On Thursday, Nov. 12, Dallas Morning News science writer Anna Kuchment spoke with two medical experts about the state of the COVID-19 pandemic in North Texas and best practices for the upcoming holiday season.

The experts were Dr. James Cutrell, associate professor of internal medicine in the division of infectious diseases and geographic medicine at UT Southwestern Medical Center; and Dr. Erin Carlson, associate clinical professor and director of graduate public health programs at the University of Texas at Arlington’s College of Nursing and Health Innovation.

The conversation, held via conference call, was open to the public, and the panel took questions from readers submitted via email. To hear about upcoming calls, support The News by becoming a member.

Dr. Cutrell and Dr. Carlson provided readers with numerous suggestions for mitigating the risks of COVID-19 ahead of the winter holidays. Their responses have been edited and condensed for space and clarity:

Combat ‘quarantine fatigue’

From the doctors:

North Texas and the United States at large are currently battling another surge in coronavirus cases. As of Nov. 12, physicians have counted 52 million cases globally, with about 1 in 4 cases appearing in the U.S. Over 240,000 American deaths can be attributed to COVID-19 thus far. Dallas County is once again averaging over 1,000 new cases per day, with Tarrant County trailing closely behind at over 900 new cases per day. The local test positivity rate hovers around 15 percent. In Dallas-Fort Worth, hospital visits and virus-related hospitalizations are climbing and bed availability in the local intensive care units is decreasing. While area doctors are yet to see rises in death or a significant strain on health care capacity and infrastructure, small gatherings associated with upcoming holidays could accelerate the spread of the virus.

Dr. Erin Carlson: “With regards to this surge, I’m not going to say ‘second wave’ because in the United States, we never stopped the first wave. But, we are seeing a surge and we’re reporting in public health that the reason for this surge is that we’re seeing a lot of cases due to small gatherings. There isn’t a ginormous outbreak, a big gathering that caused this surge, but rather people are getting together, you know, just simply with people from other households and without distancing. And we think a lot of it’s due to quarantine fatigue, and that’s probably a big contributor to this. People are tired of distancing. They’re tired of being away from their family and friends. And that’s where we’re seeing an uptick in small gatherings and the cases that result from such person to person interaction. Given the current magnitude of community spread, the likelihood that someone at such a gathering has COVID-19 is higher than ever before.”

Dr. James Cutrell: “I agree with Dr. Carlson’s assessment. She used the term quarantine fatigue, which I think is a very good and accurate description of what we’re seeing when we look at some of the modeling that my colleagues have been doing at UT Southwestern. Our RT value, which is the reproductive number showing how many people are likely to be infected by someone with COVID-19, since the end of September, has consistently been above one in both Dallas and Tarrant Counties. And so, that means the [virus] is going to continue to spread. When we look at some of the non-pharmacologic interventions, like if people are reducing their mobility or their distancing, we’re seeing that the adherence to some of those measures has waned compared to earlier in the pandemic. I think quarantine fatigue and the kind of behaviors that are coming out of that really explain a lot of what we’re seeing. You know, it’s hard to tease out specific things, like whether Halloween gatherings specifically had anything to do with the increases in cases we’re seeing. Certainly, the medical community and the public health community are very concerned [about the winter and holiday season] where typically, people are going to want to gather with family and travel and do other things like that. This is a really perilous time. ... We know the things that we need to do to bring the cases down. But, the question will be whether the public will is there to do that."

Practice safe-gathering strategies

From the doctors:

While recent developments in the creation of a vaccine and monoclonal antibody treatments for COVID-19 are encouraging, Americans should accept that much is still unknown about the virus. Pandemics rarely disappear quickly, and it’s likely that the coronavirus pandemic will be with us long term. Many political, logistical and scientific challenges remain before normal behaviors can resume, and some aspects of virus prevention could stick around permanently. It’s too soon to consider doing away with mask-wearing and social distancing, and people shouldn’t make plans that don’t involve masks and distancing through the end of 2021.

Carlson: “I want to remind everybody about asymptomatic transmission. ... It makes testing and contact tracing difficult. It makes gathering difficult, because somebody seems perfectly healthy. And they’re your friend. Our natural response is to say that it’s fine being around them, but we cannot take this lightly. We have to act as if everyone is infected and that we might be infected ... I think there [are ways to gather safely for the holidays], we just have to be careful.

“Here’s what I would suggest. I have this little acronym because I love dogs. All Dogs Be Loved. OK? A D B L.

"A, attendees. We should consider how many attendees and where they’re from. Are they from a hot zone? Are they from a place of a very high incidence of cases? How many different households? It’s important that we limit the number of attendees. Keep it under 10, if possible, under nine is better. Under eight is even better, et cetera, et cetera. And from no more than three different households.

"D, duration. We want to keep the gathering to under two hours.

"B, behavior. We need distance, we need to wear masks, we need to maintain that behavior throughout. We also want to limit alcohol because when we have alcoholic gatherings, it increases close contact. We tend to get closer, inhibitions go down and also we speak loudly. We speak more loudly when there’s alcohol involved and that increases transmission by increasing the amount of those virus droplets that can enter into the air.

"L, location. We want to make sure that those gatherings are held outdoors whenever possible.

So, if we follow these guidelines, we can still be with others, but we can do it safely. It might feel a little awkward at first, but it’s well worth getting to be together."

