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COVID-19 Winter

Daily COVID-19 cases are soaring throughout the United States in a pre-winter spike that many experts feared and predicted. Ultimately, that means it’s more important than ever to double down on prevention strategies, even if you’re experiencing pandemic fatigue like so many others are right now.

“Cases are exploding, and we have the most infections and hospitalizations we’ve ever had,” says Bernard Ashby, MD, a vascular cardiologist and health policy expert in Miami, Florida. “Based on all of the available projections, the coronavirus pandemic is expected to get much worse before it gets better.”

It’s important to keep in mind that about 40 percent of COVID-19 transmission is driven by people who don’t have symptoms, per the U.S. Centers for Disease Control and Prevention (CDC). That means that being indoors with people who are seemingly healthy this winter can still pose a significant risk, especially if you’re at high risk for COVID-19 complications.

However, there are a few simple yet effective ways to mitigate your risk of getting the coronavirus this winter and increase your chances of staying healthy.

Why COVID-19 Is Worse in the Winter

Although COVID-19 isn’t considered a seasonal disease quite yet, it may become one — like influenza, which doesn’t widely circulate during the spring and summer — after vaccines become available and more herd immunity is achieved, according to research published in the journal Frontiers in Public Health.

According to the researchers, dry and cold weather conditions during the winter often drive more respiratory tract infections by increasing virus stability and transmission while potentially weakening your immune system.

Although SARS-CoV-2 (the coronavirus that causes COVID-19) spread widely throughout the summer, once population herd immunity is attained through vaccinations and natural infections, its basic reproduction number — the number of secondary cases resulting from a primary case — is expected to drop significantly. (The basic reproduction number is a measure of how contagious a virus is.) This will make the virus more prone to seasonal fluctuations.

Even though COVID-19 is not considered seasonal yet, cold weather in the winter is already leading to behavior that increases the risk of transmission.

Spending time with others indoors

For instance, people are more likely to gather indoors now than in the summer or fall.  Individuals from different households might be tempted to gather for the holidays.

“If you’re outside and someone coughs or sneezes, a lot of it gets diluted in the fresh air,” says Peter Gulick, DO, infectious disease expert and Professor of Medicine at Michigan State University in East Lansing. “But now that we have to be indoors more, it’s much more risky. When you’re in a closed area, you have the same stagnant air where aerosolized COVID-19 particles can live for three hours or more.”

Dry air

Some research has also shown dry air — which is more common in the winter — may play a role in COVID-19 transmission.

One study published in the journal Transboundary and Emerging Diseases estimated that every 1 percent decrease in relative humidity was associated with a 7 to 8 percent increase in COVID-19 cases in New South Wales, Australia. A 10 percent drop could double infections.

Humidity is helpful because it makes airborne infectious particles heavier and larger, causing them to drop from the air and onto a surface instead. “COVID-19 is more sensitive to humidity and periods of lower humidity might forecast spikes in SARS-CoV-2 transmission,” note the researchers.

However, more research is needed to confirm this link and what strategies might be used to offset the risk of lower-humidity conditions, like those you may encounter indoors in the winter.

What These Winter Risks Means for People with Chronic Illness

The increased risks for COVID-19 transmission this winter unfortunately are coinciding with widespread pandemic fatigue.

Many people are exhausted from months and months of following precautions like social distancing, wearing masks, and limiting gatherings, which may increase risky behaviors when vigilance is needed more than ever.

“My advice to patients now is reasonably similar to what it was before, except we have to double down,” says Lynn Ludmer, MD, Medical Director of rheumatology at Mercy Medical Center in Baltimore. “All of us are experiencing some COVID-19 fatigue, and we wish it was gone, but it’s not. Others aren’t necessarily following guidelines, so I want people to really think about how they can control what they do to stay safe.”

If you have chronic illnesses that could increase your risk of COVID-19 complications, this is especially important. Although you can’t control the actions of others, it’s important to stay vigilant about following COVID-19 prevention guidelines yourself (and avoiding being around people who don’t).

“The chronically ill and older individuals are the ones who are at higher risk,” says Dr. Gulick. “People who have such conditions as obesity, diabetes, high blood pressure, chronic lung disease, cancer, and other chronic illnesses all require very close monitoring.”

