By Victoria Knight, Kaiser Health News

Vivek Kaliraman, who lives in Los Angeles, has celebrated every Christmas since 2002 with his best friend, who lives in Houston. But, this year, instead of boarding an airplane, which felt too risky during the COVID pandemic, he took a car and plans to stay with his friend for several weeks.

The trip — a 24-hour drive — was too much for one day, though, so Kaliraman called seven hotels in Las Cruces, New Mexico — which is about halfway — to ask how many rooms they were filling and what their cleaning and food-delivery protocols were.

“I would call at nighttime and talk to one front desk person and then call again at daytime,” said Kaliraman, 51, a digital health entrepreneur. “I would make sure the two different front desk people I talked to gave the same answer.”

Once he arrived at the hotel he’d chosen, he asked for a room that had been unoccupied the night before. And even though it got cold that night, he left the window open.

Scary Statistics Trigger Strict Precautions

Many Americans, like Kaliraman, who did ultimately make it to Houston, are still planning to travel for the December holidays, despite the nation’s worsening coronavirus numbers.

Last week, the Centers for Disease Control and Prevention reported that the weekly COVID hospitalization rate was at its highest point since the beginning of the pandemic.

More than 283,000 Americans have died of COVID-19. Public health officials are bracing for an additional surge in cases resulting from the millions who, despite CDC advice, traveled home for Thanksgiving, including the 9 million who passed through airports Nov. 20-29.

Hospital wards are quickly reaching capacity. In light of all this, health experts are again urging Americans to stay home for the holidays.

For many, though, travel comes down to a risk-benefit analysis.

According to David Ropeik, author of the book “How Risky Is It, Really?” and an expert in risk perception psychology, it’s important to remember that what’s at stake in this type of situation cannot be exactly quantified.

Our brains perceive risk by looking at the facts of the threat — in this case, contracting or transmitting COVID-19 — and then at the context of our own lives, which often involves emotions, he said. If you personally know someone who died of COVID-19, that’s an added emotional context. If you want to attend a wedding of loved family members, that’s another kind of context.

“Think about it like a seesaw. On one side are all the facts about COVID-19, like the number of deaths,” said Ropeik. “And then on the other side are all the emotional factors. Holidays are a huge weight on the emotional side of that seesaw.”

The people we interviewed for this story said they understand the risk involved. And their reasons for going home differed. Kaliraman likened his journey to see his friend as an important ritual — he hasn’t missed this visit in 19 years.

What’s clear is that many aren’t making the decision to travel lightly.

For Annette Olson, 56, the risk of flying from Washington, D.C., to Tyler, Texas, felt worth it because she needed to help take care of her elderly parents over the holidays.

“In my calculations, I would be less of a risk to them than for them to get a rotating nurse that comes to the house, who has probably worked somewhere else as well and is repeatedly coming and going,” said Olson. “Once I’m here, I’m quarantined.”

Now that she’s with her parents, she’s wearing a mask in common areas of the house until she gets her COVID test results back.

Others plan on quarantining for several weeks before seeing family members — even if, as in Chelsea Toledo’s situation, the family she hopes to see is only an hour’s drive away.

Toledo, 35, lives in Clarkston, Georgia, and works from home. She pulled her 6-year-old daughter out of her in-person learning program after Thanksgiving, in hopes of seeing her mom and stepdad over Christmas. They plan to quarantine for several weeks and get groceries delivered so they won’t be exposed to others before the trip. But whether Toledo goes through with it is still up in the air, and may change based on COVID case rates in their area.

“We’re taking things week by week, or really day by day,” said Toledo. “There is not a plan to see my mom; there is a hope to see my mom.”

And for young adults without families of their own, seeing parents at the holidays feels like a needed mood booster after a difficult year. Rebecca, a 27-year-old who lives in Washington, D.C., drove up with a roommate to New York City to see her parents and grandfather for Hanukkah. (Rebecca asked KHN not to publish her last name because she feared that publicity could negatively affect her job, which is in public health.)

“I’m doing fine, but I think having something to look forward to is really useful. I didn’t want to cancel my trip completely,” said Rebecca. “I’m the only child and grandchild who doesn’t have children. I can control my actions and exposures more than anyone else can.”

She and her two roommates quarantined for two weeks before the drive and also got tested for COVID-19 twice during that time. Now that Rebecca is in New York, she’s also quarantining alone for 10 days and getting tested again before she sees her family.

“I think, based on what I’ve done, it does feel safe,” said Rebecca. “I know the safest thing to do is not to see them, so I do feel a little bit nervous about that.”

But the best-laid plan can still go awry. Tests can return false-negative results and relatives may overlook possible exposure or not buy into the seriousness of the situation. To better understand the potential consequences of the risk you’re taking, Ropeik advises coming up with “personal, visceral” thoughts of the worst thing that could happen.

“Envision Grandma getting sick and dying” or “Grandma in bed and in the hospital and not being able to visit her,” said Ropeik. That will balance the positive emotional pull of the holidays and help you to make a more grounded decision.

Harm Reduction?

All of those interviewed for this story acknowledged that many of the precautions they’re taking are possible only because they enjoy certain privileges, including the ability to work from home, isolate or get groceries delivered — options that may not be available to many, including essential workers and those with low incomes.

Still, Americans are bound to travel over the December holidays. And much like teaching safe-sex practices in schools rather than an abstinence-only approach, it’s important to give out risk mitigation strategies so that “if you’re going to do it, you think about how to do it safely,” said Dr. Iahn Gonsenhauser, chief quality and patient safety officer at the Ohio State University Wexner Medical Center.

First, Gonsenhauser advises that you look at the COVID case numbers in your area, consider whether you are traveling from a higher-risk community to a lower-risk community, and talk to family members about the risks. Also, check whether the state you’re traveling to has quarantine or testing requirements you need to adhere to when you arrive.

Also, make sure you quarantine before your trip — recommendations range from seven to 14 days.

Another thing to remember, Gonsenhauser said, is that a negative COVID test before traveling is not a free pass, and it works only if done in combination with the quarantine period.

Consider your mode of transportation as well — driving is safer than flying.

Finally, once you’ve arrived at your destination, prepare for what might be the most difficult part: to continue physical distancing, wearing masks and washing your hands. “It’s easy to let our guard down during the holidays, but you need to stay vigilant,” said Gonsenhauser.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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