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With cases of COVID-19 on the rise around the country, my family is trying to plan a safe Thanksgiving gathering. Our household consists of my husband, his elderly parents, and me. Our two grown children, their spouses, and their children are planning to join us from out of state and will be staying at separate vacation homes nearby. The plan is for our children and their families to arrive the day before Thanksgiving and go immediately to a local urgent care facility that offers rapid testing, with results in less than 30 minutes. Assuming everyone is negative, we’ll go ahead with our gathering the next day. Is this a reasonable plan? Is there anything we’re not thinking of?
With Thanksgiving and other holidays on the horizon, you’re not the only one considering this strategy. Unfortunately, it’s not that simple.
Let’s start with the test itself.
Rapid tests, like the one you are considering, are antigen tests — the COVID-19 equivalents of home-pregnancy or rapid strep tests. As with all rapid tests, there’s a trade-off between speed and accuracy. In addition, these tests were never intended to reliably detect infection in asymptomatic individuals.
When used as authorized, as quick diagnostic tools for individuals with recent onset of COVID-19 symptoms, positive results on antigen tests are almost always accurate. This allows symptomatic people who test positive to be isolated quickly, before they can infect others. But even when someone has a viral load high enough to produce symptoms of the illness, antigen tests often have a false-negative rate of 10 percent or more. When this type of test is used on an asymptomatic individual, the likelihood of a false negative is even higher.
These are not the odds you want when your family’s safety is on the line.
But even if your family members could arrive a few days earlier, giving them enough time to get a more accurate PCR test and hunker down for a few days to await the results, negative COVID-19 tests results do not guarantee a risk-free family holiday.
A COVID-19 test is simply a snapshot in time. Even with the more accurate PCR test, a negative result does not mean an individual is not infected. A negative result means only that, at that particular moment, the sample did not show viral levels high enough to be reliably measured. It doesn’t mean the virus isn’t there. It doesn’t mean that the individual wouldn’t test positive tomorrow — or even later tonight. And it most emphatically does not mean that it’s safe to crowd around the dining room table, remove your masks, and consume vast quantities of turkey, green bean casserole, and pumpkin pie.
Viewing a negative test as a license to socialize freely ignores two important facts about the virus: The first is that people who have been exposed and infected typically do not test positive or show symptoms until at least five days have passed. The second is that infected individuals are at their most contagious in the two to three days before they are likely to test positive or exhibit symptoms. In other words, some of the very individuals who are central players in “superspreading events” — those who are both asymptomatic and highly infectious — are among those least likely to be identified by a COVID-19 screening test.
A recent report illustrates both the limitations of testing and the importance of other precautions. In this case, a 13-year-old girl who tested negative for the virus four days after a known exposure transmitted COVID-19 to her grandparents and nine other relatives sharing a vacation home. None of the individuals staying in the home wore facemasks or practiced physical distancing. Notably, however, an additional six relatives who visited for 10 hours on one day and three hours another day, when multiple overnight attendees would have been infectious, avoided contracting the virus by maintaining physical distance and staying outdoors at all times.
So, where does this leave your Thanksgiving plans?
If it were up to the Centers for Disease Control and Prevention (CDC), all of your family members would stay home and celebrate the holiday in their own homes, spending time with distant relatives through a “virtual dinner.” The CDC classifies any gathering with people outside of your own household as a moderate- to high-risk activity, even if you follow the agency’s guidelines for hosting gatherings or cookouts. Outdoor gatherings carry the least risk, but the agency still recommends wearing masks whenever possible and arranging tables and chairs to keep groups of individuals from the same household at least six feet away from other family groups. Unfortunately, typical Thanksgiving Day weather in much of the country renders outdoor dining somewhere between uncomfortable and impossible.
If you are determined to celebrate any holiday with individuals outside of your household, you should think of it in terms of a temporary social bubble. This involves having all would-be attendees quarantine strictly for two weeks prior to the holiday and drive to the gathering in private vehicles without having contact with others along the way. Depending on where your family members live, this might be an option for you. If so, it will be important to make sure everyone agrees to the same guidelines for the quarantine period — for example, no seeing friends or going to the office or the gym during that time. And, unfortunately, if your grandchildren are attending in-person school, that’s a deal breaker.
After many months of separation, it’s incredibly tempting to let down your guard to see the people you love. Many of us are feeling real pressure to do something — anything — to make our lives feel “normal” again. But it’s important to balance temptation with precautions and ground rules. So, start communicating! Hop on the phone, or send an email, and make a plan. Whether you choose a bubble or Zoom, you and your family can be still be thankful — for your health, your safety, and hot turkey sandwiches for weeks.