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UPDATE: Family Gatherings in the Time of COVID-19: Are They Safe?

Susan Fleischman, M.D., chief medical officer, Blue Shield of California Promise Health Plan, offers advice for safety during the holidays

Editor's note: This story has been updated to address new statewide measures announced Nov. 16, by California Gov. Gavin Newsom.

The COVID-19 pandemic has radically transformed how we work, whom we see, and how we navigate our daily lives. Now that the holidays are upon us, it makes gathering with friends and family especially fraught.

“We are very worried about the upcoming holidays. People are experiencing ‘COVID fatigue,’ and craving time together with their friends and families. We are also seeing increased risk in most counties in California, and we are about to enter flu season. All of those things combined can create a perfect storm for worsening situations in our communities,” says Dr. Susan Fleischman, chief medical officer of Blue Shield of California Promise Health Plan. Below, she answers our questions about how to have a safer season this year.

Dr. Susan Fleishman

Dr. Susan Fleischman

Do masks still need to be worn for outdoor holiday gatherings?

The safest way to be together is to be outside, to wear masks and remember to stay six feet away from those not in your household. Being outside is not a guarantee of safety, but indoor gatherings do pose more risk than outdoor gatherings. Indoor gatherings in poor ventilation areas pose even more risk. 

But if you have to be inside with people not in your household, wear a mask and open windows and doors. 

If you’re planning to gather in a small group, should everyone in the group take a rapid COVID test beforehand?

The Centers for Disease Control (CDC) doesn’t recommend testing before an event, even though many people think that adds a layer of safety. There are a variety of reasons for discouraging this. We want to be sure testing capacity is used in the best way, starting with symptomatic, exposed, or high-risk individuals. Also, there are false negatives in testing, which can lead to a dangerous confidence and risky behavior if someone is actually infected. And the timing of the test is critical. For example, if you were exposed to COVID-19 yesterday, and have a test today, and then go off to Thanksgiving in a week, your test could be negative and give you a false sense of security by the time you reach the Thanksgiving table. If you got infected on Thursday and had a test on Friday for a Saturday gathering, those early results will likely still be negative but you’re able to spread the disease. A negative test the day before an event does not guarantee safety. 

How reliable are the rapid tests? 

All testing has the possibility for false negatives, and it depends on timing. Even if you’re showing negative results, you should still follow COVID-19 safety protocols of washing hands, wearing masks and distancing.

What’s the limit of people you should have if you’re having a holiday gathering? How long can you safely gather?

First, you should follow local county and city ordinances regarding the limits for social gatherings.

The longer you are together with people outside of your household, the higher the risk is. There’s no “safe” number of people because it just takes one super spreader to infect an entire gathering. There’s no scientific cutoff, but if you’re playing odds, shorter is better than longer and a smaller gathering is better than a bigger one.

Do social distancing and masks apply for young kids at holiday events?

Children ages 2 and older should wear a mask when in public and around people who don’t live in your household. 

What are the recommendations for serving food at a gathering?

It’s always important, but especially now, for the person preparing the food to wear a mask and wash their hands frequently, and for everyone to wash hands before they eat. No buffets—plate the food first. And because you have to take your mask off to eat, it’s even more important to maintain that six-foot distance from people.

Are there any specific safety steps that should be taken when holiday shopping?

The same rules apply: wear your mask; wash your hands; stay six feet away. Inside is riskier than outside. Longer is riskier than shorter. Remind yourself that it is OK to turn around and leave if you’re uncomfortable with how crowded a store is—no gift is worth the cost of your health, or infecting someone else. And, obviously, online shopping is the safest. 

Is it safe to fly to visit my family?

Governor Newsom published a new travel advisory Nov. 13 asking Californians to avoid non-essential travel at this time.  Also per the advisory, “persons arriving in California from other states or countries, including returning California residents, should practice self-quarantine for 14 days after arrival. These persons should limit their interactions.”

The CDC says staying home is the best way to protect yourself, though airplanes are not the major mode of transmission right now—it’s actually family gatherings. You can get COVID during travel, and even if you have no symptoms, you can spread it. You’ll also want to check the number of cases where you’re going, and where the people you will be with are coming from. Remember, it just takes one person to pass along an infection.

Spending time in lines or in terminals brings you in close contact with others.  While the ventilation during flights is good, social distancing is difficult on a crowded flight. Sitting within 6 feet of someone for hours can increase your risk. 

Should grandparents and seniors take any special precautions when visiting with family and friends?

Because the risk goes up with age, in particular over the age of 65, I would caution grandparents around any family gatherings, as sad as that is. Children frequently don’t get sick but can spread the disease. The older you are, the riskier it is to attend or host a family gathering—even with all the precautionary measures in place. 

If we host an outdoor gathering, is it safe for guests to go inside to wash hands or use the restroom?

Yes, but they should wear a mask. They should make it brief, have the window open, and if possible, leave time to ventilate in between people using the restroom. Of course you want people to wash their hands—you can also add a bottle of sanitizer (at least 60% alcohol) to every table to reduce the number of trips inside.

Is it best to use disposable plates, cups and utensils?

While we haven’t seen transmission from washing dishes, the person doing that task is making contact with a lot of surfaces others have touched.

The big benefit is that it’s a great way to avoid dishwashing!

Anything else people should know?

Even though we want to enjoy the holidays, the virus does not respect the importance of holidays. 

As much as I want to see my family, I absolutely don’t want to ever have to live with the thought that I might have infected anyone, especially a loved one. The best thing might be to change our expectations for this year.

We can get through this if everyone does what we need to do. Here’s to a safe holiday season.