Cutrell: “I would echo all of that. I would also say that this is a time to really do a self-assessment of your own health, as well as the health of those that are gathering. And so it’s not just your own health and your own medical conditions. For some people who fall into some of these high-risk categories, really the safest thing for them to do is to pursue more virtual options and avoid gathering with people outside of their household. ... This is really an opportunity to think about our neighbors, think about our family and friends and behave in a way for the greater good. ...”

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Wear a mask, test in advance

From the doctors:

Health experts and the CDC agree that mask-wearing is a crucial method of curbing COVID-19′s spread. Testing and quarantining ahead of a family gathering may also bring some peace of mind if other preventative measures are taken.

Carlson: “The CDC very recently published a brief on the efficacy of mask-wearing. That CDC brief is publicly available, and you can just Google ‘CDC mask science,’ and that brief will pop up. Very good studies with very large sample sizes and very appropriate scientific methods have repeatedly shown that mask-wearing reduces transmission of the coronavirus by anywhere from 70 to 87-plus percent. So, we know that masks help prevent transmission. If you yourself have an underlying health condition and are particularly concerned, [wearing a mask would be advisable]. Mask-wearing is also something that we do out of respect for others. We do it to prevent our germs from going into that potential viral mist in the air that others breathe in. ... And it’s very effective ... and study after study after study has shown that.”

Cutrell: “The most likely test to pick up that someone is infected with COVID-19 is a molecular or a PCR test. If someone’s going to get a test prior to a gathering, that’s probably the main one that we would recommend. Now, there certainly are rapid antigen tests out there, which do have a place, although usually those tests are going to be more effective when they’re being done kind of serially or repeatedly. Because they may occasionally miss picking up someone who’s positive. In terms of the timing of when it should be done... you know, the Achilles heel of all of the testing is that it’s just a one-time snapshot. It tells you that you’re not infected or contagious at that one moment. It doesn’t account for getting exposed that same day, or maybe you’re early on in your incubation of the virus. Really, the recommendation right now is if you were to do a test and then really isolate or self-quarantine yourself for up to 14 days, that may be the safest way to approach it. But, I think I would caution people that just because people tested negative two to three days before doesn’t mean that you can neglect or be complacent about all the other measures we’ve discussed. I think relying simply on negative testing is a mistake that I want people to avoid.”

Check-in

From the doctors:

Generally speaking, the travel and hospitality industry has acclimated well to pandemic conditions. Holiday travelers should not be overly concerned about the cleanliness of hotel rooms. Travelers are encouraged to check on their property’s COVID-19 protocols in advance of their stay.

Carlson: “In my opinion, based on all of the travel guidance that exists and based on all the protocols that the travel industry is taking, which have been pretty extraordinary, I would say that yes, I would personally feel comfortable spending the night in a hotel. Now, what I would suggest you do, especially if you have any concerns on underlying health conditions, is select a hotel chain that is following those COVID-19 prevention guidelines. Meaning specifically, they’re leaving a night between guests where nobody stays in the room. I think that’s important because the virus can hang in the air for several hours. ... We want to have a wash-out period before you go in and occupy that room. There would be ample time for that. I would suggest that you look for that, or that you just simply call the hotel and ask what the hotel is doing. Many hotel chains are using special sanitizing procedures right now. And I don’t just mean they’re wiping down things. I mean, they are actually using a type of sanitation that is used in some health care settings. So, there are excellent precautions being taken right now in the hotel industry. And I personally would be comfortable with that. And with bed linens, it’s unlikely you’re going to get COVID-19 from touching the fabric. That kind of touch point, I wouldn’t have any concerns about that any more than usual. I think some of us who are germaphobes always have some concerns about the bedspreads and covers and those kinds of things, but no more than usual, nothing special for COVID. And I think generally, hotel rooms are safe given the precautions.”

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Prepare for departure

From the doctors:

[Updated Nov. 21: This interview was conducted before the Centers for Disease Control and Prevention warned against traveling for Thanksgiving, saying “the safest way to celebrate Thanksgiving is to celebrate at home with the people you live with.” More guidance from the CDC can be found here.]

Data suggests that with airlines taking proper safety protocols, commercial flights are a relatively safe place to be during the COVID-19 pandemic. That doesn’t mean that air travel is completely risk-free, however. Holiday travelers who are looking to fly this year need to plan ahead more than ever before. How will you lower the risk of virus transmission or spread during each stage of your journey? The airplane may be clean, but the airport and transportation we use to get there may not be.

Cutrell: “I think, actually, the data that’s coming out suggests that, you know, commercial flights are fairly safe, particularly with the safety protocols and other measures that the airline companies are taking into account. Certainly, you know, if someone is very concerned and it’s close enough that they’re able to drive in their private car, that might be preferable. But, I think overall that flying is still quite safe. I think the key thing is just coming in with a plan and a strategy for, you know, from the beginning of when you get to the airport. Wearing your mask, trying to avoid lingering in large gatherings, being aware of your surroundings, bringing your own hand sanitizer so that you can frequently wash your hands, maybe bringing some wipes that you can wipe down your seat and your tray table with onboard. I think the airlines are doing a good job of sanitizing those items. ... I think the other thing that maybe was under-represented or under-recognized at the beginning is that airplanes are designed so they are frequently undergoing HEPA filtered air exchanges. As long as people are following the protocols of wearing masks, that stuff really helps contribute to making the inside of the aircraft a relatively safe location to be.”

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