Mirroring the national surge of COVID-19 infections, this past week, I received a barrage of requests from patients seeking pre-travel COVID-19 tests. Despite urgent pleas from the CDC not to travel this holiday season, Americans seem hellbent on celebrating Thanksgiving the way we always do; around a table with family and friends. If COVID-19 is our mortal enemy, we are playing right into her hands. We are a stubborn nation of rugged individualists. The get-tested-and-feel-falsely-reassured strategy has irked me since the beginning of the pandemic. The scenario plays out endlessly as a variation on a theme over telemedicine and clinic visits. “I’m traveling to [insert non-essential destination here], and I need a COVID test, so I don’t give it to my friends/family/burning man decompression group.” I earnestly try to explain that the test is a snapshot in time, that at any moment after the test, one can subsequently test positive for COVID-19 if they are pre-symptomatically infected. What of that exposure a week ago? You’re a ticking time bomb. And now I’ve falsely reassured you with a premature test. If you were exposed or gathered with other humans in congregate settings, you need fourteen days of quarantine, not a test, to prove that you aren’t infectious with COVID-19. What about travel itself? There’s the departure airport. The far-more-crowded-than-expected flight. The arrival airport. A bathroom filled with strangers who largely don’t understand how to, or care to, wear a mask. The rideshare has been certified “clean” per a safety protocol invented to satisfy lawyers. And then you accidentally forgot we are in a pandemic and rubbed your eyes after the long journey. The clock starts ticking. Where will you be, and who will you be with when the bomb goes off? You’re eating Thanksgiving dinner. The food is incredible, and all the people you love are in one place. Think about it. At least one of these people has a pre-existing condition or is elderly and susceptible to severe COVID-19. And where have they been, or from where did they travel? Was the test they got before traveling even a validated one? Or did it falsely reassure them everything was going to be OK for the next week? “But I won’t go if I test positive!” This is the most common rebuttal patients offer when I suggest that the test-and-travel strategy is ill-fated. Certainly, we’re preventing the spread of some COVID -19 by canceling a few trips for pre-travel positive tests. But how many pre-symptomatic infections are we missing, and post-travel exposures are we creating by taking this approach? Countless more. I see it every day when I take histories from COVID-19 patients who have recently traveled, many of whom were tested before they left. I have not seen my family in nearly a year. My grandmother turned 102 years old last weekend, and we celebrated over dreadful Zoom. She’s on hospice now, and I wonder if I’ll ever see her again. But I don’t want any other members of my family or myself to end up on hospice, so I’m staying in my one-bedroom apartment for the holidays. I won’t travel home until we are out of a massive surge and we have more tools at our disposal, like rapid daily home testing, which could identify those initially negative, soon to be positive, tests. So what can you do this holiday season? Stay at home. If you must gather, only do so with members of your household or a minimal number of trusted people; ideally, people who have maintained a strict fourteen-day period of isolation, having done so yourself. If these COVID-19 vaccines work as well as are purported to, we’ll be able to gather with our families and friends next Thanksgiving safely. Won’t it be better to celebrate with them next year, free of any guilt you’d feel for giving them the gift of COVID-19 this holiday season? Don’t be falsely reassured. Stay at home this holiday season. Russell Johnson is an internal medicine-pediatrics physician. Source
