Cozy family gatherings are a staple of the winter holiday season. But this year, with COVID-19 continuing to circulate throughout the country, getting together with family will look decidedly different.

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In this Q & A, Krystina Woods, MD, Hospital Epidemiologist and Medical Director of Infection Prevention at Mount Sinai West, answers questions about how families can celebrate the holiday season while preventing the spread of COVID-19. 

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Read the latest recommendations from the CDC urging Americans to stay home on Thanksgiving

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How can families in the tri-state area safely celebrate together this holiday season?

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This year, in particular, everyone is really looking forward to holiday festivities because this has been a year in which we have had to keep our distance from friends and family. However, like with the rest of the year, the safest thing to do this holiday season is to gather virtually. Throughout the COVID-19 pandemic, we have learned that gathering outdoors presents a lower transmission risk than gathering indoors. But in the northeast, most of the holidays that we look forward to are going to be in colder weather which makes meeting outdoors impossible or, at the very least, uncomfortable.

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I know that there are many people who are not looking forward to celebrating virtually, but in terms of safety, the best thing to do is to not meet in person.

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I am hosting a small holiday dinner. Are there health-related questions I should ask guests before arriving?

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If you are going to take the risk of gathering indoors, the most important thing to do is to make sure that everyone in attendance is taking precautions outside of the gathering. If you—the host—are very careful about masking, washing your hands, limiting outside activities, and you are working from home, then your risk for contracting COVID-19 is going to be low. So, you want to think about the people coming into your home. They should have a similar risk profile to yours.

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It defeats the purpose for you to be super careful, and then invite someone to your home who is taking risks, like going out to a lot of events or parties. So, it is a good idea to get a sense of a guest’s risk profile if you don’t already know.

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In a blog post on how to safely date during a pandemic, Mount Sinai pulmonologist Lina Miyakawa, MD, advised asking potential partners the following risk profile questions. They provide a great start in assessing anyone who enters your home for a holiday get-together.

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To assess your guest’s risk profile, you can ask them these questions:

• How many contacts do you have on a daily basis?

• Who do you live with?

• Do you leave the house? If so, where do you go?

• Do you follow the recommendations to mitigate the risk of exposure, like wearing a mask and practicing social distancing?

• Do you work in situations with high exposure risk?
   

If families choose to gather, what precautions should they take to minimize the risk of spreading COVID-19?

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Here are five suggestions:

1. Head outdoors. If families insist on meeting in person, the most important thing would be to try to gather outside. But again, with the weather being what it is in the tristate area for the winter holidays, that will be tough.

2. Keep it brief. Although it goes against what we all think about holiday celebrations and how to enjoy them, keep any gatherings relatively brief. The longer you are with a group of people, the more chance you have of possibly getting sick.

3. Keep the numbers small. This isn’t the time for large extended family gatherings. This is the time to think about keeping the group smaller.

4. Increase the air flow. If you have to be indoors, make sure that the space is well ventilated. While it is not environmentally friendly to have windows open while the heat is on, it is essential to have fresh air coming in.

5. Mask up and keep your distance. If you are going to gather indoors, wear face coverings for as much of the gathering as possible. That may feel strange since you are inviting a sister or a parent to your home, but given the pandemic, it would make an indoor gathering safer for everyone. It is also important to keep six feet of distance from others, even if you’re wearing masks inside, and especially when you’re eating.

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Should changes be made in how food is served?

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Buffet-style meals are not ideal because you don’t want a whole lot of people handling utensils.

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There are two different ways to serve food in a safer way. The first is that everybody brings their own dish which, would not work for a holiday like Thanksgiving because you will have a ton of food leftover. The second is that you have one person serve everyone, preventing each family members from touching the tongs, the spoons, the forks, etc., when filling their plate. This person should be masked and should clean their hands before touching any dishes or utensils. 

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Also, when sitting to eat, you should try to distance people by six feet. More space is better, but those who live in and around the New York metropolitan area don’t always have the luxury of ample space. However, if you will be gathering, try spacing out with six feet being the minimum.

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Is it safer to gather indoors if all family members get tested for COVID-19 prior to gathering?

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There are a lot of questions about using testing as a sort of permission slip to meet up with others.

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If you test before you have a get-together, it is helpful if someone comes back with a positive test result. At that point, you know for sure that this person should be excluded from the gathering. However, it is not so helpful when someone receives a negative test because it does not give you an idea of their potential to turn positive within the next day or the next few days.

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For example, if I receive a negative test on Monday, this result does not tell me what my status will be on Tuesday or Wednesday. So, if I attend a family gathering on Wednesday and I start experiencing COVID-19 symptoms on Thursday, everyone who I met at that family gathering will have been exposed to the virus.

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Unfortunately, I think testing is giving people a false sense of security. You should continue to take all precautionary steps, specifically if your test result is negative. And, if it is positive, you know that you should be isolating at home and taking care of yourself.

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How can families maintain safety in the 14-day window following an indoor gathering?

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After any gathering, especially one that is indoors, keep your distance from other people in the two weeks following. This limits the potential that you unwittingly expose anyone to COVID-19. Also, if you go to a party and two days afterward an attendee tests positive, you will have to quarantine. So, if you kept to yourself for those two days after the party, you will not need to worry that you exposed a friend, colleague, or loved one to the virus.