Deciding Thanksgiving
Large family gatherings are discouraged this year, but some of the risks can be mitigated
The holidays can promote a lot of interpersonal stress. • Thanksgiving, in particular, “has always been dicey for families,” said Sara Hopkins, director of outpatient mental health services for Rochester Regional Health in New York. “Emotions run high anyway, and this year is all the more stressful.” • Because in 2020, the question isn’t whether it’s wise to talk politics with Uncle Joe during the dessert course – it’s whether it makes sense to gather for Thanksgiving, period. • Medical experts agree that having people congregate in small, poorly ventilated indoor spaces for extended periods of time should be avoided during the coronavirus pandemic, especially as COVID-19 cases rise here and across the country.
In multiple interviews, the nation’s leading infectious disease expert, Dr. Anthony Fauci, has expressed concern that upcoming holiday celebrations could further increase transmission rates of the novel respiratory illness and is advising Americans to forgo their big, traditional Thanksgiving Day plans.
Dr. Emil P. Lesho, an epidemiologist and infectious disease consultant for Rochester Regional Health, agrees. Unlike in the past, he and his wife aren’t traveling to visit family for Thanksgiving this year. “We’re staying put,” he said, and he’s urging his relatives to do the same.
“How are you going to sit 6 feet apart? At Thanksgiving, you’ve got a bunch of people sitting around a table, and that’s high-risk,” he said. “You’re not going to sit 6 to 12 feet apart from each other.”
Said Dr. Brenda L. Tesini, an infectious disease specialist at the University of Rochester Medical Center, “No one’s going to be able to say categorically that this is safe and a fine thing to do.”
As much as holiday gatherings can be fraught, “For some families, not being able to be together after almost a year of not being together is hard,” Hopkins said. “It’s stressful to not be able to do that.”
For those who don’t want to skip Thanksgiving entirely, steps can be taken to mitigate the risks, Tesini and Lesho said.
Keep your circle small
The safest way to go is to keep your celebration small by limiting the guest list to members of your own household – “the people you already live with,” Tesini said.
One step beyond that would be including people outside your household with whom you routinely interact and share similar pandemic-related behaviors, she said.
Before inviting anyone into your home, it’s imperative you understand how they’ve been conducting themselves throughout the public health crisis, Tesini said.
It’s not the time to “get together with a relative who has been quite vocal about not wearing a mask and not social distancing,” she said, or with relatives from around the country.
That may be especially true now that the air is drier. Mucus protects respiratory-tract linings, Lesho explained. When the air dries out, as happens in the fall, those linings can become dry, too, and develop microcracks, allowing pathogens to get through more easily.
But really, he said, the biggest risk factor for contracting COVID-19 isn’t the dryness or quality of the air, “it’s the close contact.”
No guarantees
So while you might embrace the idea of choosing your Thanksgiving dinner guests judiciously, there are no guarantees.
It is impossible for even small, well-acquainted groups of people to know each other’s COVID-19 status definitively.
People can get themselves tested ahead of time, and Lesho encourages that. But, “A test is only negative at the time you’re tested,” he said, and rapid-results tests aren’t entirely reliable.
Family members might assume that their loved ones are not infected simply because they know them well.
The same sort of thinking leads people to ask close relatives for blood donations during a health crisis, he said. But no data support the notion that blood from a relative is safer than blood from a community supply. In fact, on its website, the American Red Cross notes, “Social pressure associated with directed (blood) donations may compromise the reliability of the donor’s answers to health-history questions.”
In addition, many of the COVID-19 clusters that have popped up recently have resulted from small gatherings of wellacquainted people who weren’t wearing masks, Lesho said.
Something else to consider about Thanksgiving celebrations is that they’re often intergenerational. Older people are more likely to develop serious complications from COVID-19, and “It’s really hard to ask grandchildren to not hug their grandparents,” Tesini said.
Do HEPA filters help?
Throughout the pandemic, but especially with the holidays approaching, there has been talk on social media and elsewhere about using portable air purifiers with HEPA, or high-efficiency particulate-arresting, filters to increase the safety of indoor gatherings.
HEPA filters are indeed capable of trapping particles far smaller than the virus particles that cause COVID-19, so HEPA devices could provide some protection.
But, “How effective they are depends on the size of the space and how much air is getting through the filter,” Tesini said.
The machines work best in small, closed-off rooms and generally are seen as offering a benefit in a case where an infected person is quarantining versus in the dining room of an open floor-plan home.
Another high-tech solution that’s gotten some attention is the use of ultraviolet-c, or UVC radiation, lamps, which have been shown to destroy the outer protein coating of other coronaviruses.
“However, currently there is limited published data about the wavelength, dose and duration of UVC radiation required to inactivate” COVID-19, the Federal Drug Administration says on its website. What’s more, if not used properly, the lamps themselves pose health risks.
In lieu of deploying sophisticated gadgetry, people simply “could have windows open and fans sucking air out of the windows, I suppose,” Lesho said.
But, “None of these things replace the lowtech practices that we know work – wearing masks and maintaining social distance,” Tesini said.
How to talk about it
Which brings us back to family conflict. Across the country, debates continue to rage over maskwearing. It stands to reason that not everyone in a family or close-knit group is going to agree about whether it’s safe to get together for Thanksgiving.
However, “It is fair to set a limit that is right for your health and your family’s health,” Hopkins said.
Certain approaches lessen the chances of escalating arguments and hurt feelings, she said. First, start talking now. “Have a conversation early and open a dialog early before the event to make a plan about what’s going to work for you and your family,” Hopkins said.
“If you’re invited to an event and don’t believe it’s safe for you and your family to go, communication is really key,” she said. “Avoid making judgments. Oftentimes, if we talk about what is right for us, that’s a way to avoid conflict. Saying, ‘You’re doing something wrong’ or ‘You’re making the wrong choice’ is hard for people to hear. … If we can communicate that we’re trying to make decisions based on our own health and safety, it’s hard to argue against that. The more we keep the focus on ourselves, and the less we put on other people, the better the conversation should go.”