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Dec 10, 2021Liked by Katelyn Jetelina

Gorgeous picture of you and your girls -- thank you for sharing, and for sharing your sensible, measured advice.

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I wish you and your family a safe and happy holiday. And I often find your pieces very valuable and insightful, so thank you for writing YLA. That said, I'm reading a lot of cognitive dissonance in this piece. You described a lot of reasons why travel/gathering in our current context is not a good idea. Then, you justify your own holiday plans with a quick, vague reference to mental health and individual risk calculus. But the one mental health survey you cited involves a lot more nuanced conclusions than simply "we should gather during the holiday to improve our mental health." And individual risk calculus is a lie privileged people keep telling themselves. The bottom line is that we cannot exit this pandemic individually, and you said as much ("We also know that infectious diseases violate the assumption of independence.") before launching into a confusing justification of your own individual choices. I understand a lot of us are tired and hurting; I think we can spare ourselves and our communities a lot more pain if we make sacrifices now, including forgoing holiday gatherings in order to stop community spread.

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I appreciate your feedback. And there is cognitive dissonance. I am a regular person that also has to navigate a very confusing pandemic while my girls are still unable to get vaccinated. But this is what I decided I'm doing and juggling and I thought that it may be useful for other moms. Agree or not, that's fine

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I empathize. This is really hard. And I'm not a parent, so you're navigating challenges that I will never fully understand. I appreciate that your core mission is to help other people, and I certainly benefit a lot from your work overall, so thank you again.

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We're all in this unfortunate, terrible position because of a lack of collective response to this pandemic. I feel like all I can do at this point is keep calling the White House and Congress to demand that they distribute N95s and COVID tests through USPS to everyone living in the US.

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founding

I just want to say I completely understand where you are coming from and agree with you to a large extent. Unfortunately those of us with kids are having an entirely different struggle than those without.

Personally we, the USA, have utterly lost against COVID-19. Full stop, there is no denying how poorly we have done throughout this pandemic. I think it is foolish to even try to think otherwise and I suspect Dr.Katelyn agrees. There are too many who have shown they do not care about others for this to end well. That being said, this post is about as balanced between risks and spreading the disease as it gets. Being vaccinated is our best tool followed by masking. She is suggesting both. Then follows it up with suggesting people test as well. She is also presenting a very real scenario many people are facing "how to deal with our unvaccinated family members this Christmas."

Now, I firmly refuse to visit any friends or family who are unvaccinated in an unmasked environment. That is my family's standard and will remain so. However, not everyone has family who will adhere to this so the antigen tests offer a compromise to help prevent an outbreak in families while at least trying to be safe. Her post has red lines where if they refuse rapids, she won't meet with them.

Now I agree with you Greenknight and believe it is better if people simply stayed home and did not travel this Christmas. It is incredibly risky but, realistically, people will ignore that advice this far into the pandemic. Not without reason, I might add, because some people have been isolating from family who have limited time left on this earth. So I get why some want to see family even if I disagree with it. But our fight against covid is lost. At this point we are trying to prevent those of us who still care from spreading the disease further. Requring antigens is about as much compliance you will get from many unvaccinated family members(though I caution anyone using this method that you should think of a method to ensure they do not lie to you i.e.make them send you a photo of the negative antigen instead of merely a text message). Perhaps people might say I am being harsh in my assessment of our situation, but my optimism has long been gone with trying to manage the pandemic in this country. There are just not enough people who care. I, and others who do care, can do what we can to try to make sure we ourselves are doing what we can to make sure we do not contribute to the spread of covid.

If this is too blunt, I can remove this comment but I thought I would chime in my 2¢ after reading this post as I agree with both of you.

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No worries, I appreciate your bluntness. And I am sorry to hear about the frustration and despair you expressed here. We should not be in this situation.

I do not think Dr. Jetelina is recommending anything extremely reckless overall, despite the presence of cognitive dissonance. My concern is that this piece frames the experience of the pandemic largely on the individual and the ways an individual navigates that experience with consumerist choices.

That perspective (though I'm not attributing it to Dr. Jetelina, I think folks like David Leonhardt are much more culpable) contributed to our present situation. Too many wealthy, privileged, and non-disabled people (also often white) assume they can do what they want, that bad things will not a happen to them, and that everything will work out okay. None of those things are sure results. And continued travel/dining out contributes to the community spread that is most severely impacting people outside of the caste that I described above. From "Variation in COVID-19 Mortality in the US by Race and Ethnicity and Educational Attainment" (https://pubmed.ncbi.nlm.nih.gov/34812846/)...

"f all groups had experienced the same mortality rates as college-educated non-Hispanic White individuals, there would have been 48% fewer COVID-19 deaths among adults aged 25 years or older overall, including 71% fewer deaths among racial and ethnic minority populations and 89% fewer deaths among racial and ethnic minority populations aged 25 to 64 years."

This combined with all personal health risks from COVID and the strain on our medical systems leads me to believe that a lot of people should reconsider the significance of their holiday travel plans. I don't think we can unequivocally call our fight against COVID a lost fight; we need to try harder.

