As the holiday season arrives, Americans are contemplating Thanksgiving recipes and putting together gift lists at one of the worst points so far during the coronavirus pandemic.
More people in the US are now in the hospital with COVID-19 than ever before as the country climbs over 10 million recorded cases during its third wave. Unlike previous surges, nearly every state is getting hit. November has been particularly dreadful; since the start of the month, the number of new cases being recorded each day has doubled as more and more people infect one another. The number of people dying every day is rising too.
But despite the fact that almost a quarter of a million Americans have died of COVID-19, fatigue has set in among many. More people are hosting social gatherings in their homes with people they don’t live with, or who are outside of their “quarantine bubble,” leading to more infections. In many parts of the country, people have rejected guidance to wear masks.
The holidays will likely be no different.
“We know we’re going to get cases after Thanksgiving,” Amesh Adalja, infectious diseases physician and senior scholar at the Johns Hopkins Center for Health Security, told BuzzFeed News. “It’s just a question of trying to keep them as minimal as possible.”
After Canadians gathered for their Thanksgiving meals on Oct. 12, there was a sharp rise in the number of already climbing cases in the country in the subsequent two weeks (the typical incubation period for the virus is between 5 to 14 days). "Many of the cases that we are seeing now are the result of spread over Thanksgiving when families gathered together," said Deena Hinshaw, the chief medical officer for the province of Alberta in an Oct. 22 update.
Part of the problem is the weather. While the summer heat allowed people to gather more safely outside in parks or at beaches, the colder temperatures will push more Americans inside, where there is a higher risk of breathing in the virus via tiny water droplets called aerosols that linger in the air.
On Nov. 10, the CDC issued updated guidance on Thanksgiving, suggesting that people consider alternatives to celebrate the holiday. If people do choose to gather, the health agency said, they should wear masks, limit their number of guests, take precautions with how they prepare and eat food together, open windows, and celebrate outside if possible. “Travel increases your chance of getting and spreading COVID-19,” the CDC guidance said.
Anthony Fauci, the nation's top infectious disease expert, said this week he recognized Thanksgiving was an important holiday for many people, but that Americans need to weigh the risk of unwittingly killing someone they love, especially if there are elderly or immunocompromised people in their families. “Make your own decision,” he told MSNBC. “What kind of risk are you willing to take?"
BuzzFeed News interviewed seven experts about their plans for the holiday season. All said they were taking extra precautions and either postponing Thanksgiving dinner or keeping it to an extremely small event with people in their bubble.
“I consider this holiday season to be a sacrifice and an investment in future holidays with the people that I love,” said Angela Rasmussen, a virologist and research scientist at the Center for Infection and Immunity at the Columbia University School of Public Health.
If you are planning to try to see family on Thanksgiving, experts say you should have started to quarantine on Nov. 12, giving your bubble two weeks to know that they’re entering their big dinner virus-free.
For everyone else, the experts told BuzzFeed News that avoiding a crowded party this year means it will be more likely you can safely attend one next year.
“Particularly with the [Pfizer] vaccine news, we’re probably trying to look to get through another six to eight months and then it’s highly likely the next Thanksgiving will be fine,” said Robert Wachter, chair of the Department of Medicine at the University of California, San Francisco. “So you really need to weigh the benefits of doing these things against the small but real possibility that you’ll get sick, and depending on your age and comorbidities, the small possibility that you could die from it.”
Here’s what the experts said they’re planning this holiday season:
Are you traveling for the holidays? If so, how? By plane or car?
WACHTER: No and no. I think it’s a scary time and enough of my family is here in San Francisco that we’ve decided to hunker down, but the chances of catching COVID from a single flight is low. The best estimate is about 1 in 5,000, but that varies depending on the probability of people sitting near you having the virus — so as there’s more of a surge nationally, that probability goes up.
GEORGES C. BENJAMIN, executive director of the American Public Health Association: We’re not traveling; we’re going to stay home for Thanksgiving, for sure. It is possible that my kids who live locally — my daughter and her husband, who have been living in our bubble — might join us. We’re all figuring out how we can maintain our bubble. We’re linked and isolated separately. My wife helps with her kids’ homeschooling. Otherwise we’re all working from home and the kids are doing homeschooling.
