From the WebMD Archives

Editor's note: Since this story was published, the CDC has issued updated guidance for Thanksgiving. You can find their advice for "Holiday Celebrations and Small Gatherings" here. It adds to, and is not in conflict with, the advice from our experts, below.


Oct. 28, 2020 -- Thanksgiving 2020 just isn’t going to look the same. If you’re trying to find ways to gather, but still protect vulnerable loved ones from COVID, here are some ideas from the experts.

William Schaffner, MD, Infectious Disease Expert, Vanderbilt University: Skip the Meal

This year, you may not be able to have your pumpkin pie and eat it together, too. Something’s got to give.

“This year is the COVID year. Thanksgiving has got to be different,” says Schaffner. “Let’s not get too excited about this. It’s only one year.”

His family will gather, but without the food, since eating together requires taking off your mask.

“We’re not having Thanksgiving in person around a dinner table. We’ll all be very happy to see each other, but no hugs or kisses.”

Schaffner says his family’s plan is to get together for about 90 minutes. The longer you are together, the higher the risk, so they’re going to keep an eye on the time. They will all wear masks and observe social distancing.

Schaffner says his family members are all very vigilant in their day-to-day lives, so they’ve decided not to get tested for the virus before getting together.

Because people are most contagious before they have any symptoms, testing can be helpful, he says, but it’s not foolproof. There are different kinds of tests available now, and they’re not equally accurate. Many doctors’ offices and urgent care clinics offer rapid tests, which return results the same day and don’t require the uncomfortable swab deep inside the nasal cavity, but these kinds of tests are also less reliable. A negative result on some kinds of rapid tests needs to be confirmed by the more accurate, gold-standard PCR test.

For that reason, Schaffner suggests seeking out a deep-swab PCR test to begin with. “I live in Nashville, and you can drive up and get the gold standard at a number of sites around the city now.” Wait times for results in many places have come down, too.

But since you need to know the results before you go, he suggests calling ahead to find out what the turnaround time is for the test you’re going to get, then plan accordingly.

“Then make sure, if you’ve got a positive. Stay home,” he says.

Also keep in mind that test results are only good for the day you got the test. If you test negative and then get on public transportation to travel, you could still be carrying the virus home to your family. That’s why you’ll still need to wear a mask and keep your distance, even after a negative test.

As for travel, Schaffner recommends keeping your Thanksgiving plans closer to home. “Traveling great distances -- don’t do that. This is not an essential trip.”

Isaac Bogoch, MD, Infectious Disease Expert, Toronto General Research Hospital: Keep It Small, Use Your Digital Tools

In Canada, Thanksgiving is in October, so Bogoch has already been through all these challenging conversations with his family and friends. “So everything you're about to discuss we've already been through, and I feel like I'm a veteran at it,” he laughs.

First he says, it’s important to realize that Thanksgiving could be a real danger to the very people you so desperately want to see. You could end up passing COVID to Aunt Sue along with the mashed potatoes.

“Thanksgiving is a perfect setup for transmitting and amplifying this virus,” Bogoch says, “We know that the vast majority of transmission is going to be in close-contact, indoor settings with no masks and poor ventilation. Well if you cram all your immediate family and friends and extended family under one roof and you’re gorging on turkey, you know, you can also transmit COVID-19.”

He says he and his family followed Canada’s public health guidelines for the holiday, which were, “If you don’t live under that roof, you shouldn’t go into that house. Easy peasy. Full stop. And it’s tough because it’s a break and it’s a time when people want to get together with family members.”

He says he shared his meal with just his immediate family and then used video conferencing -- like Zoom -- to connect their meal to other branches of the family tree.

What about eating outside?

“I think that’s totally reasonable. I love this approach because it’s not, ‘Let’s cancel Thanksgiving,’ but ‘How do we make it safer?’”

Eating outside might work, weather permitting. “So you can have your family together in a backyard or in a park or in an outdoor venue? Yeah, it’s probably a lot safer,” Bogoch says, “But you still don’t want to have crowds of people, and you might want to take extra precautions if there’s someone at risk.”

He says he can’t be overly prescriptive. A lot of your approach -- and the risk involved -- will depend on who wants to get together, their age and health, and how much COVID is circulating around you.

Cameron Wolfe, MD, Infectious Disease Expert, Duke University: Pre-Game the Day, Travel Carefully

Wolfe says many young people will have to travel home for Thanksgiving because colleges have decided to conclude their academic terms at the holiday.

“We recognize travel is an added risk because it moves your little bubble of people who you hang around with and engages with another bubble who you weren’t hanging around with and blends risk, then potentially you bring it back,” he says.

When possible, travel by car. If you have to use public transport, choose direct routes to lessen stops. And prepare for your trip by locking yourself down for 10 to 14 days before you go. Order groceries. Limit your trips out of the house. Avoid close contact with others.

“The preparation for Thanksgiving begins 10 to 14 days before a gathering would actually take place,” he says. “Tell the rest of your family the same thing.”

Wolfe says if people can be mindful of that, it will cut the chances of bringing the virus home to vulnerable parents and grandparents.

