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A gathering of friends around a candlelit table with turkey in the middle of the feast.
While many of us are ready to restart our holiday gatherings, officials urge caution because a potential winter spike could overwhelm hospitals in some areas. (Cottonbro/Pexels)

Hosting Loved Ones for Thanksgiving 2021? Here's How to Keep COVID Out

Hosting Loved Ones for Thanksgiving 2021? Here's How to Keep COVID Out

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We've come a long way since Thanksgiving 2020.

A year ago, vaccines had not yet been approved, daily deaths were rising sharply — surging to more than 2,000 a day by December — and many hunkered down and skipped holiday celebrations to reduce their risk.

California now has one of the lowest coronavirus infection rates in the country, with 1.9% of people testing positive for the disease in the last week. Coronavirus hospitalizations in the state have fallen about 14% in the last month.

About half of people living in the U.S. are planning to gather in groups of 10 or more for the holidays, a recent survey found. While many of us are ready to restart our holiday gatherings, officials urge caution because a potential winter spike could overwhelm hospitals in some areas.

Nearly two years into this pandemic, we've learned a lot about how to reduce the risks of catching and spreading the coronavirus, including the simple steps of masking, hand-washing and taking precautionary COVID tests.

Experts warn we still need to keep COVID risk reduction in mind. Even if you and your family are fully vaccinated, young kids, people over 80 and immunocompromised people are still at higher risk of severe COVID. Now, the Centers for Disease Control and Prevention recommends booster shots for everyone 18 and older, especially for those 50 and up.

We wanted to hear directly from our readers and listeners about the frank and even tough conversations they were anticipating having with their loved ones, from setting personal boundaries to even having COVID-safer gatherings outside.

Here are some reminders from experts on how to keep your holiday gatherings safe.

Be transparent about your personal boundaries for gatherings of any size or setting

Even in a holiday season without a pandemic to consider, your movements and actions regarding an event like Thanksgiving are always yours to decide. Regardless of what others, like family, friends or strangers, may think, your time and your personal space are completely and utterly your business and yours to direct as you see fit.

If you're weighing whether or not to attend a gathering with loved ones this year or to host a dinner of your own, it's important to be able to communicate your personal boundaries in a variety of settings, even if it leads to uncomfortable conversations.

Dr. Richard Carpiano, a professor of public policy at UC Riverside and speaker on vaccine hesitancy, underlines the importance of checking in with the host (or your guests) and stating what your personal comfort levels are and what precautions you're taking — whether it's wearing a mask indoors or preferring to eat outdoors — in a frank way.

Ultimately, you can make it about you and your personal preferences. Be specific about your COVID safety choices with hosts or other guests, he says: "It's very important that people should be willing to speak up and not feel peer-pressured because they have to show up to some place or feel like they're being put in some sort of undue risk."

Sure, some of these conversations could feel awkward at first. But Carpiano says that ultimately these conversations are with friends and family — and they should support the decision you choose for yourself.

Ultimately, you're making this decision to reduce your family's risk of contracting and spreading COVID-19, and it's your way of keeping them safe from harm.

"That is an ultimate act of care and we need to focus on that," says Julia Feldman, a teacher and sex educator in the Bay Area.

Be firm and up front about getting vaccination statuses from guests — and don't feel guilty about asking

Just as much as the ingredients on your shopping list, knowing the vaccination statuses of other guests is an essential part of hosting a COVID-safer gathering.

While it might feel like trespassing on personal information, Carpiano reminds us that we're in a pandemic and our fates are intertwined. "This is not something like if somebody has high blood pressure or diabetes where their condition is not affecting other people," he says.  

He suggests making a plan to communicate to guests what your preferences are and what your stance is — especially if you're the host.

If you're speaking with someone who still hasn't been vaccinated, it's important to lead with the facts and be clear on your priorities for keeping everyone healthy — especially if young people, older people and immunocompromised guests will be attending.

Trying to "convince" your loved ones of the pandemic's devastating seriousness by sending them statistics and literature probably isn't going to change their minds at this point, Feldman says. So, what can you do? "You just really have to come from an emotional place of being honest," Feldman says.

