As Christmas nears, virus experts look for lessons from Thanksgiving
By Manny Fernández, Josh Holder, Lauren Leatherby, Jennifer Valentino-DeVries and Lucy Tompkins
More than three weeks after Thanksgiving, public health researchers and local health officials across the country are picking apart the holiday, seeking signs of the pandemic’s latest riddle: the Thanksgiving effect.
In the days before Thanksgiving on Nov. 26, infectious-disease experts and elected officials repeatedly warned Americans to limit their travel and family gatherings, fearing that the holiday would turn into a nationwide superspreader event.
But experts and data suggest what happened was something like a microspreader, more a tornado picking its spots than a hurricane blowing down everything in its path.
Public health researchers said coronavirus case numbers and other data show that in many parts of the country, Americans altered their routines during the holiday, staying home instead of traveling and canceling large family gatherings. But there have been regional and isolated surges that can be attributed in part to activity around those days in late November, including in areas of Texas and California.
Like much about the virus, exactly how much Thanksgiving gatherings spread it and why the effects seem to have varied so much from place to place remain unclear. But, with Christmas and New Year’s around the corner, holiday gatherings — and how much they can spread the virus — could be crucial in determining whether the coronavirus surges even further over the next month.
In California, the worst days of the pandemic are right now, as a spike in new cases, hospitalizations and deaths has shocked the state. In Los Angeles County for a period last week, a coronavirus death was recorded every two hours, and infections have touched many families. On Thursday, Eric Garcetti, the mayor of Los Angeles, announced that his 9-year-old daughter had tested positive for the virus.
Public health researchers in a handful of communities in and near Los Angeles are linking some of the surge to families who ignored warnings and decided to hold small gatherings during Thanksgiving. Cases in the region were spiking before the holiday, but the widespread transmission that occurred during Thanksgiving gatherings in Riverside, Los Angeles, Orange and Santa Barbara counties and others was contributing to the pace of spread, officials said.
The number of people hospitalized with COVID-19 in those four counties jumped 156%, to 8,687 from 3,400, in the three weeks from Thanksgiving to Dec. 17, according to data from the California Department of Public Health. In the three weeks preceding Thanksgiving, hospitalizations increased 108%.
“We had all these little fires going all throughout the county, and then someone with Thanksgiving just threw some gasoline — that’s what it kind of feels like,” said Wendy Hetherington, the chief of epidemiology for the public health department in Riverside County, where roughly 1 out of every 5 residents is testing positive. “We’re increasing at a steeper rate.”
Other parts of the country have reported small upticks that officials connect to Thanksgiving. Before the holiday, two public hospitals in Harris County, which includes Houston, had 33 coronavirus patients between them. On Friday, they had 66.
“Unfortunately, it’s exactly what we anticipated and hoped against,” said Dr. Esmaeil Porsa, the president and chief executive of Harris Health System, which runs the two hospitals. “There hasn’t been any other superspreader event since Thanksgiving that could explain this.”
Health officials and public health researchers fear that some regions already seeing a spike in cases will see another shortly after Christmas and New Year’s. In some ways, Christmas could present more risk than Thanksgiving: It is a longer holiday period, often with larger gatherings, multiple get-togethers over several days and nonfamily events, such as office parties. And those who were cautious and stayed home during Thanksgiving might not do the same in the coming weeks.
“I really worry about stacking more cases on top of what we already have,” said Dr. Arghavan Salles, a volunteer physician who has been working in the intensive care unit at an Arizona hospital.
The story of the coronavirus in America is a compartmentalized one, with different places experiencing different spikes for different reasons at different times. For experts seeking clues to the Thanksgiving effect, there has been no clear indication why some areas have seen a holiday-related spike but others have not.
It is virtually impossible to pinpoint the holiday activity of Americans with precision. Most infected people have multiple possible points of exposure, and those points only increase during the holidays, when people may catch the virus at a family gathering, at a gas station or while doing grocery shopping the day before.
Still, experts said that, in general, parts of the country that were improving pre-Thanksgiving continue to improve post-Thanksgiving, while other regions experiencing surges before the holiday continue to worsen, suggesting that any nationwide Thanksgiving effect was muted.
“The fact is, people took precautions, and those have helped to not make things worse — not enough to make things better, but enough to not make things worse,” said Ellie Murray, a professor of epidemiology at Boston University. “We probably have enough data to say that people didn’t do things completely as normal, and we are not in the worst-case scenario.”
