The holidays are almost here, and one gift has come early. Two effective vaccines against SARS-CoV-2, and perhaps more to come. However, it is important to remember that merely approving a vaccine does not immediately end a pandemic, and the coming months will remain crucial.
Pre-Thanksgiving, one of us argued that an unyielding "Just Don't Do It" message is unlikely to be persuasive. Public polls and TSA screening numbers suggested that people were desperate and longing for social connections with their families. Christmas and New Year's are on track to be similar based on early TSA reports.
We continue to believe that abstinence-only messaging is misguided and may not be successful. Instead of what not to do; we wish to offer ideas and suggestions about what to do.
Beyond Cancellation
"Cancel everything" has become reflexive in efforts to control a pandemic, and in recent weeks targets have included playgrounds, social gatherings, and outdoor youth athletic activities. Restrictions on social and recreational outlets represent a convenient solution for leaders short on resources and even shorter on public support for renewed lockdowns. The problem is that these measures undermine the best available tools to combat pandemic fatigue and thwart low-risk ways to satisfy the understandable desire for social connection. We instead need to pair public health restrictions on the highest risk activities with a massive scale-up of safer social and recreational activities.
Planning recreational activities at the height of a pandemic may seem misguided and perhaps disrespectful toward the hundreds of thousands of lives lost. But, the reality is pandemic-fatigued Americans are already seeking outlets to satisfy their need for social connection and recreation. Playground outings with friends shift to indoor household play. Video games among teenagers may replace youth sports. Dinners at shuttered outside restaurants become backyard gatherings that move indoors as night falls. Cancellation may paradoxically lead to riskier behavior. How can we balance the need for social and recreational activity while minimizing the risk of transmission this holiday season?
Enable and Organize Holiday Fun
We should reject the urge to postpone social and recreational activities until the spring and instead actively create and incentivize opportunities for social and recreational activities. We can encourage these activities by reopening safer outdoor spaces, distributing discounted and free gear, and providing access to passes and recreational fees.
Cities can open public parks, open spaces, and golf courses for walking and play. Colder climates might open sledding hills and expand ice-skating rinks (a straightforward task when the temperature is below freezing). Warmer climates may reopen kayak rentals for local lakes and streams. Municipalities can organize outdoor games and activities for kids and adults -- with food trucks and hot chocolate stations for parents (no-refills). These efforts may even modestly stimulate spending if done right.
Outdoor athletics and organized activities for kids are vital to a sense of purpose for families and can be done safely. We need to think creatively about the activities that can happen safely -- soccer, skating, skiing, football -- and then work to make these activities organized and enjoyable. Indeed, much of the disease transmission that has happened in athletics may have occurred off the playing fields -- in locker rooms, carpools, and team social activities -- and be reduced with good mitigation strategies.
Guidance for Home Activities
Most public health efforts have centered on America's main street -- schools, businesses, and healthcare settings -- and yet, disease transmission also occurs in its living rooms and backyard gatherings. With the holidays arriving, Americans need enabling guidance and support for their private lives that can help them to identify the highest risk activities and structure safer ones. In short, they need both clear instructions to enjoy fun more safely as well as the resources to do so. Access to warm winter clothing, fire pits, or bonfire materials can enable this. Encouraging folks to move their holiday (and winter) gatherings from the living room to a backyard bonfire can lower the risk of holiday celebrations that are likely to occur either way.
A Holiday Tailgate
Even on the coldest days, college football tailgating shows how when organized and motivated, people can enjoy hours together braving the elements. Municipalities can designate space, and provide water, trash, and grill access for folks to set up tailgate stations. Streets can be closed off, and picnic tables deployed, to facilitate outdoor gatherings. Free food and drink can be provided. Outdoor sporting events can be organized.
It's Not Over Yet
News of vaccines offers much-needed hope, and we share the excitement, but we still need to sustain a public health response over several months, which may be the darkest yet.
Pandemic fatigue and stress are high, and the need for social connections is as real as our thirst for water. Americans are a fiercely independent society, but the holidays mark an important time where we crave, seek, and need to spend time with others. We can celebrate this season by coming together in ways that minimize risk, but still satisfy the real and understandable desire of social connection.
Vinay Prasad, MD, MPH, is a hematologist-oncologist and associate professor of medicine at the University of California San Francisco, and author of Malignant: How Bad Policy and Bad Evidence Harm People With Cancer.
Anne N. Sosin, MPH, is the program director for the Center for Global Health Equity at Dartmouth College and the co-lead on Dartmouth research on COVID-19 and rural health equity in Northern New England.
https://www.medpagetoday.com/blogs/vinay-prasad/90368
