It’s time for Americans to plan for a very different kind of Thanksgiving. Many of us need to be prepared to accept a Thanksgiving where we do not see our loved ones in person — or if we do, only with serious precautions.

I had hoped we wouldn’t get to this point. Up until a few weeks ago, I thought there was a chance we could turn the trajectory of COVID-19 enough to lower the baseline of infection, allowing us to resume holiday gatherings.

That didn’t happen. On the contrary, we are in the midst of a major coronavirus surge. On Friday, the United States recorded more than 70,000 new daily infections, the highest rate since the previous surge in July. Fourteen states set records in hospitalizations in the past week, and local and state officials are warning that ICUs could once again exceed capacity. What seems to be driving this latest surge is informal gatherings of friends and extended family. Think Thanksgiving.

People who are already worrying about the holidays ahead may be facing resistance from family members who cherish tradition. This is the time to have difficult conversations, because none of us want to host an event that could sicken those we care about the most.

First and most important, plan to celebrate outdoors. We all know by now that coronavirus transmission is substantially reduced in the open air. If you want to share a turkey with anyone outside your immediate household, do so in your yard, not around your dining room table. Even outdoors, keep the different households separated by at least six feet. Plan for inclement weather: bundle up, supply blankets, use fire pits and outdoor heaters. With an eye on the weather forecast, stay flexible: Thanksgiving can be celebrated the day before or after, too.

What about family members who normally travel to see you? Before saying yes to houseguests, consider where they are coming from and what precautions they are taking. Many parts of the country are already virus hot spots; by Thanksgiving, even more probably will be. A lot of people have returned to work or school, or might be otherwise interacting with people in a way that increases their overall exposure. If you are older with underlying medical conditions, this is not the year to have them stay with you. Consider asking them to book a hotel, and agree to see each other outdoors.

Some might still decide they want to share their homes. If so, they should take precautions to reduce risk. I’m less concerned about the travel itself than the risks of acquiring COVID-19 through daily activities before the trip. The host could ask visitors to self-quarantine for 14 days, then get tested the day or two before they leave. If the travelers test negative, then take precautions during travel (such as wearing masks in all public spaces), it would be pretty safe for them to stay in your house and socialize with you indoors without distancing or masks.

The key is to reduce risk for the two-week period before the trip. The hosts should decide in advance what activities they’d consider to be sufficiently low-risk. Going grocery shopping could be fine, for example, but not dining indoors at a restaurant.

It’s not rude or inappropriate for hosts to set expectations. Adult children who come to visit might also want to see old friends, but doing so adds risk to your household. Discuss limits in advance, such as asking them to attend no other indoor gatherings while they are staying with you.

I’m particularly worried about college students who come home over the holidays. Many universities have had substantial outbreaks. Young people are much more likely to be asymptomatic or mildly symptomatic, but they can still infect others. Some students might be able to self-quarantine and test ahead of returning home. Those who can’t should stay completely separate from the rest of the household while indoors, and only socialize with their family outdoors. They should quarantine for their first 14 days at home, then get tested before resuming indoor family activities.

What if the whole Thanksgiving trip is going to last a week or less? Consider postponing it. This might have to be the year for virtual family celebrations and in-person, outdoor Friendsgivings.

All of this might seem extreme. People will wonder how we can give up so much, when we’ve already gone through almost eight months of isolation and stress. But that’s exactly the point. Don’t let that sacrifice be wasted. By this time next year, we could well have a vaccine and multiple therapeutics that will make it safer for us to travel and see one another. But first we need to stay healthy and get through this winter.

That means, for many Americans, the best way we can give thanks for and to our loved ones is to not see them in person this Thanksgiving.

Leana S. Wen is a emergency room physician and a visiting professor of health policy and management at the George Washington University Milken Institute School of Public Health.

Leana S. Wen is a emergency room physician and a visiting professor of health policy and management at the George Washington University Milken Institute School of Public Health.

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