Following warnings from federal and local health officials, many Americans either stayed home or limited the size of their Thanksgiving gatherings, according to movement data from Cuebiq, a data intelligence firm. In 93% of counties, people had fewer contacts this Thanksgiving than they did during the holiday last year, according to the firm’s Contact Index.
Parsing the impact of Thanksgiving at a local and national level is as much an art as a science, involving not only knowledge of the statistics but also an understanding of how people in a given area are behaving.
Experts have analyzed case rates reported by government health authorities, a task made more difficult by lapses in testing and reporting over the holiday weekend. They have surveyed people about their travel plans and dug into data showing where cellphones were pinging. Some have looked to indicators such as wastewater data — which showed a surge in the coronavirus about five days after Thanksgiving in the suburbs north of Boston, for example, but no such jump south of the city. At the most granular level, contact tracers have been asking infected people about the size of their Thanksgiving gatherings.
In Santa Barbara, the Southern California city nestled between the Pacific Ocean and the Santa Ynez Mountains, the peaceful coastal views have clashed with a record-breaking coronavirus surge, tied in part to those who attended Thanksgiving gatherings. Last week alone, those infected while socializing during Thanksgiving told contact tracers in Santa Barbara County that the family gatherings they attended ranged in size from six people to as many as 40.
“It doesn’t surprise me because Thanksgiving is traditionally a time that people get together,” said Van Do-Reynoso, director of the county’s public health department. “Families miss each other. It’s been 10 months into the pandemic. It doesn’t surprise me, but it’s disappointing.”
Oscar Gutierrez, 36, a city councilman in Santa Barbara’s Westside, urged his mother not to attend a small Thanksgiving dinner with relatives. He lives with his 70-year-old mother and his girlfriend, and he had been taking the precautions seriously, attending council meetings virtually for months from his living room. He and his girlfriend celebrated Thanksgiving at home. But his mother decided to go to the dinner.
“She kind of just got overtaken by the pandemic fatigue, and she wanted to see her relatives and so she went out,” Gutierrez said. “They had their dinner outside. They kept it to less than three households and they were only there for a couple hours. But that’s all it took.”
Days later, one of the relatives started to feel sick, so he and his mother got tested. They were both infected.
“I was pretty upset,” he said. “I lost my temper a little bit. I’ve spent over 10 months not getting it, and then all it took was one dinner and I got it.”
For Gutierrez and others infected during the holiday, there is a tumult of emotions. Some are reluctant to speak about it, worried that their families will be shamed or ridiculed. There is anger and guilt, and ties between relatives have frayed. Some of Gutierrez’s relatives were upset with him for discussing his family’s gathering at a council meeting.
In Texas, Danny Cooke, 62, and his family decided to play it safe on Thanksgiving in Fort Worth. He and his wife hosted an intimate dinner with Cooke’s daughter, her husband and their two children. They opened all the windows and let the Texas air flow through the house.
But by the weekend, Cooke’s daughter, Amanda Ayala, a pediatric nurse, started to show symptoms of COVID-19. She tested positive, and several days later so did Cooke and his wife.
“We kind of thought we were OK,” Cooke said. “But obviously, that was the wrong thing to do.”
Cooke’s wife and daughter have both since recovered. But more than three weeks later, he is still struggling with a fever and a cough. On Thursday, Ayala went to her father’s home to check his blood pressure and oxygen levels. She blames herself for getting him sick.
“It weighs on me,” she said. “I’m just hoping for it to pass.”
Cooke had been working in-person during the pandemic at Lockheed Martin. He has come into contact with many people at work. But it was at home, at a holiday gathering of six, where he believes he caught the virus.
“Of course, as my wife keeps telling me: ‘You can’t let this kill you because your daughter will never forgive herself,’” he said.
In Manassas, Virginia, Christine Pabico had spent months protecting her 73-year-old father, who lived with her along with his wife, from being exposed to the virus. But after a nine-person family get-together, Pabico’s sister developed a fever. She had been exposed, unknowingly, to the virus the day before Thanksgiving, and it spread throughout the home.
Eventually her father was admitted to a hospital. And on the day it became clear he would not make it, hospital staff allowed his family to join him to say goodbye. For his final request, he asked that they bring him his favorite brand of coffee ice cream, and Philippine adobo with rice.
They shared a final meal, and said their goodbyes.