A Thanksgiving bubble to be thankful for
October 5, 2020 1:23 PM   Subscribe

Dear askmefites, I’d like to have a Thanksgiving in these pandemic times that I’ll be grateful for, not regretful of, so could you please check my thinking and help me navigate social expectations around forming a family bubble for the holiday?

My sibling has proposed traveling to my location and forming a family bubble for Thanksgiving. My sibling and their family would take a flight to my location, go into quarantine, take a nasal swab test 3 days after they land, and go back into quarantine until they get test results or hit 14 days in quarantine, whichever comes first. If my sibling’s family comes out clear, we would form a bubble and do things like share a home, meet inside without masks. Other members of the bubble would be myself and my family, my parent, and my SO’s quite elderly grandparent. All these folks live in the same area as me and are self isolating, social distancing and wearing masks. 

Social factors compelling me to consider going forward this plan rather than sitting out:
- My sibling and I had babies earlier this year, and my sibling wants to connect in person to maintain the family bond, and to heft and sniff cute new babies.
- My sibling hopes to help and boost morale of our depressed parent by having us all together. Our parent lost their spouse (also our parent) to a long term illness, right before lockdown, right before we had babies. Our surviving parent is lost at sea, not eating well, not sleeping well, not really taking care of themselves.
- My sibling is taking a lot of work and risk on themselves to fly out, and I feel like I would look like the jerk if I backed out. Im pressuring myself to play ball to meet them halfway.

The idea of my sibling taking a flight, attempting to shortcut quarantine with testing and clustering much of my family in a bubble (especially my SO’s grandparent) has me uneasy and fearful of setting up my family to be wiped out by the Rona. I can’t tell if this is me being too uncompromising on my take-no-chances standard operating procedure, or am I actually having a reasonable fear this is stacking too much risk together?
posted by starelephant to Human Relations (13 answers total) 2 users marked this as a favorite
The big flaw in many people's "get tested" plans is that the swab tests have a pretty high false negative rate. This meta-study estimates that only about 70% of infected people test positive. It would be safer for everyone to quarantine for 14 days before merging bubbles.

Beyond that, it's a matter of (a) whether you and your family can agree on behaviour to follow while everyone is in the same bubble, and (b) whether you trust your family members to follow the agreed-upon rules. And of course, the more people you have in a bubble the greater the chance that someone in the bubble will be exposed, regardless of precautions.
posted by mekily at 1:45 PM on October 5 [7 favorites]

So right now you are in a bubble with your family, your parent, and your partner's grandparent, right? It sounds like your sibling wants to join your bubble, if only temporarily. What length of quarantine and isolation would feel comfortable for you?

How much do you trust the CDC right now? I don't know, but there's this:
The incubation period for COVID-19 is thought to extend to 14 days, with a median time of 4-5 days from exposure to symptoms onset. One study reported that 97.5% of persons with COVID-19 who develop symptoms will do so within 11.5 days of SARS-CoV-2 infection.

That's about symptoms. But how quickly after exposure will a test show positive? I don't know the answer to this, but this is what MIT says:
On the other hand, if you get a positive test, you are almost certainly infected, because the false-positive rate is very low. But because a false negative is possible at any stage of infection, it’s important to get tested at the optimal time, when you are most likely to test positive if you are infected. Based on our current knowledge, that window would be approximately five to seven days after a probable exposure.

What if your sibling got tested after a few more days? Would that be more comfortable for you?

You have both lost a parent, and your surviving parent is having a hard time. I can see why your sibling would want to travel to be with you all. You might try talking to your doctor about this, too.
posted by bluedaisy at 1:51 PM on October 5 [2 favorites]

Everyone is allowed to have different risk tolerances, and the risk here is not immaterial at any stage. A lot will vary on the transmission rates of the areas you are flying from/into, and what the current levels of paranoia in the populations are.

However, your sibling is following the recommended protocols (although it would be best that they get tested maybe 5 days in, or at least wait the full 14 days before interacting with your rather immunocompromised bubble), and if you trust them to remain safe within your bubble (ie you basically self isolate together once they are in... no visiting other friends or anything) once they're in the clear I think the familial bonds/joy/benefits definitely make this worth exploring/considering.

I personally would be fine with these protocols, and would also take COVID tests before meeting them as well. COVID testing isn't perfect, but if you have a negative test and no symptoms for 14 days, generally you're in the clear.

I also trust my siblings and parents to take the same level of precautions, but YMMV.
posted by larthegreat at 1:52 PM on October 5 [5 favorites]

I can't speak to whether this is reasonable or too risky for you, but here are the questions/thoughts that I would consider with this plan:

1. 3 days seems early to get tested based on articles I've seen, but I'm not up on the current best practice. Perhaps 5 or 6 days or another length would be better to agree upon. Also, per the comment above about false negatives, will everyone in your sibling's family (other than the baby) get tested? I'd be much more comfortable with multiple people testing negative than a single test.

