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Summer is here, and many are looking forward to an opportunity to de-stress with friends and family over the December holidays. But in 2020 everything is different – the coronavirus pandemic is still very present, so how do we go on holiday safely and responsibly? Some of South Africa’s leading scientists, including SAMRC President and African Potential Foundation co-founder, Professor Glenda Gray, offer guidance.

Some people are rightfully concerned about buzzwords like “second wave”, “reinfections” and “long Covid”, while others have “Covid fatigue” and are getting on with life as if everything was back to normal.

Should we even think of enjoying the summer break?
The answer is yes, if you follow these rules to keep everyone safe:

1. Keep your distance – avoid crowds whenever possible, irrespective of whether you are at home, on vacation or travelling. If you can’t avoid gatherings, remain in the group for as short a time as possible, preferably less than 15 minutes;

2. Heroes wear masks – be a hero! Wear a fabric mask, whenever you go out in public and will be in close contact with people, such as in shopping malls, on public transport and especially when indoors with people with whom you don’t live;

3. Do as many activities as possible outdoors;

4. Avoid indoor venues with poor ventilation; wherever possible, open doors and windows to allow fresh air to circulate, ESPECIALLY on public transport (not planes!);

5. Regularly wash your hands with soap, or sanitise your hands, especially when outside the home and where you are likely to touch surfaces in public places;

6. Stay away from people if you are sick or if they are ill, and obtain medical advice on what to do if Covid-19 is suspected;

7. Adhere to all of these even if you have had SARS-CoV-2 (the virus that causes Covid-19) before; we do not know enough about immunity yet.
   
8. Be mindful when travelling to outlying communities or visiting elderly or immune-compromised friends or family.
   
9. When travelling try to sanitise areas as much as possible, ensure mask compliance and ventilation, and spend as little time queuing or crowding as possible.
   
10. Remember your little herd is only as strong as its weakest link – if you are spending time with them everyone must commit to showing the love by keeping everyone else safe with these simple behaviours.

We all need to help protect those around us and be aware of our actions, but that does not mean you cannot go away on holiday – on the contrary, if you consider large family gatherings at home, with visitors all taking their masks off and embracing, it could prove to be more dangerous than going away on holiday (good news if you hate your in-laws!).

If you take these fairly easy, sensible measures, there is no reason why you cannot enjoy the summer, whether you travel to distant places or remain at home.

Save Lives and Livelihoods

There is scientific concern that the virus may spread to outlying areas that have been less affected. People from urban areas, where there is ongoing transmission, may take the virus to rural communities (as happened when people moved to the Eastern Cape from Cape Town in March), and people visiting these urban areas from rural areas may in turn be exposed.

There is a danger if people let their guard down, as we have seen in some ‘’superspreading’’ events locally (such as the Tin Roof Club in Cape Town) and abroad. Contagion happens in nightclubs, churches, funerals, weddings and anywhere else where large crowds gather, usually in poor ventilation and over sharing food or drink.

Events with a lot of people in the same confined area are almost always going to be at the most risk – picture New Years Eve gatherings! The chances of being infected with SARS-CoV-2 rises exponentially in big gatherings: five people vs fifty people = about 100 times safer for you and those around you.

We all need to help protect those around us and be aware of our actions, but that does not mean you cannot go away on holiday – on the contrary, if you consider large family gatherings at home, with out-of-town visitors all taking their masks off and embracing, it could prove to be more dangerous than going away on holiday (good news if you hate your in-laws!).

The virus is still circulating (we have cases every day in all the provinces, and more so in major urban areas, see here), although at lower levels than in June/July. Just because the number of new cases is lower than before, does not mean there is no ongoing risk.

December may see a resurgence – the so-called “second wave’’ – especially if there is complacency around the use of face masks and physical distancing, and an increase in large gatherings and indoor activities. But even without a second wave, there is still significant risk:

Remember who is most vulnerable – the elderly, people who are overweight, people with diabetes or hypertension, and those with other chronic diseases. This will be difficult to explain to children who might be looking forward to hugging their grandparents after months of not seeing them, but this must be managed very carefully. Also keep in mind that many infected people have very few symptoms, especially younger people – so it is important to regard everyone coming into contact with vulnerable people as potentially infectious.

Travelling to and from your holiday destination

There is no need to test yourself for Covid-19 before going anywhere (unless local or international regulations insist on it).

It’s best not to rely on the various antibody and antigen tests being offered at pharmacies to see if you are “safe’’– we do not yet have tests that reliably tell you if you are immune, infectious or not carrying the virus. If you are exposed (meaning a high-risk exposure to someone who is currently infected or showing symptoms) or test positive then please test yourself (visit the NCID website for your closest clinic).

Wearing a mask and washing/sanitising your hands regularly while travelling is a no-brainer. But how about travelling in a taxi, bus, train or plane? All of these modes of transport pose risks but there are ways to make it substantially safer.

1. Road travel

For people lucky enough to have private transport, travelling together in a ‘pod’, where you maintain close contact only with everyone in that pod, is safest. Remember that the pod is only as safe as its weakest link. It needs a lapse of judgement by one person to inadvertently expose everyone within the pod.

Make sure everyone in the pod is on the same page, has a common understanding of what is expected and understands the risk of lapses – this is critical for everyone to holiday safely. Adults should exercise greater vigilance over younger people at this time, but, as experience shows, cooperation is best achieved through persuasion, not threats.

Public transport is the main mode of transportation for most people travelling during this period. Taxis, trains and buses are often filled to capacity and people are in close proximity to each other for long periods.

• Wearing a mask all the time is a must! Invest in another model of (reusable cloth) mask that you can wear comfortably for hours, and a second or even third one so you can change it when it gets sweaty. If you can afford it, disposable masks sold by pharmacies and some supermarkets are effective, light and comfortable.

