Stop planning for a Thanksgiving crowd: How to have a safer — but not safe — holiday

Thanksgiving 2020 couldn’t come at a more dangerous time, or pose more serious risks for coronavirus spread.

We know Covid-19 spreads easily in households, among people who know each other. We know Covid-19 circulation increases when people spend a lot of time together indoors, talking, eating, and drinking, like Thanksgiving. We know there’s a risk in bringing together people from different generations, from different regions of the country, with different risk factors, to one location, as often happens at Thanksgiving.

We also know the risk of spreading the virus is higher when community transmission of the disease is spiking, as it is in so many places across the United States right now. Plus, come the end of November, it will be cold outside in many parts of the country. Eating outdoors or opening windows to increase ventilation in a home may be tricky.

So, the uncomfortable question: Should Thanksgiving be canceled — or postponed? It’s something to think critically on.

Every family or group gathering for the holiday should practice what epidemiologists call “harm reduction.” That is: If we’re going to celebrate the holiday this autumn, how can we make it as safe as possible?

“One of the ways that we can adapt is to have some flexibility around our traditions and rituals that are really important in our lives,” Julia Marcus, a Harvard infectious disease epidemiologist, says. “I would encourage people to think outside the box.”

If the point of the holiday is to get back that social connection, there are ways to do that without dangerously convening family members inside around a turkey.

A Covid-19 Thanksgiving requires a lot of planning, and time is starting to run short. Thanksgiving in the US is now two days away. If you can’t take many precautions with a planned gathering, it’s time to cancel it. That’s because if people aren’t safe around Thanksgiving, the pandemic will grow worse.

“The situation in two to four weeks is going to be grim,” Andrew Pavia, the chief of pediatric infectious diseases, at University of Utah School of Medicine, said during a press briefing Wednesday. “If … people gather as we all want to do, without taking precautions, we could see another acceleration [of cases] going into Christmas.” It will be a repeat of what happened with Memorial Day, and Labor Day. People celebrated the holidays as usual, and then, cases surged.

Here are some questions to consider to potentially reduce Thanksgiving risk (you can also check out California’s guidance for private gatherings, which will help decrease the chance of spreading or contracting the virus).

11 questions to ask ourselves if we really, really must celebrate the Thanksgiving holiday in person

During the Covid-19 pandemic, there is no eliminating risk; there is only reducing it. Any one strategy — whether that’s masking, social distancing, or increasing ventilation — is no perfect measure to prevent the spread of the virus. So “we need to invest in multiple intervention strategies instead of just one,” Saskia Popescu, an infectious disease epidemiologist and assistant professor with George Mason University, says.

Consider the “Swiss cheese” model of infection prevention. Each layer of prevention has holes. But line up a bunch of layers together and you have yourself a better barrier.

So how many of the following 11 options can you layer together? (Yes, it’s a lot. And perhaps the number of things to consider is reason enough to avoid a Thanksgiving as usual.)

Can the holiday be remote?

Ugh, I know, a Zoom Thanksgiving. Depressing, right?

But it’s still better than nothing. And it’s safe: “Celebrating virtually or with members of your own household (who are consistently taking measures to reduce the spread of COVID-19) poses the lowest risk for spread,” the CDC writes in its guidance for holiday celebrations. And there are ways to be creative around increasing the feeling of togetherness during a Zoom meal.

“If you want to make a big meal and you live around a lot of your family, make the meal, put it in some Tupperware, do a contactless handoff, and then you can all zoom in together and eat together,” Popescu suggests as a workaround. “So you’re still eating the same food, you know, you’re still enjoying that together.”

Can Thanksgiving be held outdoors?

If an in-person gathering is to be held, it ought to be in the safest possible environment. We know outdoor spaces are vastly safer than indoor spaces and should be considered.

Again, there’s room to be creative here.

“Is it possible to instead of a traditional Thanksgiving meal have like an outdoor fire pit party,” Marcus suggests as a possibility. She also suggests people be more flexible around when they celebrate the holiday. If it’s warmer outside on November 12, for example, maybe have an outdoor Thanksgiving then instead of on the 26th, when it may be colder.

An outdoor Thanksgiving isn’t foolproof: People still, ideally, need to be distanced several feet from one another, particularly while eating or drinking without masks on. People also need to be careful to keep up social distancing and mask-wearing when preparing food or going inside to use the bathroom.

Can it be a very small gathering?

It’s hard to put an exact number on the question of “how many people is too many?” But know: More is more dangerous. The state of California is prohibiting private gatherings of more than three households, for example, but emphasizing “the smaller the number of people, the safer.” Other states have even stricter limits; starting October 23, Colorado reduced the limits on personal gatherings to no more than two households and no more than 10 people total.

If it’s indoors, can it be well ventilated?

If a gathering is going to happen indoors, consider ventilation: opening windows, exhausting old air out of the space with a fan, introducing new air into the space, and perhaps running a HEPA air purifier. Ideally, the volume of air in an indoor space should be replaced by outdoor air or filtered six times per hour (though it can be hard to measure whether this has been achieved).

There are no perfectly safe indoor environments during the pandemic. We can’t ventilate and air-purify our way out of the need to wear masks, reduce occupancy in indoor spaces, and physically distance. But a well-ventilated space is at least somewhat safer than a poorly ventilated one.