Extra Precautionary Steps You Can Take This Winter

 You’re already familiar with the general guidance for preventing the spread of COVID-19. It’s simple, but sometimes difficult to adhere to all the time:

  • Maintain a social distance of six feet or more from people outside of your household whenever possible.
  • Wear face coverings when out in public and when you can’t be socially distant.
  • Wash or sanitize your hands frequently and disinfect commonly touched surfaces.
  • Avoid large groups or situations when it will be hard to be socially distant.
  • When spending time with others, being outdoors is safer than indoors.

There are also a few extra steps you can take in the winter months to improve your chances of staying healthy and avoid exposure to COVID-19.

1. Get your flu vaccine

 This year, it’s more important than ever to get vaccinated, per the U.S. Centers for Disease Control and Prevention (CDC).

Of course, the flu vaccine won’t protect against COVID-19 infection, but it has been shown to reduce the risk of flu, hospitalization, and death — and can help keep you safer at home when COVID-19 is running rampant in the winter.

Read more here about getting the flu vaccine during COVID-19 when you have inflammatory arthritis and why you still need the vaccine even if you’re strictly isolating.

“If you get influenza, you’re going to have a weak immune system and your lungs are going to be weaker, which can make COVID-19 even more serious,” says Dr. Gulick. “Make sure you’re also up to date on your pneumonia vaccine.”

It’s recommended that all adults age 65 and older get the pneumonia vaccination. For adults with inflammatory arthritis and certain other chronic conditions, the vaccine is recommended at any age, however. Read more here about the pneumonia vaccine.

2. Stock up on cold and flu supplies

In case you do get sick with a cold or flu, make sure you have basic items on hand so you don’t have to leave the safety of your home to make unnecessary runs to the supermarket or pharmacy. This way, you’ll also be less likely to infect others.

“It’s important to make sure you have a thermometer, acetaminophen, soup, and other basic things you might need for colds and flu in case you get ill,” says Dr. Ludmer. “You should not go out if you’re sick.”

In the spirit of planning ahead, make sure you also have a strategy in place to protect yourself if someone in your household were to sick with COVID-19.

Be prepared for the infected person to isolate at home by using a separate bedroom and bathroom if possible, have masks on hand for both you and the infected person to wear if you have to briefly be in the same room (say, to bring them food, pick up dishes, etc.), and have plenty of disinfectant to clean high-touch surfaces like tables and doorknobs every day, per the CDC.

3. Wash your hands, even after wearing gloves

You may be wearing warm gloves regularly during the winter months, but that doesn’t mean you should skip handwashing. “It never hurts to be more cautious than not, especially right now,” says Dr. Gulick. Plus, it’s easy to get germs on your hands as you’re taking off your gloves.

The CDC recommends washing your hands often with soap and water for at least 20 seconds, especially after you’ve been in a public space or if you’ve blown your nose, coughed, or sneezed.

4. Bring an extra mask when you’re in public

If you do need to go to the store for essential errands like picking up groceries or medications, bring an extra mask with you. This way, if you sneeze into your mask or have a runny nose, you can clean up quickly. Keep tissues and hand sanitizer on hand too.

“If you’re in a public space, go to an area where you’re beyond six feet from others,” says Dr. Gulick. “Once you’re isolated from others, clean off your nose and change into a clean mask.”

5. Ensure there’s always proper ventilation if you’re seeing people outside of your household

 Although it may be more difficult in the cooler temperatures of winter, it’s paramount to only meet with those who don’t live with you in areas with plenty of ventilation — preferably outside.

“If you want to see family, I strongly encourage you to do it outside,” says Dr. Ashby. “If you can’t do it outside, ensure that wherever you are, it’s properly ventilated. Try to open windows.”

If you are socializing with extended family members or anyone else who does not live with you, keep a mask on — even in someone’s home.

6. Take advantage of rapid testing

Although it’s not a fail-proof method, COVID-19 testing may help determine if it’s safer for certain family members to come in contact with you.

There are two basic types of tests that can detect an active COVID-19 infection, per UC Davis Health:

Rapid antigen tests: Most rapid diagnostic tests are antigen tests, which means they detect a protein that is part of the coronavirus. They are taken with a throat or nasal swab. Although these tests often provide results quickly (in less than 30 minutes), the downside is that they can be less accurate. If someone is not near peak infection but still contagious with low amounts of virus in their body, the tests could come back as negative. False negatives may be as high as 20 percent.

