It’s been a year of sacrifice, social distancing and skyrocketing stress. Can we at least enjoy Thanksgiving?
In terms of risk, the timing of the Thanksgiving holiday couldn’t be worse. The coronavirus is raging across the country, setting new daily infection records. More than 235,000 Americans have died of Covid-19, and small gatherings are believed to be fueling much of the spread. While public health officials caution against family and friends gathering in homes for the traditional Thanksgiving meal, they know many people plan to spend the holiday together anyway.
The solution? A scaled-back Thanksgiving — with open windows, fewer people and a big serving of precautions.
“You don’t want to be the Grinch that stole Thanksgiving,” said Dr. Anthony S. Fauci, the nation’s top infectious disease expert. “But this may not be the time to have a big family gathering. That doesn’t mean no one should gather for Thanksgiving. It’s not going to be one size fits all. You’ve got to be careful. It depends on the vulnerability of the people you’re with and your need to protect them.”
Many of us feel safer gathering in our homes, rather than at a restaurant or public space, but experts say we underestimate the risk when it comes to private get-togethers. Homes are now a main source of coronavirus transmission, accounting for up to 70 percent of cases in some areas. A recent study by the Centers for Disease Control and Prevention of 101 households in Tennessee and Wisconsin found that people who carried the virus, most of whom had no symptoms, infected more than half of the other people in their homes.
Health officials say they believe small home gatherings are fueling the spread of Covid-19 in part because most homes, by design, are poorly ventilated. Most office buildings, hospitals and restaurants have mechanical ventilation systems that pull outside air inside, push stale air outside and recirculate indoor air through filters. But homes typically don’t have those kinds of ventilation systems, and indoor air changes far more slowly as it leaks through small cracks or gaps around windows and doors. Many homes, in fact, are sealed up tight to make them more energy efficient.
While that may save on heating bills, it means that invisible viral particles from an infected guest or family member can build up quickly in your home or around the table as that person breathes, talks or laughs. Large droplets fall to surfaces or the ground, while smaller particles, called aerosols, can linger in the air, putting everyone in the house at risk.
The World Health Organization recently said that to reduce viral spread, buildings should have ventilation that changes the total volume of air in a room at least six times an hour. Although there’s wide variation in how different spaces are ventilated, some hospitals, planes and new buildings may change the air as much as 12 times an hour. Some schools and restaurants may have air exchange rates of three to five times an hour.
By comparison, the air in a typical home changes only about every one to two hours, said Shelly Miller, professor of mechanical engineering and a ventilation expert at the University of Colorado, Boulder.
“I’ve been concerned that people are not completely understanding how ventilation in the home is different than ventilation in commercial spaces or schools or hospitals,” said Dr. Miller. “I want people to understand that their homes are generally not ventilated. If you have friends over for dinner and someone is infectious, aerosols can build up.”
Depending on the home, weather conditions and other variables, research shows that opening multiple windows — the wider, the better, and in every room if possible — can increase the air exchange rate to as much as three times an hour. If it’s cold outside, turn up the heat or use space heaters as needed.
Dr. Miller also suggests turning on exhaust fans, which are typically found in bathrooms and over the stove. While those precautions won’t eliminate risk, even a few exhaust fans, combined with opened windows, can help.
“Exhaust fans were put in homes specifically to take out contaminants that are a problem,” said Dr. Miller. “You are creating a negative pressure inside the space, sucking air out at a higher rate.” (Don’t use a regular fan, she warns, which just moves air around the room and can increase risk to the group if someone nearby is infected.)
A portable air cleaner can also reduce risk, but buy an appliance large enough for the room size, or obtain multiple air cleaners for a large space. Use this online search tool from the Association of Home Appliance Manufacturers and read more from Wirecutter, a New York Times company.
Look for a cleaner with a high “clean air delivery rate,” or CADR, said Linsey Marr, a professor of civil and environmental engineering at Virginia Tech and expert on aerosols. “It’s going to bring down the levels of virus that might be in the air,” said Dr. Marr.
The most difficult choice you have to make this Thanksgiving may be winnowing down your guest list. Experts advise keeping it small and limiting the number of households attending. (It’s best not to mix households at all.)
Dr. Fauci, who is 79, said his three adult daughters, who all live in different parts of the country, have decided to skip the family Thanksgiving to avoid putting him and his wife at risk. He said people often wrongly assume they are safe if they just invite family or trusted friends.
“Most people feel when they’re in the house with friends, they almost subconsciously let their guard down,” said Dr. Fauci, director of the National Institute of Allergy and Infectious Diseases. “They don’t realize they’ve come in from multiple cities, spent time in airports. They come to a house where Grandma and Grandpa are, or someone with an underlying condition, and they innocently and inadvertently bring infection into a home. It’s dangerous. You’ve got to be careful.”
If you do decide to invite outside guests, you should take as many precautions as possible. Here are additional suggestions to help make your Thanksgiving safer for everyone.
Assess the risk
To start, answer a series of questions to determine the potential risks of your gathering. Do you have a vulnerable person at your family table? Are virus cases on the rise in your area? Are guests traveling from hot spots? If the answer to any of those questions is yes, you should reconsider bringing those guests into your home.
Ask your guests to take early precautions
Once you’ve decided to invite additional guests, ask them to be vigilant in reducing their contacts and potential exposures for at least a week, and preferably two weeks, before Thanksgiving. If testing is available in your area, consider asking all guests to be tested a few days before the holiday, timing it so they get the results before coming to your home.
“Everyone can try to reduce the number of contacts for at least the week before the event, and do the same after as well,” said Julia Marcus, an infectious disease epidemiologist and associate professor in the department of population medicine at Harvard Medical School. “Just trying, to the best of your ability, to be more conscious of the contacts you have before and after you gather can be a risk reduction strategy.”
Move the dinner outside
If the weather permits, try hosting all or part of your holiday celebration outdoors. Look into space heaters and fire pits to warm a porch or patio. Or consider a partially open space, like a screened-in porch or a garage with the door open to reduce risk.
Reduce the time you spend together
If an infected person joins your dinner, your risk of catching the virus increases the longer you spend time together. Keep your holiday celebration as short as possible.
Wear masks during downtime
All guests should wear a mask when not eating. Screaming and cheering increases the amount of viral particles that a person emits, so skip the big game or at least wear a mask while you’re watching it.
Don’t share serving utensils and other items
Guests should have separate serving spoons and avoid sharing and passing serving dishes or utensils. Be mindful about touching water pitchers, wine bottles and drinking glasses handled by others. Wash hands frequently. Place disposable paper towels in the bathroom so your guests aren’t sharing the same hand towel. Space your guests so they aren’t crowded around a table.
While all this might sound like overkill, remember that the virus is highly transmissible, said Dr. Asaf Bitton, executive director of Ariadne Labs at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health. Dr. Bitton said he knows his patients are suffering from pandemic fatigue, but he advises against socializing with non-household members for the holiday.
“They say, ‘Thanksgiving is really important to us. If we just have a small gathering inside, would that be OK?’” Dr. Bitton said. “I can’t recommend that. I think people have a lot of wishful thinking. I am totally sympathetic to it. This whole situation stinks.”