SciLine interviewed: Dr. Lisa Maragakis, the senior director of infection prevention at the Johns Hopkins Health System and an associate professor at Johns Hopkins University School of Medicine. Her research explores the control of infections that spread in health care settings, and she serves as a member of Maryland’s Coronavirus Response Team, executive director of the Johns Hopkins Biocontainment Unit, and incident commander for the Johns Hopkins Medicine COVID-19 response.
What factors should people consider when making holiday plans as the pandemic continues?
LISA MARAGAKIS: The safest thing to do this year is to celebrate the holidays at home, with members of your own household. Data, unfortunately, show us that the numbers of cases of COVID-19 and the viral transmission is increasing across the United States. And what we know from studies and outbreak investigations is that gatherings indoors – particularly indoors – is the biggest risk for viral transmission. So this year, I would say we have to forego travel and attending or hosting gatherings for the holidays. We also should be thinking about using quarantine periods for anyone who must travel. For instance, we know that students will have to return home from school, but a quarantine period of up to 10 to 14 days is the safest way to make sure that those individuals are not bringing the virus to their loved ones. And I know how difficult this is after such a long and challenging year, but we really need to continue the infection prevention measures and avoid travel, if at all possible.
We do have a light at the end of the tunnel. We have vaccines that are on the way. And so for the next weeks and months, we really need to continue protecting ourselves and each other by doing these things.
Are there particular precautions people should take depending on their mode of transportation? Do cars and planes pose any unique risks of exposure?
LISA MARAGAKIS: Unfortunately, this year, no one should plan to travel for this holiday season unless it’s absolutely necessary – for instance, students might be returning home from school or someone might need to travel to help a family member. For those who must travel, driving personal vehicles would be the safest mode of transportation. And when driving your personal vehicle, really, the safest way is for that to be only driving alone or with those from your immediate household. On the way, remember to avoid crowded indoor spaces, wear a mask when you’re around other people and avoid being near others, particularly those who are not wearing masks.
For those people who must travel, a quarantine period at the required destination or once you return home is the safest way to avoid transmitting the virus to other people.
How much can testing mitigate the risk of exposure at gatherings of family and friends?
LISA MARAGAKIS: Testing for the coronavirus is a very important way to prevent viral transmission. And we use it along with isolation precautions and contact tracing. But I want to emphasize that it is only one strategy, and we really must use it in combination with the other infection prevention strategies, including wearing masks, practicing physical distancing and avoiding gatherings, particularly gatherings indoors.
I’m concerned that many people think that testing is a way to receive a negative test result and then relax those infection prevention precautions and take some risks like traveling or gathering indoors. We have to remember that a test result really only represents one point in time, and repeated testing is needed to get a fuller picture of the situation.
So data show us that the test can be negative when the virus is already present and it’s just at too low of a level to detect. So that test result that took some time to come back may actually be negative when the person goes on to test positive on subsequent hours or days. And that’s why we really need to use the test along with masking, physical distancing and avoiding indoor gatherings.
Why do public health experts recommend wearing masks even with close friends or family outside of one’s household?
LISA MARAGAKIS: Studies show us that masks are the very best way to prevent viral transmission of the coronavirus that causes COVID-19. The virus is transmitted by respiratory droplets, and these are small bits of fluid that are expelled when we cough or sneeze, and now we know that they are expelled even when we sing or talk. These droplets can carry small particles of virus that can transmit the infection to other people. And sometimes the droplets are extremely small, and those tiny droplets can remain aloft in the air and be inhaled by someone else, even after a period of time.
So masks do two things. They contain the respiratory droplets of infected people so that those respiratory droplets are not projected as far and don’t carry the virus to others in the room. And the other thing that masks do are protect the wearer. So studies show us that wearing a mask protects not only others from our respiratory virus or respiratory secretions, but it also protects us if we happen to be around others who are carrying the virus, that that can be a barrier to prevent us from acquiring the virus or, if we do, unfortunately, contract the virus, that we’ve inhaled a smaller amount, and that is correlated with less severe disease. So please, everyone should wear their masks.
If someone is planning a holiday gathering with others outside their household, what additional precautions can they take?
LISA MARAGAKIS: The safest thing to do this year is to not gather for the holidays with others outside of your household. This is extremely important because we know that people who are asymptomatic and don’t know they have the virus can still transmit it to others. So it’s extremely important that any time you’re outside of your own household, each of us wears a mask, maintains physical distance from anyone that is not in our immediate household and avoid large gatherings, especially in indoor settings. Studies show us that this is the biggest risk. And we know from outbreak investigations and superspreader events that large indoor gatherings can be a particular risk.
What alternatives to large indoor gatherings would you suggest?
LISA MARAGAKIS: We know that this holiday is going to have to be different from previous holidays and, hopefully, our future holidays, the safest way is to celebrate with those in your immediate household and to find other ways to reach out to family, friends, colleagues and community members through electronic means, by sending gifts, cards and letters and reaching out to others, but not gathering, particularly at parties or indoor gatherings where the virus can be transmitted. We should remember, however, that when we talk about physical distancing, that’s an infection prevention measure to stop the virus from being transmitted person to person. But what we really do need this holiday season is connection to others. And we know that a lot of people are suffering from feelings of isolation and depression and just extreme loss and sadness under this very challenging situation.
So please, do reach out to loved ones and those in our community who may be suffering from isolation. And this holiday season is a great time to make sure that we use alternate means to connect with each other.
What else should we consider as vaccines are distributed?
LISA MARAGAKIS: So we’re all looking forward with anticipation to the time when one or more vaccines are authorized for distribution and administration to the public to prevent COVID-19. I think one topic that we’re really going to need to tackle in the coming days is vaccine hesitancy, those who are concerned about the vaccine. And of course, we all need to look at the science around the vaccines, how they were studied, how we know they’re safe, how we know that they will work to prevent the viral transmission. And all of those data are going to be very important to get to everyone across the country so that we can evaluate and be confident in stepping forward and getting this vaccine that has the promise to end the pandemic.