When navigating a difficult conversation, you might be tempted to stay extra firm and resolute in your communication, in case the recipient interprets any hesitation as a cause for hope that you haven't really made up your mind. Being firm and specific in what you will and will not do is great, Feldman says, but don't let that stop you from "expressing [your] sadness and regret," she says.

Think carefully about how to include unvaccinated family members

Deciding whom to invite to your home is a matter of personal discretion, but experts say at this point in the pandemic it's pretty clear that a fully vaccinated group is the safest scenario.

"I think it's reasonable for people to require their guests to be immunized," says Judy Guzman-Cottrill, a pediatric infectious disease expert at Oregon Health and Science University, especially if guests include kids too young to be vaccinated (or who have only received their first shot) or people less likely to have a strong immune response to the vaccine, like the immunocompromised.

"Those are the people who we still really need to make sure we keep as safe as possible because this pandemic is not over," she adds.

A vaccine requirement could lead to some hurt feelings or conflict, but physician and public health epidemiologist William Miller of The Ohio State University suggests framing the decision as a way to protect older loved ones.

"I really do think that it's perfectly acceptable to say, 'I'm sorry you're not vaccinated. You know, Grandma's here, and by you coming, that increases her risk substantially,'" Miller says.

An alternative is to ask an unvaccinated guest to do a lab-based PCR test 24 to 48 hours before the event (as long as they're able to get the results back in time) or a rapid antigen COVID test just before their arrival. In addition, Emily Landon, an infectious disease physician at the University of Chicago, recommends asking unvaccinated guests to take extra precautions in the week leading up to the event, including wearing masks in public places and limiting exposure to other unvaccinated people.

"We think with the delta variant, most people are getting sick a few days after exposure, but it can take up to a week, maybe a little longer," Landon explains. "I think it makes the most sense to take precautions for one week prior to having close, unmasked contact with someone who's at high risk."

Take precautions if your young child is unvaccinated or has had only one shot

Many children age 5 to 11 have received their first of two recommended doses, but won't be eligible for a second dose until after the Thanksgiving holiday. Immunity builds gradually after vaccination, but it's not known exactly how much protection just one dose of the COVID vaccine provides to kids, says Guzman-Cottrill.

"I know many families find themselves in this annoying state of limbo right now because their kids will not be fully vaccinated by Thanksgiving," she says. Given this "limbo" state, "it's really important to just keep in mind that this is not the time for those families to let their guard down," she says. It's not a reason to cancel multigenerational gatherings, but it's a reminder to take precautions.

Carpiano says that caregivers should do risk management of sorts and be prepared to bring masks and buy home tests you can take the day of arriving at someone's house. "What we're finding right now with testing is that these home tests can be really quite effective in [detecting] if an immediate or recent sort of infection has occurred," he says. While these home tests might be a little hard to find, they are available at many local drugstores.

So, what precautions are recommended for protecting more vulnerable guests from possible exposure due to unvaccinated kids? It depends on the health and age of the relatives who will be attending.

"If Grandma is a spry 70-year-old woman who has no medical problems and has two doses of vaccine plus a booster, I don't think these kids are going to pose a ton of risk," Landon says. But if the grandparent is over 80 and has medical problems, the risk of a bad outcome is much higher.

An easy step to take if you're concerned about your unvaccinated kids passing the virus to grandparents is to mask up, not only during the visit, but also for a week in advance when in public, especially avoiding crowded, indoor spaces, even if mask mandates are not in effect.

She says she would not recommend keeping kids out of school to avoid exposure unless there are extra risks associated with your kids' school — such as an outbreak of cases or a lack of masking. If the circumstances warrant missing school to protect a high-risk relative, "then that may be a layer you want to add," Landon says.

Another option: If you live in a temperate climate, like many parts of the Bay Area, stay outdoors as much as possible for mixed-generation social events, and maybe choose to not sleep over in the same house with the grandparents.

"Just come during the day for the big event and stay at a hotel," Landon suggests. Or have the grandparents sleep in a hotel, she adds. If a hotel is not financially possible, you might consider asking friends or neighbors if their home is empty over the holiday season and available for you to use.

Bottom line: "You have to think about the risk of the individuals involved — about what would happen if they got COVID," says Landon. And better to err on the side of caution.

If you're gathering with grandparents or other older people, realize this: They're still at risk

Reality check: People over 80 have an elevated risk of dying from COVID, even if they're vaccinated.

