Nov 17, 2020 9:00 AM

How to Reduce (but Not Eliminate) Covid Risk at Holiday Gatherings

With a surge in cases, there is no safe way to travel or gather for Thanksgiving or Christmas. But if you must, here are some ways to lower your risk.

For Amelia Vanyo’s family, Thanksgiving is the most important holiday.

Vanyo says her parents, two sisters, grandparents, uncle, aunt and cousins—and sometimes a boyfriend or two—get together for a big dinner and to share in each other’s company.

But the 21-year-old, who is originally from Texas but is currently attending college in Maryland, says she won’t be flying home this year. “We decided it’s not going to happen,” she says. None of them want to risk getting the family sick, especially Vanyo’s grandparents, who she says have been shut up in their home for safety reasons since the pandemic began.

“I’d much rather miss out on this year and have many, many years in the future,” she says.

It’s becoming an increasingly common question as the winter months approach: How do you safely handle the holidays during the pandemic? And it’s becoming increasingly more urgent as states experience a marked increase in cases.

Americans “may have to bite the bullet and sacrifice” Thanksgiving, warned Anthony Fauci, director of the National Institute of Allergies and Infectious Diseases, on CBS in October. He said his own Thanksgiving may look very different this year and warned people to be careful about social gatherings, calling gathering for holidays a risk. His own children, he said, won’t be returning for Thanksgiving.

The Centers for Disease Control and Prevention has created a Thanksgiving section on its website, reminding people that staying home is the safest option but outlining varying levels of risk associated with traveling for the holidays—from the low-risk virtual dinner to the high risk of large gatherings with people not in your household.

Public health experts tell WIRED there is no completely safe way to hold a Thanksgiving gathering this year, but there are ways to reduce risk. Georges Benjamin, executive director of the American Public Health Association, says safety during the holidays depends on the individual and where they live, pointing out that many states are now facing higher prevalence of Covid-19.

Neil Sehgal, an assistant professor in the Department of Health Policy and Management at the University of Maryland, compares risks during the pandemic with risks associated with sex.

Abstinence-only approaches tend to be ineffective as people partake in behavior anyway, he says, but teaching people how to do so safely can reduce harm. And he understands people are itching to hold the holidays.

“We're social by nature,” Sehgal says. “The barriers to social gatherings are frustrating to us because they don't feel right. But for better or worse, we have to fight the urge” to fall back on old sociable habits, he says.

Crystal Watson, a senior scholar and assistant professor at Johns Hopkins Center for Health Security, agrees that people are frustrated with quarantine.

“I think we're all feeling really fatigued at this point and need as much social support as we can get,” she says.

It’s certainly how Alicia Burns-Wright feels about visiting home for the holidays. The 34-year-old from Washington, DC, says she values being able to spend time with her mom as they both get older. Burns-Wright is planning on visiting her in Philadelphia from Thanksgiving through New Year’s. But, as experts recommend, she’s taking serious precautions in the lead-up to her travel, strictly quarantining starting November 7, ahead of her November 21 trip.

Duke University School of Medicine professor Cameron Wolfe called it a “pre-quarantine” during a recent Duke University media briefing on holiday travel.

“If you know you’re going to have to travel and then come back, really try to think about the two weeks leading up to Thanksgiving, for example, as your pre-quarantine. Where you can minimize the risk of inadvertently bringing Covid to loved ones,” he says.

Strictly quarantining is a better approach than simply getting a Covid-19 test, as questions remain about the effectiveness of some often-used tests, experts say.

Benjamin says the PCR test, which can tell you if you’re currently sick, is the most reliable, more so than the newer rapid-response tests, which can give false negatives or positives. Still, “the test is as good as it is on the day you took it,” he warns. Wolfe agrees, saying, “you can’t do testing by itself and expect it will get you out of a problem.”

The public health experts we spoke to say testing is no get-out-of-jail-free card for holiday travel. Instead, it should be seen as a complement to quarantining, physical distancing, mask-wearing, and symptom monitoring. Benjamin adds that some symptoms of allergies and Covid-19 can look similar. If you wake up on the morning of planned travel not feeling great, he says, rethink the trip.

As for travel itself, driving is your best bet. Even then, Benjamin says, the risk isn't negligible, especially if you make pit stops. Burns-Wright plans a one-way car rental up to Philadelphia with minimal stops on the way.

Flying isn’t a no-go, experts say, but people should be cautious and mindful of the risks.

A recent study by the Department of Defense and United Airlines says the risk of transmission when everyone in the plane is wearing a mask is low, but the study assumed optimal airflow in the cabin and assumed that everyone did indeed wear their mask for the duration of the flight. In the real world, the CDC warned in September that approximately 10,900 people were potentially exposed to coronavirus on flights between January and August, CNN reported.

Watson points out that there are a lot of different opportunities for exposure at an airport, from security to sitting on the tarmac. Masks are encouraged, the experts say, and Wolfe even encourages people to bring extra masks should their ear loops snap during travel.

As for other forms of transport, Watson warns people that public transport can also have risks, including buses, which often have less stringent rules on safety and cleanliness than airlines, and definitely have less ventilation.

When you arrive at your destination, public health experts recommend creating a bubble with those you’re staying with, quarantining together.

“Think about the NBA bubble and try to avoid being the NFL,” Sehgal says. For Burns-Wright, that means only seeing her mom, who lives alone, during her visit and occasionally her mom’s neighbor, but only in outdoor settings, like on their front porches. They don’t plan on having anyone else over for Thanksgiving.

But all experts warn that even small group gatherings still pose a risk. CDC director Robert Redfield warned on a call with governors earlier this month that small group gatherings were driving up infections.

“We're seeing a lot of transmission amongst families and friends in small groups,” Sehgal says. He adds that the social interactions people prize during the holidays put people at particular risk, from cooking together in close proximity to multigenerational gatherings. “All of these things put us at increased risk of transmission of airborne infectious disease,” he says.

It’s why public health experts say hosting an outdoor gathering is safer than indoor gatherings. Sehgal even says he has encouraged friends to get outdoor heaters. And while the experts say there’s little evidence that sharing food or touching shared surfaces can spread the virus, it’s important to be cautious and practice basic hygiene, like handwashing. It’s much less the sharing of food that’s a concern, but the behavior of doing so, Sehgal says, pointing out that refilling one another’s glasses or reaching over a table for food puts each other in closer proximity, which should be avoided.

Of course, there are alternatives to gathering with family from different places if that isn’t possible, director of health equity at Duke Family Medicine Viviana Martinez-Bianchi says.

“A low-risk activity would be to have a small dinner with only the people who live in your household,” she said during the Duke briefing. “You could have a virtual dinner and share recipes with friends and family.”

For those with family members who have compromised immune systems, Benjamin says, an in-person celebration wouldn’t be his first choice. “My first option would be to plan a virtual celebration.”

And even with all precautions taken, public health experts agree, gathering for the holidays means taking on higher risk, which could potentially end up having a widespread impact.

“Tragically, this is a disease you get from other people,” Benjamin says. He says it’s possible that the US will see a continued increase in cases and deaths over the next several weeks, and a recent rise in diagnoses and deaths around the country have begun to bear that warning out.

“Our hope is that it doesn't correlate into an acceleration in the number of very sick people and deaths. But we just don’t know,” he says.