The Cost of Thanksgiving

I am seeing quite a few messages from friends and family about Thanksgiving and the debate over having people over, indoors, without masks. Governors and health care workers trying to manage overburdened health care systems at the same time are cautioning, please don’t do it. And limitations to 10 guests are part of charges by Kayleigh McEnany that these restrictions are “Orwellian” (we’ll leave the misuse of this term aside—you get the point).

So I would like to suggest—nay, plead—that you celebrate but have no one over. Let me, from our experience on Canadian Thanksgiving, lay out what can happen (for the uninitiated, Canadian Thanksgiving happens on the second Monday in October).

I was feeling unbelievably disconnected, distracted, and depressed with the coming holiday. Our area was experiencing a spike in cases, with new guidelines about gatherings. The restrictions for indoor gathering were this: no one should have private gatherings. None. But one person living alone could get together with another person living alone.

Let me be clear: these were restrictions, but no one was knocking on people’s doors to check. No police were dispatched to throw anyone in jail. While they were restrictions, they were counting on us to follow them. This is, after all, the way that most policy works most of the time—we follow guidelines not because of some threat of tickets or arrests, but because policy is enough for us to follow in order to guide behavior.

Nevertheless, I misread the guidelines: I thought we could have one person over who lived alone. So I invited him over. And when I found out I was wrong right before we were expected to get together, I thought, ‘what’s the risk—he lives alone. He really hasn’t been out (he told me so!), and it would be mean. Besides, the cost of not celebrating—we need some connection’. So he came over for dinner, ate with us for hours, and sat across the table without a mask for Canadian Thanksgiving.

Three days later he messaged us to tell us he was positive for COVID. He was pre-symptomatic when he came over and, as it happened, was still pre-symptomatic. He received a message the day after we gathered telling him he was exposed so went for a test immediately. He got his results back two days later and informed us. The next day he developed symptoms. We trudged to the nearest testing center. We were sure, given the circumstances, we would test positive.

Before I tell you the outcome, consider this. I invited one person over. He got a message early on that he was exposed and got test results back before he developed symptoms. But he was positive when he was indoors, at our house, for hours to have turkey because I wanted to celebrate. That’s the window for transmission.

While there are general statistics and patterns of people who are more risk of dying and those may be comfortable, there is still considerable variation—so you don’t necessarily know what the outcomes will be. My friend was exposed while playing sports (outdoors-only socially distant activities allowed) at the gym. He thought it was safe given the restrictions. He still got it. So did several other people who were present that day. And while he was in rough shape for a bit (I guess you could say his case was 'mild'), another person exposed in his group at the same time ended up in the ICU, intubated. A 30-year old, in great shape, intubated, from activities outdoors at the gym. Sure, he recovered, but after being in the ICU for a month and on a ventilator. Despite all of the studies and the general patterns with higher rates for those that are high risk, no one can tell you about why their cases went in different directions. No one can say why one had a mild case and the other ended up in the ICU.

And while we have been paying attention primarily to mortality rates, the fact of the matter is the people who say, ‘there are trade-offs’ and ‘risks’, no one expects to be exposed much less end up in the ICU. And this kind of rationalization obscures all of the other costs—costs to all of us—for all exposure and transmission. And those costs are manifold. Think of it like this:

I had one person, who was pre-symptomatic, over for hours indoors. The dinner was great, the company was nice, and the celebration was definitely appreciated. But no amount of celebration and gathering—and the moments of connection that they bring—accounts for the dread of going to get tested after learning you were exposed, the anxiety of waiting for your test results, the knowledge that you exposed your family, and the two weeks of isolation where you have to rely on your neighbors or family while you quarantine. I had to call people and rely on them to buy us groceries while we stayed indoors. We were, for two weeks, isolated all the more. And we were dependent on the kindness of others while we paid the price for connection on one evening with home isolation for two weeks.

We were fortunate: we were tested immediately. There was no line and we got our results in 24 hours. When we remarked about this at the testing facility, the nurse responded that it wasn’t luck—that rates had been skyrocketing, which meant exposure and thus tests recently skyrocketed as well. In fact, the testing system was under stress just the week before. The wait in lines, for tests and for test results strained the system as a result; just a few days before people were waiting an average of 5-7 days for their results. The reason for the change, the reduction of tests and stress on the system and thus our faster results? Because they had put in the new restrictions. And people mostly respected them.

By some miracle, we tested negative. And we tested negative at our follow-up test 10 days later. I have no idea how; I also know that were definitely exposed and so, no, the lesson is not that he wasn’t positive when he came over and all was good. It is that when you are saying to yourself, “I really need a celebration; one person is within limits and ok,” or, “there are other costs, so I need this!”, you are not thinking about the call from the guest who tests positive, the knowledge that everyone who was at the table with you was exposed as well, the dreaded wait in line to be tested, the anxiety of results, or the guilt associated with exposing your family and relying on people who weren’t exposed to help you through the long, isolated two weeks ahead. That, combined with the very real prospect that we could have tested positive and all of its attendant pathways and possibilities, should make the calculation of costs fairly simple: don’t do it. Gather on Zoom; they are making the platform free for the day. Make dinner and celebrate, by all means. But don’t for the love of everyone close to you and the costs to everyone—including especially the nurse who is taking your test, the system that has to process the results, and the medical professionals who are working long hours for the innumerable cases that end up bad enough for treatment and hospitalization—don’t have indoor gatherings where rates are high. It just isn’t worth it.