While many of us endured the disappointment of significantly limited gatherings over Thanksgiving, the case rates are climbing. We are heading into the holidays where friends and family get-togethers are even more important and are often for extended periods of time. Thanksgiving dinners are usually limited to a few hours together, while Christmas gatherings could have family members traveling greater distances and staying overnight for extended periods. The best way to eliminate the risk of infections, by having everyone stay in their own homes, is likely to be more than disappointing. So what, if any, are the alternatives? In this COVID-19 update blog, we’ll show some of the sobering statistics, offer some suggestions on how to be as safe as possible, and tackle how to have some of the difficult conversations that may be needed.

Since mid-November, the US has seen cases approaching and even exceeding 200k/day, and it is suspected that this trend could continue or get even worse as we head into the later part of December. As the number of cases of active infections increases, so does the risk of others becoming infected, and there are still concerns about people without any symptoms being infectious. Below are some charts showing the trends of significantly increased daily cases in the last few weeks.

You can see the dramatic increase in cases presented in the Johns Hopkins COVID-19 Dashboard. This trend is common across the US and other countries, not just those where the weather is turning colder. Below are some state and international trends that follow a similar pattern of significant increases in cases as we transitioned into fall and approached the Thanksgiving holiday.

Many factors may drive the statistics, including testing rates, population densities, and behavioral changes. Weather may be driving people indoors together, the reopening of various venues results in more close contact risk, and COVID caution fatigue is a real thing. In some instances, the use of face coverings can be compared to how many felt about using seatbelts in the ’60s. “I’ll only be in there for a few minutes, so I shouldn’t need the mask” is becoming the new “it’s just a short trip to the store, so I don’t need to buckle up.” Or more commonly, “Oops, I forgot.” One important factor is the growing number of people that are ill. Like a snowball gaining speed and size as it rolls down a mountainside, the case rate grows exponentially as more people become infected and interact with those around them.

We hear much about our “bubbles,” but it is important to recognize that if you are not locked down in your home, your bubble easily expands into the bubbles of each person with whom you come in contact. Here is a diagram from healthoregon.org that shows the impact of extending your bubble.

To many, this is such an important time of year when friends and family count on gathering together. As the pandemic continues to gain momentum into the holiday season, more and more people find that they have to make decisions related to their personal safety and comfort levels. Exchanging gifts can be a major highlight, which can still be done without gathering, but for many, the best and most anticipated part of the holidays is getting together with loved ones. Some may be willing to throw caution to the wind and gather as if COVID never existed, while others in the same family are less willing to accept those risks. These differences can be common and make it difficult to navigate through the holiday season. Below, we offer some suggestions that can help reduce risk and make gathering safer.

Staying home is safest for all. This is a must if you are ill or have been around someone who is sick.  Next best, if state or regional bans do not prohibit travel or private gatherings, quarantine for 14 days before Christmas.

Have a Plan and Follow It – Two Weeks to Isolate and Eliminate

The CDC has consistently indicated that a 14-day self-quarantine period is adequate to ensure you no longer pose a risk to others, and they have provided guidance on how best to do this. If all that will gather have eliminated their contact with others for 14 days, the risk someone will bring the unwanted guest (SARS-CoV-2) to the party is decreased to almost nothing. If this plan is followed by all, limits on the number of people gathering or the number of households represented are less of a concern. This will certainly not be easy. It means starting from December 10^th and through to any holiday gathering, purchases of groceries, toiletries, and other items should be delivered to your home. Online shopping can be valuable, has grown to include more than just gift items, and has become easier and more common. Groceries and prepared meals can be delivered to your doorstep just like bicycles, board games, and ugly sweaters. Find ways to encourage and support every intended guest in their efforts.

If someone must go out, limit this to a single person and plan for quick trips, wear effective face coverings, seek maximum distancing, and do so when stores are less crowded. Take advantage of online ordering and payment. When you arrive at the store, text your online shopper and have them bring your order to your car. If that single person could serve as the designated shopper for more than one household, take advantage and plan accordingly. Single-buyer online shopping for multiple homes and a single family member running the deliveries to others in the family can lower prices through bulk purchasing and reduced shipping costs.

For many, such as those providing essential services, this may not be an option. For them, continuing to follow safe practices diligently is critical.  If close contact with others is unavoidable when providing these essential services, it is important that you let others know about your activities and the steps you have taken to minimize your personal risk.

For everyone including designated shoppers, self-isolated individuals, and those that must be out and about leading up to the holiday gatherings, it is essential that we all stay home if we are sick and ramp up our hand hygiene, room cleaning, and disinfection practices. If one must go out, plan ahead to ensure safe distances are maintained at all times, cover your face, avoid crowds, and limit your time in indoor public spaces.

For groups that can’t self-isolate for two weeks but still intend to gather, the following are practices that should be considered.

Keep it Small, Intimate and Safe

Limit the number of people and the households represented. Numbers like “no more than 10 people from no more than three separate households” have become common recommendations for gatherings. Remember, everyone’s bubble will expand significantly when you invite others in.

Travel Smart

Be safe when traveling. Airports are great places to expand your risk bubble on an international level.  Keep your distance, your face covered, and your hands clean.  The CDC has some valuable guidance on how to travel more safely. Consider testing before traveling and plan the entire trip, including trips to and from the airport. If possible, make arrangements to have those with whom you are gathering pick you up from the airport. Avoid mass transit if you can, and if not, follow the safe travel practices and plan for less crowded times.

