How Should Your Family Handle the COVID Holidays?

Flying to Grandma’s may be safer than actually *being at* Grandma’s

by Steve Silvestro, MD  @zendocsteve

You can also listen to this article as a podcast on your favorite podcast app or click on the player below:


With the holiday season approaching, we’re capping off our 2020 with some of the biggest COVID-related decisions yet:

“Can we find a way to get together with family? What if we all get tested first? Do we risk it?”

These questions are even more pressing because for those of us who check the various COVID projection sites religiously, it’s pretty clear that by early December the U.S. will be seeing roughly the same number of daily infections as we did back at the peak in March.

Not only is that upcoming spike worrisome and disheartening—it’s also a direct result of the expectation that millions of people will gather with family for Thanksgiving.

We’ve spent much of this pandemic talking about “superspreader events” as large gatherings of people—60-person church choirs, motorcycle rallies, White House events—but the truth is that it’s actually smaller social gatherings that are currently a profound driving force in COVID’s spread through communities nationwide. For example, about a quarter of people who tested positive for COVID-19 in Washington, DC, in early October had attended small gatherings of five or more people in the previous two weeks—and similar experiences are now commonplace across the country.

Canada had controlled COVID quite well this year, especially compared to the United States. But three weeks after celebrating their Thanksgiving on October 12, Canada is now experiencing a surge in COVID infections—many traced back to family gatherings for the holiday.

So what does this mean for your family during Thanksgiving and the winter holidays ahead?

Well, the safest bet would be to avoid traveling altogether and to only celebrate in-person with the people who are currently in your “bubble”—the people you’re already in direct contact with and that’s it.

But recognizing that many families will be traveling or gathering together anyway, here are a few things to know to help make the risk slightly lower. Keep in mind, of course, that even following the steps below will not make any gathering risk-free.

Think of what follows as the “sex ed” of COVID holidays—I’d rather you didn’t do it at all, but since you might anyway, here’s how to potentially lower your risk!


There’s been a lot of talk these last several months about whether flying on an airplane is safe. It turns out that the airplane piece of the travel equation is probably the least risky of all. The air on an airplane is completely turned over every 3-4 minutes—with half of that new air being cleaned by HEPA filters and half being completely new air brought in from outside the plane. AMTRAK trains have similar air turnover features.

The bigger risk when traveling comes from crowds encountered elsewhere in the process. Flying usually requires time spent in a shuttle or people mover at the airport, places where it’s hard to keep your distance. Plus, you’ll likely be waiting in line with dozens or hundreds of people in security at the airport, at the train station terminal, etc.

Driving is theoretically safer, but it presents similar risks if you stop for meals or at rest stops. I’ve lived in the DC area for more than half my life—and with family in New Jersey, I’ve made the trip up and down I-95 more times than I can count. Every Thanksgiving weekend, even those giant airplane hanger-sized rest stops are jam-packed with hundreds of people at a time.

If traveling is a must, I’d suggest wearing a mask AND a face shield when you’re anywhere but your car.

It’s also worth keeping in mind that from a public health perspective, traveling outside your local area is the kryptonite to getting this pandemic under control. If people don’t travel, the virus doesn’t spread and it can be contained in a single region; people unwittingly bringing the virus from one area to the next is what creates new hotspot areas.


This is a question I’ve been asked quite a lot over these last several months, but especially right now. In short, getting everyone tested and quarantined before gathering is a great idea. However, there are things to keep in mind:

  • Not all tests are equal. The majority of the rapid tests—those that come back in minutes or a few hours—have a higher false negative rate when someone is asymptomatic. Assuming that everyone in the family who’s getting tested is asymptomatic (because after all, no one who has sick symptoms should be gathering with family anyway…), then the rapid test isn’t the best choice. Instead, aim for the PCR test, which likely takes a few days to return results but will be more accurate.
  • You’ll need to quarantine until you get your test results back. A test is really just a snapshot of a moment in time—if you got tested on Tuesday and find out on Friday that you’re negative, all you really know is that you were negative on Tuesday. You need to make sure that you don’t pick up COVID in the days between your test and your family gathering, which means isolating until your results come back. This also means that if you’re going to be traveling, the most cautious thing to do would be to get tested before you go, isolate until results come back, travel, then get tested once you arrive and isolate again while waiting for results—only seeing your family once the second test results return.
  • Even quarantining for 14 days beforehand has some points to consider. If everyone who’ll be getting together can quarantine before meeting up, that’s great. But be sure that you all agree on what “quarantining” means. Is someone still going to work? Shopping? Are kids playing with neighbors? You’ll want to hammer all of that out together. Plus, if there’s traveling involved, take into account anyone’s possible risk of infection during their travels.