While the vaccines offer strong protection against hospitalization and death, breakthrough infections are a reality. Often, a coronavirus infection following vaccination leads to only mild illness, and sometimes people test positive but show no symptoms at all. However, older people and those with compromised immune systems are at higher risk of getting a severe breakthrough COVID case.

Though it's rare for breakthroughs to lead to hospitalization or death, the chances for one group are higher. As NPR reported, CDC data from August showed that fully vaccinated people age 80 or older were about 13 times more likely to die from COVID compared to the general vaccinated population (of all ages). That's one reason getting boosters is especially important for older adults.

"This is something that we must be conscious of as people are gathering across generations," Miller says. "Grandpa and Grandma are protected relative to if they hadn't been vaccinated, but they are still at risk."

That's why it makes sense to take precautions during travel and in the week leading up to any celebration where older friends and relatives will be present.

"I would absolutely encourage people to continue to wear masks" in crowded, indoor places such as grocery stores, Miller says, even if it's not mandatory. This will reduce the risk of being exposed and passing on the virus. And remember, the Transportation Security Administration's face mask requirement remains in effect through Jan. 18, 2022, requiring masking in airports, aboard commercial airline flights, and on commuter bus and rail systems.

So, bottom line, even if everyone invited to your holiday gathering is vaccinated, it's still important to protect loved ones who are older or immunocompromised.

Get a booster shot if you're eligible

Federal health agencies now recommend COVID vaccine boosters for all adults six months after their last shot — and they may be especially important for adults over 50 or any adult with underlying conditions or a high-risk job. Getting one before holiday travel and gatherings could increase your immunity against COVID.

The agencies' decision was based on emerging evidence that immunity can diminish over time and evidence that shows a booster dose can, just as the name implies, boost protection.

Some of the most recent real-world data comes from the U.K. Back in September, the U.K. government introduced a booster program targeting people 50 and older.

Dr. Anthony Fauci, White House medical adviser and director of the National Institute of Allergy and Infectious Diseases, said the new analysis points to a significant increase in protection (against symptomatic infection) from a booster dose.

"If you look at the third dose in people whose protection has drifted down to about 63%, you boost it back up to at least 94%, which is really quite impressive," Fauci says. "That's exactly the kind of thing you want boosters to do."

Fauci says immunity begins to rebound within days after getting a booster shot, though you don't get the peak of protection for two to four weeks later. He says before joining indoor holiday gatherings, especially in places with high viral transmission, "I would recommend if you are eligible for a boost, go get boosted right now."

Rapid tests can protect your guests. Here's how to know when to take one

As a risk-reduction measure, you might want to ask your guests to take a COVID test before a large holiday get-together. A year ago, it was hard to get real-time information from COVID testing due to delays in test results and a lack of rapid test options. Now, there are plenty of over-the-counter rapid antigen tests, such as the Abbott BinaxNOW or Orasure InteliSwab, available online and in pharmacies.

"A rapid antigen test is an added layer of protection for everyone," says Guzman-Cottrill, the pediatric infectious disease expert at Oregon Health and Science University.

"The antigen tests are a quick snapshot to see if the viral proteins are present in that person's nose that day," Guzman-Cottrill explains. So if a person was just exposed and the virus is still incubating, they could get a negative result one day followed by a positive result the next day.

The tests are not 100% reliable if someone has just been exposed, agrees Emily Landon, the infectious disease physician at the University of Chicago. "The test really doesn't pick up really low levels of the virus in your nose, and so it's not going to pick up a really early infection," she says. So she recommends taking the test the morning of the gathering, or as close to the start of the gathering as possible.

Some families test before they travel, and then again when they get to their destination, depending on the level of risk of the people they're staying with. (Note: Depending on which test you buy, instructions vary. For instance, BinaxNOW instructs that people should be tested twice over three days with at least 24 hours between tests for most accurate results.)

William Miller of The Ohio State University College of Public Health is on board with a test-to-be-safe strategy, too. "It's kind of a mindset," Miller says.

It's a way to signal: Let's make the visit as safe as it can be.

Copyright 2021 NPR.

This post includes reporting from KQED's Alex Gonzalez, Brian Watt, Carly Severn and Lina Blanco. Thank you to our readers and listeners for sharing their questions with us. 

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