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How to Trick or Treat, Enjoy Holidays Safely This Year

Duke doctors discuss planning for holiday travel, gatherings

Part of the The Briefing: The Impact of COVID-19 Series
Doctors Viviana Martinez-Bianchi, Emmanuel Walter and Cameron Wolfe
Doctors Viviana Martinez-Bianchi, Emmanuel Walter and Cameron Wolfe

Ahh, Halloween. Gaggles of Hermione Grangers and Casper-the-Friendly-Ghosts running through the streets, breathing heavily behind plastic masks, packed tightly in yelling, giggly groups. Knocking on doors, yelling “trick or treat,” raiding candy bowls.  

If this seems like a vignette from a more innocent time, well, it is. With Oct. 31 fast approaching – and with Thanksgiving and Christmas not far behind – three Duke doctors spoke to media Wednesday about ways to navigate the trickiest of holiday seasons with COVID-19 lurking around the darkened corner. Watch the briefing on YouTube.

Here are excerpts: 


Dr. Emmanuel Walter Jr., chief medical officer, Duke Human Vaccine Institute 

“Trick or treat will not be as normal this year. Understanding everybody is kind of fatigued from COVID, I just have real concerns about trick or treat as usual going door to door … with large crowds of kids. I just think that’s a perfect way to potentially spread the virus.” 

“People could do pumpkin carving at home. They could potentially even do it in some smaller groups, socially distanced. You could do a home scavenger hunt with candy, just keeping it small. You might consider doing a home movie night instead.” 

“For those so compelled that they really want to do a trick or treat … what I would advise is that you not do it in large groups. Keep it really small. If you’re a person that’s handing out candy, you might consider putting the candy out at the driveway on a table in little bags. That’s one thing you might consider to keep it safe.” 

“Parents should make sure their children are wearing masks – and not Halloween masks – they have to wear a cloth or surgical mask. Maybe just incorporate that into their costume. And they ought to carry hand sanitizer with them.”  


Trick or Treating Strategies

“Going within your family group and going to a limited number of homes,” said Dr. Emmanuel Walter Jr. “Maybe, potentially people that you know very well just to keep it on a limited basis. In terms of candy and children, I think if they’re reaching into a bowl to pick out candy, and other people have reached into that bowl, that may be the time when I’d grab the hand sanitizer. The safest thing is maybe if people have grab bags where you grab one thing at a time.”

“Would I go so far as sanitizing the wrappers on my children’s candy when I got home? Good luck with that. Children are going to be children and eat their candy before you get home. I would not be so proscriptive as to say that.”

“But keeping the group small, taking hand sanitizer, wearing a mask, avoiding long contacts, don’t go into people’s houses.”

“A Halloween mask is definitely not protective. The best thing would be to get a cloth mask that would be protective and figure out a way to incorporate that into the costume this year and make it fun. I’m sure there are a lot of creative people out there that can figure out a good way to do that.”

  • Wear a cloth mask; that Frankenstein mask from Target won’t protect you.
  • Bring hand sanitizer and use it between trick-or-treat stops.
  • Keep your trick-or-treat group small.
  • Don’t go into people’s houses.


Dr. Emmanuel Walter Jr. 

“If you have COVID you really should follow recommendations and not be participating in any Halloween or trick or treat activities. The biggest risk is social gatherings with older teens and young adults for Halloween festivities. Those are very, very common. If you potentially mix alcohol in with those kinds of events, you really risk a high-transmission, super-spreader type of event. I really would caution people against larger gatherings.”  

Dr. Cameron Wolfe, infectious disease specialist, Duke Health 

“When we’ve looked on our college campus at the amount of virus that’s shed by different students, I am consistently shocked that some of the most prolific shedders of COVID are completely asymptomatic. If there’s a message there, it’s please don’t fool yourself into believing you’re safe just because your symptoms aren’t there. If you know you’ve had an exposure … please take that seriously even if you’re feeling well. There’s a reasonable chance you can be infected and just not know.”  



Dr. Cameron Wolfe  

“Travel is a congregant activity by its very nature.” 

“When it’s important to consider if I can travel by car … that would be a better choice from a safety point of view.” 

“If you have to travel and you have to travel in a way that involves public transport, be mindful of the groups around you. Wear your mask. Hand washing is still important. We’ve hammered the masking message … but we still need to be respectful that this virus survives on surfaces much longer than many typical viruses like flu. So hand-washing remains important.” 

“When you sit in the waiting wing of the airport, that is a busy place with lots of people around. People would do themselves well to be very sensitive to the groups of the people around them. Perhaps not stop for that extra meal.” 

“I encourage folks to take a second mask when they’re going. How often do we find that an ear loop snaps or something and you’ve got five hours sitting beside someone on a plane.” 



Dr. Viviana Martinez-Bianchi, associate professor, family medicine and community health 

“It is a different and difficult year. We have to plan properly. If you or anyone in your household has symptoms of COVID-19 or the flu …. do not host or participate in any in-person gatherings. If you are a person on quarantine or in isolation, you should celebrate only with those who you may quarantine with. Avoid larger gatherings.” 