Take it Outside

Fresh air is your friend. If weather allows, do as much as possible outside. More passionate actions where voice volumes are likely to go up (singing, shouting, etc.) should occur outdoors regardless of the weather. Passions that are common at holiday gatherings may run even higher this season. Increased conversation volumes may not be limited to specific topics or activities such sports, politics, COVID, arguments, etc. When many people in a space are trying to be heard over several other noises, the sound from the TV or background music can result in louder conversations. Be the one that says, “let’s take this conversation outside,” or be cooperative with the one that does. One note of caution, an outdoor tent with four walls and a roof is still an enclosed space. To be a safer place for these activities, it needs to have adequate, fresh air ventilation. This means open windows and perhaps even a fan to keep the fresh air coming in. However, if portable fans are used in their Considerations for Gatherings, the CDC reminds us to “take steps to minimize air from them blowing from one person directly at another person…”

Time, Distance and Crowd Control

When you do gather, choose areas where all in proximity can keep a safe space between them. If you must get up close and personal, keep it brief and keep your mouths and noses covered. Place hand sanitizers and disposable face coverings around the house to be a reminder and readily available. When not eating or drinking, wear masks indoors or when in close contact with others. Consider adding some safety signs as reminders, as well. While this may seem impersonal or a break in the spirit of the gathering, these are extraordinary times that call for extraordinary measures. Some may think it unnecessary, while others may greatly appreciate it. If someone comments that this is not appreciated, remind them that while many may agree, others are concerned, and while it can be annoying to some, it may be just the thing that others need to feel secure and supported.

During the meal, keep your utensils to yourself and choose one person to plate the holiday meal for others, minimizing the number of nearby people handling the food. Another option is to order food that arrives as individual servings, eliminating both the need to cook and handle food.

Be Mindful All Evening

As the evening wears along, the chances people will let down their guard increase. Let everyone know early who will be the room monitor, how they will remind others when they are starting to drift away from the safety plan, and the importance of honoring their directions.

In years past, the awkward family and friends’ conversations during the holidays have been known to occur around the dinner table. Now, as we enter December in the year 2020, those uncomfortable conversations may happen before anyone steps foot in your home. Letting others know that your favorite holiday traditions will have to be canceled or dramatically changed may be hard for people to say or hear.

Below is a list of examples to use to help make the uncomfortable conversation less uncomfortable. Remember when engaging in these that this is the time for compassion and understanding rather than escalation. Be sensitive to the concerns of others even if you are not in complete agreement.

Question: Why are you staying home/telling me to stay home this year?

Some possible responses:

• I’ve read way too many stories about small family gatherings ending in tragedy, and I’m just not willing to take that risk with my loved ones.
• This is one of many holidays we plan to spend together. Let’s do all we can to make sure it is the last one we have to do this way.
• I would rather stay home this year to ensure that we’re all around and healthy next year.
• I’ve barely left my home all year. As much as I love holiday parties, I’m just not comfortable interacting with others during this pandemic.
• I love you and I couldn’t bear it if I got you or anyone else sick.
• Although I know you try to stay safe, there are just too many uncertainties and we shouldn’t risk it this year.

Question: “I think this is much ado about nothing (e.g. it’s political, it’s just the flu, the things we are being told are lies, controls are not working so why bother, and other assorted arguments and conspiracy theories).” Therefore, Is this really necessary? 

Some possible responses:

• While I understand that you and perhaps others feel this way, one thing we can all agree on is that this has been hard on everyone, including those that believe that the risks are real. And their feelings and desires to be together, especially this year, are as important to us as yours.
• I know this is inconvenient, but this too shall pass. Please know that we respect your decision to decline this year if you are not comfortable following our plans to ensure all that join will feel safe and welcomed.
• We are trying to keep things as normal as possible in the most abnormal time we have seen.  While you may not think this is necessary, others do, so we will need you to be cooperative and supportive of others if you do decide to come.

It is probably best to avoid sharing names or the specific concerns others may have and speak for the group as a whole.

Question: What is your plan to keep my family safe if we do come?

Share your plans for how the house will be set up, how many are coming, and from where and what you expect of all who attend when they are at your home for the weeks leading up to it.

Question: Is there anyone that we should tell to stay home?

Certainly, anyone that has symptoms related to COVID-19 should be asked to stay home. Beyond that, you should consider having those with the potential for more serious illness to stay home, as well.  Unfortunately, the people for whom gatherings are the riskiest, like the elderly and people with underlying health conditions, may be the most in need of the social connection. Setting up televised or live streaming events at home with members of your household can help family members feel connected while remaining safe in their own homes. Connections can be maintained even virtually during this time. Decorating gingerbread houses or opening presents together on live streaming platforms such as Zoom, MS Teams, or others can allow those who cannot or should not gather to be a part of the festivities.

Question: What should I bring?

Answer: Anything but that green pea and mayonnaise salad!

OK, that last question was probably unnecessary, but we wanted to finish with a reminder that we can still have fun and be together even if at a distance. It may be different from what we are used to, and some changes may not be ones we like, but people can be resilient and find humor, intellectual stimulation, and new levels of intimacy in the worst of times. Seek out and share useful resources for tackling this challenge, be deliberate about finding ways to come together safely and creatively, recognize the efforts and sacrifices of others, and be a positive influence on those around you.