Thanksgiving Isn't Lost, Innovate Your Plans

November 23, 2020
by Lori Lennon

Photo of Dr. Cassandra Pierce

Dr. Cassandra Pierre, an assistant professor at the Boston University School of Medicine, Medical Director of Public Health programs, Acting Hospital Epidemiologist at the Boston Medical Center, and chair of the Diversity and Inclusion Council, joined Thinkubator Media for a chat about how to celebrate Thanksgiving safely.

You can watch our video interview here

Thinkubator Media: You have been very, very busy. I think we should dive right into some of the great work that you're doing to help keep everyone in Massachusetts safe because we're in the middle of a pandemic and a week away from Thanksgiving.

Officials in Massachusetts are urging people to be safe, responsible, and cut back on their ideas of what Thanksgiving and the holidays look like this year. Can you tell me a little bit about some of the work you've been doing at Boston Medical Center to help with this pandemic?

Dr. Pierre: Well, we all do our best and I know we're all incredibly busy. I always like to say to people that their second job should be acting as a public health official themselves. Everyone needs to evaluate their risk, and I feel like a lot of what I do both in my hospital and in the community is giving people the tools to allow them to evaluate what that risk really is. And that risk keeps changing.

At the beginning of the pandemic, we talked about travel, then we talked about wearing appropriate PPE, and avoiding crowds. We added additional layers of infection prevention with physical distancing and hygiene. Then it was really about maintaining adherence to your bubble and not mixing households.

We now know that indoor gatherings are the things that are going to drive our numbers highest, in the fall and the winter with the holidays in particular. I am very concerned about that, but there are also hidden risks. I think we aren't talking as much about indoor restaurants, indoor gyms, and places where people have a lot of respiratory secretions, even if they're wearing masks.

I do see a lot of people who are coming in and they've done everything right, They've worn their masks, they've isolated, they've been in a household by themselves, and they don't go out. These people are not sure where they're getting infected. When we do their risk assessment, we find that they go into the gym every single day and it's heartbreaking to say that's the mechanism of it.

It's easy for me to say, consider switching it up, running outside, engaging in outdoor and winter recreation, but the truth is for many people, there are no safe outdoor venues, especially as the winter weather comes in. They might need to access equipment that is not readily available for them in the outdoors or may not be able to afford that equipment for themselves. So, I'm really sympathetic.

There are tough conversations that need to be had about whether to shut down. As a whole, people really want to try and press the infection prevention measures, wearing masks, physically distancing, and those things are absolutely still true, but we do see that they are only partially effective in those indoor venues with poor ventilation. I also think many of the hospitals, including mine, have an escalation plan of when we deescalate or when we draw down on some of our activities that are tied to metrics.

Thinkubator Media: How are you seeing COVID impact Boston Medical Center and other hospitals? We've started really seeing an increase in numbers here in Massachusetts.

Dr Pierre: Yeah, absolutely. I remain surprised, even though we knew this was coming, to see the numbers rise so quickly for so long. We had seven people or less with COVID infection in our hospital, and then it was steadily rising as of three weeks ago. Now we have 40 people in the hospital who are COVID positive and a significant number of those in the ICU. It feels very much like an uncomfortable dejavu and many of us are a bit on edge. I don't want to paint a very bleak picture, but many of us have been going since the very beginning.

We feel like we understand transmission, we understand what PPE we need to wear to keep ourselves safe, and we know that we don't necessarily want to do what we did last time. We shut down all of the elective surgeries and all of the preventive primary care visits. What we saw was that people's health did worsen in those situations where we were not actively attending to their health. So we don't want to shut the doors on all of those things and we can't really afford to for the health of our population.

That being said, we certainly have been very creative in this time and we continue to draw on a lot of the partnerships and collaborations that were strengthened at the beginning of the surge.

Thinkubator Media: As we get closer to Thanksgiving and the holidays, what kind of advice, as an epidemiologist, would you give people? There's a lot of people out there who feel immune to COVID. One of the instances I can think of was on Facebook. Somebody posted that this could be your last Thanksgiving ever, so spend it with the people you love, which seems ironic to me.

Dr. Pierre: So I think the message actually should be if you want this to be your last Thanksgiving, spend it with the people you love and multiple households without any infection prevention. You know this is a false dichotomy. Either you hunker down and you stay to yourself and you have no Thanksgiving, no merriment, or you just say, "Forget it, I've got to live my life. I can't do this any longer." You have a blowout and you do all of the things that we've been recommending that you don't.

We understand that it's difficult sometimes for people to adhere to the letter of the public health law, and we want to make sure that there are options for people. There is a middle path. Certainly, my preference would be, as a public-health individual, that people limit their celebrations to certainly less than 10 people, but also to single households, if possible.

Think about changing up your routine. Who says your Thanksgiving has to be your entire family gathered around the table? One thing this year has taught us is that there are ways to rethink the way we live our lives. There's a lot of darkness around this time, but there's also a lot of innovation and ways to rethink what we've been doing for so long. For some people, holidays are actually a source of stress. You're going to be cooped up with your aunt who has extreme political views or an aggressive interrogation style, you know? There are lots of ways to rethink this.

Even if you are having a holiday celebration just for your household, it's not blizzard conditions in Boston at this point. You can still have outdoor meetups with people, physically distanced in the park. You can go for a walk. That's what my family is doing. We're going to have dinner, then we're going to go see the grandparents and have a nice walk in the park together.

If you are going to be with anyone who's immunocompromised, anyone who's at high risk of severe complications of COVID, I would recommend that you don't mix households or include that person in your celebrations, but you can quarantine before the event, or relatively quarantine, to limit your exposure to others.

You can get tested, not just once, but twice or more times to increase your sense of assurance that everyone going to the gathering is negative. There are many things and many layers of infection prevention that you can put together to further and decrease your risk but I would encourage you to study those things and avoid an all-out blowout and throwing caution to the wind.

We have many more years. You want to preserve the number of holidays that we spend together, and we can certainly do that. COVID is not inevitable, despite what you might think, despite what you've been hearing, it is not inevitable.