Preparing For a Socially-distanced Halloween at Home

September is the time my two boys, ages four and six, begin to explore what they're going to be for Halloween. 

Last year it was superheroes, Black Panther and Iron Man; the year before it was Buzz Lightyear. A couple of weeks ago, they asked to be superheroes again, and to have their new baby sister be Wonder Woman when they go trick-or-treating. 

But this year's Halloween —or, for that matter, Thanksgiving and Christmas — won't be the same. Instead, we'll be practicing a socially-distanced holiday season.

To understand risk levels and activities that may pose a greater risk in terms of exposure, it's important to keep the three C's, or key factors to avoid: crowded places, close-contact settings with extended duration of interaction, and confined and enclosed spaces. The three C's are based on the modes of transmission of COVID-19, which can include contact, droplet, airborne, and fomite transmission — among others.  

Traditionally, Halloween trick-or-treating is primarily an outdoor event, and we know outdoor events are much less riskier given better ventilation. But the activity also involves going to multiple homes and getting treats. For the purposes of this discussion, I'll focus on fomite transmission, as Halloween activities can involve not only coming into close contact with someone, but also getting a treat (e.g. candy).

If someone is infected with COVID-19, their respiratory secretions can contaminate surfaces or objects, creating fomites. Fomites can potentially transfer the virus to a new person. For example, an infected person with COVID-19 coughs or sneezes into their hands, and then proceeds to touch a bowl of candy to distribute or directly expels droplets into the bowl of candy. A new person touches the contaminated candy, then proceeds to touch their mucous membranes (eyes, nose, or mouth). Sounds scary? Well, this is much easier said than done; let's break it down a bit further. 

First, fomite transmission is not the primary mode of COVID-19 spread — respiratory droplets and close-range aerosol transmission are. 

Second, fomite transmission can potentially occur if there's enough viable SARS-COV-2 virus that can cause infection – but we still don't know the amount of virus, or viral load that can actually cause infection. 

Third, the possibility of someone infected with COVID-19 expelling enough viable respiratory droplets on a treat and trick-or-treater, then touching that same area, followed by touching their mucous membranes is low (but not zero). 

And fourth, with all this said and done, there are no specific reports which have shown direct fomite transmission. There's a lot we've learned about COVID-19 over the past eight months, but there's still a lot we still don't know.