It may be safest to skip this yearâs family holiday gathering if possible, public-health experts say â but the decision is a personal one, and there are ways to minimize the risk of COVID-19 transmission if you choose to forge ahead.
The U.S. Centers for Disease Control and Prevention this week issued detailed guidance for a pandemic Thanksgiving as coronavirus cases surged across the country and hospitalizations hit record highs that surpassed Aprilâs figures, stressing that âthe safest way to celebrate Thanksgiving this year is to celebrate with people in your household.â Potential alternatives include a virtual Thanksgiving meal with friends or loved ones and contact-free delivery of safely prepared traditional dishes to family and neighbors, the CDC suggested.
âIf you do plan to spend Thanksgiving with people outside your household, take steps to make your celebration safer,â the agency added. Those steps start with properly wearing a mask, maintaining at least six feet of distance from people who donât live with you, and washing your hands often (or using hand sanitizer in a pinch).
The CDC had issued earlier advice on how to navigate fall and winter holidays, noting that âunfortunately, the COVID-19 epidemic is worsening, and small household gatherings are an important contributor to the rise in COVID-19 cases.â
Risk factors to consider before attending a gathering include whether there is community spread of COVID-19, both where the gathering is held and attendees are coming from; exposure during travel; the location and duration of the gathering; the number of attendees and capacity for physical distancing; and attendeesâ preventive behaviors before and during the gathering, the agency said.
âUse of alcohol or drugs may alter judgment and make it more difficult to practice COVID-19 safety measures,â it warned.
M. Kit Delgado, an assistant professor of emergency medicine and epidemiology at the University of Pennsylvania, said traveling to family festivities this holiday season presented medium-level risk at best â and âcan very easily be high-risk.â Sitting out this yearâs big family gathering can help keep everyone safe â especially vulnerable family members â and avoid overburdening hospitals during flu season, he said.
âUnfortunately, the merriment we crave â eating, drinking and singing together in a cozy room â are among the highest-risk scenarios for transmitting COVID-19,â Delgado told MarketWatch. âIâm optimistic that things will be different next year, and we can give up this year as an act of charity to our friends, family and community.â
But while it might be ideal to forgo holiday travel and gatherings, the decision is also a risk-benefit calculation that people have to make for themselves, said Sandra Albrecht, a Columbia University assistant professor of epidemiology and chief epidemiologist for the science-communication project Dear Pandemic.
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After all, seeing family members is important to many people, and mental-health problems have proliferated during the coronavirus crisis, Albrecht pointed out. And if this feels like the last Thanksgiving you might have with an elderly relative, for example, that would likely factor into your plans. âThe benefit of seeing that family member could outweigh the risk,â she said, âbut youâd have to assess the whole slew of risks involved.â
Ultimately, thereâs no straightforward answer as to whether you should travel for the holidays, she said, because there are a number of factors to consider in evaluating risk. But Albrecht, Delgado and other experts, along with the CDC, provide a framework for reducing risk if you do decide to head to your folksâ place or another gathering. (There are also charts that can help guide you.)
Here are some questions to ask yourself:
â A positive test result, of course, means you should scrap your plans to see family. But a negative result isnât a license to abandon precautions. â
Are you at higher risk for COVID-19 complications? What about the people youâre visiting?
If you or a family member falls into one of the groups most severely impacted by the virus â people who are older than 65, have underlying health conditions and/or have weakened immune systems â you should be even more vigilant.
âUntil a vaccineâs available, I would say most people who will fall into those categories should shy away from those visits for the holidays,â said Karl Minges, an assistant professor of health administration and policy at the University of New Haven.
The CDC goes a step further: âIf you are an older adult or person with certain medical conditions who is at increased risk of severe illness from COVID-19, or live or work with someone at increased risk of severe illness, you should avoid in-person gatherings with people who do not live in your household,â it says.
Where are you coming from? And where are you going?
Be aware of the coronavirus infection rate in your own area, as well as in the area youâre traveling to, said Usama Bilal, an assistant professor of epidemiology and biostatistics at Drexel University. Check state quarantine requirements for visitors, he added; some states also require virus testing.
Consider too whether your destination is home to a lot of people at heightened risk for severe COVID-19 infection, such as elderly people, Bilal said. âIt isnât only you and your family â itâs the community,â he said. âIf you are infected and you go visit family, thereâs a risk that could lead to an outbreak for people beyond your family.â
Can you get tested, self-isolate and/or get your flu shot before traveling?
Donât host or attend gatherings if you or a member of your household has been diagnosed with the coronivirus and hasnât yet met the criteria for being around other people; has COVID-19 symptoms; is awaiting COVID-19 test results; or might have been exposed to someone with the virus over the last two weeks, the CDC says.
If youâve been in a variety of environments in which virus transmission might have occurred, getting a COVID-19 test can provide some extra reassurance, Minges said.
Albrecht, acknowledging the barriers to testing access and long turnaround times for some people, also advocated for getting tested at multiple points on your journey if possible â perhaps before traveling, after reaching your destination but before seeing family members, and again upon your return.