To estimate how risky it might be to host or attend a get-together, he suggests checking out the COVID-19 Event Risk Assessment Planning Tool, which was built by researchers at Georgia Tech in Atlanta.

Toggle the event size to the number of people you are planning to have in your group to see how likely it is that someone will bring COVID with them to the party. The risks are based on positive cases over the last 2 weeks in each county in the U.S. If people are traveling from outside the county where you’re meeting, you can also use the tool to learn their risk of bringing it with them.

The tool estimates that in Tennessee’s Davidson County, there’s a 32% chance that someone attending a 10-person event will be COVID-positive. In Grand Forks County, ND, the same event has a 75% chance of hosting a COVID infection. Fresno County, CA, has a 12% risk.

Clio Andris, PhD, an assistant professor in the School of City and Regional Planning who helped build the tool, says it has limits. “We don’t have projections for a month later right now. So really, the tool is better for short-term planning. But you can definitely read the tea leaves and see how a certain part of the country has been doing,” she says. “You can look at your own county and you can say, ‘Hey, you know, we’re a hot spot right now, and I’m worried that I may be at risk of transmitting the virus.’”

Marc Lipsitch, Epidemiologist, Harvard T.H. Chan School of Public Health: Celebrate Early, Eat Outside

“There are a lot of things you can do short of having a big gathering of people” to save Thanksgiving, Lipsitch says.

His top suggestions: Try to eat outside before the weather turns too bitingly cold, and keep your guest list small.

Rather than having all 23 of your nearest and dearest together at the same time, spread out the visits into smaller groups.

“Get a couple of those people at a time together in your backyard, roast a chicken, and have stuffing and call it Thanksgiving,” Lipsitch says. “In October, while it's still possible."

Even then, you’ll need to follow all the safety guidance from public health officials. Give everyone at least 6 feet of space, and wear a mask.

“People have a very real need to see their families, and you’ve got to figure out ways,” he says.

But, he says, “I don’t think that big holiday gatherings make a lot of sense.”

Lipsitch says he and his wife usually host about 16 people who all come in from out of town. “And we’re not doing that this year. Nobody’s traveling.” He says dinner will be just the four people in his immediate family.

They’re keeping the celebration small because his own research has shown that group size has a big impact on a person’s risk of catching the virus.

“Roughly speaking, the risk to each person goes up in proportion to the size of the gathering,” Lipsitch says. He hasn’t published this research yet. He says the paper is due out soon. “As a rule of thumb, if you double the size of the group, the amount of transmission risk goes up by a factor of four. If you triple it, it goes up by a factor of nine, because you have three times as many potentially infectious people and three times as many participants,” he says. “That’s why people have warned against large groups.”

Shelly Miller, PhD, Aerosol Scientist, University of Colorado Boulder: Crack a Window, Spread Out

If the weather is already too cold to make an outdoor meal work, or perhaps you’ve got older relatives who are very cold-sensitive, you can still take steps to reduce risk at an indoor meal.

First, wear a mask when you’re not eating.

“If you’re going to hang out and talk for a half-hour or 45 minutes while the dinner is prepping and you’ve only got five people over, you’re still going to be generating a ton of aerosol,” Miller says, “so you have to wear a mask if you’re going to hang out and talk with other people and share their air.”

Crack a window. Opening a window every so often will help bring in fresh air and help lower any potential amount of virus in the air. This works even better, she says, when there are large differences between the temperatures of outdoor and indoor air. The temperature difference will help drive the air out and ventilate the space more quickly. Yes, the heating bill will go up, but this isn’t the year to worry about energy efficiency.

Spread out as much as possible. Eat in different tables or in separate rooms. If possible, stay outside until it’s time to eat.

When choosing which home should host, go for the largest.

“Bigger volumes are better. Big-volume spaces with minimal people are better because there’s more volume to mix the virus into,” Miller says. Try to eat in rooms with more doors and windows. Even if you’re not opening them, they still allow air in because they’re an opening in the building’s shell.

Basic Principles

Remember that nothing is risk-free. “I don’t like to use four-letter words like ‘safe’ that’s an absolute,” Schaffner says.

It’s better to concentrate on layers of safety. Keeping your hands washed and sanitized is one layer, for example. Keeping your distance from other people is another layer. Wearing a mask is another. Limiting travel is another. Building more layers of safety between yourself or your loved ones and the virus is the best way to lower everyone’s risk of taking home a disease no one is thankful to have in their lives this year.

Show Sources

William Schaffner, MD, professor, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville.

Isaac Bogoch, MD, clinician investigator, Toronto General Hospital Research Institute, Toronto, Canada.

Cameron Wolfe, MD, associate professor, infectious diseases, Duke University, Durham, NC.

Clio Andris, PhD, assistant professor, School of City and Regional Planning, Georgia Institute of Technology, Atlanta.

Marc Lipsitch, professor of epidemiology, Harvard T.H. Chan School of Public Health, Cambridge, MA.

Shelly Miller, PhD, professor, mechanical engineering, University of Colorado Boulder.

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