- Three Insider editors shared their Thanksgiving plans with public health experts.
- A common thread is that bubbles are never as small as you think, and adding even one outside guest increases your risk of exposure.
- People who have had COVID-19 and recovered may have some level of immunity, but there's no such thing as an "immunity passport."
- Testing negative before traveling also is not a golden ticket to celebrate as you please.
- Visit Insider's homepage for more stories.
Across the US, people are still scrambling to decide whether it's safe to see loved ones this Thanksgiving or if they should skip the holiday altogether.
Even New York governor Andrew Cuomo isn't sure of his Thanksgiving plans. His announcement that he'd be celebrating with his 89-year-old mother and two of his daughters was met with backlash, and he's since canceled his plans.
Dr. Anthony Fauci is also keeping the holiday small this year. His daughters declined to visit in order to keep him safe — after all, the infectious disease expert is high-risk himself at age 79.
Three Insider editors decided to go public with their Thanksgiving plans, submitting them to health experts for an evaluation of the risks they're taking and tips on how they could make their gatherings safer.
Whether you have a relative flying in from out of town or you're trying to understand whether you have immunity to COVID-19, the advice they got could help inform your holiday arrangements.
Family dinner in Wisconsin with one relative flying in from out of state
– Rebecca Harrington, Deputy News Editor of Insider
Rebecca is in a "pod" with eight relatives in Wisconsin who gather for Friday night dinners. They are all healthy (aged in their 20s to 50s), living in 4 different houses.
Five of the eight go to work (in construction, physical therapy, and school administration). Two of the eight have already been infected with and recovered from COVID-19.
One young relative who works in a lab in Connecticut planned to fly in for the holiday. She has been living alone since March, wears a mask around other people, and is very careful. She has not had COVID-19.
She has booked a direct flight to travel from Connecticut to Wisconsin, and planned to wear a mask and glasses for the duration, before getting picked up by relatives to drive home from the airport. She does not plan to get a COVID-19 test prior to flying.
Editor's note: Prior to publication, the family changed their plans and won't have a relative flying in. They're only going to have Thanksgiving dinner with the nuclear family of five that's already been in a pod together. These comments are based on the original plan.
Amesh Adalja, senior scholar at the Johns Hopkins University Center for Health Security: This is a relatively safe plan.
If most of the Thanksgiving group has been gathering on a weekly basis, they've already assumed a level of risk that comes with forming a pod.
"But, there's always a caveat that even when you have a pod you don't really realize how big your pod is," Adalja said. "If some of those people are going to work as a physical therapist or were working in a school, that pod is a little bit bigger than just the eight people that they say."
The fact that two family members have recovered from COVID-19, affording them some level of immunity, and that some are working from home, also lowers their collective risk, making this a "relatively safe" plan by Adalja's evaluation.
To minimize the risk added by an outside guest, the person traveling from Connecticut should be extra careful and try to shrink her circle of contacts in the week before traveling. She should also be prepared to get a test or quarantine for 14 days upon her return to the East Coast.
Matthew Fox, professor of epidemiology at Boston University: This is a high risk plan.
Matthew Fox, on the other hand, said he considers this level of inter-household mixing high risk, and that risk is made even greater by the addition of a guest traveling by plane.
"The fact they are mixing with a number of other families means that they are sharing risks across those families," Fox wrote in an email to Insider. "Having additional people for the holiday, especially one who has to fly to get there, makes the risk even greater."
Lindsey Leininger, clinical professor at Tuck School of Business and CEO of Dear Pandemic: Moving outside could reduce the risk by "a whole heck of a lot."
Leininger said she looks at COVID-19 risk protection like a Jenga game: a tower of protective behaviors with the most fundamental factors at the bottom. One of those foundational blocks — keeping the community infection rate down — has already been pulled out in Wisconsin, where cases are surging.
The Harrington family still has control over another fundamental Jenga block: staying outside.
"When I look at a situation like that, I think, 'Wow, wouldn't it be great if, instead of sharing a long indoor meal together, maybe they got together for an outdoor bonfire?'" Leininger said.
Even if it's cold out and the family isn't able to gather for as long as they would indoors, limiting the duration of time spent together also reduces the risk of transmitting the coronavirus.
Driving with one friend from Chicago to New York via Michigan
– Mia de Graaf, Health Editor of Insider
Mia lives alone in Brooklyn, New York City. She works from home and socializes with friends at a distance, outdoors, with masks. When socializing indoors, she opens all windows.
Mia fell ill with COVID-19 symptoms in April while living with a relative who was COVID-19-positive. There were no tests available at the time to confirm Mia was COVID-19-positive. She has since been exposed to COVID twice — once to people with symptoms, once without — and has not gotten sick.
For Thanksgiving, Mia is meeting a school friend in Chicago, Illinois, to pick up his car and help him drive it to New York, where it's being sold.
