How to safely celebrate winter holidays

More than six months into the COVID-19 pandemic, the U.S. finds itself at a precarious point.

Overall, controlling the spread of SARS-CoV-2 remains challenging, and transmission rates are high in many areas. And now we're moving into a time when fall and winter weather in many areas of the country may limit outdoor activities. This pandemic will not be over any time soon, so we need to figure out how to have enjoyable experiences with friends and family. Nothing is zero risk, but we can all make choices that minimize risk.

A decision-making framework can help us pace ourselves for this next phase in the pandemic marathon. There are a few core elements to consider as you plan for the holidays and gatherings ahead:

• Outdoors is still better than indoors. This may involve being creative in the winter months, layering up in warm gear, and setting up yards and outdoor spaces such as parks in new ways.

• If you have to be indoors, consider air flow. Ventilation and air circulation are your friends. Open windows, increase circulation, and keep room density as low as possible with fewer people in one space.

• Consider a pod. Consider setting up a small group of friends or family with similar mindsets and a commitment to restricting activities outside the pod. You'll need to consider chains of transmission and avoid interactions with large numbers of people, or with individuals who may themselves be interacting with a large number of other people.

• Mask up. Wear masks whenever you are around people outside of your immediate pod or household—at all times inside and outside when it's not possible to be six feet or more away from others.

• Wash your hands. Hand hygiene remains a critical way to help stem the spread.

• Have a plan for quarantining and isolation. Be prepared in case someone in your household or pod has exposure to a known COVID-19 case, exhibits symptoms, or is diagnosed. Know where you can be tested. Plan for how you would implement a 14-day quarantine if you are exposed. Plan for how you would isolate and care for an infected person in your home for at least 10 days (with an additional 14 days of quarantine after the infected person recovers for the caregiver who was in close contact).

• Think carefully about travel. Travel brings its own particular considerations. Some states have implemented mandatory quarantines that could impose travel restrictions or fines for out-of-state travel or visitors. If you are exposed at an out-of-state gathering, you may have to unexpectedly extend your stay in that area for 14 days. Traveling out of state may also mean quarantine requirements from your work or child's school when you return home, particularly if you traveled to an area with high levels of community transmission. If you become ill shortly after you arrive at your destination, you may have to seek medical care in an area away from home.

Getting sick with COVID-19 is not the only risk to consider. We tend to think the two greatest risks of the pandemic are contracting or spreading COVID-19, but there are other risks as well. Consider whether anyone has a work or home situation that could be complicated by quarantine or isolation. Not all jobs allow for time off or working from home in the event of a need to quarantine, and some employers may even require testing before returning to work if there has been known exposure.

Now, let's consider some specific scenarios.

SCENARIO 1: Halloween Trick-or-Treating

This Halloween, let's keep things safe as well as spooky.

Here are more tips for planning this holiday season: https://t.co/34aSq3yn5e pic.twitter.com/oHcb1BaS87

— Johns Hopkins Bloomberg School of Public Health (@JohnsHopkinsSPH) October 19, 2020

Halloween is one holiday that can probably be celebrated relatively safely, but you'll still have to weigh the benefits and risks neighborhood by neighborhood. If your area can get very crowded, you may want to leave the candy outside and have a private candy hunt in your own yard or house.

Here are some things to consider:

• All festivities should be held outdoors

• Walk in small groups (e.g., your family or pod) and keep distance from others; don't congregate in large groups

• Leave candy on a table or a front porch rather than handing out in person, and consider spreading it out on a blanket or table near the sidewalk to reduce crowding around a bowl

• Wear masks that cover your nose and mouth. A Batman eye mask is not enough! You can get creative by including a mask as part of your costume. We might see a lot of ninjas and medical clinicians this October

SCENARIO 2: Hosting out-of-state guests in your home or traveling out of state

Hosting friends or family who have traveled from out of state, or traveling yourself, requires clear communication ahead of time. Here are some things to consider:

• Driving is safer than flying

• Carefully consider travel to areas with high levels of community transmission

• If testing is available, consider asking everyone to get a COVID-19 test a week or so prior to the event and then quarantining between testing and travel

• Acknowledge that there are risks to gathering and have an open discussion about those

• Discuss how an exposure or diagnosis would be communicated to everyone

• Plan for post-event quarantining and testing

• Check whether you will face mandatory quarantines from your local jurisdiction, workplace, or child's school if you go to an area with high community transmission

SCENARIO 3: College students returning home for Thanksgiving/winter holidays

Some college students may return if their campus had to close due to an outbreak that would necessitate quarantining and possibly testing.

But for those who have been in session all fall, getting tested upon arriving home is still a safer bet for the whole family. Quarantine for 14 days upon arriving at home—regardless of a test result—may be warranted if you know the institution your child attended had high transmission rates prior to the holiday break.

SCENARIO 4: Attending a holiday party, funeral, wedding, or other large gathering with family and friends

In-person attendance at these activities should be considered high-risk. Events can be made safer if held outdoors with participants wearing masks and keeping physical distance from one another, but it can be very hard to maintain these safety practices, particularly at celebratory events.

Innovation is key. Consider planning a small and intimate or fully online event now, and a larger in-person event once the pandemic has resolved. Consider attending "in spirit" with a small ritual in your home or create a synchronous moment on a specific date and time when those not in attendance observe a ritual to show their support and feel connected.

SCENARIO 5: Celebrating birthdays—especially for children—in the winter months

Zoom parties are still the best option for gathering a group, but if you're burned out on screen time, there are a few ways you can get creative.

• "Drive-by" parties on front porches and sidewalks

• Card parties: Have lots of friends and family send postcards and cards

• Balloon celebrations

• "Pod" parties with a small group, ideally outdoors and still with distancing (think Pin the Tail on the Donkey rather than Telephone)

• Undivided attention can help children feel special: Play "Ruler for the Day" where the child picks the activity (a family movie, hike, or perhaps craft) and the meals—Donuts for dinner, anyone?