“I want people to be wise, safe, but not scared,” says Dr. Ndidiamaka Koka, pictured here. Credit: Ben Hovland | Sahan Journal

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As the holiday season and the end of 2021 approach, COVID-19 still rages across the state and the nation. 

As of this writing, Minnesota is one of the top five states in the country for the highest COVID-19 transmission rate per capita (that is, 75 active cases per 100,000 people). The current wave of infections is also the second-worst by cases that Minnesota has seen since the start of the pandemic. Intensive care units are perpetually full, and the situation is so dire that the federal government is deploying emergency response teams to help staff Minnesota hospitals.  

Many safety precautions fell away over the summer. Now, the weather is cooling, daylight is disappearing, and social activities have moved indoors. Unlike similar times last year, people can now go to big indoor gatherings like sporting events, public holiday celebrations, and arts events with minimal restrictions. 

Dr. Ndidiamaka Koka, who practices family medicine at Hennepin Healthcare’s East Lake Clinic in Minneapolis, has been working through the whole pandemic. She’s seen how bad COVID-19 can get and wants people to be as cautious as they can to prevent further spread of the virus.

“Let’s not mess around with this,” Koka said.

At the same time, she believes people can still enjoy themselves in public and in holiday gatherings if they take the proper precautions. In other words, don’t spend the winter self-isolating in paranoia, she said.

“I want people to be wise, safe, but not scared,” she said. 

So how should we act this winter? Should all vaccinated adults get a third booster shot to protect against the virus? Can adults bring their unvaccinated kids along to run an errand? What about an indoor sporting event? How should families celebrate the holidays together? 

Sahan Journal called up Koka at the end of last week and asked for her thoughts and advice. She stressed both calmness and vigilance in her recommendations. 

“When we can lean on each other’s expertise and what we know works in different ways, then that’s how we’re going to be safest,” she said.

The interview has been edited for length and clarity. 

Sahan Journal: Has anything changed now with how you’re instructing people to act in public compared to a couple months ago when the virus wasn’t spreading as rapidly as it is now? 

Dr. Ndidiamaka Koka: There’s always been hotspots for the virus this whole time; it’s just been in different parts of the country. Right now, there’s still the same recommendations of avoiding crowded places that are not well-ventilated, masking indoors, making sure that your mask is well-fitted around your nose and your mouth when you go into public indoor spaces. [Health experts recommend N95s or KN95s as the most effective masks to wear indoors.]

I think the confusion has been between the fully vaccinated and the non-vaccinated. Speaking more from Minnesota, where there’s definitely been an increase in the viral load, what I would say differently now is to consider masking indoors, even if you’ve been vaccinated. So, masking indoors in poorly ventilated spaces or crowded spaces, like an arena or concert or gymnasium or something, because that decreases transmission no matter what. 

Really, what you’re trying to do is decrease the transmission. We know that outdoor spaces are better, which becomes harder when Minnesota starts getting cold. And we know that less-crowded spaces are better. That’s the key. 

And then we also know that people coming together in different households increases the transmission rate. So, the more households you have in a gathering, such as a sports arena, the more likely that there may be someone who could transmit.

What are some tips you give for people to know if a place is well-ventilated or not? 

First of all is to be aware that you’re going indoors. So, things you think of first of all: “I’m going indoors, mask.” Second of all, are there windows, and are they open? Those are probably, from at least a public standpoint, the easiest thing to do. Because otherwise, you really need to get info and know more about what an arena has done to help with ventilation, and that’s very varied. 

You don’t want to be downstream. But even that sometimes is hard to know: knowing the air flow and where it’s being taken out of the room and recirculated. The person who sits in that area actually has more risk. But it’s hard to find that on a public level. One recommendation I would have, if you have the time, is read what that facility says to the public about what they’ve done to prepare for COVID. Sometimes that’s very helpful.

If someone is vaccinated and wants to go to a sports game, and it’s indoors and they’re wearing a mask, should they still feel cautious?

Each of the things that you’ve said, except for going indoors, has limited your risk. Now, if you have a medical condition that would put you at more risk should you get COVID, then you should also consider having the booster and not going out until two weeks after the booster. And the second consideration may be making sure that you have a very good mask, a filtered mask.

Going to a Timberwolves game or another sporting event? “At the game, maybe don’t eat inside the arena,” Dr. Koka says. “Don’t go to the concession stands, get some food, and then take off your mask to eat. Staying in your seat would be more helpful.”

At the game, maybe don’t eat inside the arena. Don’t go to the concession stands, get some food, and then take off your mask to eat. Going to the concessions, that’s probably the area of most risk, because it’s a smaller space with a lot more people. Staying in your seat would be more helpful. Those are things that would very much help decrease your risk of exposure. 

