Recommendations from CNN Medical Analyst about Thanksgiving 2020

(CNN)If you want to visit your family for Thanksgiving and avoid passing coronavirus on to them, experts say you need to quarantine for 14 days.

That's two weeks of doing even less than we're doing now, and it needs to start today.

CNN talked to CNN Medical Analyst Dr. Leana Wen, an emergency physician and a visiting professor at George Washington University Milken Institute School of Public Health, to find out what that entails. Here's her guidance.

CNN: Why do we need to quarantine before seeing relatives?

Dr. Leana Wen: The United States is suffering through the worst part of the pandemic that we have seen yet. We have added 1 million new infections in just 10 days. Hospitals in multiple states are already diverting patients because their emergency rooms and intensive care units are too full.

Remember that people we love can carry the virus as much as strangers can. When the level of virus in the community is so high, it's not safe to get together in person, indoors, with anyone not in your immediate household bubble. 

If you want to get together with other households for an indoor Thanksgiving, you need to quarantine for 14 days and then get tested.

CNN: Why is quarantine 14 days long?

Wen: Fourteen days is the maximum incubation period for the virus that causes Covid-19. If you quarantine for less time than 14 days, you could be infected and not know it. I am certain that none of us would want to inadvertently spread Covid-19 to those we love the most. Taking a test too early -- before a 14-day quarantine -- may not pick up on the infection.

CNN: What can we do during our quarantine?

Wen: In this case, quarantine refers to staying away from others and minimizing your risk as much as you can. It doesn't mean staying locked in your house. Getting fresh air is good and important for your physical and mental health. So it's fine to take walks and exercise outdoors. Try your best to stay away from other others, and keep at least a 6-foot distance when outdoors.

We know Thanksgiving can involve a lot of cooking, and therefore grocery shopping. Going to the grocery store can also be low risk, although you should try to go during off-times and try to go just once during your 14-day period. You could also try to order groceries or the entire meal to be delivered to your home.

CNN: What should we not do?

Wen: Here's what's high risk and should be avoided during this period. Do not go to indoor bars or restaurants. Avoid gyms. Most important: do not get together with anyone else outside your household for anything indoors -- no dinner parties, no birthday celebrations or any other get-together indoors. If you are socializing outdoors, make sure you keep a 6-foot distance from others at all times.

If you're getting together with other households for the holiday, you should discuss what other activities you would be OK with. Many doctors' offices have put in place precautions and it's probably low-risk to visit the doctor. Many workplaces have instituted many protocols to reduce risk, and it may even be very low-risk to go to work if you can keep at least a 10-foot distance from others and wear masks at all times.

CNN: Does everyone have to quarantine?

Wen: Yes. The key is that every member of every household that wants to get together must participate in the quarantine for 14 days. If one person breaks quarantine, that person is exposing everyone else to their risk. This requires a lot of trust, so set that expectation in advance.

CNN: What about daycares and schools?

Wen: This is a tough one. Daycares and schools may be necessary for a lot of families when it comes to childcare for working parents. They may be relatively lower risk for transmission, especially for younger children. However, there is an infection risk, especially given the high level of coronavirus across the country. I would not consider a family that's still sending kids to daycare or school to be low risk enough to be part of an indoor celebration. But if kids stop daycare or school now and then get tested in 14 days, they could see other relatives indoors.

CNN: Can we still see one another if we don't quarantine for 14 days?

Wen: Yes, but you can only see them outdoors, with households spaced at least six feet apart. You can still host safely and have fun! But do not get together indoors.

CNN: Are there other ways to celebrate if we can't get together with our family?

Wen: Yes! Being safe doesn't mean we should stay isolated. Maybe we can't get together in person with family. You can plan an outdoor "Friendsgiving." Bundle up and bring warm blankets. Be flexible if it turns out that we can't celebrate Thanksgiving on that day because of the weather.

CNN: What if we have to travel to see family for Thanksgiving?

Wen: I'm less concerned about the travel itself than the activities before the travel. The 14-day quarantine period should happen before the travel. Then do everything you can to minimize risk while traveling.

CNN: Is driving better than flying?

Wen: Driving will be safer than flying because you can control who's in your car. Keep rest stops to a minimum. Make sure to wear a mask if you're using a public restroom and sanitize your hands after leaving. Even flying has relatively low risk, with only a handful of infections reported for flights where everyone is wearing masks. Make sure to wear a mask the entire flight, ideally an N95 or at least a 3-ply surgical mask.