A positive test result, of course, means you should scrap your plans to see family. But a negative result isnât a license to abandon precautions, Albrecht said, because testing too early can lead to false negatives that give a false sense of security. Continue wearing a mask, practicing social distancing and washing your hands.
Delgado also recommended self-isolating as much as possible for at least two weeks prior to the trip. Get your flu shot before you go.
â âHave a shared plan about what the visit is going to look like â do whatâs comfortable to you; do whatâs comfortable to the relative who youâre visiting.â â
Who else is going? How many people will be there?
Holidays typically attract large gatherings, which tend to be associated with higher COVID-19 transmission levels, Albrecht said. So youâd ideally want fewer people gathering than usual, and itâs even better if theyâre people already in your âbubble.â
The risk level also depends on attendeesâ social contacts and exposures over the preceding couple of weeks, Delgado said. Gathering two groups of people that had completely self-isolated in their homes for two weeks presents far lower risk, he said, than hosting family members from all over the country who have kids in school and travel by train or plane to their destination.
At the gathering, maximize distance between people, minimize density, and limit the duration of time spent together as much as possible, Delgado added. âPeople donât always have the privilege of living in housing conditions that are not crowded, but certainly having more space indoors and allowing for less crowding is helpful,â Albrecht said.
Is everyone feeling OK?
This goes without saying, but anyone with symptoms should self-isolate at home and abstain from participating in the event, Delgado said. Even a childâs runny nose or low-grade fever could be cause for concern, Minges said.
Can you set boundaries and expectations ahead of time?
âHave a shared plan about what the visit is going to look like â do whatâs comfortable to you; do whatâs comfortable to the relative who youâre visiting,â Minges said. âCome up with a plan that youâre both OK with, keeping in mind the public-health precautions.â Itâs fine to draw boundaries for how the visit will go, he said.
And while this might feel awkward, itâs also OK to ask family members how theyâve been protecting themselves from infection, Minges added. âIf they havenât, you have a right to say, âWeâre not visiting,ââ he said. âI would be cautious from visiting family members who have not been following precautions at this stage.â
â A brief 30-minute encounter with someone who lives close by presents a far lower risk than staying over for a week and having multiple indoor encounters. â
How are you getting there?
âDrive your own car if possible to the event,â Delgado said. âIf traveling in public transportation, mask use and hand hygiene is critical.â
Each travel mode carries a different level of risk and exposure to other people, Albrecht said, as does the duration of travel. A long train ride will come with higher risk than driving a short distance.
âTravel increases your chance of getting and spreading COVID-19,â the CDC says. âStaying home is the best way to protect yourself and others.â
How long will you be there? Do you have to spend the night?
âBe together for a short amount of time to minimize exposure,â Delgado said. A brief 30-minute encounter with someone who lives close by presents a far lower risk than staying over for a week and having multiple indoor encounters.
Albrecht agreed that âthe ideal is to be staying elsewhere.â But if you have no other option, itâs best to sleep and stay in an isolated area of the home, Minges said, ideally a dedicated space not close to the rest of the dwelling that has its own bathroom.
Is it warm enough to gather outdoors? If not, can you improve ventilation?
While holding the event outdoors would be ideal for reducing transmission risk, that might not be feasible in the cold weather cloaking much of the U.S. later in the year, Albrecht said. Try to improve indoor air flow through strategies like opening windows or using air purifiers. âYouâre not going to get the level of risk down to zero, but you can do these small things to help decrease the likelihood of transmission,â she said.
Will everyone be wearing a mask? What will you do at meal time?
Always wear a mask around people you donât live with, Delgado said, and wear a mask indoors at all times. Removing your mask to eat or drink while talking âimmediately becomes a high-risk situation,â he said; do so in a way that minimizes close interaction with folks outside your household.
Try staggering eating times so that people from the same household can eat together at the same table, Delgado said. Consider eating with spaced-out seating, Albrecht added, and saving conversation for before or after the meal.
âPerhaps you would want to eat in separate areas of the house, just to allow for the greatest amount of air flow when youâre not wearing a mask,â Minges said. âMake the whole house your dining room, if you can.â
The CDC suggests bringing your own food, drinks, dishes and utensils; steering clear of food-preparation areas like the kitchen; and opting for disposable dishes and flatware, as well as single-use products like condiment and salad-dressing packets.
Can you save that hug for next year?
The CDC advises guests against making direct contact, such as hugs or handshakes, with people from outside their household.
âThe lowest risk would be to not hug,â Albrecht said. âThat said, there are lots of benefits derived from hugging.â Consider whether you or the other person are at high COVID-19 risk, your respective comfort levels, and what you can do to minimize the risk of transmission, she said: A hug between two mask wearers carries less risk than a hug between two unmasked people.
To avoid hurt feelings, include shows of affection in your boundary-setting discussion prior to the visit, Albrecht suggested â especially if you have family members who donât agree on the need for such precautions.
âThis can be a touchy subject,â she said, âand I can see family members being offended by a loved one saying they donât want to hug or kiss because of COVID.â
This article was updated on Nov. 11, 2020.