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This is an excerpt from Second Opinion, a weekly collection of health and medical science news emailed to subscribers every Saturday morning. If you haven’t signed up yet, you can do so by clicking here.
Canadians planning to reunite with loved ones over the holidays this year face some harsh realities.
The country faces a perfect storm: record rates of COVID-19 amid a growing sense of pandemic fatigue at a time when we usually travel to see our loved ones and spend time together at home.
But COVID-19 is insidious, an unwanted guest that can slip unnoticed and wreak havoc despite our best efforts to control it.
“We have to honestly ask ourselves, should we socialize? And the answer is probably not,” said Raywat Deonandan, a global health epidemiologist and associate professor at the University of Ottawa.
“There’s no way to eliminate the risk other than not doing it in the first place.”
But we’ve learned a lot more about how COVID-19 spreads since it first surfaced earlier this year, which can help us educate ourselves on where we’re most at risk.
Confusion about vacation guidelines
There is understandably a lot of confusion as to what kind of festive gathering it might be reasonable to consider this year, especially since depending on where you live in this country the rules and recommendations differ.
The Official Board of the Canadian Chief Public Health Officer it’s avoiding large gatherings, non-essential travel, and keeping things as small as possible within your family.
Some provinces, like Ontario, recommends skipping extended family reunions altogether and taking precautions such as self-isolation for 10-14 days for those returning home from afar, including colleges and universities.
While others, like Quebec, have placed a lot of faith in their population by allowing gatherings of up to 10 people for four days during the holidays after a seven-day self-imposed quarantine period.
But Deonandan says we can’t necessarily rely on people to completely isolate ourselves, which requires not leaving the house to shop, essential items, or even walk the dog.
WATCH | Dr. Theresa Tam does not recommend large gatherings or non-essential trips
Canada’s chief public health officer, Dr. Theresa Tam, says it’s clear Christmas this year won’t be like other years. He recommends against any meeting, but has some advice if people choose to forgo public health guidelines. 0:48
“You’ll also have outliers that have infectious periods longer than two weeks,” he said.
“If enough people do that, you’ll get enough people who don’t fit into that umbrella who are actually contagious and start epidemics.”
The silent spread of a “key factor” of the outbreaks
As we consider whether it is also possible to safely reunite with friends and family in a pandemic, it is important to keep in mind the unseen dangers we might invite, even in parts of the country that have low COVID-19 rates.
“The problem with this virus is that it’s like many other viruses,” said Dr. Allison McGeer, a medical microbiologist and infectious disease specialist at Mount Sinai Hospital in Toronto who worked on the front lines of the SARS outbreak in 2003. “You lost the virus before you got sick and some people who get infected don’t develop symptoms.”
“That’s why what worked is that everyone wears masks and everyone keeps their social distance, because there’s no telling who will be the next infected person.”
McGeer says that viruses like the flu, chickenpox, and measles typically have symptoms in the body before people are infectious, but the virus behind COVID-19 is different.
The U.S. Centers for Disease Control and Prevention released an updated scientific guide this week recognizing that asymptomatic or presymptomatic individuals represent more than half of all COVID-19 transmissions.
“Silent transmission is one of the key drivers of the outbreaks,” said Seyed Moghadas, professor of applied mathematics and computational epidemiology at York University in Toronto.
“There is a misconception in the general population that if someone is feeling well, then they are not infected. A person can certainly be infected, contagious and feel completely well.”
Moghadas, the lead author of a study published in the journal PNAS on the silent spread of COVID-19 that was cited in CDC guidelines, he says this underscores how difficult it is to control the virus, a closely “magnified” challenge.
In Nova Scotia, it successfully contained the spread of COVID-19 during the pandemic despite the bursting of the Atlantic bubble this week, catching those silent speakers before they unknowingly infect others is the key.
Dr. Lisa Barrett, an infectious disease specialist at Dalhousie University, has partnered with public health authorities in a pilot project use rapid COVID-19 tests on people without symptoms in high-traffic areas of Halifax.
It’s only been a few days, but what they found was amazing.
On the first day they tested 147 people and found one asymptomatic case, on the second day they tested 604 more and found another, and on the third day they did 804 tests and found five more.
“We’ve recognized that there are a lot of people out there, even if they’re doing the right thing, who don’t know they’re infected, don’t know they’re infectious, and could spread to other people,” Barrett said.
“When there is a spread in the community of a virus that has a long period of time where you can be contagious without symptoms, you have to test extensively in the community or you have no idea what’s going on.”
‘A negative test is not a license to socialize’
A new approach to avoid meeting loved ones while it is unknowingly contagious that has surfaced is to get a COVID-19 test early to detect it early.
But the timing of that test is incredibly important and there’s a lot of room for error, so it might be a less effective strategy than it first appears.
A new study in the journal Science looked at 1,178 people infected with COVID-19 and more than 15,000 of their close contacts to determine when people were most contagious.
It found that most of the transition – 87% – occurred in a fairly large window of time, up to five days before or after symptoms appeared, while 53% were in the pre-symptomatic phase.
“It’s possible to be early in the disease cycle in such a way that you don’t detect any viral presence. But in two days you’re suddenly contagious and now we’re screwed,” said Deonandan, of the University of Ottawa.
“So a negative test is not a license to socialize.”
However, Deonandan says there will be people who will socialize anyway, so they better do it with precautions like testing and self-isolation than nothing, even if those precautions aren’t perfect.
Whether you’re celebrating Christmas, Hanukkah, Kwanzaa, or the winter solstice, Canadians are told to consider meeting virtually, avoid risky indoor encounters without masks, and instead find ways to connect while still physically spaced.
“I think the point for people is that yes, we’re used to having time off from school and we’re used to seeing everyone,” McGeer said. “But this is the year to delay.”
WATCH | Tam during the holiday season and how the pandemic won’t last forever
Theresa Tam, Canada’s Chief Public Health Officer, talks to National’s Andrew Chang about the holiday season and the end of the COVID-19 pandemic. 6:31
“The best advice this year is perhaps not to go too far from home,” Barrett said. “Is it worth losing control of the virus?”
“We’re hanging by a thread here. Please don’t let that thread break.”
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