With the COVID-19 case counts again surging across the nation, this year’s family holiday gatherings are going to look a lot different than usual. There will be tough choices ahead regarding how to safely celebrate Thanksgiving, Christmas, New Year’s and other winter fall and winter holidays. Find out from an infectious diseases expert about some key considerations that patients should keep in mind.

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“This is not the normal holiday season and as much as we miss our loved ones, staying safe and reducing risk—even if that means that you can’t necessarily make it to an in-person holiday gathering—might be the smartest thing to do this year because you want to make sure those same loved ones are around for the following holidays to come,” said AMA member Megan Srinivas, MD, MPH. She is an infectious diseases specialist and translational health policy research fellow at the University of North Carolina at Chapel Hill.

“Not gathering for the holidays is the only real safe way to handle the holidays this year,” said Dr. Srinivas. “But, if people must travel, these are the suggestions.”

Here is what Dr. Srinivas, a delegate for the AMA Resident and Fellow Section (RFS), had to say about holiday gatherings during the COVID-19 pandemic.

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“We’re going to see a rapid uptick in transmission because, first off, we’re seeing surges across the country right now just because people’s behaviors have become lax,” said Dr. Srinivas who is also the RFS member on the AMA Council on Medical Service. “We’re bringing those already high infectious rates into a holiday situation.”

“Then on top of that, unfortunately, it's happening in the backdrop of what we expect to soon be the start of flu season,” she said. “So, really, the worst six to eight weeks are coming up now and that's going to be right in the midst of when people are gathering.”

Since travel may increase a person’s chance of getting and spreading COVID-19, Centers for Disease Control and Prevention (CDC) guidance on celebrating the holidays notes that “postponing travel and staying home is the best way to protect yourself and others this year.” However, if someone chooses to travel, there are ways to make it safer.

“I am recommending to a lot of people to avoid holiday gatherings altogether because, unfortunately, you can't ensure that people are quarantining as well,” said Dr. Srinivas. “The issue is so many people in the United States don't quite understand what it means to quarantine and how to do it appropriately.”

“The more people you bring into the situation, there's always a risk,” she said, adding that “if somebody could strictly quarantine for two to three weeks,” then it might be OK.

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For flying, “even though people are wearing masks, it doesn’t give quite the protection that you would hope it would when so many people are crammed” into a relatively small indoor space, said Dr. Srinivas. That doesn’t even take into account “what's happening in the airports on your way to travel and all the exposures you have there.”

“If you can travel by car, that's the only way I would recommend traveling if you are traveling for the holidays,” she said. However, “you still have to be careful at gas stations and everything—make sure you have hand sanitizer.”

Since the pandemic began, while miles driven by Americans decreased, estimates from the National Safety Council found that driving became more dangerous. During July 2020, the number of roadway deaths increased by 11% and the fatality rate per miles driven increased by 26% compared to a year prior. This means, if you drive, it is important to wear a seatbelt, drive the speed limit and pay attention to the road to minimize risk. 

The CDC offers more information on different factors that contribute to the risk of getting and spreading COVID-19 at small in-person holiday gatherings, including exposure during travel.

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“The risk factors you have to consider are going to be dependent on the people involved,” said Dr. Srinivas. “If you've been quarantining and everybody involved has been quarantining reliably, meaning no exposures for at least two weeks, and you feel like you can meet each other safely, then staying in the same house is fine.

“But if you're looking at people who are working in the hospital, not necessarily quarantining, who are going to be bringing in their different daily exposures all together—being within an indoor confined space and spending the night in the same place only increases that danger,” she added.

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“If you look on Airbnb, for instance, there are different ways to denote who’s doing what type of cleaning,” said Dr. Srinivas. “They’ve actually found a way to say that these people are taking it more stringently and specifying exactly what’s being done.”

However, “I would still message them and ask them, how many people are coming through in the sense of—are you leaving time between occupants?” she said. “I do the same thing with hotels. I’d call to check if they have reduced capacity, are spacing stays out and requiring masks. Some are doing it right, some aren’t, so we need to call to verify before staying.”

“Staying at a hotel or an Airbnb always has its risks, but there are ways in which you can mitigate it and ensure that you’re taking the safer precautions when you have to choose one of these,” said Dr. Srinivas.

When possible, holiday gatherings should be held outside. However, for colder states, that is when “you want to limit the size,” said Dr. Srinivas. “The other thing, even when you’re limiting the size, is considering the risk factors of each person you’re inviting.”

“I would rather invite five people who I know are completely quarantining than to invite two people who I know have been exposed to the world and haven’t been taking it as seriously,” she said. “That’s a much higher risk situation.” 

The CDC also offers guidance on considerations for events and gatherings for the upcoming holidays, including smaller outdoor gatherings.

“Wearing a mask can definitely help, but being in that confined space—that alone is so high risk,” said Dr. Srinivas. “You can sit next to the people that you’re living with, physically distance from others and wear a mask to help reduce that risk.”

Using disposable utensils and plates might also help minimize risk from using the same handles to serve food, she added.

“But then if there’s a full food spread and you’re all using the same handles to serve yourselves and going around the same food and talking, that’s all going to be risky,” said Dr. Srinivas. “Once you’re indoors and with those other people, you’re really essentially exposed to whatever the other people have.”

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