• Wipe down the plastic and metal surfaces near your seat before you sit down – and carry hand sanitiser with you. Always flush toilets with the cover down. If alcohol-based sanitisers cause irritation, go for an approved peroxide-based sanitiser.

• Travelling during the warmer months also means that you can usually open the windows. Good ventilation is a very effective way to disperse virus-carrying air quickly.

• Sanitise and wash hands as often as possible.
  
• Safety measures taken by private and commercial operators can be haphazard, so prepare beforehand as best you can by packing additional masks and sanitiser.

Stopping on long road trips can be made safer by limiting exposure wherever possible:

• Keep your bathroom and food stops as brief as possible.
• Where possible and practical, wipe down the places you may touch, like toilet seats and taps.
• Try to eat outside your vehicle, while maintaining physical distance.
• Always wear your mask over your mouth AND nose.
• If you fiddle with the outside of your mask, always wash or sanitise your hands afterwards.

2. Air travel

Airports and planes have fairly stringent measures in place, making air travel pretty safe. The filters inside modern aircraft are very effective at removing the virus, so the risk is in queueing and getting on board, not really the flight.

Whether it is a short hop to Richard’s Bay or a monster flight to Seattle, the risk is low as long as you are careful.

• Turn the ventilation nozzle above your seat towards your head.

• Even though queuing and boarding is now strictly regulated by airlines, try to get on and off the plane as swiftly as you can; do not linger in confined spaces with a crush of other passengers.

• Take care queuing for check-in, immigration, at gates or at the baggage carousel; keep a safe distance as best you can and be sure to wear your mask.

• Obviously, if you are ill, do not travel – you will put others at risk. Isolate yourself (10 days from the onset of symptoms before you come into contact with others.

3. Arriving at your venue

There is absolutely no need to “deep cleanse” your room – avoid harmful and unnecessary chemicals and remember that simple soap and water is a highly effective way of killing the virus. These are things you may want to consider doing:

• Immediately open all windows to allow proper ventilation;
• Give a quick wipe down to high touch areas with any household cleaner or alcohol-based rub – door handles, TV remotes, railings;
• Work out when communal meal venues are the quietest and try to schedule around that;
• Do as much outdoors as you can;
• If staying with family, quickly scout out the safety levels and ensure that you are comfortable with whatever protocols are in place.
• Having fun at the venue

Do everything you can outdoors – dispersal of the virus by wind is very effective. Sun is a good disinfectant. Take advantage of South Africa’s generally good weather over December. 

Some more tips to enjoy your holiday safely:

• Avoid kissing and hugging people outside your pod. Elbow greet and blow kisses.
• For those big family gatherings, try to get everyone to agree to gather outdoors and set up protocols for children who might want to play.
• A braai or meal outside is an excellent alternative to dinner indoors.
• If you go to a restaurant, choose an outdoor option whenever possible, or try to sit near an open window. It is crucial for restaurants to have windows open; ask them to have them open and dress warmer if it is a cool evening. If you are happy to risk indoor dining with closed windows, consider that staff may not have a choice.
• Swimming in the sea, in pools and elsewhere outdoors is very safe.  The beach may be one of the safest places to be.
• Hiking outdoors in small groups is very safe.
• Our sports advisory tells you how to have fun playing your favourite sport or how to safely go to your gym. Again, you can make it very safe by following the same basic principles.

Be aware that alcohol reduces inhibitions, tends to lower compliance with protective measures and promotes risk-taking, such as drinking and driving.

As we have seen here and abroad, bars and nightclubs are responsible for superspreading events. For owners, staff and clients of these establishments, it is important to bear in mind that mask wearing and physical distancing tend to lapse as people drink alcohol, so planning ahead and anticipating this is the responsible thing to do.

Owners and organisers of events should carefully consider where and how the food and drinks sites are arranged (buffets lend themselves to queues and crowding), with proper seating arrangements, as well as calmly but firmly insist on masks and appropriate distancing where people are likely to congregate.

Holiday romances are a quandary and sexual contact, especially outside a ‘pod’, carries significant risks, as physical distancing and mask wearing isn’t possible (unless you are into that kind of thing).

If any form of close contact occurs, use our quarantine guideline (ideally 14 days of being careful after last contact or 10 if following the department of health guidelines).

Managing vulnerable populations

Although we do not understand everything about transmission and immunity, we do know that everyone can transmit the virus and everyone is susceptible to some or other consequences of infection.

It is dangerous, although perhaps understandable, to say things like “I would prefer to get it and have immunity” or “children don’t get sick and we must drive herd immunity’’. Infection can have severe consequences, even in healthy people, and deliberately putting yourself at risk puts you and others in danger.

We still do not fully understand the extent to which one is protected through immunity following infection, hence everyone needs to be vigilant.

You must be very aware that elderly people, diabetics, hypertensives and other people who have uncontrolled conditions (such as people on chemotherapy) are at much higher risk of severe Covid-19 and must be especially protected.

Some have suggested that prior to visiting such high-risk people during the holidays (e.g. going to stay with the grandparents), one should consider undergoing a period of voluntary self-isolation (14 days is safest; 10 days if following health department guidelines) to ensure everyone can enjoy the holiday safely. 

Enforcing mask-wearing and restricting the natural exuberance of children is difficult. Be sensible – encourage children to play outdoors as much as possible, weather permitting. If children congregate indoors, try to keep them near open windows and encourage distancing if they cluster around television or computer screens. 

The consultants on this piece include African Potential Foundation co-founder and SAMRC President, Professor Glenda Gray, as well as other medical professionals from South Africa.