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This thread by Gregg Levine I think is a good summation, punctuated with a relevant anecdote, about why those of us with the means need to cut back on the behaviors that can spread COVID-19. tl;dr: "If you are a person who has the economic means to make choices about your interactions, access to medical professionals, and an awareness of what is going on, it is essential you use your privilege to help slow the spread of the virus. Not doing so makes you part of the problem." https://twitter.com/GreggJLevine/status/1470092763391737863

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I also think it's unrealistic to tell people not to do anything. People aren't going to do that. So I can help guide them to do things as safe as possible, then we will still spare our communities a lot of pain.

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I'm not saying don't mark the holiday. There are ways to still enjoy this time of year remotely. Get on family calls with Jitsi. Play board games on Board Game Arena and chat through Discord. Use Teleparty to watch content together.

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Life is with people.

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Indeed. I think it's great that there are many options to spend time with people virtually during pandemic, to get that people-time safely.

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My concern is that if we keep trying to reach some sort of happy medium on precautions, there will be folks who step over the line while there will be other folks left behind. Right now, some people cannot attend to their basic health care needs because community spread is too high. We should prioritize the needs of our most vulnerable people, and from there find ways to mark the holidays with everyone's safety in mind.

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Sure, some folks will still ignore even the best possible precautions, but if we make those best possible precautions the norm then I think we get the best yield on safety. And more people will be willing to go along with those precautions because they are the norm.

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And yet, life goes on. Our babies are growing up, and our elders are getting older and dying. This will happen during the pandemic years, regardless of the choices we make. If we never get to see our aging parents again, or if our children don't get to see their grandparents, or if our babies don't bond with their cousins, it won't be much consolation that we did our tiny part to end the pandemic.

Somewhere in the range of possible choices is a balance between doing our part as responsible members of society, and not pretending we can put our lives on hold for 2 or 3 or more years without lasting consequence.

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I understand your perspective. This is really hard. The fear of missing out is real.

I think it's important to balance that fear on the individual level against a broader vision of our social contract. Children will age and elders will die, yes. Children and elders also died before their time because we continue to allow this virus to spread. I doubt that seeing our relatives now will be much consolation if we will be unable to see them again because of the choice we make now, especially if actually committing to public health measures would have given us all many more holidays with our relatives.

I think the more privileged among us should reflect on the fact that some people will never see their relatives again or have their lives on permanent hold due to COVID-19. I think that realization should inspire more people to think carefully about whether it's truly worth it/necessary to travel and contribute to the toxic norm that is furthering the propagation of the virus.

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I know this is different because we "can't exit the pandemic individually," but I do think there is value in individual risk assessment and risk assessment of spreading to others. I know people who live dangerous lives based on where they live and what they do for jobs. To them, going into a subway vaxxed and masked (which they have to do anyway to earn a living, but they are also doing it for recreation and visiting friends and relatives) is OK because the risks are less than what they face every day without a pandemic. Will that lead to more spread? Probably. But what is there community without human interaction? What will it be like in the remains after 2 or 3 years living like we did before the vaccine? Weighing factors is what we need to do, and one of those factors is hospital capacity where you are.

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I think individual risk assessment is a cover for people to give up on managing the pandemic. That type of calculus might be appropriate when deciding, in normal times, to do an activity that ultimately impacts only you (i.e. going skydiving, running a marathon, etc.). In a pandemic, each individual's decisions impact the community, especially in the case of an airborne pathogen that can infect asymptomatically.

I think you're also making a lot of assumptions about people doing essential work. Perhaps they feel comfortable in their personal lives with assuming the danger that they already assume for their work. But perhaps they do not, and they shouldn't have to do that anyway. And those of us who can work/live from home as much as possible should do that, so that the folks who have to go out to work can do so as safely as possible.

I also think you're exaggerating the decline of human interaction. For the folks with the means, there are still a lot of ways to connect through the internet. And for the folks without the means, we should (as a society) make the necessary investments (expand broadband, distribute free PPE and tests) to ensure safety as much as possible.

The truth isn't that the US can't manage this pandemic; this truth is that it has not tried. It should not be up to us all to navigate this pandemic as individuals, alone, weighing a multitude of factors from hospital capacity to vaccine distribution to the virulence of the latest variant. We've been abandoned.

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Almost 40% of my city does not have personal broadband access. I am a librarian, and we are actively using American Rescue Plan Act funds to help alleviate this, but it is hard with lots of practical roadblocks. Many of those people access the internet through the public library, but now that there are so many restrictions in place at the library, it is hard for them to do that too.

I know that is just my little snippet of the world, but it is the one I am living in, and I do think it is unrealistic to expect people just to hole up at home without severe negative consequences down the road. It is hard to weigh those unknown consequences of staying at home vs the unknown consequences of being out and about. There are no easy answers!

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First of all, thank you for the work you're doing to support your community. Local libraries are critical public resources that all too often must endure severe neglect.

I'm not denying that broadband access issues exist. We need to expand broadband. And we need to tear down barriers to internet access, because access to information (especially during a pandemic) can often make a huge difference in life.

