How to See Family & Friends More Safely Over the Holidays, Part II:  Forming a Bubble  or PodThe safest thing you can do is spend the holidays with people you live with. For people who are going to gather  despite public health  recommendations,  creating a bubble  could be a way to  reduce risk.Read our blog post: see Part 1 of this blog for tips around the winter holidays. 

Gathering is risky

Every activity outside of your household carries some risk, which is why the safest thing to do is to not gather with people you don’t live with. We strongly urge you to spend the winter only with people you live with and to spend time virtually for people you don’t live with. This is especially critical as cases and hospitalizations continue to rise.

What is a bubble?

For people who are going to gather despite public health recommendations, creating a bubble could be a way to reduce risk. A bubble doesn’t have an official definition, but it is used to describe a group of people who only have close contact with each other. “Close contact” is defined by the CDC as being within 6 feet of someone else for a total of 15 minutes in a day. This 15 minutes could be all at once, or could be through several shorter interactions (like standing close to someone for 5 minutes each, 3 times in one day). Close contact can also include touching someone else (like hugging), being sneezed or coughed on, or touching, handling or sharing items with someone.

Some bubbles are more “airtight” than others. A person who works from home, lives with someone who works from home, and doesn’t have children may be able to limit their close contact only to their bubble. But someone who works in a restaurant, has a roommate who works in an office, and who sends their kids to daycare will have many exposures outside of the bubble. Smaller bubbles are also more likely to be successful. Just like soap bubbles, a large bubble is more likely to pop right away, while a small bubble can float along for longer.

We recommend that anyone who is forming a bubble consider all the risks that each person brings to the group. We strongly urge people to not form bubbles if people in the bubble are exposed to many others through their work, school, or personal lives.

Map out people’s risk

In order to understand the risk of a potential bubble, you must first map out the risk in the group before gathering. Here’s an example:

Forming a bubble: Example 1,  Household 1: One partner works from home; the other works in a library that is open to the public   No other exposures, Houshold 2: Both partners work from home, and their child attends school virtually  No other exposures, but one parent has Type 2 diabetes, Household 3: Works from home Doesn't have a car, so has to take public transportation (taxis and the bus) to go to essential places Gets her hair cut at the salonIs the risk worth it to you given everyone's exposure levels?  What can you change about the risk of illness in your bubble?

In this case, with some modifications, the risk may be low enough for people to socialize relatively safely. For example, this group may want to have a conversation about lowering household 3’s risk:

Have a conversation and set boundaries to reduce your risk. household 1 says: I want to see you in person, but I'm at higher risk of getting really sick from COVID-19 because of my diabetes. Would you be willing to lower your risk by not getting haircuts? And could I give you rides to the grocery store instead of you taking the bus? . Household 3 says: Yes, I can do that! I'm happy  to do that to make you  feel more comfortable!

However, in other scenarios, the risk in the group might be higher, and people may not be able to lower that risk as easily:

Forming a bubble: Example 2, Household 1: Both partners work in a restaurant in the back and cannot distance from coworkers. Household 2: One partner works as a bartender, and patrons often refuse to wear masks  Other partner was working from home, but their office required them to come back to work in the office in cubicles. Household 3: Both retired, not working Both like to go out to eat with friends and do not wear masks or socially distance Both are over 65 years old One person has hypertension . Is the risk worth it to you given everyone's exposure levels?  What can you change about the risk of illness in your bubble?

In this scenario, you should not form a bubble or attend a gathering together. While these conversations might be difficult, it’s more important to keep everyone safe than to give in to social pressure:

Have a conversation and set boundaries, even when it's hard! Household 1 says, Sorry mom, but we aren't  coming to Thanksgiving this year. It's too high of a risk with Mark and I working at the restaurant, and we don't want to get you and Dad sick." Household 3 says, "But I need to see my kids over the holidays! And I go out with friends all the time and haven't gotten sick! Can't you just come over for dinner?" Household 1 says, "No, we seriously will not be visiting. We love you and we can't risk you getting sick. We don't want to get sick from you either. We can do a video chat or phone call but we can't  see you in person."

Set up ground rules

If you decide to move forward with forming a bubble, we recommend that you follow these ground rules:

  • Have a conversation every time a new risk comes up. Does someone suddenly have to work in person one day a week? Is your child’s school now in person instead of virtual? Does someone else have to take taxis because their car broke down? Alert your bubble of any of these changes every time they come up, and reassess whether the risk is still worth it.
  • Respect everyone’s boundaries. To you, maybe getting a haircut isn’t a big deal (although it likely is close contact with another person). To your sister, it’s a level of risk she isn’t comfortable with. Figure out if skipping the haircut is worth seeing your sister, or if you’d rather see her virtually instead and have a fresh hairdo. Or, compromise and don’t see your sister for 14 days after getting your hair cut. (If you do this, you also need to make sure you’re not doing other activities in the 14 days that create the potential for exposure.)
  • Look at the local data. As cases rise, so do the chances that any one of you may come in contact with someone with COVID-19 if you leave your house. In August, you may have been fine with your sister-in-law working at a library; now, maybe you are uncomfortable given the level of cases in the community. Continue to stay on top of the latest COVID-19 data and start a discussion with the bubble if you are no longer comfortable with your level of risk.
  • If you feel at all sick or off, cancel the gathering. Things can always be rescheduled—yes, even Thanksgiving. It’s not worth powering through any sort of illness and getting everyone in the bubble sick. In the winter, people are more likely to have cold and flu symptoms, so you may be rescheduling a lot—that’s okay! It’s better to keep everyone healthy.

If you don’t trust the people in your bubble to follow these rules, then you shouldn’t be meeting up with them.

What doesn’t work

Large groups. Once a bubble has more than a few people involved, the risk is likely too high to protect you from COVID-19. The more people involved, the less you will know about everyone’s exposures and the more likely people are to have exposures. Keep your bubbles small to lower your risk. Check out this tracker from Georgia Tech for one model of how many people with COVID-19 might be at a gathering, depending on the size.

Group activities, such as youth sports teams. Sure, some professional sports teams can pay people to not have any other exposures. But for your local youth hockey team, the chances that every family involved is able to avoid exposure outside of practice and games is miniscule. Some parents likely work in person or socialize with other adults; some siblings likely go to daycare or school. Be wary of large groups like this that claim that their “bubble” is keeping everyone safe—unless the entire group of players and players’ family is very small, that bubble probably isn’t doing anything to keep you safe.

Not talking honestly with everyone. Too afraid to create conflict with your dad over his weekend card game tournaments with friends? Don’t form a bubble. If you can’t state all of your boundaries and feel confident that they’ll be respected, then it’s not worth it.

This content is free for use with credit to the City of Madison - Public Health Madison & Dane County and a link back to the original post.