The US Didn’t See A Major Additional COVID-19 Thanksgiving Surge. Christmas Will Be A Bigger Challenge.

Anthony Fauci told BuzzFeed News people need to stay vigilant heading into the rest of the holiday season: “I’m not saying at all that we need to cancel Christmas. What I am saying is that we need to be really careful.”

Public health experts feared that Thanksgiving would bring a COVID-19 apocalypse for the US, with the prospect of extended families spending several days together, unmasked and indoors. No one raised the alarm more than Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, who on Nov. 29 warned on network television “we may see a surge upon a surge” in two to three weeks' time.

Three weeks later, it’s hard to see any clear changes in the trajectory of cases and hospitalization indicating an additional Thanksgiving surge.

The national situation remains dire, with reported deaths, the number of Americans in the hospital, and new confirmed cases all at unprecedented levels and still rising. But given that people who become seriously ill typically turn up at the hospital about 10 days after getting infected, experts would have expected a Thanksgiving surge to show up by now.

BuzzFeed News asked Fauci and other experts about what to make of the data we’ve seen since the holiday. They said the expected Thanksgiving surge may have been masked by the bigger pattern of the recent wave of COVID-19 spreading across the nation; they also suggested that maybe many people did listen and stay at home. But the experts agreed: Even if we did dodge a bullet on Thanksgiving, people should rein in their festivities over Christmas and New Year's celebrations, or we could see another big surge.

“I’m not saying at all that we need to cancel Christmas,” Fauci said. “What I am saying is that we need to be really careful.”

US national trends for key COVID-19 measures

The data shows a lag in reporting of cases and deaths over the Thanksgiving break, then a catchup in the next week or so, followed by a return to roughly the same trajectory as before. If there was a Thanksgiving surge, it is hard to see against the tidal wave of coronavirus cases that was already breaking over the nation.

“I was concerned about just continuing to go up and up and up,” Fauci said.

But Fauci argued that the holiday likely did spur additional spread of the virus, at least in some regions. “If you and I were having this conversation and we said the United States is California, you would say absolutely California is having a post-Thanksgiving surge,” Fauci said. “But then you look at another part of the country and you say, wait a minute, not only are you not having a surge, you’re actually going down.”

Others were cautiously optimistic. “I agree we have largely been continuing our pre-Thanksgiving trends,” Caitlin Rivers, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, told BuzzFeed News by email. “Sometimes these things can take longer to show up in the data than expected, but I am growing more hopeful that Thanksgiving was not a catalyst.”

That’s welcome news if current trends hold. But experts agreed with Fauci that the focus now should be continuing to keep our guard up and not making plans to gather indoors with our families and friends over the rest of the holiday season. While there is a debate among epidemiologists about the extent to which small gatherings in people’s homes are driving the spread of the virus, studies have shown that once the virus gets into a household, other family members are at high risk of being infected.

“All of the evidence we’ve gathered through the pandemic is that gathering indoors without masks and eating together is high risk,” Lauren Ancel Meyers, a computational epidemiologist at the University of Texas at Austin and director of the UT COVID-19 Modeling Consortium, told BuzzFeed News.

The fall surge of COVID-19 cases and deaths first hit hard in the Upper Midwest, overwhelming hospitals in states including Wisconsin, the Dakotas, and Nebraska. But new cases and the number of people in the hospital in those states topped out in mid-November and have since been declining. Thanksgiving seems to have done little to change that.

Daily reported COVID-19 cases in the Upper Midwest

By Thanksgiving, the surge had spread out across the nation and was hitting hard in populous states, including Florida, Texas, and California — which is now seeing a particularly alarming rise. It’s hard to tell whether Thanksgiving caused a significant acceleration in the growth that was already underway.

But in Austin, Texas, hospital admissions have started to rise rapidly this month. Meyers said that anecdotal reports from hospital staffers suggest that many of these patients thought they probably got infected at Thanksgiving. “It’s clear that the pace of transmission has picked up since Thanksgiving,” she said.

Daily reported COVID-19 cases in the four largest states

Against the enormity of the fall coronavirus surge, any changes caused by people’s behavior over Thanksgiving will be hard to spot. “This is something we’ll be debating for a decade after the pandemic,” said Justin Lessler, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health.

What’s more, the methods used to test whether events including the Sturgis Motorcycle Rally and Black Lives Matter protests caused upticks in viral transmission can’t be applied to look at the effect of Thanksgiving across the nation.

For events in particular locations, researchers have compared trajectories of new cases in those counties with those in counties matched for other characteristics but where the events didn’t occur. That’s not possible for Thanksgiving, which was celebrated in homes across the entire country.

“The problem with Thanksgiving is that it was ubiquitous,” Douglas Bernheim, an economist at Stanford University, told BuzzFeed News by email. Shortly before the election, his team concluded that President Donald Trump’s political rallies had increased transmission of the coronavirus in the counties in which they were held. “I don't see a route to applying our methods to Thanksgiving gatherings,” he said.

There was also a peak in coronavirus testing before Thanksgiving — presumably caused by people getting tested before deciding whether to visit family. This is likely to have boosted the number of new cases being picked up in the run-up to the holiday, making it even harder to determine whether the trajectory has changed.

One important reason why the nation may have avoided an obvious additional explosion of cases after Thanksgiving is that many people probably did listen to the warnings of Fauci and other experts and abandoned plans for big holiday gatherings.

“You ask, ‘How did you spend your Thanksgiving?’ I think more often than not, people say, ‘It was very quiet this year. We just had my wife and my children around. And aunts and uncles and grandma and grandpa and others didn’t come and travel, and we didn’t go to them,’” Fauci said. “There was a certain amount of that that we’re probably not fully appreciating.”

While more people flew on the Wednesday before Thanksgiving than on any day since air travel plummeted in March, passenger screening data from the Transportation Security Administration shows that air travel was still dramatically down compared to Thanksgiving last year.

Not surprisingly, mobility data collected by technology companies shows that on Thanksgiving, people tended to stay at home. Google’s data, for instance, shows big drops over the holiday in the presence of personal devices at retail outlets, transit stations, and workplaces. Data from Safegraph, meanwhile, shows a pronounced spike in the number of devices that stayed in their home locations all day. So it’s also possible that increases in viral transmission due to family gatherings were offset by reductions in exposure to the virus elsewhere.

As we head toward Christmas, health experts told BuzzFeed News that it’s important to continue to heed advice and avoid gathering indoors with people we don’t live with. Indeed, with cases, hospitalizations, and the death toll still rising for the nation as a whole, the situation is even more perilous than it was before Thanksgiving. “We’re entering this next holiday period at even higher risk,” Meyers said.

Fauci agreed that Christmas could pose an even bigger threat. “It’s a larger holiday. It’s extended over a larger period of time. It goes from a couple of days before Christmas to New Year’s Day, which is much longer than Thanksgiving, which is essentially a weekend holiday,” he said. “So I’m afraid it might be a little more dramatic than what we saw with Thanksgiving.”

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