Still, I urge everyone to reduce nonessential travel. Even though the travel itself is low-risk, I worry about people coming from all over the country, since nearly every part is a coronavirus hotspot at this point.

CNN: What about college students coming home for the holiday?

Wen: Many colleges have had outbreaks. Young people tend to be asymptomatic spreaders, and returning college students should be treated as being very high risk.

It's probably not practical for students to quarantine for 14 days before they return. In that case, they need to quarantine once they return home. That means staying in an area of the house that's totally separate from anyone else. They should not be in any indoor areas with other people for 14 days. They can socialize outdoors only during that period.

CNN: This is a lot. Is it really necessary?

Wen: Yes. I know it's a lot. But we have to get through this winter. There is hope on the horizon, with a vaccine and therapeutics likely next year. We need to get to that point. That means we have to keep up all these precautions. Wear masks. Physical distance. Wash our hands. Avoid indoor gatherings.

We've already endured so many sacrifices. We can get through this winter, together.

Recommendations for Coping Well During the COVID 19 Pandemic

For Couples:

Collaboration:  As challenges emerge within your home, joint decision-making is crucial.  You and your spouse are the co-owners of your family business, and each of you will have portions of duties related to being CFO, Chief Technology Officer (which may get delegated to a smart teen), Head Chef, Chief Environment Officer, Classroom Teacher for those with younger children, School Principal for those with
teenagers, and Chief People Officer trying to keep everyone safe and happy.  Carve out a few minutes each day independent from children overhearing to check-in on how each of you are doing with the assigned duties.

Establish routines:  Understand and respect each other’s work schedules; consider a large calendar with markers to show what times your spouse is truly unavailable.

Embrace Space:  If you have not done so by now, ensure you each have your own “office” and your children have their own “play spaces.”

Avoid Pushing for Sexual Intimacy :  Stress hampers libido in 85% of adults.  When you feel interested, then
create a safe and nurturing environment with no strings attached to see if the desire is mutual. 
Focus on Small Blessings:  Gratitude is essential for experiencing hope.  Thank your spouse for how s/he
contributed to the day going well.  Don’t have meals in front of the TV, but rather share a meal talking together as a couple keeping the conversation focused on our blessings and how we are helping each other

Strategies when Unsafe:  If you have been a victim of domestic violence, no quarantine is more important than your health. Local resources are available through Broward County’s Women in Distress 954 761 1133.

For Parents:

Create a Plan:  Be clear with your kids about the local guidelines about what’s allowed and what’s not including curfews, off limits spaces like pools and gyms, wearing masks if helping with errands,
and the risks associated with sharing sports equipment and toys with friends who don’t live with you.

Make it Fun:  Board games, card games, rotate who chooses a movie or program for everyone to watch and discuss, take a family hike or bicycle trip

Keep Kids Close:  You can hug those you are living with; those are the only people that your kids can hug right now, so your affection and reinforcement of comfort is critical.  Depending upon their age and level of responsibility, decide whether to have children accompany you to a grocery store or pharmacy

Be Honest with Your Children:  Communicate about the facts of the situation.  For middle school and high school students, consider watching the local news together and then discuss as a family .  Let children
express their feelings and comfort them when expressing worry or sadness.

Give Kids Control:  Give kids choices about what game to play what song to sing, what meal to cook together,

Read Books:  This is not the best time for scary books, but uplifting, fun books and those whose storylines are encouraging and uplifting.

Let Kids Help:  Delegating cleaning chores, and cleaning up after pets are a wonderful way to teach responsibility.  Teenagers are likely to embrace showing compassion, particularly for grandparents, other families in need, and their close friends.  Find the balance with being creative and helpful whole staying physically safe.

Be Patient:  Sometimes children regress; those who may have successfully moved forward in stages of development may regress to bed wetting, aggression, obstinance, or screaming uncontrollably.   This will test your patience; if you are fortunate to have a spouse or partner who shares the home, collaborate together.

For Singles:
This is the time when people learn the depth of friendships   Allies are people that you rely on during difficult circumstances.   Confidantes are persons that you entrust with difficult emotions or decisions such that you will typically accept their feedback and still apply the constructive criticism. 

Outside of work hours, please engage with social opportunities online:  Zoom gatherings, discussion groups related to or having nothing to do with COVID 19, online recovery meetings are examples of great outlets. 