I appreciate you sharing your snippet. I think that we're in the situation we are in now because of a lack of collective response and too many people inappropriately assuming they can flex the privileges they enjoyed pre-pandemic. Not everyone can stay home 100%, but I think everyone needs to try within their means to do, especially those of us with the privileges of wealth, work-from-home, and wifi. There are no 100% easy answers, but I think right now the more privileged folks in our society are going with the answers that are easiest _just for them_ and that is adding to toll exacted by the virus.

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The consequences on the mental health of teens, young adults, and the elderly have been particularly devastating. I've seen it first hand. Human beings are not made for long-term social isolation, and the internet isn't a substitute for everyone.

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This is certainly a very hard time. I am sorry to hear about the suffering you witnessed first hand. I hope things work out for the better.

And sure, the internet is not for everyone. Differentiated approaches need to be considered, especially in the realm of education as long as community spread gets managed very carefully. Though in a lot of ways the internet offers the safest mode of communication/interaction and can be an effective substitute for in-person activities.

I think it's also important to be careful about the ways we discuss the implications of the mental health burdens resulting from this pandemic. Especially with regard to children. For more on on this topic, please check out this podcast - https://soundcloud.com/deathpanel/covidposting-w-abdullah-shihipar-111921

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Here's a thread by Tyler Black, MD. The subject matter is tough, though it's through a data-based lens. tl;dr: "when lockdowns were strongest (least amount of school), suicide rates amongst kids were lowest." https://threadreaderapp.com/thread/1470785676316663820.html

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Dec 10, 2021Liked by Katelyn Jetelina

Thank you for your clear and helpful information. Between Andy Slavitt, my local public health officer and you I feel better equipped to navigate these challenging times. I hope that you and your family have a safe and joyful Christmas gathering with your family.

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Dec 10, 2021Liked by Katelyn Jetelina

Thank you so much for your guidance! Wishing you and your family a wonderful holiday.

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Dec 10, 2021Liked by Katelyn Jetelina

Thanks for the advice, and the lovely pic of you and the girls. Happy Holidays! 😻

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Dec 10, 2021Liked by Katelyn Jetelina

Fabulous - love the plan. Wishing you and yours a Happy Healthy Holiday!

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Can, or have you, done a post about the assumption of independence? I think a lot of people have a problem understating this as it relates to infectious diseases during a pandemic.

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Do boosters matter yet? We have some family who are vaxxed but not boosted (and had J&J originally) and I can't decide whether to do a "normal" christmas visit with them or to require rapid tests (this would cause some drama).

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founding

Thank you for sharing your plan. Have a safe journey!

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On antigen tests, my family would need 12 tests and that adds nearly $200 to the budget. I know our health is invaluable! But is there any advice to reduce testing everyone? Just hoping.

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All testing at Walgreens (or the like) should still be free and is a great choice for rapid testing. You usually need to schedule those tests 2+ days in advance.

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It may not be free if you don't have symptoms or a script, depending on your community and your insurance.

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Right now they're $24 for 2 tests ($12 each) so that would be $144 for 12 tests. Still a significant chunk of change. They'll soon be reimbursable through insurance and free through public health centers per Biden's plan. It's high time they were free and widely available. The UK has been sending them to households for free.

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Hello all, new subscriber and first time poster! yay!

The flow chart for how to do the Antigen testing seems to be designed for a short visit, because you could be testing in the 0-7 day portion of a 14 day incubation period where the viral load isn't high enough for either test type to detect. If that's the case then if the visit extends into or past the 8-14 day incubation period, you could have contagious family on your hands.

Is that a correct reading of the flow chart? I understand that is a worst case scenario, but want to make sure I'm following the flow chart, timeline of viral load, and detection capabilities of the antigen tests correctly. Thanks!

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My daughter is 11, and is finally 2 weeks post 2nd vaccine. She's been waiting to attend scouting events until fully vaccinated. Their holiday party is tomorrow, and we just found out that the potluck portion will be indoors (I previously thought it was outdoors). If we are a fully vaccinated household and wear KN95s the whole time (not removing them or eating while there), is that considered safe at this point? She needs the social interaction so badly, but I don't want to put us in a risky COVID situation. It's a mixed group of vaccinated and unvaccinated, there is not rapid testing ahead of time.

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Hi Katelyn. Thank you for the updates. I am a minister at a church in NY. Trying to keep folks safe, at least when they're in worship. We are planning a hybrid Christmas Eve service. All masked indoors, most vaxxed and boosted. Should we be spacing out and leaving windows open? Should we be meeting at all???

Thanks

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Is there any data yet on: how long the patients are contagious vs. delta/beta? How long the incubation period vs. delta/beta? How many days is the rapid negative while the PCR is still positive?

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Fantastic advice as it is realistic! Thank you for all you do!!!

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how often would you rapid test for a multi-day gathering? every day?

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If you're spending time with people for a multi-day gathering, I would get PCR tested before you leave home to detect an early infection that's still incubating, with very low viral load. A rapid test only tells you that you're not contagious on the day the rapid test was taken.

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