“There are safe ways to gather for the holidays. A low-risk activity would be to have a small dinner with only the people who live in your household. Think about preparing traditional family recipes for family and neighbors.”  

“You could have a virtual dinner and share recipes with friends and family.” 

“On shopping day, shop online rather than in person so you aren’t exposing yourself to crowds.”  



Dr. Emmanuel Walter Jr. 

“If you have an infected parent and you have a fairly dense living situation with a lot of people in one house, the attack rate is much higher. If you have three or four children coming in from that house, often if it’s four, three will test positive.” 

Dr. Viviana Martinez-Bianchi 

“In primary care, we often are seeing … that whole family units are sick. If it’s someone who is coughing a lot … it is more likely that family members are also going to be infected as well.”  

Dr. Cameron Wolfe 

“One of the things we’re also trying to figure out is to better understand household and close-contact transmissions.” 

“It’s not just the household. It’s the household plus who travels with you to work. What’s the work transport like? What comes back into the house?” 



Dr. Viviana Martinez-Bianchi 

“Getting a flu shot right now is extremely important. We don’t want to end up crowding hospitals with people with influenza. Go and get your vaccine for the flu. If you have chronic medical conditions you want to keep them in check. You want to treat your hypertension. You want to treat your diabetes. Check with your primary care doctor.” 

“We’re already going through a pandemic. We don’t want a second pandemic of the problems that went untreated or unchecked.” 



Dr. Cameron Wolfe 

“We recognize travel is an added risk. It moves your little bubble. It blends risk and potentially you bring it back to your college campus.” 

“Not everyone goes home. If you’re a grad student, if you’re an international student, going home may not be possible.” 

“If you have to travel at all, let’s consider a car travel rather than airline travel if you can. If you have to travel, consider it to be one-way where you don’t have to come back in December. If you know you’re going to have to travel and then come back, really try to think about the two weeks leading up to Thanksgiving, for example, as your pre-quarantine. Where you can minimize the risk of inadvertently bringing COVID to loved ones.” 



Dr. Viviana Martinez-Bianchi 

“To make it safe, you want to avoid the larger gatherings. You want to prepare traditional family recipes. Play music in your home that your deceased loved ones enjoyed.” 

“You can work with your kids to make and decorate masks or make an altar. You can set out pillows and blankets in your home intended for your deceased to rest. You can join a virtual get together.” 

“If you’re going to go to the cemetery, do it, but keep that distance.” 

“The most important thing is to avoid high-risk activities during Day of the Dead. You don’t want to attend large, indoor celebrations with singing or chanting. Avoid having a large dinner party.” 



Dr. Emmanuel Walter Jr. 

“It might be somewhat helpful … but we can’t be fooled totally by testing. Somebody may have been exposed and may not have totally developed symptoms. If you test them too early you may miss the test positivity. It can be reassuring but potentially, falsely reassuring. I wouldn’t put all my stock in testing.” 

Dr. Cameron Wolfe 

“You can’t do testing by itself and expect it will get you out of a problem.” 

Dr. Viviana Martinez-Bianchi 

“You have to do the prevention and mitigation. We know that wearing masks, doing good hand-washing and keeping distance really helps. Testing alone will not do this. The most important element we have right now is to wear a mask. If it wasn’t for masks, everybody at our health system would be sick.” 

“Just do it.” 

(EDITOR’S NOTE: This June study demonstrates effectiveness of mask use in health care settings.) 



Dr. Emmanuel Walter Jr. 

“We are hopeful. There are many candidate vaccines that are in the pipeline. It’s a really complicated situation. There are many vaccines out there. Not all of them will come to be available at the same time. There will be limited amounts to start off with.” 

“I think we will see a gradual rollout of vaccines next year. I’m hopeful by mid-next year we’ll have a broader dissemination of vaccine in the population. Once we get through this second surge of infection and we have a vaccine by mid-next year … things may normalize a little bit more. Does that mean we’ll be back to normal? I don’t know that I can guarantee that at this point.” 


The experts:

Dr. Viviana Martinez-Bianchi 

Viviana Martinez-Bianchi is an associate professor in Family Medicine and Community Health, where she is a primary care physician and director of health equity. She specializes in health disparities and access to health care. Martinez-Bianchi will make her opening comments in Spanish and English, and can answer questions from reporters in both languages. 

Dr. Emmanuel Walter Jr. 

Dr. Emmanuel “Chip” Walter Jr. is chief medical officer of the Duke Human Vaccine Institute, where he directs the Duke Vaccine and Trials Unit. Walter is also a professor of pediatrics at Duke University School of Medicine.  

Dr. Cameron Wolfe 

Dr. Cameron Wolfe is an infectious disease specialist at Duke Health and an associate professor at the Duke University School of Medicine. His areas of study include infectious diseases and biological and emergency preparedness for hospital systems.