Enraged by the Rage outbreak, and ambivalent about upcoming “simple” travel plans, patients have increasingly contacted me this week, enquiring as to the safety of going on holiday this December.
What a complicated – yet unsurprising – situation we have landed in, as we reach the pot of gold at the end of an isolating and protracted 2020.
Internationally, COVID-19 is still unremitting, and in most countries – even those with the best preventative measures in place – a significant second wave has occurred at a mean of 57 days after the first wave.
We all expected another rise in cases in South Africa. The uniqueness of the South African picture is that this potential second wave coincides with our festive season. With a 2020 mantra of “stay home, save lives” in mind and now apparent proof that those who didn’t stay home and attended the matric Rage celebrations indeed contracted COVID-19, our community members are justifiably asking questions like, “Doctor, am I crazy to be going to Umhlanga next week?”
The April 2020 level-5 lockdown was partly informed by panic. Our understanding of COVID-19 has evolved significantly since then. I clearly remember the WhatsApp video clips I received of citizens in Wuhan seemingly dropping dead from COVID-19 after “breathing in its air” in April. We have since learnt that COVID-19 is spread primarily through respiratory droplets. Its main route of spread is direct contact, at less than 2m, and that simple mask wearing reduces the risk of transmission significantly.
Conversely, in the initial weeks of this pandemic, it was unclear how sick a patient had to be in order to transmit the virus to another individual. We have since learnt that asymptomatic transmission is very real (as seen at the Rage festival). We have, therefore, learnt to take precautions.
Another real shift in understanding has been the shift from sterilising surfaces to sterilising hands. I may not have let my children sit on a public bench in April 2020. Today, I maintain my focus on cleaning hands. These examples of the evolutions of COVID-19 knowledge talk to the point that we are much better equipped to go on holiday in December 2020 than we would have been 10 months ago.
There is no doubt in my mind that the safest way to live through this pandemic is to confine yourself to a room indefinitely. Don’t leave. Ensure you pass sterilised food only through a small crack in the door, and you won’t contract COVID-19.
In reality, the challenges for mental and developmental health on a personal and family level as a direct result of COVID-19 isolation measures has never been higher. Every day I see patients with significant depression, anxiety, loss of income, and relationship break-ups as a direct result of “preventing” COVID-19. We need a holiday more than any other year. Holidays help recover relationships, shift perspectives, and allow for rejuvenation.
Can you go on holiday safely this December? In my mind, absolutely yes. Safe holidays require a return to boring basics though. I have attempted to stratify the following tips in order of importance in my mind:
• Ventilation during social interaction is vital. Unless you are exposing yourself to family you live with, all other social interaction should happen outdoors or at least in very well-ventilated spaces;
• Masks work. Pictures with friends look great with masks too. Set the tone of, “It’s cool for us to have fun and wear our masks too – just in case”;
• Avoid large crowds. Full supermarkets with social distancing and sanitising are not large crowds. Packed night-clubs, clubhouses, or concerts are;
• Hosting guests for a meal must be done with seichel (wisdom). Ensure that there is at least a >3m distance between you if you are eating, and as for as short a time as possible. Serve the food while wearing masks. Let the host do the serving as much as possible;
• Alcohol magically washes masks away and closes distances. Take extra precautions if you drink;
• If you feel unwell, contact a doctor and get tested. Identifying a positive case early prevents major outbreaks. The Rage super-spreader event started with a couple of cases at most.
What’s the safest way to travel to and from your holiday?
Car travel with adherence to festive-season road safety is certainly the safest option. It also allows for a possible return home should you become infected. However, a study published in the JAMA journalin October 2020 showed that with the implementation of new air-travel regulations, the incidence of COVID-19 cases were negligible.
I recently flew. Scrutinising my trip, here are my tips for safe air travel:
• Wear a well-fitted mask throughout the process. Door-to-door. A three-layer cloth mask (or a medical mask if they are available);
• Don’t touch your eyes or your face on the flight;
• Use your hand luggage as a barrier to ensure other passengers don’t come too near to you during embarking and disembarking;
• Stay in your seat at the departure gate or on the plane until there is ample space for you to move;
• Keep the air vent above your seat blowing on you throughout the flight. (The air is filtered);
• Try not to eat or drink on the flight. You can manage a short flight without refreshments.
Lastly, how about hotspots? Should you be anxious if you are travelling to Plettenberg Bay on the Garden Route as opposed to the Magaliesberg?
The most challenging issue with hotspots is the relative lack of resources for patients who may complicate in that region. For example, intensive-care units in the Garden Route have been saturated lately.
If you are a patient with significant comorbidities and lack the means to be privately transported home early in an infection, I believe you may want to reconsider your choice.
However, it’s important to remember that by adhering to basic principles and keeping in mind daily that COVID-19 is still with us, even in the hottest spots in South Africa, you can enjoy a well-earned holiday and pace yourself for a better and healthier 2021.Dr Daniel Israel is a family practitioner in Johannesburg.