2. Where are they quarantining/what do they understand that to mean? It seems like many people have many different interpretations of quarantine. Will their quarantine location be pre-stocked with groceries or do they expect to go to the store or to restaurants? Will they need to go to a pharmacy or a convenience store? What will they do for entertainment? What if there is a problem with the quarantine location (internet, cable, plumbing, heat, etc) - how will it be addressed safely? Is there outdoor space for them to use or will they travel elsewhere to get some fresh air/exercise?

3. How does your SO and SO's grandparent feel about this plan? What would be required for them to be comfortable?
posted by Caz721 at 1:53 PM on October 5 [3 favorites]

Adding on that it sounds like this bubble would be emotionally wonderful for everyone, if your most vulnerable family members are on board and you can find a way to do it safely.
posted by mekily at 2:59 PM on October 5 [7 favorites]

I would advise 14 days of hard quarantine. It's how Taiwan has managed to keep an island of 24 million people to only 7 deaths and 518 confirmed cases. They removed the test on arrival requirement in July. With this simple measure, they all get to go to school and dine out and play golf and everything, not that I'm jealous.
posted by dum spiro spero at 3:16 PM on October 5 [5 favorites]

Also perhaps good to think through what will happen if they do get sick during travel. You and your sibling could make a list and discuss all possible details. Including: Are they mentally prepared to potentially be really unwell away from home? Can they make sure they know what their health insurance will cover if they are away from their usual providers? Depending on your personalities, detailed planning for the very worst case scenario might help you feel more certain that you can do it - or that, on reflection, it would be better to postpone till spring.
posted by EllaEm at 3:26 PM on October 5 [4 favorites]

I think your sibling’s 14 day logic is sound in terms of protecting the bubble. But it does put the sibling, baby, and any co parent on that trip at risk.
posted by warriorqueen at 5:03 PM on October 5

I want to emphasize that they really need to do the entire 14 day quarantine if you want this to work properly. With the number of high risk people in the bubble and the types of interactions you’d like to have together, there’s no way to shortcut this.

Additionally please consider additional protective measure such as downloading your state or country’s COVID exposure notification app. While exposure notification isn’t the same as contact tracing and quarantine, it’s another tool we have to mitigate risk. (Feel free to send me a message if you need help finding the appropriate app).
posted by raccoon409 at 6:41 PM on October 5 [2 favorites]

NZ tests on day 3 and day 12 of managed isolation, which has mostly been working well.
posted by inexorably_forward at 11:05 PM on October 5 [1 favorite]

Agree that 14 days of quarantine is important regardless of when they get tested/ receive test results. Travel is the source of potential exposure and you will want to remove as much time as possible between that exposure and the joining of the bubbles - especially for the older/ more vulnerable members of your family.

You will also need a plan for how you will manage things if any of the traveling group test positive (unsure where you are located, so this will depend on local prevalence). Do they stay in quarantine (assuming mild symptoms and no requirement for medical treatment or hospitalization) until they receive a single negative test? Or, given the high rate of false negatives, do they need to get two negative tests, administered N days apart.
posted by lulu68 at 11:44 PM on October 5

Everyone above is right - you cannot test your way out of quarantine. See this recent case study -- a person tested negative, but went on to infect the entire family (12 people) staying in a house together. They were tested too early (or got a false negative), and the consequences were bad. A hard quarantine (staying in a house and getting any needs delivered contactless) for 14 days is the best route.

Regarding lulu68's comment on what to do if positive, guidance in my city would be that the positive person must isolate until the following criteria are met:
- at least ten days after symptom onset (or, if no symptoms, 10 days after test date)
- no fever for 24 hours (without taking advil or tylenol)
- symptoms improved (including cough)

Anyone who cannot stay away from the positive person (so the infant, any caretakers) must quarantine for an additional 14 days after the person is no longer considered infectious -- so a total of 24 days after the positive person's symptom onset.
posted by quadrilaterals at 4:57 AM on October 7

Friends of ours with a 6 month old baby have had both sets of grandparents and siblings visit with similar but less stringent procedures. The one thing that they did in addition to what your sibling has outlined is that visitors took tests prior to traveling as well.

Would keeping certain risk-reducing measures in place within the bubble help?

My spouse and I have traveled to see family and even after observing a 2 week quarantine, we continue to wear masks in the house except during meals. We also have separate bathrooms. That said, we are also the ones who are running to the grocery store and doing other errands, so we would be the primary vectors of infection.

Have your family members gotten the flu shot yet?
posted by spamandkimchi at 11:44 AM on October 7

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