Okay, so let’s say you’ve made it through the gauntlet of steps above. Great job! But you’re not done—there are still a handful of things to think about to make the actual gathering itself as COVID-safe as possible (though again, nothing is a guarantee):

  • Hang out & eat outdoors if possible. We know that enclosed spaces present the biggest risk for catching and spreading COVID. If weather permits doing so, spend the entire time outside.
  • Cut down indoor risk. If you’re going to be indoors, you can try to boost ventilation by keeping windows open. You could also invest in a HEPA filter. Perhaps better still, consider making the experience a masked social visit rather than a full meal. It won’t feel like the same holiday experience, but eating together means everyone taking their masks off for prolonged periods of time—not the safest choice.
  • One person to serve them all. If you do eat, you’ll want to minimize how many people handle the food. Designate one person to prepare and serve everything. That person should wear a mask and gloves while doing so.
  • Limit the number of people. There isn’t really clear insight on how many people is “too many” when it comes to COVID risk, but the fewer the better. If you’re able to limit to no more than three households, great—two, even better.
  • Again, make sure that everyone’s on the same page. If your family’s been laying low for 7 months but Uncle Jim eats indoors at a restaurant four times a week and thinks this whole COVID thing is a hoax, well this may be the Thanksgiving that you don’t see Uncle Jim. The issue gets a little trickier when everyone is doing what they can, but their job or something else in their lifestyle simply requires that they’re more exposed. Someone who works in a restaurant, a grocery store worker, the nurse who cares for dozens of patients a day. If they’re doing everything they can to be cautious but you’re still left feeling uneasy about getting together, say that in as understanding a way as possible: “Hey, I know you’re doing everything you can to be safe and I respect what you have to do. But my own worries about this mean I’m just not in a place where I feel comfortable getting together right now. Can we come up with a way to still be in touch that day?” If this person whose job requires more exposure is you (in my family, that’s me), it’s helpful to recgonize that: “I’m doing everything I can to be safe a work, but I recognize that I’m a lot more exposed than your family is. If you guys are uncomfortable with that, I’d understand.” Ultimately, the goal really is to make the least comfortable person feel more comfortable—which is kind of a good goal for families at any time, pandemic or not.  (For more info on this, use these tips from my conversation with Evie Granville & Sarah Davis).


Just so you know, I’ll be following my own advice this Thanksgiving. See, we thought we’d had it all figured out—we had found a way for the Maryland Silvestros and the New Jersey Silvestros to meet up for Thanksgiving and it seemed perfect. We’d each be staying in separate homes, one of which had a large screened-in porch with ceiling fans. If we felt confident about doing so, we could eat together there—the NJ crew at a table on one end of the porch, the MD crew at the other. If we didn’t feel great about eating together, our families could just spend time outside over the course of a couple days.

Well, this morning we officially called it off.

If you’ve followed my articles and podcast this year, you know I’ve been tracking COVID stats like crazy. I had really hoped that the numbers wouldn’t pick up too much until after Thanksgiving (again, the rise partly being because of Thanksgiving). Unfortunately, the stats in both New Jersey and Maryland—and, really, everywhere else—have been skyrocketing over the last two weeks. And it’s not even a curve—the charts are going straight up!

I know that my family’s been making smart choices and that the NJ Silvestros have been, too. But I also know that the worry about the potential risk would likely be stuck in the back of my head throughout our travels and the whole time we’d be together. That, combined with the unknown of where things will be a just few weeks from now, made canceling our plans the smartest decision no matter how much of a massive bummer it is to all of us.

But I also know this isn’t going to stop us from having a great Thanksgiving and Christmas up ahead. So many of the problems faced this year have been a result of everyone trying to jam round pegs into the square hole that is 2020. But 2020 requires a bit more creativity and an open mind, and we’re ready to dig deep to find the fun.

No decision this year has been easy. But my hope is that with the information above, you can make informed decisions that are best for your family—so that you, too, can find the fun and create holiday joy in whatever way you can.