We recently passed the third Sunday of Advent. In my faith tradition, that is a day we focus on joy. I write today about the joys of having a “cozy COVID Christmas” and how we can celebrate our respective holidays while minimizing the risk to our loved ones and community.

I am an ICU doctor who has taken care of too many suffering and dying from COVID-19. The loss is staggering. We have over 73.1 million cases and over 1.6 million deaths worldwide, with over 300,000 deaths in the United States. Heartbreakingly, this is devastating already disadvantaged communities to a greater degree than the general population. There is every indication that the numbers of dead and affected will accelerate in the short term, despite the hope that the new vaccines bring. We have so many children who will not have their parents or grandparents at the holidays this year. I have cared for people who have been hospitalized along with family members, struggling in isolation in different parts of the hospital. The most haunting and horrible part of this illness has been the cruelty of the solitary death. Before COVID-19 and its safety restrictions, if we knew someone was dying, family and friends would come surround the bed in a vigil: sharing memories and celebrating their life. It made a bitter moment bittersweet. This year there is so much bitterness as the ability to have family present in the same way is gone. The patient is often more confused and alone. The family may be outside in a car, or calling in frantically, wild with understandable grief. They will suffer for a long time from the inability to be truly present at the moment of passing. It has been hard to be in the ICU during this time.  Every time I leave the hospital, I pull into the garage, go to the room we have designated for Mami’s hospital items, change my clothes, follow my decontamination ritual, and then hug my children and greet my husband, trying to take a moment to recognize with deep gratitude that my family is currently healthy and whole, but that has never felt so fragile.

All the grief can be overwhelming. But in my faith tradition, this is also the season where we focus on hope coming in the darkness. I know that many faiths have similar values in their winter holidays, in which we recognize how vital hope is despite the call of despair and how we can find joy in sorrowful times.

In my home with two full-time working parents and three children, I know we are not alone feeling like the holidays can be an extra busy time thrown on top of a schedule that barely has enough room in it. The first gift of this extra time COVID has forced upon us has been a very valid reason to jettison the frantic schedule and spend more time with our families in a sustained way. We can take time to read that extra book, play a game, bake, and build memories that will last. Travel and mixing of households is risky for COVID-19 spread, so spending a simple and small holiday this year can be embraced as an opportunity prior to the likely resumption of busier holidays in the years to come.

We can embrace the gift of the relative safety of the outdoors. COVID-19 has been a virus that is insidious in its long pre-symptomatic phase and capacity to spread through the simple intimate moments of conversation, of laughter, and singing. It is precisely the kind of gatherings that we traditionally long to have at the holidays that make COVID-19 most likely to spread. Outbreak investigations have shown the dangers of indoor spaces over and over again. There is the dramatic example of a choir in Washington State, in which one person with COVID-19 spread the virus to 53 out of 61 people there, with three hospitalized and two dead following. It was sobering to learn of a person dining indoors infected from another 20 feet away after only five minutes. This makes the idea of the kind of indoor gatherings and religious celebrations many of us want to have in this time unsafe. Evidence has shown the importance of lack of ventilation, of close contacts, and indoor spaces for allowing both droplet and aerosol spread of the virus. It appears that spending more time outside is much safer, especially when combined with masking and distancing.

So how can we spend time with our loved ones, especially vulnerable individuals such as grandparents, those with diabetes or hypertension, immunosuppression, or other potential risks for severe and potentially deadly COVID infection? My family has embraced walks in nature with grandparents as well as outdoor gatherings on porches and patios with safe distancing and masking. We even bought a heat lamp for the season to spend distanced time with loved ones outdoors. None of this comes with zero risk, but the risk of transmission outdoors is far lower than indoors, and when coupled with distancing and masks, becomes acceptable. Yes, it is chilly, but it certainly makes new memories!

This is obviously not as satisfying as our usual family holidays, in which we pile more people into a house than fit comfortably, enjoy the chaos and noise of children running all over and the sweetness of multiple generations under the same roof. However, the collective love and respect we are all showing by physically distancing during the holidays is a gift we give to our families and communities. That gift will mean there will be more of us around to celebrate the holidays next year.

I’m working ICU nights over Christmas this year. I sincerely hope I don’t see you or any of your loved ones in my professional capacity. I wish you a wonderful holiday season, sharing the gift of safety and finding joy in dark times.

Erika Maria Moseson is a practicing, board-certified pulmonary and critical care physician. She is founder, Air Health Our Health, an educational website and podcast on the importance of healthy air and a stable climate, and can be reached on Facebook and Instagram.

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