AARON GLATT, doctor at New York’s Mount Sinai South Nassau hospital and a spokesperson for the Infectious Diseases Society of America (IDSA): I think travel is safe. I work in a hospital essentially full-time so I don’t have the luxury, but I would love to travel. The traveling part isn’t a real danger. If you’re going to an area that’s a high-incident area, that’s a concern. Travel itself is fine. Traveling by car poses minimal risk if the people you travel with are all your family. If you stop at a hotel and it’s sensibly cleaned and you’re not eating in inappropriate settings and if you’re masking and distancing, I don’t think it’s a problem. Probably planes are nowhere near as risky as we originally thought, and if you’re masked and distanced and it’s a relatively short flight, you’re probably fine.
GERARDO CHOWELL, professor of epidemiology at Georgia State University’s School of Public Health: We are not going anywhere, at least for Thanksgiving, and I don’t think for Christmas yet. I think we will wait for the vaccine, but for Thanksgiving I have a brother who lives in New York and he’s planning to visit. So the plan is that he will get a PCR test the day prior or so before traveling to be sure that he is negative. He has been very careful and he's observing very strict social distancing there so we think it’s going to be OK. He’s going to fly. I think flying is pretty safe if you wear a mask throughout the flight. It looks like it’s pretty safe.
ADALJA: I’m not traveling. I don’t have family other than my parents and they live in the same area that I do. So I don’t usually travel.
MAIA MAJUMDER, computational epidemiologist at Boston Children’s Hospital and Harvard Medical School: My husband and I are not traveling for the holidays; instead, we will be spending Thanksgiving this year with my parents and my mother-in-law.
Are you meeting family or friends outside of your immediate household? If so, how many and under what circumstances (e.g., eating outside)?
MAJUMDER: My parents and my mother-in-law live nearby and in their own single-family residences; they also all work from home or are retired and can afford grocery deliveries, which makes their risk of contracting SARS-CoV-2 minimal on a day-to-day basis. Nevertheless, all five of us will also be adhering to a strict two week quarantine ahead of Thanksgiving (i.e., no one in the household leaves the house and no one outside of the household enters) to make sure that we're as safe as possible when we meet. I would advise anyone who wants to meet with loved ones outside of their household to do the same — and I would also advise folks to be as selective as possible in restricting the number of individuals they'll be gathering with.
ADALJA: I usually do meet family and friends, but these are people I’ve already mixed with. It’ll probably be indoors because I live in Pennsylvania where it’s not very warm this time of year. But they’re not new people being introduced. They’re people I’ve already interacted with. There’s obviously some risk and it’s about what each individual’s risk tolerance is. I want to keep it to people I generally mix with and I have some idea of what their COVID risk might be. I think as an infectious disease expert my risk calculation is probably better than the average person though.
RASMUSSEN: No, we are not. In western Washington, where I am now, it’s not possible to eat outdoors comfortably, so we won’t be going to my parents’ house (normally a 45-minute drive from our place in Seattle) as we usually do. Our kids are going to be with us, but because their time is divided between our house and their mother’s, we are not getting together with my extended family as well.
CHOWELL: It’s not clear. We are going to try to follow some social distancing here at home. We have some neighbors around here and we meet on the porch outside. For the election, we went out and had a glass of champagne with some neighbors around here but it was all outside. We don’t do inside at all. For my brother, we will probably try to spend time outside. The fact that he has been in a social bubble in New York and he has been very careful gives me a lot of confidence, plus the fact he’ll get a test.
GLATT: It’s much smarter if you want to do these things outdoors in parts of the country where that’s feasible. In New York City at the moment there’s a very mild weather spell so you can actually do that right now. So a lot depends on what the weather looks like.
BENJAMIN: We won’t be eating outside unless we can and the weather permits. As I said, we’re trying to be like the NBA. We’re trying to live in a bubble and try to protect ourselves. I understand there's no such thing as zero risk, but I’m doing all the things I’ve been telling other people to do.