What are some general tips for Thanksgiving or holidays with families coming together? What are just some general tips you have for doing that safely? 

First, get vaccinated and make sure you’re up to date with the vaccination. For those with health conditions that could get them sicker, or who have more exposure to the virus, like essential workers—grocery store workers, health care workers—make sure you have your booster. See if the younger kids are eligible to start getting their vaccines.

Worried about visiting older family and bringing a COVID case with you? “Maybe don’t go to a concert during the week before the holiday, so you are not in the midst of your body trying to figure out if it has had a COVID transmission risk,” Dr, Koka says. 

Try to minimize activities before you meet up. What that means is, maybe don’t go to a Timberwolves game right before you see granny. Maybe don’t go to a concert during the week before the holiday, so you are not in the midst of your body trying to figure out if it has had a COVID transmission risk. 

One great idea: You can get an at-home COVID testing kit from CVS, Walgreens, or any store like that. It’s usually a nasal swab that goes in the nose, so it’s pretty straightforward. Read the directions well, of course, but it’s not too hard to do. 

There are also all these COVID testing sites and you could get one done 72 hours before the event, almost like you were traveling. Get it done before and make sure that it looks like you don’t have a new case. 

If you have sniffles or if you’re sick, don’t go. At the event, wear masks if you are not fully vaccinated or if there’s somebody who is at high risk—meaning that they may have gotten the vaccine but they are a cancer survivor or have other conditions that make it harder for them to get the immunity that they need with the vaccine. 

Try some creative things with ventilation. Can it be on the porch with an outside heater, with blankets? Could it be a bonfire? Could there be other ways you could do it so there’s more fresh air? We’re in the cold and some of that may require a little bit more creativity.

Let’s say I’m vaccinated, I have kids who are too young to get vaccinated, but they already had COVID-19 and recovered. Does that mean going out in public with the kids carries less risk, or should I still take the same precautions?

I would still take the same precautions. Those kids can get COVID again. We know that for those who have had COVID, the protection is incomplete. So that’s one big big risk. The second is, a kid could be a carrier for others. So I would still have the kid mask in public. 

The only exception would be a kid under 2. It may be riskier for their breathing to have that on their face than it is to just let them breathe without the mask. If you have somebody with special needs, you might want to increase mask wearing to age 3 and above. 

If you’re all going to meet grandma and grandma is frail, you could still have everybody test before then.

If you have to bring an unvaccinated child along on an errand like going to the grocery store, do you have any recommendations on that?

I would say sure. You should still do the same masking and hand-washing before and after, especially with kids, because they tend to do things like messing around and putting their hands in their faces. But we still need the children to be with the adults, so there’s this balance. 

Most grocery stores are not messing around. I don’t know if that’s the best example, because they tend to actually have much better protocols around COVID than other stores. Groceries just went through the wringer through the pandemic, and I doubt there’s a single one that does not know the ins and outs of different COVID protocols.

Other types of errands, like going to clothing stores, may have more lax protocols. But hopefully you’re not getting huge crowds there like you’re getting at the Timberwolves game. Hopefully you can still distance 6 feet apart.

*PQ: “Holiday season crowds like at Mall of America or day-after-Thanksgiving sales, those might not be great places to bring kids if they are not fully vaccinated.”

That said, we are approaching the holiday season, so I would avoid crowds. If you’re going to go to a place that’s super crowded, maybe don’t bring kids along to that errand. Holiday season crowds like at Mall of America or day-after-Thanksgiving sales, those might not be great places to bring along kids if they are not fully vaccinated. 

Do you recommend everybody eligible gets a booster shot, regardless of their personal situation?

I’m in healthcare; I’ve worked through the whole pandemic. I’m coming from seeing people who were sick. Thinking back on it, my eyes go big, and I go, “Oh my gosh!”  Some of it was very shocking. I would say, eyes big, let’s not mess around with this. 

“I’m all for everyone getting a booster shot. We know that protection from vaccines wanes over time. Antibodies go up about two weeks or so after you get the shot and then slowly decrease over time, to a point that six months after your last shot, it’s a good idea to get a booster.”

I’m all for everyone getting a booster shot. We know that protection from vaccines wanes over time. Antibodies go up about two weeks or so after you get the shot and then slowly decrease over time, to a point that six months after your last shot, it’s a good idea to get a booster.

Bottom line, I just want people to be wise, safe, but not scared. We’re all in this together. When we can lean on each other’s expertise and what we know works in different ways, that’s how we’re going to be safest. Not by isolating and being scared and paranoid.

Joey Peters

Joey Peters is a reporter for Sahan Journal. His work has appeared in Reuters, Public Radio International, Columbia Journalism Review, KFAI Radio, the Pioneer Press, City Pages, MinnPost and more. He previously...