PCR-based tests: These tests detect genetic material of the coronavirus and are sensitive enough to do so with just a tiny amount of the virus. The best tests have required trained personnel, specific reagents, and expensive machines, and are close to 100 percent accurate. Lower-quality ones can have false negative rates of up to 15 to 20 percent. These tests tend to take hours or days (depending on how busy labs are) to provide results after a sample is collected with a throat or nasal swab.

“If you’re able to test yourself or have family members test themselves before they come into your home for the holidays, I strongly encourage that,” says Dr. Ashby. Of course, everyone should also be quarantining except for getting their test as well. If someone tests negative but doesn’t quarantine afterward, they could be exposed and infected in between getting the test and seeing you.

That said, the safest route is to celebrate the holidays only with those who live in your own home, per the CDC.

Gathering with family and friends who don’t live with you can increase your chances of getting or spreading COVID-19.

Read more here about why testing doesn’t give you permission to socialize without precautions.

7. Limit activities except essential ones 

Throughout the pandemic, the general guidance has been to avoid going into crowded public spaces — especially indoor ones. Now, however, it’s more important than ever to limit nonessential activities. This is especially true if you’re in a high-risk group prone to poor outcomes from COVID-19.

“Given the fact that the pandemic is essentially out of control, I would encourage folks who are vulnerable to avoid any spaces where they could potentially come in contact with the virus if at all possible,” says Dr. Ashby. “If they have to go and do essential things like shopping and what not, take all precautions possible.”

That may mean that you utilize prescription medication or grocery delivery if it’s possible for you. Avoid holiday shopping in person at malls and stores.

It’s also very important to stay out of venues known for spreading COVID-19. For example, a November 2020 study in the journal Nature found that gyms, restaurants, and hotels are among the venues that carry the highest risk for COVID-19 transmission.

8. Prepare for uncomfortable conversations

 As infections continue to soar throughout the United States, you may need to have difficult talks with both loved ones and strangers. For instance, if you suspect family members or friends are not following precautions — maybe your grandchildren are having indoor playdates or friends have been gathering for indoor get-togethers — you may have to tell them you can’t see them at this time.

“It’s a really difficult topic, but you have to be very careful about who you’re exposing yourself to,” says Dr. Ludmer. “People feel as though their family members can’t have COVID-19, but those family members may be potentially going to bars, gyms, and other venues where they might be exposed to the coronavirus.”

You might also have to find ways to kindly ask others you encounter in public to socially distance from you — say, you’re in the checkout line and another customer isn’t giving you enough space.

“If you’re out at the supermarket and someone is not socially distancing from you, then you have to be proactive without being confrontational,” says Dr. Ludmer. “You don’t want to start a fight, but feel free to very nicely say to people: ‘I’m sorry, but can you back up a little? I’m uncomfortable because I’m a high-risk individual for COVID-19.’”

9. Stay active when you’re at home

This winter, you may have to get creative about how you stay active as you avoid going to gyms and other public spaces for exercise. Simply tracking how many times you get up during the day or using a pedometer is a good place to start.

“Getting up and walking around during TV commercials and keeping track of your steps daily can help you to stay active, but you may have to remind yourself to do it,” says Dr. Ludmer.

You can also find many low-impact exercise videos for free online, schedule time into your day to stretch, walk around while you’re on the phone, and clean small sections of your home each day.

Here are more ways to move more at home when you’re stuck inside during the COVID-19 pandemic.

10. Find little ways to combat loneliness

During the first months of the COVID-19 pandemic, loneliness doubled for older adults, according the University of Michigan National Poll on Healthy Aging. Feelings of loneliness may be even worse during the holidays and shorter days of winter this year, when seasonal depression also becomes an issue for many.

No matter what your age, take time to actively connect with others, talking to them about your concerns and feelings. The CDC also recommends connecting with community- or faith-based organizations, either online, through social media, or by phone.

“Combating loneliness right now is so hard for many people,” says Dr. Ludmer. “It’s a matter of reaching out to friends and being proactive about it. Most of us have support systems and we need to tap into those, whether it’s through video chats, phone calls, or even writing holiday cards.”

If you can take on the responsibility long-term (even after the COVID-19 pandemic and social distancing measures are lifted), pets can also offer solace and help ease loneliness.

“I rescued a cat this year, and that’s been extremely helpful to have a little kitten to come home to and to not feel so alone at home,” says Dr. Ludmer. “I think there’s a lot of value in pets, and my patients agree — I’ve had many do the same thing during the pandemic.”

