Are Doctors Comfortable With Holiday Gatherings This Year?

MedPage Today asked several doctors and public health experts to share their holiday plans in light of the current COVID-19 situation in the U.S.

With the availability of vaccines and testing, would their holidays look vastly different from last year? Or are they erring on the side of caution, especially given the recent plateau -- and slight increases -- in U.S. COVID case levels?

Some responses have been lightly edited for length and clarity.

Carlos del Rio, MD, Emory University -- Infectious Diseases

Last year I traveled for the Thanksgiving holiday. I had a brand new granddaughter in New York. Seventy-two hours before I got on the plane, I got a PCR test, and when we got here, we all got a PCR test again. We didn't go to restaurants, we didn't go to the grocery store, we did take-out. That was pre-vaccination.

This year the big difference is vaccination. I still travel with a mask on, but we're not going to do testing ahead of the trip. We'll do rapid testing when we get to New York, and before we all gather together. That, to me, is very safe. Between vaccines, masking, and testing, you can do things very safely.

I think testing isn't used as much as it should be. It's expensive. Paying $25 for a box of two tests is ridiculous. We have the resources and we can pay for it, but frankly it's a travesty that in the middle of a pandemic we have such poor access to rapid testing. It should be subsidized by the government.

People need to realize that this is not about whether to gather or not. It's about, how do we gather safely?

Robert Wachter, MD, University of California San Francisco -- Internal Medicine

I'm now OK traveling pretty much everywhere. For Thanksgiving, I'm visiting my elderly parents in Florida (which also happens to have a low case rate right now). Will wear an N95 on the plane and minimize the time I have it off. I'm boosted, as are my parents and my wife, who will travel with me. I was willing to travel last year at this time but only for essentials like seeing my parents -- this year, I've taken vacations (which I wouldn't have done pre-vax).

Leana Wen, MD, George Washington University -- Emergency Medicine

My husband and I ... are both vaccinated. I got J&J and then a Pfizer booster. My husband had COVID and got vaccinated, so he's effectively boosted. We're both sufficiently protected, but my one-and-a-half-year-old and my four-year-old are both unfortunately too young to be vaccinated. That said, our holiday will be very different from last year because other people around us are vaccinated and we have more options, like access to rapid testing, that we did not have at this time last year.

Last year, we had neighbors over, but it was outdoors only. This year, we are planning to get together a group of 15 very close friends, all of whom are fully vaccinated, though most of our kids are unvaccinated. The protocol is that we're going to spend most of our time outdoors on a covered patio. Everyone will reduce their risk as much as possible for three days prior to getting together, like not having other people over indoors and not going to indoor bars or restaurants. Then, that morning, everyone will take a rapid test.

You can't eliminate all risk, but this makes getting together a lot safer. We have multiple layers of protection.... We'll probably do something similar for Christmas since our families live too far away.

Katelyn Jetelina, PhD, UTHealth School of Public Health -- Epidemiology

I have two little girls who are not yet eligible for the vaccine (2.5 years and 1 year), so we'll continue to take a layered approach for the holidays. Every holiday season we fly back to California (my hometown) so the first hurdle is travel.

Thankfully, planes are incredibly safe because of mask requirements, mask enforcements, and air filtration systems. I get more nervous of exposure to and from the plane. We usually find a corner far removed from the crowds while waiting to board the plane. I try and bribe my toddler to wear a mask. And my husband and I take turns getting the luggage while the other takes the girls outside. We do the best we can.

Once we get into town, we'll attend the big family gathering. Thankfully everyone is fully vaccinated except for those ineligible. We've all agreed that in order to keep the great-grandparents safe and the unvaccinated safe, everyone will take a rapid antigen test that morning. If everyone is negative, we'll celebrate as normal as pre-pandemic. I cannot wait!

Paul Offit, MD, Children's Hospital of Philadelphia -- Pediatrics, Infectious Diseases

Will be driving to southern Virginia to be with my in-laws and extended family, all of whom are fully vaccinated. ... I didn't visit anyone during the holidays last year.

Peter Hotez, MD, PhD, Baylor College of Medicine -- Pediatrics, Infectious Diseases

Just a small gathering. ... It's looking increasingly likely that cases and transmission will go up again as we head towards the holidays. So the key to a safe holiday season: 1) ensure everyone is fully vaccinated in your gathering; 2) remember "fully vaccinated" means 3 doses of mRNA or 2 of J&J; 3) keep gatherings small, and if possible outside, if not in a well-ventilated indoor area, possibly near an open door; 4) masks when possible, especially if you find yourself in crowded, large gatherings.

