Why health officials are terrified of a pandemic Christmas

Americans heard the pleas to stay home. They were told what would happen if they didn’t. Still, millions traveled and gathered during last week’s Thanksgiving holiday, either doubting the warnings or deciding they would take their chances.

Now, like any partygoer waking from a raucous weekend – feeling a bit hungover and perhaps a tinge of regret – the nation is about to face the consequences of its behavior and will need to quickly apply the lessons before heading into the doubleheader of Christmas and New Year’s.

Health experts point to several key takeaways: Many states were overwhelmed by unexpected surges in testing – with many families hoping a negative result might make their planned gatherings a little safer. Some airports were not prepared for the huge crowds that had not been seen since the beginning of the pandemic, making it difficult for travelers to maintain social distancing.

But perhaps the most obvious lesson: Public health messaging needs to be retooled, as whole swaths of the country are simply tuning out the warnings from officials and experts.

“We have to rethink how we’re communicating. Blaming people, yelling at them, stigmatizing them – clearly it’s not working,” said Angela Rasmussen, a virologist at Georgetown Center for Global Health Science and Security. “We have to show compassion and empathy. Understand where people are coming from and persuade them to do otherwise.”

As bad as the country’s infections and hospitalizations are now, they will probably worsen in coming weeks because of the millions of interactions that occurred over Thanksgiving, experts say.

In recent days, America’s infection curve has already become a sheer mountain climber’s cliff with record-breaking case numbers and hospitalizations. If people travel and gather for Christmas as they did this past week, they project, the country’s already catastrophic situation could reach levels where hospitals are forced to choose which patients to save and which to let die and where lockdowns become unavoidable realities of everyday life.

“What concerns me is that Thanksgiving is an American holiday,” said Melissa Nolan, an epidemiologist at the University of South Carolina. “Christmas is an international holiday – it’s celebrated around the world. So if Thanksgiving is an indicator of how much travel we can expect at Christmas, I think that is very concerning.”

The days around Thanksgiving ended up among the busiest for air travel since the start of the pandemic, according to figures from the Transportation Security Administration. The agency screened nearly 4.6 million passengers between Nov. 25 and Nov. 29 this year. That’s down almost 61% compared to the same time frame last year, when the number was 11.7 million.

Still, the days around Thanksgiving made for some of the busiest travel times since mid-March, and many airports saw large crowds. At Chicago O’Hare and Phoenix Sky Harbor International airports, people crammed into security lines and around check-in kiosks, with little space separating them, local TV outlets reported.

Experts say airports should be prepared for holiday surges and more stringently enforce mask-wearing, speed up check points and space out boarding gates so travelers can stay several feet apart.

Meanwhile, top officials are trying to mitigate the damage already done for this holiday. Those who traveled during the holiday should get tested and avoid crowds, said Assistant Secretary for Health Adm. Brett Giroir.

“Make really sure you adhere 100% to mask-wearing, to avoid crowds because you could inadvertently have gotten COVID and spread it,” Giroir said on CNN.

During this small window between Thanksgiving and Christmas, the thing most in need of course correction is the country’s messaging, many experts believe.

“If we see a post-Thanksgiving surge of cases and deaths, is that going to change people’s minds for Christmas?” asked Rasmussen, the Georgetown virologist. “I kind of doubt it because cases and deaths were going up already before Thanksgiving.”

Many people seem to be continuing to indulge in a kind of magical thinking and denialism as they have all year long. “It’s like ‘I know this is a bad idea, but I want to do it, so I’ll find a reason and way,’ ” Rasmussen said.

To counter that, some health departments released messages ahead of Thanksgiving designed to shock and scare residents into paying attention. Among the bluntest messages were images posted by the Salt Lake County Health Department on Twitter. One showed a family smiling for a photo around a Thanksgiving table.

“Everybody say, ‘I was just exposed to COVID!’ ” a text bubble says. The caption offers a stark warning: “Thanksgiving leftovers won’t taste as good if you’re on a ventilator.”

The campaign was intended to shock people out of pandemic fatigue, said health department spokesman Nicholas Rupp.

“It’s kind of time for gloves off, to be really direct and to say, ‘You need to understand what’s at stake here,’ ” he said.

In Mississippi, health officials’ message was even starker.

“We don’t really want to see Mama at Thanksgiving and bury her by Christmas,” Mississippi State Medical Association President Mark Horne said. “You’re either going to be visiting her by FaceTime in the ICU or planning a small funeral by Christmas.”

