LITTLE ROCK, Ark. -- Like many people in this unusual year, I am adjusting my family's holiday plans so that we can all be safe during the ongoing coronavirus pandemic.

I am an epidemiologist and mother of four with a large extended family. Given the serious nationwide resurgence of COVID-19 infections, gatherings of family and friends over the upcoming holidays have the potential to amplify the spread of the virus. Several recent studies have further confirmed that indoor socializing at home carries a significantly higher risk of viral transmission than outdoor activities.

Health officials, including Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, have warned that much of the transmission this fall is happening across all age groups at small indoor gatherings.

For the past 15 years my family tradition is to travel from Washington, D.C., along with both grandparents, to sunny Florida to celebrate Thanksgiving with cousins. This year we decided to skip the travel and will have fall and winter celebrations at home.

We are not canceling the holidays, but to keep ourselves and others safe, we are keeping plans small and flexible and remembering that the health of those we love is most important as we enter the season of gratitude.

Before you gather

First, it is important that everyone who will be attending any holiday celebration is on the same page about how to take precautions before getting together. The idea is to lower infection risk in the weeks leading up to the holidays and then test to confirm.

In general, everyone should plan to be vigilant in their public health practices beforehand, especially since grandparents are at higher risk. In my family, we have agreed to limit contact with other people as much as possible the week before Thanksgiving. We have also agreed that everyone needs to be extra cautious around the few close people we see regularly.

In conjunction with quarantining, testing is the second strategy.

Research has consistently shown that people are most contagious a day or two before they show symptoms, so everyone plans to get tested with an RT-PCR test within 72 hours of Thanksgiving, while still being able to get results in hand before we gather.

If the demand for tests is high and wait times are long, we will get rapid tests. But these are a second choice, as they are less reliable and can be expensive.

Where and how to eat and socialize

No matter how careful you and your family are, there is some risk that someone will be infected. With that in mind, the goal is to reduce the conditions that lead to viral spread. The biggest risks are indoor spaces with poor ventilation, large groups and close contact. So we are planning the opposite: a short outdoor Thanksgiving with a small group and plenty of space between everyone.

To reduce the risk of infection from flying and to keep the gathering small, the only people coming to Thanksgiving at my family's home in D.C. are my mother, my aunt and my uncle - all of whom live within driving distance. This is in addition to myself, my husband and our kids. When deciding how many people will come to the holidays, keep it small and consider the amount of space you have to maintain social distancing.

If the weather cooperates, we plan to be outside for trivia games and the turkey meal. Rather than eat around one table, we will have individual tables and place settings spaced far apart and space heaters around. I've got a mini care package planned for each guest so that everyone will have their own blanket, hand sanitizer, utensils and a festive mask.

My mother won't be helping out in the kitchen this year and, unfortunately, that goes for cleanup too. We won't take a group picture but I will be sure to capture some of the special moments.

If the weather doesn't cooperate, Plan B is to be inside in the large family room with as many windows open as possible and with everyone spaced as far apart as possible. Being outside is safer, but if you must be indoors, improve ventilation by opening doors and windows. Consider turning on exhaust fans and using an air purifier.

Everyone who lives in the household will be in one section while my mom will have her own individual area, as will my aunt and uncle. Even though we won't hold hands before sharing the meal, we will still recite that we are "thankful for family, friends and food."

Whether outside or inside, everyone will wear masks when they aren't eating, maintain 6 feet of distance and use the hand sanitizer that I will place throughout the house.

It is also important to be mindful of alcohol consumption, as a pandemic is not the time for lowered inhibitions and bad judgment.

After the event

I hope everyone enjoys the meal and quality time spent with one another in this melancholy year, but the work is not done once the dishes are clean and everyone is home safely.

Everyone is planning to get another COVID-19 test one week after the meal. Additionally, Thanksgiving is our family's trial run for Christmas, so a few days after, I plan to call everyone and discuss what worked well and what didn't. If all goes well, I hope to repeat this quarantine, test and gather process for Christmas.

The ending of 2020 deserves to be celebrated, given this difficult year. This Thanksgiving will be different from those of other years, and my kids understand they need to manage their expectations. But we still plan to uphold our tradition of writing all that we are thankful for and reading our messages aloud to one another. We will still share love, some laughs and a good meal while everyone does their part to protect one another.

This story was produced with original reporting from Melissa Hawkins and is a collaboration with The Conversation. Read the full article here.