Keep updated with CDC guidelines related to sheltering at home, symptomology of COVID v allergies v flu v colds, wearing of masks and gloves outside of home, social distancing recommendations, and local guidelines about accessing businesses and recreational activities. 

Without recommending anyone turn into a hoarder, ensure you have 2 – 3 weeks of food and supplies should
local authorities further restrict options for leaving our homes.  In this area, we have often withstood several
days at home without power post hurricanes; this time we have access to our refrigerators, our ovens, our microwaves, our washers and dryers, our crock pots, our laptops and our cell phones.  This is a great time to practice your cooking or baking skills.

Build those endorphins:  go outside for a bike ride or run, practice yoga, do some calisthenics (push ups, abs, burpees, etc.)

I’m old enough to remember the marketing phrase, “Long distance is the next best thing to being there.”  Choose supportive family members and friends (likely meeting the criteria for allies and confidantes) to speak with by phone for encouragement, for sharing funny stories and coping strategies, and to
affirm that you are managing your COVID response. 

For those of you under the age of 50, the late 1970’s & early 1980’s was a period in history in which HIV and AIDS first became prevalent.  Single persons had to make decisions about risk factors associated with romantic expression and the use of condoms skyrocketed to reduce risk of becoming HIV Positive.  With COVID 19, a hug, a kiss and any form of touch can spread this virus.  Many of us are hopeful that we can return to “normal” in the next few weeks.  For now, I encourage you to be extremely cautious about making any exceptions for intimacy. 

Beginning 2020 with a Fresh Start

The holidays are known as a time of hustle and bustle.  School systems and courtrooms essentially shut down between the Christmas holiday and New Year’s Day.   People purchase the right gifts for their family and friends, then pack luggage and cope with traffic or airport security lines or they prepare to host several family members that are visiting.   And now that 2020 has arrived, people consider losing weight, re-examining one’s career, or reflect upon concerns and feelings that arose during the holiday which motivate changes.

Treatment centers and counseling offices also notice an increase in utilization. Some of the reasons people seek assistance during this New Year include the following:

• Disagreement with a loved one about alcohol or other drug use, and the resulting consequences.

• Recognizing sadness after a family visit that did not meet expectations.

• Wishing communication with a spouse or partner could be improved.     
  Missing a loved one who passed away and the holiday triggered grief.     
  Still feeling anxious or stressed after the holiday period ends.

• Job dissatisfaction, especially if you dread returning to work after the holiday break. 

Clinicians help clients create goals associated with the catalyst for seeking help. To successfully reach those
identified goals, consider utilizing the SMART goals format:

• Specific: Being able to answer who, what, where, when, and why about the objectives.

• Measurable:  Establishing criteria for your objectives to be reached.      
  Attainable: Ensuring that the goals established can come true.    
  Realistic:  Ensuring you are willing to and can execute completion of the goal.

• Timely:  Setting deadlines for achieving the outcomes

For someone who decides to stop using drugs, an example of a SMART goal could be for the next ninety days, I will remain abstinent from alcohol and other drugs, avoid bars and parties, attend at least
three weekly 12-step meetings, and create a relapse prevention plan with both my sponsor and therapist.

For someone who wants to improve communication with his/her partner, SMART goals could include any of the following ideas:  for the month of January, my partner and I will set aside twenty minutes daily to remind each other why we love one another, negotiate a monthly budget to reduce the intensity of arguments about finances, and to discuss any disappointment experienced that day so to re-build a greater level of mutual trust.

For someone who is recognizing grief or unmet expectations from family, shift your focus back to finding joyfulness or happiness.  An example of a SMART goal in this case would be, during January, I will schedule a social event each weekend with a trusted friend that is likely to have me laugh on occasion and feel
grateful that I went out rather than remained sad at home by myself.

For someone who has decided to change jobs because of dissatisfaction in the workplace, SMART goals might include for the next three months, I will distribute my updated resume to at least five LinkedIn connections weekly as well as apply for a minimum of three jobs online weekly with a minimum salary of $xx,000 (specify the amount).

Clinicians who collaborate with you to establish SMART goals will not only monitor your progress, but will provide you with an opportunity to reflect on your feelings and responses to your progress and success as well as discuss any roadblocks your experience along the journey.

One other blessing:  we live in South Florida where you can take a brief respite to stick your toes in the sand and your feet in the ocean as an affirmation that you reside in a wonderfully therapeutic place to live as you
address any concerns that served as a catalyst for seeking help!  Happy New Year.