You can also participate in educational programs or classes online for a sense of community. For instance, consider taking a Spanish class or a cooking class that meets weekly for virtual instruction. The COVID-19 Patient Support Program, offered free from CreakyJoints and our parent nonprofit the Global Healthy Living Foundation, also offers online community events, such as cooking classes, Bingo, educational webinars, and more.

Sign up here and you’ll be notified about events as they happen.

11. Keep in touch with your doctor

If you have already had and recovered from a suspected or confirmed case of COVID-19, it’s important to stay vigilant about possible long-term effects.

“There’s a good amount of data that shows once folks are infected with the flu, they’re more likely to have an acute cardiovascular event like a stroke or heart attack,” says Dr. Ashby. “Given the fact that COVID-19 is like the flu but a much more lethal virus, we have every reason to believe that folks are more likely to have a heart attack or stroke after it, too.”

Because of that, it’s important to be aware and vigilant of any heart attack or stroke symptoms, including chest discomfort, shortness of breath, or weakness.

“I also recommend anyone who has been infected with the virus, especially if they have any preexisting cardiovascular disease, to check in with their doctor to make sure they’re dotting their i’s and crossing their t’s in terms of prevention,” says Dr. Ashby.

Get Free Coronavirus Support for Chronic Illness Patients

Join the Global Healthy Living Foundation’s free COVID-19 Support Program for chronic illness patients and their families. We will be providing updated information, community support, and other resources tailored specifically to your health and safety. Join now.

Audi A, et al. Seasonality of Respiratory Viral Infections: Will COVID-19 Follow Suit? Frontiers in Public Health. September 15, 2020. https://doi.org/10.3389/fpubh.2020.567184.

Caring for Someone Sick at Home. Coronavirus Disease (COVID-19). U.S. Centers for Disease Control and Prevention. October 30, 2020. https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/care-for-someone.html.

Chang S, et al. Mobility network models of COVID-19 explain inequities and inform reopening. Nature. November 10, 2020. https://doi.org/10.1038/s41586-020-2923-3.

Coping with Stress. Coronavirus Disease 2019 (COVID-19). U.S. Centers for Disease Control and Prevention. July 1, 2020. https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html.

COVID-19 Pandemic Planning Scenarios. Coronavirus Disease 2019 (COVID-19). U.S. Centers for Disease Control and Prevention. September 10, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html.

COVID-19 Testing Overview. Coronavirus Disease 2019 (COVID-19). U.S. Centers for Disease Control and Prevention. October 21, 2020. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/testing.html.

Different types of COVID-19 tests explained. UC Davis Health. November 12, 2020. https://health.ucdavis.edu/health-news/newsroom/different-types-of-covid-19-tests-explained/2020/11.

Holiday Celebrations and Small Gatherings. Coronavirus Disease 2019 (COVID-19). U.S. Centers for Disease Control and Prevention. November 19, 2020. https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/holidays.html.

How to Protect Yourself & Others. Coronavirus Disease 2019 (COVID-19). U.S. Centers for Disease Control and Prevention. November 4, 2020. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html.

Interview with Bernard Ashby, MD, a vascular cardiologist and health policy expert in Miami, Florida

Interview with Lynn Ludmer, MD, Medical Director of Rheumatology at Mercy Medical Center in Baltimore

Interview with Peter Gulick, DO, infectious disease expert and Professor of Medicine at Michigan State University

Miller CC, et al. No, a Negative Coronavirus Test Does Not Mean You Can Safely Socialize. The New York Times. November 21, 2020. https://www.nytimes.com/2020/11/21/upshot/coronavirus-test-thanksgiving-plans.html.

Piette J, et al. Loneliness Among Older Adults Before and During the COVID-19 Pandemic. University of Michigan National Poll on Healthy Aging. September 2020. https://www.healthyagingpoll.org/report/loneliness-among-older-adults-and-during-covid-19-pandemic.

Ward MP, et al. Humidity is a consistent climatic factor contributing to SARS‐CoV‐2 transmission. Transboundary and Emerging Diseases. August 4, 2020. https://doi.org/10.1111/tbed.13766.

What are the benefits of flu vaccination? Influenza (Flu). U.S. Centers for Disease Control and Prevention. October 23, 2020. https://www.cdc.gov/flu/prevent/vaccine-benefits.htm.

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