Fall is here, and with it there's a surge in COVID-19 cases across the country. The Midwest is experiencing a rise in cases — a 25% increase over the past two weeks — and even some parts of the Northeast, where the virus spread rapidly last spring, are seeing a resurgence.
As the epidemic had waned in some parts of the country over the summer, small gatherings became more commonplace. Though, in recent weeks, experts have warned that small family get togethers are leading to clusters of COVID-19 cases. A wedding in Maine has led to nearly 150 infections and killed three people who did not attend the ceremony. A recent sweet 16 party on Long Island has led to over 35 COVID-19 cases. Some states saw cases rise after just a few indoor parties.
With flu season looming and millions of students back in classrooms, health experts and epidemiologists are urging people to shrink their "social bubbles" again.
"I think they shouldn't have opened (social bubbles) to begin with," said Dr. Yvonne Maldonado, a professor of pediatrics and health research and policy at Stanford Health Care in California. "This is a time when we all want to see our family and friends, and we can still do that, but I think we just have to be very cautious about how and when and how many."
Experts caution that as other illnesses like colds and flu become more common and it's more likely that events will be held indoors where transmission is more likely, it's important to limit the amount of people you're spending time with.
"It's going to be a lot harder to stay outdoors and try to socialize, and people are going to go inside," said Gregg Gonsalves, Ph.D., an assistant professor epidemiology at the Yale School of Public Health in New Haven, Connecticut. "And as people go inside, that's where risk increases."
Some increased socialization can be attributed to pandemic fatigue: After more than six months of restrictions and changed behavior, many people are eager to move on with their lives, especially in places where the virus has receded.
"People are opening their social circles and bubbles are sort of loosening; bubbles are getting bigger," said Barun Mathema, Ph.D., an assistant professor of epidemiology at the Columbia University Mailman School of Public Health in New York City. "Various bubbles are merging. There is sort of a collective pandemic fatigue, like 'We've been there, done that, now we're on the other side.' I would caution against that attitude. I don't think we have enough evidence to say that we're on the other side."
What statistics should people check before gathering?
Different parts of the country have had different experiences with the coronavirus and are now following unique guidelines and recommendations based on that, so there's really no "one-size-fits-all" approach to social gatherings, according to most epidemiologists.
Mathema recommends that people considering going to a gathering keep an eye on local statistics. While information can be flawed due to problems with testing, he recommends keeping an eye on community transmission.
"Community transmission in general is what one should be looking at," he said, saying that the statistic will help people understand "the force of infection" in a given community. "(Places) may do all sorts of precautions, but in my mind the most important number is how much transmission there is."
Looking at more severe statistics like hospitalizations and fatalities can help, but Mathema cautions that those numbers can be misinterpreted. In some areas, infections may be increasing, but the cases may be less severe, so the increase in coronavirus transmission wouldn't be reflected in hospitalizations or deaths.
"It's really important for us to recognize where we are in the pandemic," Mathema said. "We have not moved out of it."
Are state guidelines regarding gatherings safe to follow?
Some counties or states might have a limit on how many people can gather at once, but Maldonado said that those guidelines can be arbitrary. Like Mathema, she advises trying to understand what the community transmission in the area is like.
"If you have a 1% prevalence rate, if 1% of people in your (area) are infected and you get 100 people together, you're likely to have one infected person," she explained. "If you get 50 people together, it drops to half a person, if you get 25 people it's a quarter of a person. You're basically just reducing your risk ... It really gives you a general estimate of the likelihood that you're going to have an infected person in your population."
Gonsalves cautioned that it's also important to remember that cases of illness tend to increase "exponentially" instead of rising in a straight line.
"They speed up very quickly," he said. "... Exponential growth is how outbreaks take off. If you're in a state where you're seeing increasing numbers of infections, I would be cautious about my own behavior and my family's safety. If you're in a place where cases are falling or staying the same for two weeks, you can have a little bit more comfort and be at lower risk."
If you do decide to gather, do what you can to make sure it's safe and follow basic guidelines. Maldonado recommends only meeting in a "small group" where you know what other interactions people have had, and advises emphasizing hand-washing and masking as much as possible.
Outdoor gatherings are also usually safer than indoor options, but if you must meet indoors, make sure to open windows or doors for increased airflow and better ventilation.
What does this mean for the holiday season?
Gonsalves said that while he didn't want to be "the Grinch who stole Christmas," it may not be safe to celebrate the holidays with large family gatherings this year.
"It's the height of flu season, and we've seen research that family gatherings even in the summer have been a source of outbreaks," he said. "I think Thanksgiving and Christmas and Hanukkah and Kwanzaa this year are going to be very different. We're going to have to figure out how to adapt."
While it's a little early to determine just what will have to be different this year, Maldonado recommends preparing to limit the amount of people present and do what you can to stay socially distanced.
"It's going to be tough, but there are creative ways to do it so long as you can stay distant and masked and follow hand hygiene recommendations," she said. "Holidays can still be done, we're just going to have to keep them more low-key. We really don't want anybody to be in the hospital for the holidays, because that's the saddest thing I could think of. I think it's going to be a brand new experience for all of us."