Eric Feigl-Ding, ScD, Federation of American Scientists -- Epidemiology

It depends on whether the grandparents are around, and if they're vaccinated or boosted. My mother just got boosted this week, same with my dad. So the booster should be really important in thinking about holiday gatherings. But any vaccination is critical if it hasn't been done yet.

Ventilation is also important. ... Open the windows or host the event outside. Gathering outdoors is safer than indoors.

Testing is important but unfortunately it costs so much. It's a wealthy, urban privilege. Most of rural America can't afford it. But if you have the means, do entry testing. And get kids vaccinated.

So, boosters, getting kids vaccinated, ventilation, and testing are important. It's not "or" here. It's all of the above. Vaccination alone isn't enough. Testing alone isn't enough. Ventilation alone isn't enough. A multi-layered strategy is essential.

David Boulware, MD, MPH, University of Minnesota -- Infectious Diseases

Similar to last year, I am working on our hospital infectious disease consult service over the holidays (last year, it was over Thanksgiving near the peak of COVID-19 hospitalizations in Minnesota, and this year I'm working the week between Christmas and New Year's).

For Thanksgiving 2021, I have a small gathering of 4-5 adult family members, all of whom have received 3 mRNA vaccine doses. With a recent third mRNA booster, I feel quite confident in my own protection from moderate or serious illness.

However, I still would not have a holiday gathering with an unvaccinated family member. Why? First, because they would be a total knucklehead, and second, due to that knucklehead's risk of spreading a fatal illness to another immunocompromised family member. Five percent of the U.S. population has some immunocompromised condition, thus within one's extended family someone very well may have a weakened immune system. Fortunately, all of my family members have been vaccinated.

Albert Wu, MD, Johns Hopkins University Bloomberg School of Public Health -- Epidemiology

A colleague and friend who lives in East Baltimore had a big 50th birthday celebration for her son in late October. When the food came out, the masks came off and a week later, maybe 10 people had come down with COVID, including her daughter. Though no one became seriously ill, it was a little bit of a harsh reminder that we can't be too relaxed just yet.

My wife's family has a big family Christmas party, 70 or 80 people with small children, every year. We didn't have it last year. This year we decided we should wait one more year. I'm trying to organize a holiday social event that's for professional [colleagues], and it's going to be outside ... in a venue that's not enclosed. ... I will bet we will have a surge after Thanksgiving. Exactly how much of one, I'm not sure.

Jeremy Faust, MD, Harvard Medical School -- Emergency Medicine

We are still ironing out our plans, but our basic approach is to travel somewhat normally but to add rapid tests to the mix. We'll probably fly to California to see family, and maybe to Mexico. When we arrive to our parents' places, we take rapid tests every day for a few days just to be safe.

Until our 3-year-old daughter is vaccinated, we are not typically doing mass indoor gatherings or public indoor dining. We host and attend small gatherings with people we know are vaccinated, again adding rapid tests whenever necessary. For example, we went to an outdoor wedding event on Long Island this summer and we did rapid tests with some of our relatives we were sharing a rental with.

The major difference between this year and last year is that we are comfortable replacing quarantine with rapid tests. Once our child is old enough to be vaccinated, I think we'll return to most normal things.

Stephen Morse, PhD, Columbia University Medical Center -- Epidemiology

What I'm doing personally this holiday season probably says less about my risk calculation than our less adventurous lifestyle in the last few years. It may be overly cautious, but basically same as last year. It's flu season, too, another good reason to keep up the precautions, which reduce flu as well. And, of course, to get the flu vaccine.

We're not planning to travel, and will have a few small family gatherings (we have a pretty small family anyway). Venturing out somewhat more than last year, but still cautious. Restaurants on occasion. New York City (where my wife and I live) has fairly strict rules about restaurants and other indoor gathering places, requiring proof of vaccination and, where appropriate, masks.

We've had three doses of mRNA vaccine by now, as have most of my relatives and colleagues who qualify. The vaccine has been a very positive development, but the gaps in vaccine uptake, as well as the much more transmissible Delta variant, make me feel that discretion is still the better part of valor. There's a temptation to let down our guard prematurely whenever cases decline, and then see the inevitable spike.