Can it be quick?

One of the big overlooked risk factors for Covid-19 spread is time. The longer you spend with an infected person, the more likely the virus is to be transmitted. The rule of thumb is 15 minutes: The CDC considers risky “close contact” to be spending 15 minutes or more with an infected person. But this rule of thumb is just that. “That doesn’t mean if you spend 14 minutes your risk is zero,” Muge Cevik, a physician and virology expert at the University of St. Andrews, said earlier this year.

Overall: Shorter is better. So what if Thanksgiving wasn’t a long event, but just a quick in-person reunion? Could you live with that?

Does there really need to be food?

Yes, the meal is the centerpiece of the Thanksgiving holiday. But eating necessitates removing masks and encourages heavy mouth-breathing activities like shouting (particularly if there’s alcohol involved). If the point of the holiday is to bring the family together, perhaps it can be done without a sit-down meal?

Can guests quarantine beforehand?

The fewer number of people each Thanksgiving guest can come into contact with before attending a gathering, the better. If there’s long-distance travel involved, Popescu says people should ask themselves if they can build in some quarantine time at the beginning and end of the trip. Many states are even requiring out-of-state visitors to quarantine or get tested (find a list of state-by-state travel requirements here).

Can you arrive a couple of weeks before the holiday and quarantine before the day? Not everyone will be able to.

Will there be vulnerable people in attendance?

Not everyone is at the same risk for severe Covid-19. Older people, and people with underlying conditions like diabetes and heart disease, might suffer the worst consequences if they are exposed to the virus during the Thanksgiving holiday. Consider the guest list, and perhaps the idea of excluding those at high risk will be motivation enough to postpone the event until things are safer — or hold it remotely.

Can the number of people traveling from hot spot regions be reduced?

As of mid-November, daily cases are rising in every state in the US, making any travel risky.

But the more the virus is spreading in a given area, the more dangerous it may be to travel from that area to another, increasing the chances of bringing the virus along.

If you’re holding Thanksgiving in a community that’s not seeing a big surge in cases but inviting guests from regions that are, maybe reconsider. And if you are hosting anyone in an area of high transmission, you also might need to cancel. The more community transmission, the higher the chances someone will arrive for the holiday infected.

The CDC has a list of state health department websites, which, ideally should have current information on community prevalence to help guide your decision making (though the data quality may vary by state).

But with the widespread current US outbreaks, granular data on how one county is doing compared to another may be less helpful. When in doubt, assume cases are rising.

Is everyone attending on the same page in terms of masking and personal risk?

An important step to reduce risk within a group is having a conversation about it and getting everyone on the same page in terms of the risk they expose themselves to in their daily lives.

“Individuals who did not consistently adhere to social distancing (staying at least 6 feet apart), mask wearing, handwashing, and other prevention behaviors pose more risk than those who consistently practiced these safety measures,” the CDC explains in its guidance for holiday gatherings.

Popescu pointed me to this worksheet of questions intended to help people set up quarantine pods (groups of people who socialize among themselves but generally cut themselves off from broader social interactions) as being a helpful starting point. Families should ask one another, for instance, “How often do you wear a mask, and where?” Getting everyone joining a gathering to reduce their personal risk reduces the risk for everyone.

“I think one of the hardest things is having those conversations and both parties being on the same page about risk,” she says. “Because, you know, what I view as high risk might not be the same as, like, my mom’s.”

Is everyone in attendance willing to be transparent and honest if they do get sick?

In the case that someone at a Thanksgiving celebration does get sick, they must be committed to telling everyone else in attendance as quickly as possible so that they can quarantine and possibly get tested themselves. Ideally, this can happen without the threat of judgment from other guests. It’s how we can prevent an outbreak in one family from becoming a huge cluster.

Yes, thinking through all this is exhausting

It’s okay if you read through all of that and thought: Wow, this is all so tedious. Thinking about risk is really hard, and we’ve all been forced to do it more than we’d like. Thinking through all the risk factors for Thanksgiving “adds this layer of complexity and potential for conflict even,” Marcus says. “These decisions are hard, and I think they become even harder when they are being made around important traditions with other people.”

The desire to have Thanksgiving as normal isn’t entirely without reason. The Covid-19 pandemic has, for many, meant months of isolation, of departure from life as normal. Reestablishing some social, family connections around a beloved holiday is a normal, healthy instinct.

But if you’re not sure if you want to just skip Thanksgiving this year and are feeling very anxious about the decision, you’re likely not alone. One part of the pain and tragedy of the pandemic is that, yes, even a simple family gathering requires something of a biohazard assessment plan.

Marcus emphasizes that it’s important for us all to think hard about what really matters most to us. “What can I live with here?” she says. “And can I live with not having a traditional Thanksgiving?” The larger question: Can you live with a scenario where someone — or many people — at the gathering get Covid-19?

This calculus is different for everyone. It’s different for a small family of young, healthy people than it is for a large one where multiple generations mingle. It’s different for a person who has been painfully isolated for months than it is for someone who has had contact with their family. It’s different for someone wondering if this might be the last Thanksgiving they have with a beloved family member than it is for someone whose relatives will all likely be around next year.

What’s the same for so many people: None of these decisions are easy.