WACHTER: If it’s beautiful maybe we will eat outside … My younger son and my older son were thinking of going to a large Thanksgiving event in New Jersey with my ex-wife and probably 10 to 15 people and I vetoed it. I know they're adults but I basically said that’s a bad idea and the early plans were for them to eat outside in late November in New Jersey, which struck me as slightly unrealistic. There were going to be 10 to 15 people coming from across the country and I felt like that was unsafe.
How many people do you expect to eat Thanksgiving dinner with?
WACHTER: Our plans will be to eat with my wife, myself, my younger son, and my daughter. That has been our pod. My son lives below us and has been completely safe and my daughter, who's a medical student, has been going to work but she’s been tested regularly. We’ll eat inside at a reasonably large table and stay 6 feet apart.
RASMUSSEN: Four: me, my husband, and our kids. We will be having snacks and cocktails with my parents and brother’s family remotely over Zoom.
BENJAMIN: I think there’s seven of us [in our pod], if we do it. [My daughter’s] whole family and me and my wife. … Right now my recommendation is to monitor the presence of disease in the community, and right now my community of Maryland is having a raging outbreak again. Our numbers are going up and the positive rate needs to be 5 or less, and I check it every day. And if I have concerns about the disease prevalence going up, we will have a Zoom dinner.
GLATT: I think that we have concerns about eating Thanksgiving dinner in a small room with a lot of people who aren’t part of my family. If you’re planning on Thanksgiving and getting together with another family member, I’d recommend being very careful two weeks before. Getting together with one family is a lot lower risk than with multiple families. I wouldn’t get together with people that aren’t careful.
CHOWELL: Indoors, it’ll be your close family members and people you trust that have been following strict social distancing guidelines. And I highly recommend testing a day or two prior to the meeting and having the result obviously before your family member arrives to your place. If they can stay in a hotel that may help, but it also increases the likelihood they’re mixing with other people. It’s probably safer for them to stay in your basement or something like that and make sure they tested negative through a PCR test, not an antigen RAPID test, which is not as reliable.
ADALJA: Five to six is probably the best size. You want to keep things as small as possible.
MAJUMDER: Because we're in the middle of a COVID-19 surge right now around the country, the safest option is to restrict festivities to individual households. However, I also think we need to acknowledge that some members of our population (like our elders) need regular in-person interaction for their well-being more so than others and have already gone nine months or longer without that kind of interaction. Furthermore, not all individuals carry the same risk of contracting SARS-CoV-2; having honest conversations about this with our loved ones about their transmission risk profiles will be essential in the months ahead.
It's for this reason that my husband and I are only spending Thanksgiving with our (lower transmission risk) parents this year — even though our (higher transmission risk) cousins and siblings live just minutes away from us. We often have more than 50 people over for Thanksgiving — but because risk is additive, every additional person makes the get-together less safe for everybody else. That's why we've cut our number down to just five total this year and have chosen to only include those who will most benefit from that time together. We'll miss the rest of our family, but everyone understands the circumstances and is willing to make the sacrifice now so that we can all eventually be together again.
What would you say to those considering attending an in-person religious service for Christmas or Hanukkah?
RASMUSSEN: I strongly suggest not attending an in-person religious service. Religious services often involve singing and prolonged close contact with others indoors in non-ventilated environments and present a substantial transmission risk. I know this is really a tough ask, given that some religious services have components that require in-person attendance, such as Catholics who wish to receive the sacrament of the Eucharist (Communion). If people do attend in-person religious services, they should be sure to wear a mask diligently throughout the service unless it absolutely must come off, and places of worship should ensure that attendees are able to distance. Singing and especially choirs should also be avoided.
ADALJA: These types of events we know have been linked to spread. I would think if you’re going to go to a religious event where there’s going to be singing, I’d be very careful because we know the virus has spread rapidly pretty far in those settings. I think in a church setting we know that singing poses a particular risk and hopefully churches are cognizant of that.