But the problem with such intensely fear-based messages is they risk conditioning people to tune out even more, said Matthew Seeger, a risk communication expert at Wayne State University. Those who saw a shocking ad at Thanksgiving might be even more prone to ignore it by the time Christmas rolls around.

“It’s like when a hurricane comes and you issue an evacuation order but nothing happens,” Seeger said. “The second or third time you hear that evacuation order, you’re even less likely to leave.”

Instead of relying solely on fear-based messages, health officials need to craft messages that sound less like schoolmarm lecturing and instead make the issue deeply personal for people. “You can’t just focus on numbers and statistics,” he said. “People need to be able to see the physical manifestation of this virus in their lives for their behavior to change.”

The most effective tobacco ads, for example, show smokers speaking with an electronic voice box after having their larynxes cut out and children describing the feeling of losing their parents.

In Salt Lake County, health officials have created another campaign to do exactly that. The videos feature local residents describing their personal experiences with COVID-19, the disease caused by the coronavirus. The thinking, Rupp said, is, “Let’s take us out of that equation completely and put it in the hands of someone they might recognize.”

The other major communications problem heading into Christmas is how badly the waters have been muddied by inconsistent and often deliberately confusing messaging by the Trump administration and its allies.

Seeger was among a group of experts who literally wrote the Centers for Disease Control and Prevention’s 450-page manual for how U.S. leaders should communicate during a health crisis. And in the past year, U.S. officials have broken nearly every rule in the book.

Leading up to the holiday, several Trump allies mocked health officials’ Thanksgiving warnings. Former White House coronavirus adviser Scott Atlas said people shouldn’t avoid seeing the elderly just because health officials say so: “For many people, this is their final Thanksgiving, believe it or not.”

Sen. Ted Cruz, R-Texas, tweeted an image of a turkey above the words “COME AND TAKE IT.” He added: “Twitter Leftists are losing their minds that we’re not willing to give up Thanksgiving. Wait till they find out we won’t give up Christmas, either.”

Those advocating that people stay home didn’t always send clear messages, either. Denver Mayor Michael Hancock posted social media messages advising against travel while on his way to Mississippi to celebrate Thanksgiving with his family, the Denver Post reported. He later apologized.

In these polarized times, it’s unlikely those conflicting messages will disappear by Christmas. Going forward, the incoming Biden administration will need to establish more unified, but also more nuanced messages. For example, health experts dealing with a community where water has been contaminated often give residents multiple strategies: Drink bottled water. If you can’t, then boil the water.

“Not everyone’s willing to do the same thing,” Seeger said. “Just repeating one thing over and over at some point starts becoming counter effective.”

The sudden demand in testing that led up to Thanksgiving caused hours-long lines from New York to Wisconsin to Oregon, as many sought to establish they were virus-free before gathering with friends and families. In Denver, officials shut down one testing site within an hour of opening because it reached capacity. In Olympia, officials turned away 200 waiting cars.

Ahead of Christmas, health departments need to better spell out for families the limits of testing ahead of such gatherings. States and federal authorities also need to better coordinate public, commercial and university labs so that those at capacity can share their burden.

“Testing itself isn’t a bad thing, but people started using it to justify doing whatever they wanted,” said Saskia Popescu, an epidemiologist at the University of Arizona. “And people who really needed tests couldn’t get them because sites were overwhelmed.”

Scott Becker, chief executive of the Association of Public Health Laboratories, warned that a negative result doesn’t necessarily mean you have a clean bill of health since a person can test negative in the morning and be positive by evening if he or she was recently infected and is just beginning to incubate the virus. “There’s nothing about getting a one-time negative result that is foolproof,” he said.

“The best advice is really to stay home,” he said. “The second best thing after that is to take a variety of steps to reduce risk. You can’t just rely on any one thing.”

For at least one couple, the warnings and pleas from public health officials didn’t fall on deaf ears.

Susan Askew and her husband made the thousand-mile drive from Miami Beach to spend Thanksgiving with her elderly parents in Delaware. Askew worried a holiday alone would crush her parents’ spirits after being isolated for months.

But along the road – around the time they reached the Washington area – Askew started having second thoughts as she thought about all the warnings from authorities. After learning her mother was also questioning the gathering, they agreed to cancel at the last minute.

“I would not forgive myself if something happened because I slipped up,” Askew said.

As for Christmas, the family is leaning against gathering but will play it by ear.