Originally published on NYT – Health on 2020 05 21 by Tara Parker-Pope https://www.nytimes.com/2020/05/20/well/family/coronavirus-grandchildren-grandparents-when-can-i-see-my-grandkids.html
Grandparents have had enough. They want to see their grandchildren.
A life in permanent lockdown and isolation from grandchildren is not how grandparents want to spend their golden years. But adult children don’t want to risk exposing an older, more vulnerable generation to the new coronavirus during a family visit. The Centers for Disease Control and Prevention reports that eight out of 10 deaths from Covid-19 are in people aged 65 and older.
“This is a tricky one because older people are particularly vulnerable to this virus,” said Julia Marcus, an infectious disease epidemiologist and assistant professor in the department of population medicine at Harvard Medical School. “Of course the safest approach is to avoid any interactions with grandparents, but that won’t be sustainable for everyone, and there are important ways to minimize risk if people do choose to see older relatives.”
To start, families need their own reality check about the actual level of vigilance by every member of the household.
“What I would consider quarantine and what other people would consider quarantine are often different,” said Shan Soe-Lin, a lecturer at the Yale Jackson Institute for Global Affairs and managing director at Pharos Global Health Advisors, a nonprofit global health firm in Boston. “One of the gold standard questions is, ‘How many people have you come into contact with over the last week, or over the last month if you can remember that far back?’ I think that’s a clear test question. Everyone says that they are being super careful. Nobody self-evaluates as being completely reckless.”
So as a first step, think about human contacts, big and small, by every member of the household. How many times did someone go to a store? Did you meet up with a friend for a walk? When you jog, how close are you to other runners? At the park, did your children run up to another child before you could stop them? Is a teenage boyfriend dropping by the house? Do you always wear a mask? Do your children?
“If you’re a family and you have some leakage in your quarantine protocol — if you had to go to the grocery store, for instance, delivery people came over, other people entered your house — any time you have a break in that protective bubble I would be extremely cautious,” said Dr. Soe-Lin.
Now that you’ve taken stock, try to seal the “leaks” in your quarantine bubble. While it may be impossible to get your contact risk to zero, you can eliminate the biggest risks (like outside visitors), reduce shopping trips to once a week or less, improve hand hygiene and wear a mask. Once you’re confident in your family’s quarantine vigilance for 14 days, it’s less risky to visit an older family member. But go with a plan.
The safer strategy is to spend time together outdoors — the risk for viral transmission outside is far lower than inside. Everyone should wash their hands, and stay at least six feet apart. Some experts suggest 10 to 12 feet if the grandparent is a very elderly person or has a chronic health condition. Even outdoors, everyone over the age of 2 — and not just the grandparent — should wear a mask. Children are more likely to wear a mask if you explain to them that it’s to protect someone they love.
[Read more: Children May Be Afraid of Masks. Here’s How to Help]
“A sneeze without a mask can spread up to 20 feet,” said Dr. Asaf Bitton, executive director of Ariadne Labs at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health. “It’s also the act of speaking — we expel droplets even in quiet speech. The mask really contains a great amount of them. The mask is protecting all of us from each other.”
Masks can be removed for meals, but everyone should stay at least six feet apart from the older person. Don’t share food or drinks — it increases the risk of close contact or catching germs from serving utensils and dishes. If you have hand sanitizer, use it often. And avoid touching the face.
Remember, the biggest worry is being in an enclosed space with someone who has the virus but doesn’t know it. Keep everyone outside, if possible. But if a child must enter a grandparent’s house, monitor them and allow it only when the grandparent is outside. Everyone should wear a mask, and sanitize the bathroom after use. If the grandparent is visiting you, designate one disinfected bathroom just for them and keep children outdoors.
Linsey Marr, an aerosol scientist at Virginia Tech who studies viral transmission, said that before the pandemic, her 74-year-old mother-in-law cared for her two children twice a week. Now they meet outdoors for family meals, with everyone keeping their distance.
“We have a long table outside, and she sits at the opposite end more than six feet away,” said Dr. Marr. “We do not pass around dishes. She has not been in our house for months. We’re worried about her. We don’t want her to get sick.”
While parents may worry that all these precautions will create too much stress, research shows that even young children understand the concept of keeping people safe, “kind of like how superheroes help save people,” said Dr. Neha Chaudhary, a child and adolescent psychiatrist at Harvard Medical School and Massachusetts General Hospital.
“Parents can explain the need to keep grandparents from getting sick by keeping their body to themselves, staying behind a particular landmark like a sidewalk or set of chairs, and keeping a mask on their faces since germs come from there,” Dr. Chaudhary said. “Young kids generally understand the idea of something bad happening and trying to do good instead.”
Don’t panic if a child breaches the social distancing barrier and gets close to a grandparent. Brief encounters are not a big risk, and you don’t want to create fear in children. But long hugs, cuddles and sitting in grandpa or grandma’s lap are not advised. If both grandparent and child are wearing a mask, a quick hug from a child around the waist or knees, keeping faces as far apart as possible, poses very little risk, Dr. Marr said.
Long-distance visits to see grandparents are more difficult. You should stay in a hotel or rental nearby, not in the grandparent’s house, and still limit visits to the outdoors while wearing a mask. Even if you drive instead of fly, stopping for food and using public restrooms along the way sets your quarantine clock back to zero. It’s safest to quarantine for 14 days before visiting the older person.
Be aware that the risk of being together during the pandemic will change over time. Areas where new cases and hospitalizations are low and dropping may be safer than places where illness is high and on the rise, Dr. Bitton said. Experts say the summer may be your best opportunity to visit with older family members in many states, partly because you can spend time together outdoors, but also because a surge in cases is expected in the fall and winter, when stricter quarantines may be recommended for the most vulnerable.
Do you have a health question? Ask Well