Sen Pei, PhD, Columbia Mailman School of Public Health -- Infectious Diseases

I am not planning to travel anywhere, and probably just gather with a few close friends and colleagues. Part of the consideration is personal -- we have a toddler at home. He is not vaccinated ... and it is not convenient to travel with a kid.

Sherita Hill Golden, MD, Johns Hopkins Medicine -- Endocrinology, Epidemiology

I am planning a small Thanksgiving gathering that will include my parents, husband, and son -- all fully vaccinated. My husband and I have also had boosters. Normally my mother-in-law joins us from Georgia but we are not comfortable with her flying yet given her older age. We also typically invite other friends who may not have family in the area with whom to celebrate Thanksgiving; however, because we want to exercise the utmost caution with my elderly parents, we will not do that this year. So, a smaller celebration, but we are grateful this year that we can at least include my parents. We did not eat with them last year prior to vaccines out of an abundance of caution. So I am very grateful for small steps!

Ted Mazer, MD, California Medical Association (former) -- Otolaryngology

Last year, my wife and I wanted to see our grandchild for the first time, so we flew to New York, with visors in the airports plus N95 masks. We quarantined before we would do anything and got tested. And we were very, very careful. We wouldn't go inside restaurants.

This year we're immunized [and] boosted, and traveling again. But even though we're protected, we still know we could get infected and we don't want to carry that anywhere. We are visiting just immediate family (boosted) in Florida for Thanksgiving, with travel precautions. We're also taking a close-knit group pleasure trip in the British Virgin Islands after Thanksgiving, renting catamarans and staying away from crowds, which we would not have done last year. Everyone is boosted and COVID tested. We wouldn't have dreamed of doing that last year. ... Long-held plans to go to Europe and take cruises will still have to wait. It's not that safe yet, particularly out of the country.

If there's another surge, we -- as people who maybe know a little too much -- would probably go back into hibernation.

Robert Schooley, MD, University of California San Diego -- Infectious Diseases

I see this year's winter travel season as being very different from last in terms of where most of the country is in its relationship with SARS-CoV-2. I'm going to travel to Virginia to spend the holidays with our daughters and their families and feel quite comfortable doing so.

This being said, we're not out of the woods yet since we have relatively large segments of the population who have not yet been vaccinated and they remain at substantial risk of becoming ill if they do get infected in the midst of the holiday travel season. The places where larger segments of the population are unvaccinated are also places where healthcare systems are stressed. People with underlying medical conditions that might require acute care should be wary about traveling to places where access to care might be limited because of concomitant COVID waves.

I expect next year will be even better because by then we will have much more vaccine coverage of the pediatric population and boosters will be more widely used.

Anita Gupta, DO, Johns Hopkins University School of Medicine -- Anesthesiology, Critical Care

We plan to approach the upcoming holidays by transitioning back to the holiday season to spend time with close family and friends. While we are fully vaccinated, many are still not, so we will continue to risk-assess by choosing events outdoors, having prevention measures to minimize an uptick in the spread, and following the recommended prevention measures of mask-wearing, hand washing, and social distancing as necessary. On a case by case basis, we are approaching our invitations from close friends and family [like this]: whether events will follow prevention measures, if guests in attendance will have received the vaccine, outdoors/indoors venue, size of the event, location safety measures, and duration.

Loralei Thornburg, MD, University of Rochester Medical Center -- Ob/Gyn

We're keeping Thanksgiving to my in-home family only this year. We'll play games and relax, we're not having a big family thing. For Christmas, it will similarly be just my immediate family, and potentially my parents who are fully vaccinated and socially isolating. We're really trying to stay with limited social gatherings. There will also be a holiday party in my neighborhood, which will be outdoors and masked.

Vaccination is excellent but it's not perfect, and I work in a high-risk area with lots of patients who are COVID-positive and lots of patients who have chosen to be unvaccinated. Even vaccinated people can get COVID and shed the virus. So I'm trying to be as responsible as possible.

Ninfa Mehta, MD, SUNY Downstate Health Sciences University -- Emergency Medicine

We are doing Thanksgiving this year, but we are doing it outside. We are renting a tent. Everyone is vaccinated [except for a couple of young children in the family]. There will be about 30 people [none of whom are traveling from outside the area]. I don't think it is going to be completely normal, but with the numbers low, I think it is going to be better. Normally, we go away for Christmas break, but I'm not going to get my kids on a plane right now.

