Welcome to COVID Questions, TIME’s new advice column. We’re trying to make living through the pandemic a little easier, with expert-backed answers to your toughest coronavirus-related dilemmas. While we can’t and don’t offer medical advice—those questions should go to your doctor—we hope this column will help you sort through this stressful and confusing time. Got a question? Write to us at [email protected].
Today, J.B. from New Jersey asks:
Every year for the holidays, my aunt and uncle come up from Florida and stay with my 70-year-old parents, who host a large extended family dinner on Christmas Eve. My aunt and uncle both had COVID-19 early in the summer and tested positive for antibodies in July. Their plan is to donate blood in early December to see if they still have antibodies, then fly up from Florida to New Jersey. They believe they can’t get COVID-19 again or spread it to others as long as they have antibodies.
My cousin also wants to fly from North Carolina to New Jersey, spend Christmas Eve with our family and then visit with other family members. The only precaution he wants to take is getting a COVID-19 test before flying. He says he doesn’t go out “too much.”
Is it unreasonable to consider telling either or both of these relatives that they should not travel and stay with my parents this year?
This is undoubtedly an issue on lots of people’s minds, so thank you. It’s also a complicated one, so I consulted two experts: Dr. Kelly Michelson, director of the Center for Bioethics and Medical Humanities at Northwestern University’s Feinberg School of Medicine and a physician at Lurie Children’s Hospital, and Akiko Iwasaki, a professor of immunobiology at the Yale School of Medicine.
To answer your last question first: It’s not at all unreasonable to consider asking family members to skip the trip, or to skip a big Christmas Eve dinner entirely, as painful as that would be. At 70, your parents could develop serious complications if they were infected with COVID-19. It’s never easy to forgo a tradition, but with the virus surging across the country, it’s a possibility worth seriously discussing with your family.
Now for the details. Your question about your aunt and uncle in Florida essentially boils down to: Do COVID-19 survivors still need to take precautions? Iwasaki says the answer is, “Yes.”
It’s true that people who have recovered from coronavirus are probably at a lower risk of getting the virus (again) or spreading it to other people. But there have been documented cases of people getting COVID-19 twice, and there’s a lot that scientists still don’t know about COVID-19 immunity, including how long antibodies last (estimates run anywhere from a few months to a year-plus) and how well they prevent subsequent infections.
If your aunt and uncle tested positive for antibodies right before traveling, it could offer “a little bit of comfort” that they won’t get sick or infect others, Iwasaki says, “but it’s not a guarantee.” False results are common with antibody tests, and researchers are still figuring out how well antibodies prevent future infections. A positive test result doesn’t definitively mean your aunt and uncle are completely protected or incapable of infecting others, Iwasaki says.
If your aunt and uncle do make the trip, they—just like any traveler—should try to quarantine for 10 to 14 days pre-flight, Michelson says. And once they arrive, they should still wear masks and practice social distancing.
That brings us to your cousin in North Carolina. Michelson says she has “a lot of concern” about his plan. Getting a single test before flying really isn’t enough to rule out infection. He could be exposed to the virus the moment he leaves the testing center. Or, if he was exposed shortly before getting tested, there might not be enough virus in his system to show up on the swab. By the time he shows up for Christmas Eve dinner, though, he could be contagious. If he then goes to see more relatives, he risks infecting even more people, Michelson says.
If he plans to make the trip, your cousin should follow the same precautions mentioned above. The same goes for local relatives who may be planning to attend Christmas Eve dinner, for the record. People driving from a few miles away are just as capable of spreading the virus as people who are flying, if they haven’t taken precautions beforehand.
To make a long answer short, the safest choice—and the one recommended by the U.S. Centers for Disease Control and Prevention—is to skip holiday travel this year and get the family together virtually. If your family absolutely wants to gather, everyone should try to quarantine beforehand and continue to take precautions throughout the visit.
That’s not a very fun and festive answer, we know! These choices are extremely difficult for everyone. “It’s easy to say we shouldn’t be doing this, that, the other behavior. It’s very hard to actually not do those things,” Michelson says. For whatever solace it’s worth, though, Michelson says she can imagine a possible return to group gatherings by next summer, with effective vaccines seemingly headed toward approval. Hopefully that serves as a little motivation this season.
“It would be really sad,” Michelson says, “to have one of the people you love get sick knowing that if you had waited five or six months, things would be different.”