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Dr. Esther Choo Thanksgiving amid Covid may doom Christmas — but there's light at the end of the tunnel

We've almost certainly already set in motion a trend that will negatively affect our ability to celebrate winter holidays. But it's not too late to commit to one last containment push.
Illustration of man inside a home with holiday directions looking out his front door with coronavirus spores snowing down.
Rather than mourning holidays lost, can we think of every life lost as a tragedy we have the power to prevent? Keith Negley / for NBC News

With nearly every state experiencing increasing rates of Covid-19 and hospitals across the Midwest becoming overwhelmed by the influx of patients to their wards and ICUs, public health officials are preparing Americans for a very different kind of holiday season. Many states are banning anything but limited gatherings of 10 or fewer people. The Centers for Disease Control and Prevention recommended a variety of safe practices for holidays like Thanksgiving, including mask-wearing, eating outdoors if possible, keeping groups small and staying 6 feet away from anyone who doesn't live in your household.

In a recent national survey of more than 2,000 U.S. residents, many participants said they intended to socialize in ways that don't comply with these recommendations.

Nevertheless, in a recent national survey of more than 2,000 U.S. residents, many participants said they intended to socialize in ways that don't comply with these recommendations. More than a third said they plan to gather in groups of 10 or more people this holiday season, another third said they wouldn't require friends or family to wear masks, one-quarter said they wouldn't practice social distancing, and 18 percent said they wouldn't ask those with symptoms of Covid-19 to stay away. AAA reports a mere 10 percent drop in expected holiday travel compared to 2019.

Just last week, the CDC announced updated guidance that people avoid travel for Thanksgiving altogether. However, unless the late-breaking recommendation was unusually effective, we've almost certainly already set into motion an upward trend in cases that will negatively affect our ability to celebrate Christmas and other winter holidays safely.

Coronavirus case numbers have spiked predictably after the social gatherings around Memorial Day, Independence Day and Labor Day. The summer holiday spread, though, was likely mitigated by the nature of the celebrations and the warmer weather, which kept people outside. This fall, people are staying indoors in closer quarters, and large social gatherings seem to have become normative again. Labor Day led to warnings against Halloween; Halloween celebrations led to surges that have compromised the safety of traditional Thanksgiving get-togethers. And yet, people are still celebrating.

Why the disconnect between escalating case numbers and risky behaviors? There are many contributing factors: the administration’s inconsistent messaging and failure to enlist the willing cooperation of the public in the shared task of observing safety measures, the undertesting and underestimations of Covid-19 cases, the scale and duration of the pandemic and the sustained nature of the public response, with the attendant weariness of imposed restrictions.

The declining mortality of hospitalized patients may also be contributing to a sense of invulnerability. But there is little discussion about how keeping hospital caseloads manageable (i.e., "flattening the curve") and wearing masks (not only to prevent transmission but potentially also to mitigate the severity of infection) are key components of improving patient outcomes.

Further, staving off Covid-19 requires a different health behavior "ask" than managing other health risks, for which the consequences are more immediate, vivid and personal. It's not hard to make the case for, say, buckling a seat belt, wearing a bike helmet or replacing a fire alarm battery. With the coronavirus, you give up something you love — the joy of spending a holiday with your family and friends, for example — in response to an invisible threat. The reasons are imperceptible in the moment, and the inherent benefit is often not immediately apparent. Outbreaks at social events like weddings have ended up affecting more people who didn't attend the event than those that did. The behavior that keeps everyone safe — staying home, wearing masks, keeping gatherings small and brief — requires people to be invested in those who aren't even there and who are usually unknown to them.

Stopping Covid-19, in other words, takes work. But it also takes imagination.

So how can we think about this virus as we head into winter?

From the health care side, we're asking people to keep in mind a simple reality: We can't care for you or your loved ones for any health condition — whether Covid-19 or something else — when our hospitals are overwhelmed. And in many places, our hospitals are being stretched to the point of breaking. More than 20 percent of U.S. hospitals expect critical staff shortages in the coming week, according to the Department of Health and Human Services.

Psychologically, we need to tap into the understanding that all of us, acting together, can do what no one person can do. Participating in social contracts is how we make society work; it's also an unspoken connection with one another. When we obey traffic lights and stand in orderly lines at the store or avoid setting campfires in the woods in a dry summer, we are signaling our regard for our neighbor and participating in the mass shared responsibility for keeping society operational and safe. Our social contract in this moment encompasses actions that lower virus transmission.

My children have been modeling another attribute we all might emulate: their adaptability around norms. They grab masks from a basket on their way out the door almost without thinking and rarely need reminders to keep them on in stores or among others indoors. The masks have become part of their normal. We can look to our children for a certain casual, shrug-your-shoulders, what's-the-big-deal approach to simple behavior changes.

We must consider our options using a future-oriented frame — activity restrictions now are solid investments in expanded activities later.

We also must consider our options using a future-oriented frame — activity restrictions now are solid investments in expanded activities later. We can and do sustain some illness-avoidance behaviors for incredibly forward-thinking gains. My mother-in-law's early heart attack precipitated my husband's behavioral change for more than three decades. Day after day after day, he takes cholesterol-lowering medications to stave off an event with much less immediate danger than the coronavirus.

Unlike a diet, medications or exercise, though, Covid-19 containment behaviors require painstaking consistency. If you reach your exercise goal for the week, you can take a well-deserved day off. But complying with Covid-19 restrictions doesn't earn you a break or a "cheat" day. That may be why people follow school and work distancing rules but then gather socially in ways more likely to spread the virus; after long days and weeks of sustained distancing, relaxing such restrictions may feel like a well-earned treat.

That's also why it's important to remember that this period is finite. We're exhausted from the trials and sacrifices of the past year. But with vaccine distribution now in sight, there is reason for renewed hope. As a society, can we gather this hope and use it to fuel a final, concerted effort?

Rather than mourning holidays lost, perhaps we can think of every life injured or lost by Covid-19 between now and widespread vaccine uptake as a tragedy that is within our power to prevent. If we can — if we can commit to recommended virus containment measures in a consistent and sustained way, if we can reach deep and find the adrenaline for this last push — we’ll be able to find our way back to bustling holiday celebrations in the new year, with as many of us present as possible.