Mary Tanski, MD, OHSU School of Medicine -- Emergency Medicine

My family is definitely looking forward to the upcoming holidays but have very modest plans given that my twins are only 3-and-a-half, so not eligible to be vaccinated yet. Pre-pandemic we would host a huge Friendsgiving with around 20 friends and their kids, but this year we will be having a small gathering with only one fully vaccinated and boosted couple who have been in our tiny pod since the beginning. For Christmas, instead of traveling as usual, we are just having my fully vaccinated and boosted parents over. Delta is still out there and we have come so far, so we are making these decisions to protect our kids until they can get vaccinated too.

Matthew Mintz, MD, George Washington University Hospital -- Primary care

We plan on having Thanksgiving dinner with my family (myself, wife, and two daughters -- one home from college), my parents (who are in their 70's and live locally), and my wife's sister's family who are coming from out of town. We are planning a normal, unmasked, indoor feast and I have no concerns, despite having parents that would be considered high risk.

First, everyone attending will be vaccinated, with some of us having recently gotten the booster. In addition, the case rates where I am from [Washington, D.C. suburbs] are low in general, and very low compared to the rest of the country, as our county [Montgomery, Maryland] has a very high vaccination rate. One issue that did come up was inviting other local relatives who have chosen not to get vaccinated. They will, unfortunately, not be invited and [they] understand why. I have offered to answer any questions they might have about the vaccine, but since I am not their physician, I do not push too hard.

Jordan Tishler, MD, Association of Cannabinoid Specialists -- Internal Medicine

My wife and I are both physicians. We're pretty conservative in our activities. We don't go out much, and if to a restaurant, usually outdoors.

It's pretty clear that many people have decided that the pandemic is over and are returning to prior activities in droves. Even with the vaccine and boosters, the risk is still there. As you mentioned, the numbers aren't looking good recently and increased gatherings will only spike those numbers.

We won't turn down all invitations, but will see only family and perhaps a few friends in small groups. Everyone will have been vaccinated and boosted. Masks will be worn in all public settings.

Anne Liu, MD, Stanford University School of Medicine -- Immunology, Infectious Diseases

It's always in the details. I think that there's [a need] to deliver a nuanced message. People want to know, "is this 100% safe, or is this not safe at all?" And really, everything is somewhere in between. ... But most situations are somewhere in between, although hopefully as more and more people get vaccinated around the world, the spectrum will shift towards most things becoming safer.

Obviously, you can't mask while you're eating and holidays mean eating, so to the extent that meals can be taken in outdoor areas where there's really good ventilation or indoor areas with excellent ventilation, that can hopefully be done. But I know that's not possible all over the country, given that there are some places where you just can't really go outside a whole lot in the winter. So that I think does make it a lot tougher.

I think that if cases are low, and our kids are both vaccinated, and the situation looks fairly safe, we would be willing to travel on a plane and travel out of state. If I had the luxury of time and money, then we would travel to other countries, depending on the COVID situation there.

Justen Elbayar, MD, NYU Langone Health -- Orthopedics

My wife is a family medicine doc. ... We don't have anything big planned, partly because of COVID. This year, all we're going to do is hang out with our immediate family here on Long Island. Because we're both in the medical field, prior to us going to see our family, we'll do the rapid test a couple times. We usually take two of them just to be safe. We're vaccinated, and my entire family is vaccinated -- I think most of them now even have their boosters -- but we'll do the COVID over-the-counter test a couple of times to make sure that we're negative the day before. We do Thanksgiving lunch, that's kind of our thing.

Ryan Ribeira, MD, Stanford University School of Medicine -- Emergency Medicine

I don't actually know what all of my holiday plans are yet... First off, I'm fortunate to live in a highly vaccinated area. So consequently, the case rate is currently very low. When we think about the safety of events like gathering in your home, one of the biggest factors is the case rate in your surrounding area. For us, in a lower case rate area, the risks are going to be different.

I anticipate that before Christmas rolls around, for example, or even before Thanksgiving, that likely we'll be able to get our youngest children vaccinated as well. Personally, we don't anticipate gathering with anybody who is not also themselves vaccinated. When you're talking about something like an in-home gathering for a Christmas holiday or even for Thanksgiving -- if you are talking about a fully-vaccinated family from a low case area gathering with another fully-vaccinated family from a low case area, then the risks are relatively low.

Amanda D'Ambrosio, Ryan Basen, Cheryl Clark, Kara Grant, Jennifer Henderson, and Kristina Fiore contributed reporting to this story.

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