GLATT: I think indoor services are fine assuming everyone is masked and distanced. I pray every day three times a day. If people are following the rules, it’s OK.
CHOWELL: That’s a tricky one because many of the clusters that have been reported have occurred within churches and religious services, so I highly encourage to actually attend those services at a distance through online. Many churches are doing this, they are running services online, and I think that would be the safer way to go — particularly now with the prevalence levels in the country. It’s a much higher risk now to catch COVID in enclosed places.
BENJAMIN: I think that large group services and things like that are a challenge. My advice would be not to do them and do them remotely. The challenge we’re having right now is we’re having a resurgence of the disease. So let’s not make things worse. In many communities we’re starting to shut down selected activities again. They've just this week reduced the occupancy rates that are allowed in restaurants again here.
WACHTER: The question is going to be if everyone is masked and if they are far enough apart. Otherwise, they are the elements of superspreader events. I’m not a religious person so it’s not on my list of important things to do, but if it were important for someone I’d try very hard to ensure everyone is wearing a mask and staying 6 feet apart and the crowd is minimal. If not, this would be a year to forgo it.
What are some things people could do to try to minimize risk over the holidays? Or things they should keep in mind?
WACHTER: A lot of it depends on the state of the virus where you are. There’s really no parts of the country that are not getting worse, and the general ground rules now are clear: Inside is bad, large groups are bad, being without masks is bad, singing is worse than talking, no ventilation is bad.
I went to visit my parents in Florida three months ago because I was pretty confident my 90-year-old father would not survive another year and I wanted to see him alive. As I was getting on the plane, I was asking myself, if I get sick or die from this, will I feel bad? Will it have been worth it? For me, it was a reasonable decision. So in weighing the importance, it’s really worth asking yourself that.
BENJAMIN: I think that people need to have as much situational awareness about what’s going on about the disease in their community. I think they need to be thoughtful about traveling outside their homes and if they do so, do so safely. Yes, you can get in a car and go sightseeing and driving, but large gatherings are gonna be out for most of us over the holidays. You’re gonna have to figure out how to be thoughtful about your protective habits before you go, so that may very well mean self-quarantine as a family before you see each other and if you’re sick at all don’t go. Any symptoms — chronic fatigue, cough, muscle aches, anything like that — you should not be around others. If you have any doubt, get a test.
GLATT: The critical thing is to do things distanced. If you’re distanced, it’s definitely better. Obviously, if it’s indoors, then you definitely should be masked. If you can wear a jacket and be outside, do that. When you have indoor things with people without masks, you really have to be distanced.
CHOWELL: I would advise to use an air purifier with a UV light. That’s also something that has been recommended by environmental health researchers. If you have a visitor, having a UV light or two in the area where you'll be spending most of the time with your visitor, and also try to ventilate the rooms as much as possible. I think that can mitigate the concentration of potential viral particles. I think that’s going to be the new normal.
ADALJA: Whatever you do, whoever you invite to sit around the table, you’re also inviting the virus. That’s a time when people let their guard down. So I’d recommend a lot of hand-washing and maybe sitting people 6 feet apart. Think about who you’re inviting. If you can be outdoors or open the windows, do that.
RASMUSSEN: The safest way to minimize risk is to not gather in groups outside your household/quarantine pod. I know this is incredibly difficult to ask, given that many have not seen their loved ones for months and we are all suffering from pandemic fatigue. However, I’d ask people to keep in mind that there was a substantial uptick in cases after Thanksgiving in Canada, which Canadian public health officials are attributing to holiday gatherings in people’s homes. I’d also ask people to consider that it is not their risk to assume alone: increased cases within families can lead to further spread in the community.
I unambiguously do not recommend people having holiday gatherings with extended friends and family, and urge them to consider that any kind of get together outside of one’s household or quarantine bubble is dangerous. If people do get together, they should limit the number of people they invite and be vigilant about masks, distancing, ventilation, and hand hygiene. If possible, they should eat outdoors. But I reiterate that people should not host holiday gatherings at all.