Most years, in the anxious days before Thanksgiving, I write a health-related FAQ. It’s meant to be fun, reminding us of the timeless risks that spike every year around this day, such as Salmonella poisoning and fires from exploding turkeys.
This year is different. On Thursday, the CDC advised Americans not to congregate with people outside their immediate household. If anything, the advisory understated the risk at hand, saying that “travel may increase your chance of getting and spreading COVID-19.” Travel does increase your risk. It should have read: Do not travel. Do not gather. Effectively, Thanksgiving is canceled. Just wait one year, and then have a basically normal holiday. If everyone in the United States did this, we’d likely save thousands of lives.
Many people have changed or pared down their holiday plans, but many others have purchased tickets, their hearts and minds made up. At this point, since millions of people are likely to attempt some form of intermediate-risk Thanksgiving, we should consider a harm-reduction approach. Just as sex-education classes for teens are not meant to encourage those activities, this FAQ is not an endorsement of Thanksgiving gatherings. It is only an attempt to respond to reality.
If you’re going to travel to see family, how should you rank the modes of transport?
Purely from the standpoint of coronavirus transmission (not carbon emissions, cost, time, or other safety concerns), here’s a very rough hierarchy from safest to riskiest:
- Walking or biking
- Driving in a car with people inside your bubble
- Riding the subway
- Driving in a car with people outside your bubble
- Taking a submarine
Does the risk of air travel change during Thanksgiving if tons of people fly?
Yes. Up until now, flying itself has proved to be low risk: The ventilation is good, and people wear masks and are mostly quiet. Airports with large crowds are likely more hazardous than time spent on the plane, and that risk will increase as more people travel. Still, the act of flying in a plane is less of an issue than close, prolonged contact in a home where people are eating and socializing. Traveling vigilantly, only to arrive at someone’s home and act as though there is no pandemic is a serious misallocation of anxiety.
I’m not feeling well, but I think it’s just a cold, because I tested negative for the virus. Should I go to an outdoor gathering?
No. A negative test isn’t enough to reassure you that you don’t have the virus, especially if you have symptoms. The most common coronavirus test, a PCR test, can confirm only that you do have the virus, but it can’t ensure that you definitely don’t.
If you’re not feeling sick, is it morally defensible to get a coronavirus test in order to see family, given testing shortages?
In many cases, no. Sick people need those tests, and so do essential workers. They don’t need to be waiting in a three-hour-long line between shifts to get tested. That said, there are situations in which people may have an urgent need to see one another this winter. The most obvious example is when someone is terminally ill or unable to care for themselves, or they are especially isolated and depressed. If you’re fortunate to not fall in any of those categories, and seeing family can wait until the spring or summer, do that. Leave the tests for those who need them.
Should my family do temperature checks at the door?
No. This is an even less effective mode of screening than PCR tests. By the time a fever develops — if it does at all — you’ve likely been contagious for days. So temperature checks give a false sense of security. The fact that someone doesn’t have a fever isn’t meaningful information that should change how they behave, or how anyone else behaves around them.
How much safer is an outdoor meal than an indoor meal?
Much, much safer. Almost all transmission of this virus happens indoors.
Even if people are close together?
Eating outdoors doesn’t mean you’re invincible. Still try to stay six feet apart. If you huddle together around a cramped table and have close, face-to-face conversations with the people next to you, you could absolutely infect them.
What if Uncle Al won’t pull his mask up over his nose?
If you insist on having a family gathering, at least make clear ground rules. Ask everyone to agree to them beforehand, and to help correct people who seem to be forgetting. Even if Uncle Al believes some bizarre chain email he read about how masks are communist propaganda, he agreed to the rules for the day. Once he has made the choice to attend, he has made the choice to wear a mask, and to wear it properly. If he doesn’t go along with the rules, the whole group should ask him to leave.
Why is everyone freaking out? I’ve gotten together with my family several times since the start of the pandemic and no one has gotten sick. Most cases of COVID-19 are mild.
I think that’s exactly the challenge. Warning people about this virus isn’t like warning them not to touch a hot stove. In that case, the outcome is predictable every single time. With COVID-19, a Thanksgiving dinner may leave everyone unscathed — or it may lead to serious illness and death for multiple people around the table, and countless more who contract the virus from them. But, taken together, it’s practically inevitable that lots of individual “it’s probably fine” choices accumulate into one enormous, very bad decision.
Anthony Fauci said this weekend that we all need to do a “risk-benefit assessment” before traveling. I think the benefit of Thanksgiving is so great that I’m willing to take the risk.
Assessing the risk of any single gathering is impossible. Even if you’re ready to die, and you’d sooner die than do a virtual Thanksgiving, you could infect other people and set off a chain of infections. Any assessment of personal risk that you’re willing to take would have to factor in how much harm you’re willing to cause.
I’m alone this Thanksgiving. What should I do?
Lots of people are alone for Thanksgiving every year. Fortunately, this year has produced tons of guides for cooking for one. There are also new ways to interact with family and friends that didn’t exist in the past. Suddenly, eating in front of your computer has gone from sad to virtuous, and potentially even fun.
Since coronavirus cases are rising in some places more than others, should people evaluate their Thanksgiving risk differently depending on where they live?
Technically, risk increases as the disease becomes more ubiquitous. That is, a 20-person gathering in a part of the world with little or no virus, such as New Zealand, is very unlikely to lead to infections. The same 20-person gathering in the U.S. is more likely to lead to infections. And at a practical level, though, no part is free of the virus to a degree that should allow people to gather outside their bubbles without extreme precautions.
Because some hospitals are overloaded, should we stop doing things that are unrelated to the pandemic? Like shoveling snow? Speeding? Opening a champagne bottle with a sword?
The sword openings are fine. But never speed. Keep a regular exercise routine to lower the chance of having a heart attack when you shovel snow. This winter is going to be a bad one to find yourself in a hospital. If you’re seriously injured, you’ll likely get medical care that’s similar to what you would receive in another year. But minor injuries and mild symptoms of conditions such as heart disease will be triaged, delayed, and missed. The health effects will play out in years to come. Those who do get treated in a hospital will add to the strain on an already overwhelmed health-care system. About one in five American hospitals is already short on staff, and hospitalizations continue to rise. There are some regional variations to this answer, but overall this is not a good time to need elective care. Be especially careful.
I feel restless. I can’t just sit at home and do nothing. I’m worried about everyone having Thanksgiving. I’m not a medical professional, but I want to help.
The U.S. is seeing a surge in food insecurity. If you can volunteer any time, money, or nonperishable foods, now is a great time to do that. You don’t need a medical degree to help address the effects of the pandemic. A sense of purpose can go a long way to staving off the darkness of winter in any year, but especially this one.
If I put a frozen turkey into a deep fryer this year, will it still explode?
Yes, thaw your turkey. Dropping a frozen turkey into boiling grease will send flames 20 feet into the air. Yet people do it every year. There are some truths about humanity that even a pandemic cannot change.
Originally published at www.theatlantic.com on November 23, 2020.