Trick or Treat … or COVID-19?

As with every other holiday we’ve celebrated in 2020, Halloween will be held under the long shadow cast by coronavirus disease 2019 (COVID-19). Without much fanfare, and with little notice by the media, the US Centers for Disease Control and Prevention (CDC) issued recommendations for Halloween and other upcoming holidays on September 21. Those holidays include:

• Halloween, October 31
• Thanksgiving, November 26
• Christmas, December 26
• Hanukkah, which starts December 10
• Kwanzaa, December 26
• New Year’s Eve, December 31

These recommendations contain many important lessons both for Halloween and how we should be living our lives in general. The first is that these detailed recommendations are what CDC recommendations should look like. When generated in a free and unhindered environment, they can provide truly helpful examples and advisements. I only wish this amount of detail were available for all other types of venues, including schools, restaurants, and other high-risk areas.

Second, is that the virus is airborne. In two different areas the CDC describes a “Moderate Risk” activity as a person being outdoors, wearing masks and more than six feet apart. This would include costume parties. But “if screaming will likely occur, greater distancing is advised. The greater the distance, the lower the risk of spreading a respiratory virus.” Screaming will aerosolize the virus and being at a greater distance is necessary since the virus can spread much further, even outdoors.

Other “Moderate Risk” activities would include walks through haunted forests, and outdoor Halloween movies. You do not need to have a degree in epidemiology to generalize these recommendations to outdoor funerals, protests, demonstrations, political rallies and realize these would be “Moderate Risk” activities. And only if participants stayed 6 feet apart and wore masks. If they did not, then the risk would of course be higher.

High risk indoor events include haunted houses, where crowding and screaming are factors. One must also realize that similar venues such as indoor movies, funerals and political rallies would also be at high risk for spread, since loud vocalization often occurs which would be expected to aerosolize the virus.

Kevin Kavanagh, MD

One way to go about trick-or treating is with preset up individual wrapped goodie bags to grab-and-go, according to the CDC’s “Moderate Risk” activity guideline. I can see little difference between a grab-and-go goodie bag, and a grab and pay for bag of M&Ms you obtain from a grocery store shelf. Viral contamination is possible. Catching the virus from items you buy is not as likely as getting it from the air, but it can probably still occur. You should take precautions of cleaning the items and washing your hands before use.

Most importantly, traditional trick or treating is viewed as a high-risk-activity. Of course, we all knew Halloween would be problematic. An important caveat for Halloween is not to use your Halloween mask to prevent the spread of coronavirus. It will offer very little protection at best. The CDC also advises not to wear your Halloween mask and viral blocking mask at the same time, since it may not be safe.

Activities which are good to do and a low risk are: Carving pumpkins with your family, a family movie night, decorating your house, a virtual Halloween costume contest and a Halloween scavenger hunt with your family.

These advisements not only detail needed changes for Halloween but also for many different venues. The virus does not care where it is, its behavior will be the same. Applying them to the opening of schools is of utmost importance. In schools, social distancing, wearing of masks, hand hygiene and pristine air quality is of utmost importance. Air should be sanitized with complete air exchanges at least 6 to 10 times an hour. Similar steps need to be taken for other retail establishments.

We need to follow public health advice and learn to safely live with this virus until a vaccine or effective treatment has been developed.