She's getting a direct flight to Chicago from New York City. Her friend is flying in from Santa Fe, New Mexico, where he lives alone. He works from home, and does some socializing indoors without masks. He has not had COVID-19.
They both plan to get tested five days before flying and self-isolate from then until the flight.
On arrival, Mia and her friend will stay two days in an Airbnb in Chicago, with no plans to venture out. They will then pick up their car, and drive to Ann Arbor, Michigan, where they will stay in an Airbnb for three nights for Thanksgiving. They will stay inside the entire time, cooking food and hanging out. Then, they are driving to New York City. Mia's New Mexico friend will fly home from there.
Adalja: This is a pretty low risk plan.
While a road trip with multiple stops might not sound like a good idea in theory, Adalja said this particular plan is relatively low risk because it only involves two people, and one of them has likely had COVID-19 already.
"We're not able to officially make public health recommendations on people who have recovered," Adalja said. "But we know that people who have had COVID-19, at least for several months, are not likely to get reinfected."
The person at risk here, Adalja said, is the one coming from New Mexico. He'll likely have to get tested or quarantine when he gets back to his home state.
Fox: This plan is a moderate risk for Mia and a high risk for her friend.
Fox also said the plan is less risky for a person who has already had COVID-19, although it's too soon to say how much that risk is reduced.
Getting tested and minimizing contact ahead of time are also good ways to reduce the risks associated with traveling during a pandemic, Fox said. But the test only captures a moment in time. It can't tell you about your exposures while flying, and it may miss the most recent exposures if you were in contact with people just before the test.
With this in mind, Fox said he would still rate the plan as high-risk for Mia's friend, who has not had COVID-19 and could be exposed while flying on a plane. Mia would incur a moderate level of risk since she can't be sure about her level of immunity and she's mixing with someone outside of her bubble.
Leininger: This would be the year to not take this trip.
Compared to the other experts, Leininger was less confident about Mia's level of immunity. She said there's no such thing as an "immunity passport." Even if having had COVID-19 keeps Mia from getting sick again, it's unclear if she could get reinfected and transmit the virus to others.
"While there are some hopeful signs that there is strong immunity conferred from having COVID, we don't know how that actually plays out," Leininger said. "We don't know if that actually keeps you from getting reinfected, or if it just potentially keeps you from getting sick."
Given that neither immunity nor testing before traveling is a sure thing, Leininger said this is not the year for a big trip — especially not a trip to Chicago, a coronavirus hotspot that is already overwhelmed.
At home in the New York City area with husband and kids, and mother-in-law coming for dinner
– Julie Zeveloff, Editor-in-Chief of Insider Life
Julie works from home. She lives with her husband, who works three to four days a week in an office in New York City with five other people. He commutes there by car.
She has a nine-month-old who never leaves home, and a two-year-old who attends preschool three hours a day for four days a week.
The family also has a nanny who visits weekdays, and is mostly isolated on the weekends.
Julie's family is going to have dinner at home. Her mother-in-law, who is over 65 and lives alone in an apartment in New York City, will join them and stay overnight. She follows social distancing rules. They already see each other indoors, unmasked a couple of times a week.
Adalja: This plan is very low risk.
According to CDC guidelines, the safest way to celebrate Thanksgiving is with members of your own household. Adalja said in this case, Julie's mother-in-law is essentially included in her household by way of their weekly visits.
He said the big question to consider in any case is, "Does the Thanksgiving get-together pose an increased risk compared to what their baseline risk is?"
Considering that the Zeveloff family is not adding any outside guests or changing their level of caution, Thanksgiving poses no more risk than a regular dinner with Grandma.
Fox: This plan is a moderate risk, but it's a risk they've already taken.
Bringing in even one outside guest adds some risk to any Thanksgiving gathering, but this situation is less risky than the others by Fox's evaluation.
"Ideally, we wouldn't be meeting indoors with anyone who we do not currently live with, but in this case, it seems like they see their mother-in-law as part of their bubble," Fox said.
He went on to rank this plan as "moderate risk," due to the family not wearing masks and bringing in one person from outside the home. But, like Adalja, he noted that this is a risk the family is already taking once or twice a week.
Leininger: This is beyond my comfort level, but I have a lot of empathy for this situation.
Leininger said she's in a similar situation with two young kids and occasional visits to the office, so she knows this is a tough choice. But she's opted not to see her mother this Thanksgiving, and will keep her gathering strictly to household members only.
This decision is especially tricky because evaluating the risk of seeing loved ones is rife with psychological fallacies, she explained.
A phenomenon called the halo effect explains why gatherings of friends and family continue to fuel the pandemic. People assume those they trust — like a mother-in-law — won't have risky exposures, and they trust themselves not to get their loved ones sick.
It's important to be aware of this common misconception so you can remain alert if you do choose to gather with friends or family, whether that means wearing masks at all times or keeping the windows open while you eat dinner.
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