me. What your story illustrates is we’re kind of in the mecca of best COVID practices in the country. Not everywhere is going to be the Bay Area.
On day five, my parents, husband and I joined them. We managed to get the last two testing slots for the morning, but the clinic moved painfully slowly and seemed woefully unorganized. Patients all used the same iPad to register with no cleaning in between, and everyone had to meet with a doctor regardless of their results. Two hours after arriving, with my parents still seventh in line for a swab and hours from leaving, we bolted.
ChinHong: What you did was adjudicate your risk benefit. You were putting your parents at risk. The juice wasn’t worth the squeeze, basically.
Because I had a mild sore throat, I felt I had to get tested, and I eventually arranged that through my insurance provider, Kaiser Permanente. But it took hours on the phone with member services, setting up a new patient record with a new primarycare physician and making a video prescreening appointment to greenlight me for a visit.
The drivethrough test itself lasted about three minutes, but no one else in my family managed to get tested during our visit.
ChinHong: It shouldn’t be that hard to get a test. You should be encouraging testing. I should be able to get a test today if I wanted to, because it’s a public health crisis.
Gandhi: I’m not sure, to be fair, if there’s any country in the world where testing can be rapidly available to everyone. Because it’s new, municipalities and city health dollars are naturally going to go to their population. We’re not the NFL. We don’t have the ability to give 300 million people access to testing whenever they want. ... It reveals the complication of perfect. You did everything right, and then you tried to do the one extra thing that made it guaranteed.
The last week
We finally moved into my motherinlaw’s house for week two of our visit. We put our masks away, starting eating dinner in the dining room, and the grandparents finally got to kiss cheeks and play with their granddaughter.
“We’re so glad we did this,” became the new mantra.
“Risk is not an allornone phenomenon,” said ChinHong. “A lot of people get frustrated because they want to have zero risk, and that’s not possible.”
We made our calculations, did our best to be careful and made it home safely, grateful for the time together. But as cases climb across the United States and families consider gathering with relatives coming from hot spots, that arithmetic will grow more complex and concerning.
Memorial Day and Labor Day both led to predictable spikes in infections, said Wachter, and “the tradition for both would be going outside and having a picnic, as opposed to having a lovely dinner around the hearth. Those are orders of magnitude different in terms of risk.”
A family member of Wachter’s recently called him to ask about attending a traditional Thanksgiving holiday in the Northeast. He wasn’t particularly encouraging.
“I think you have to sit back and really ask yourself: Is it worth it? No one wants to have a Zoom Thanksgiving, but it beats getting sick,” he said. “If you can’t create a set of situations to do it safely” — because cases are rising, because it’s too cold to eat outside, because too many relatives are traveling from too many different places — “probably by next Thanksgiving we’ll be able to do this.”