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Health disparities in Texas are not only making some people sick, but affecting the state's economy.

A new study shows Texas is losing $7 billion a year because it does not adequately address quality-of-life issues and the health care needs of its lower-income residents.

The research was sponsored by the Episcopal Health Foundation, Methodist Healthcare Ministries of South Texas, and St. David's Foundation.

Brian Sasser, chief communications officer for the Episcopal Health Foundation, said health care includes more than doctors' visits and medication.

"Everything from increasing access to affordable health insurance to investing in under-resourced neighborhoods to give them more options, whether that's exercise options or food options," Sasser outlined. "Look at policy changes that expand health insurance coverage for new moms."

The report breaks down the economic costs of preventable health differences for every Texas county. It found Bexar, Dallas, Harris, Tarrant and Travis counties are losing the most money annually because of health disparities.

The amount of the economic impact depends on the racial and ethnic makeup of the county and the size of its working-age population. Sasser added the report shows Black and Hispanic children are more likely to grow up in neighborhoods with high poverty levels, and higher rates of diabetes and obesity.

"What can we do to work to make sure that the rate of diabetes isn't dramatically different between white households and Black households?" Sasser asked. "That we can make sure the food insecurity isn't dramatically different between someone who makes over $100,000 and someone who makes less than $30,000?"

The Texas Legislature has passed laws to address some of the disparities, including House Bill 12. It extends Medicaid health coverage for 12 months for new mothers, and pays for maternal health services for community health workers and doulas.

There is light at the end of the tunnel for Tennesseans struggling with opioid addiction, as a bill has been passed to increase access to treatment for opioid use disorder at Community Health Centers.

More than 3,800 lives were lost to overdose in the state in 2021, according to the Tennessee Department of Health.

Emily Waitt, policy and advocacy manager for the Tennessee Primary Care Association, said the original bill limited the number of patients nurse practitioners and physician assistants could treat with buprenorphine. The update removes the limitations, allowing more Tennesseans to access medication assisted treatment in their communities.

"It allows NPs and PAs to prescribe to 100 patients at a time, versus 50," Waitt explained. "Basically doubling the number of patients that they can prescribe to."

Community Health Centers serve more than 423,000 patients across Tennessee, regardless of their insurance status or ability to pay. About 7.7% of Tennesseans do not have health insurance.

Libby Thurman, CEO of the Tennessee Primary Care Association, said bringing the treatment to rural health centers expands access to a crucial service for patients who otherwise could not afford it. She noted it is important because people in remote areas often face challenges finding specialists and treatment facilities.

"We really wanted to work on this issue, because we know our Community Health Centers are where patients go for care," Thurman emphasized. "We really believe in an integrated model. So we want to treat the whole person, including if they are struggling with an addiction issue or a substance abuse disorder issue."

Health Centers offer behavioral health care, including counseling, along with treatment. The clinics also focus on creating a supportive network to help patients with family resources, job assistance and community connections.

While Black Maternal Health Week is wrapping up, health disparities for pregnant Black women continues to be an issue.

From April 11-17 this year, the high death rate of Black mothers is in the spotlight. Black women are three times more likely to die from pregnancy-related causes than their white counterparts.

Dr. Patricia Egwuatu, a family practice physician at Kaiser Permanente in Seattle, said racism is at the root of the disparities, which create barriers to health care access. She pointed out lack of access can lead to problems during pregnancy that are preventable or treatable.

"They may exist prior to pregnancy and then it gets worse during pregnancy if it's not managed as part of that maternity care," Egwuatu emphasized. "There are more pregnant women that have chronic conditions such as hypertension, diabetes and heart disease that are amplified during pregnancy."

The White House released a proclamation recognizing Black Maternal Health Week. The Biden administration began recognizing the week in 2021.

Egwuatu noted there are some warning signs any pregnant woman should be aware of and check in with their physician if they develop.

"You might get some changes in your vision that is not your normal. So, like, fuzziness, you can't see as well, or an excruciating headache," Egwuatu outlined. "You could also develop new swelling in your lower extremities that's making it difficult to get around or even new shortness of breath."

Egwuatu stressed physicians also need to recognize the role of racism in medicine. She argued continuous medical education is important for learning how to confront biases, and it is important for doctors to understand how they can provide people with resources.

"Asking the questions about personal barriers," Egwuatu suggested. "Does a patient have issues with getting to work, child care, transportation? What's their education, what's their cultural background and language? And do they even have a cell phone so we can connect with them?"