Covid 19 rates are increasing in the United States including in the northeast. They are projected to climb higher with the advent of colder weather and the holidays.

Until two weeks ago through the efforts of residents and the work of health officials and health providers, rates on Martha’s Vineyard were low. But rates are likely to rise in the next weeks and months.

What can we do to reduce spread at Thanksgiving and during the winter holidays. First, although it will be difficult, the only people who should gather for festive meals are family and friends who are already in your bubble. As we have seen from a recent wedding, there can be unexpected spread of Covid.

What about family members who are returning home, in particular college students? Many colleges and universities have had high rates of infection. When students return for the holidays they may be infected without having Covid symptoms. As such they may infect family and friends.

What can you do to reduce that possibility? There are choices.

The worst option is to take no action, to assume that you are not infected and return home and take no precautions.

The best option is to do a 14-day quarantine, as it can take up to 14 days for symptoms to appear after bring infected. That will prevent the spread of Covid to others. Quarantine means remaining at home, and staying at least six feet away from anyone at home. In addition to quarantine it is also recommended to do a Covid test after 5-7 days of the quarantine.

The problem I think is that many students and families are not prepared to do a 14-day quarantine. In that situation there are other alternatives which could help although they would not be as effective as full quarantine.

There is a Massachusetts travel order that states that all visitors entering Massachusetts should quarantine for 14 days or produce a negative Covid-19 test administered up to three days prior to arrival. If there is no negative test done prior to arrival, then visitors must quarantine until they receive a negative test after arrival.

The problem with the testing part of the state advisory is that during the first four or five days following contact with an infected person, a Covid test is frequently inaccurate. It misses many new infections. So the visitor who has a negative test three days before arrival or upon arrival could be infected and infectious to others. In that situation, the person will be falsely reassured and unfortunately contagious.

An alternative action, although not an official government or hospital recommendation, would be to quarantine for seven days prior to arrival or seven days following arrival and to test on day five or six after starting the quarantine. This is now the policy in France, created out of concern that many people do not comply with a 14-day quarantine.

Arriving from off-Island is similar to a passenger taking an airplane flight with unknown exposure during and before the flight. In present discussions with the airlines, the CDC is recommending a seven-day quarantine stating it will prevent 90 per cent of transmission. Similarly, a recent review article from authors at the London School of Hygiene and Tropical Medicine projects that quarantining arriving airline passengers for eight days with a PCR test on day seven may result in a 94 per cent reduction in transmission.

The proven way for students and family returning to Martha’s Vineyard to prevent the spread of Covid-19 to their families and to the community is to quarantine for 14 days, but if you are unable to quarantine for 14 days then quarantining for seven days with a PCR test on day five or six will also prevent many cases of Covid-19.

These recommendations are difficult to carry out. It is easier to say that rates are going to increase no matter what I do. However that is not true. If you quarantine for 14 or 7 days it can make a real difference. Do it for your family, your friends and Martha’s Vineyard.

Dr. Henry Nieder is the former chairman of primary care at the Martha’s Vineyard Hospital. He retired in 2018. The opinions in this piece are solely his own.