SALT LAKE CITY — Public health experts once again face the unknown as another major holiday approaches during the COVID-19 pandemic.
That's because holidays have led to spikes in new COVID-19 cases since the pandemic began. That was true again after Thanksgiving in Utah, but it was nowhere near the bump that public health officials feared.
Health experts hope for a similar result after Christmas and New Year's conclude the major holiday season.
"We're definitely moving in the right direction with numbers down, but our big kind of obstacle to come right now is the Christmas/New Year's holiday" and its impact on the COVID-19 situation, Dr. Eddie Stenehjem, an infectious disease physician for Intermountain Healthcare, said during a virtual question and answer session Wednesday.
"Fingers crossed that Utah comes together as a community like we did in Thanksgiving," he added. "We didn't see that big surge we were expecting because Utahns took this seriously. I'm hoping we'll see the same thing out of Christmas."
Utah's COVID-19 situation heading into Christmas, New Year's
When health officials said the post-Thanksgiving spike wasn't as bad as feared, it's because new cases didn't raise the state's seven-day running average of new cases to unprecedented levels. There were still new cases and hospitalizations as a result of Thanksgiving gatherings.
To date, Utah's seven-day rolling average of cases peaked at 3,364.7 cases per day on Nov. 22 — four days ahead of Thanksgiving. The average dropped to 2,296.9 cases per day on Nov. 30 and then climbed back to 3,124.6 new cases per day on Dec. 6, which falls within the post-holiday incubation period window. It's steadily fallen since then. Utah's seven-day rolling average is 2,419.3 cases per day, as of Wednesday's health department update.
The decline is a welcome sight, but the extended data is why health experts are cautious with their optimism. For example, testing is still down as compared to pre-Thanksgiving levels, and the test positivity rate remains at 23.7% through Dec. 17. That latter is a sign that COVID-19 is likely widely underreported in the state.
At the same time, hospitals are still packed with rates that exceed state goals. The total number of people hospitalized due to COVID-19 is 560. The intensive care unit utilization was 92% at referral hospitals in Utah and 90% statewide as of Wednesday, according to the state health department. The state's warning threshold for ICUs is 72% and target utilization threshold is 85%. It's a situation that can improve only if new case count trends continue to decline.
"Yes, our case counts are down — a very encouraging sign — and we've got some other indicators to show that we truly do have decreased community transmission … but our testing volumes aren't as high as they could be and our test percentage is high, which is meaning that we're likely missing a lot of active cases that are not getting tested," Stenehjem said.
"What we would have ideally seen is our (COVID-19) numbers be really low before the holiday and New Year, which would then decrease any kind of risk of transmission amongst families that are gathering. But we still have really high transmission rates even though the (new case) numbers are down," he added.
Stenehjem said he anticipates testing for COVID-19 will rise again at the start of 2021 as a result of Utah's rapid testing of students program beginning and advancements of testing options like at-home testing kits.
What's recommended to stay safe for the holidays
Many of the public health recommendations for Christmas and New Year's are similar to recommendations for Thanksgiving. When reviewing Utah's post-Thanksgiving COVID-19 case count data, Stenehjem said he believed it showed many people took the advice seriously and that's why the post-holiday spike wasn't as bad as feared.
"I'm hoping that's what's going to happen again tomorrow for Christmas Eve and the day after for Christmas Day, and also into New Year's," he said.
That's why how gatherings are handled might be the biggest factor as to whether or not the post-Christmas and post-New Year's COVID-19 spikes in Utah also end up not as severe as feared.
Stenehjem once again said the best advice would be that Utahns avoid gatherings between different households, which includes extended families.
If Utahns do choose to have multi-household gatherings, it's encouraged that those gatherings are small and take into account high-risk contacts. Just because a gathering doesn't include people who are considered high-risk for severe COVID-19 infection doesn't mean participants won't be in contact with a high-risk individual in the time after that gathering.
"If you do choose to gather, you're really careful in terms of who you gather with, in terms of small numbers, and you don't gather with people who are high-risk or have exposure to high-risk people," Stenehjem said. "Really think about who you are gathering with. What is their risk profile? What's the risk to them or to you if you get infected? And who are they going home to? And who could they potentially infect if they get infected at your gathering?"
Stenehjem added that hospitals aren't immune to having to break from traditions this holiday season. For example, holiday potluck parties are a staple for doctors and nurses where he works, but those were scrapped this year.
"That's not something we can do safely right now," he said, adding they swapped it out with an ugly Christmas sweater competition to lighten the mood during a tough time for hospital employees.
Meanwhile, it's clear that there's still a decent amount of risk for COVID-19 spread at gatherings. As of Wednesday, most Utah counties had a 20-30% chance of COVID-19 exposure during a gathering of at least 10 people, according to the Georgia Tech COVID-19 Event Risk Management Tool. The event risk tool was created to estimate how likely a person would be in contact with at least one other individual with COVID-19 at a gathering based on county population, COVID-19 case count data, and taking into account underreporting.
The risk at highly-populated Wasatch Front counties (Davis, Salt Lake, Utah and Weber) ranged from 30% in Salt Lake County to 36% in Utah County. Statewide, Daggett County had the lowest risk at less than 1%; Millard County had the highest risk at 46%, according to the model.
The Centers for Disease Control and Prevention once again offered holiday recommendations for all of the December holidays leading up to New Year's. The CDC's recommendations include:
- Hold religious ceremonies virtually if possible
- Decorate a holiday scene to share the holiday spirit from home. It's advised to also stay at home for family photos.
- Drive or walk by holiday decorations to view them "from a safe distance"
- Throw any holiday parties online instead of in person. People can share a holiday playlist for which attendees can listen to together, or even open gifts together online.
- Hold a snowman or snow angel contest with neighbors or friends in the community, as long as every household remains at least 6 feet apart while outside.
- Reach out to local community service organizations and find out how you can give back. Officials advise people to ask about safety precautions in advance or see if there are ways to volunteer through "virtual opportunities."
- Schedule "virtual visits" to the North Pole or make any visits to Santa at least 6 feet apart while also wearing a mask.
- If you hold an in-person party, try to limit the number of guests and hold a "small, outdoor celebration" with family and friends who live in the same community. It's advised that people wear masks both indoors and outdoors and that shouting and singing be limited for any celebration or gathering involving multiple households.
The agency's full list of recommendations about COVID-19 can be found here.