But what about Thanksgiving?

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You know that moment in horror movies when someone is about to do something really stupid and you start yelling at the screen: “Don’t go in the basement!”?

Well, that’s sort of how epidemiologists are feeling about Thanksgiving this year. Because the coronavirus is so widespread right now, and because we’ve learned so much about the main ways it spreads, public health experts worry that traditional Thanksgiving gatherings will be a massive accelerator of the pandemic. So this week, we’re going to revisit a topic we’ve covered before: risk budgets. I hope this will help you—and your students and their families—make wise decisions about how to spend your holidays.

I apologize in advance that this article is going to be something of a buzzkill.

What is your Thanksgiving ritual? In my family, we try to get everyone to the same place. That means combining households from Texas, Washington state, California, and two places in Colorado. We spend the whole long weekend together. On Thanksgiving itself, we all start gathering around mid-morning. Puzzles are assembled, board games are played, football games are watched, snacks and beers are consumed, food is collectively prepared. Sometimes, weather permitting, walks are taken or soccer games played. Finally, we sit down for the big meal. Much friendly arguing, talking over each other, and riotous laughter ensue—for hours. It is really, really fun.

It is also practically a foolproof recipe for spreading the coronavirus. So it is not happening this year. No one is traveling anywhere. We’ve all agreed to find a time to play games together online, but that’ll be it. It’s a huge bummer, but even with all the risk-reducing tricks I have up my sleeve, it just wouldn’t be worth traveling thousands of miles for the kind of Thanksgiving gathering it would be safe to have.

I thought it might be worth taking you through my family’s risk-assessment process so you can see how we came to that decision and perhaps follow a similar process yourself.

You might recall a pair of articles I wrote back in May 2020 about “How do I decide what’s safe”: Part I: Assembling your tool kit and Part II: Using your tool kit. In them, we learned how to assess the risk of becoming infected in any given situation by examining five factors:

1. How big is the space you’re in and how many people are in it?
2. What’s that space like?
3. How long are you spending in that space?
4. What are you doing in that space?
5. How likely is it that there’s an infected person in that space?

Back in May, it was already suspected that the virus spread most efficiently indoors, especially in crowded spaces with poor ventilation. The longer people gathered and the more talking, laughing, singing, or shouting they did, the higher the risk. Since May, it has become clear that this kind of environment is responsible for the vast majority of transmission.

To give you an idea of the odds, a study published on November 6, 2020, found a household secondary attack rate of 53%. What does that mean? It means that when a symptomatic individual tested positive for SARS-CoV-2 (these were considered the index cases), over half of that person’s household members tested positive within the next seven days. Indeed, about half of the index cases’ household members tested positive immediately, suggesting that they had been infected before the index case showed symptoms, or possibly that the index case wasn’t actually the first person in the household infected.

Given those odds, an indoors Thanksgiving gathering taking place over multiple day would be a very high-risk event if even one person was already infected with the virus.

Now we have two choices: either find a way to assure ourselves that no one is likely to be infected or change our behavior to reduce the risk of transmission if someone is infected.

I mentioned that my family is far-flung. They’ve all been pretty careful, but they all do venture out to grocery stores and the like. Plus one is a personal trainer still seeing clients, one is in graduate school and attending some in-person classes, and one couple is part of a family bubble of 5–6 other people from several distinct households. So the risk that one of them is infected is not zero. Just how far above zero depends a lot on how widespread the virus is in their communities. I decided to see what their local numbers looked like.

You may not be surprised to hear that the availability of information varied considerably from place to place, since no national framework has been put in place for assessing and reporting local case and testing data. Here’s what I found about San Francisco, where my husband and I live:

The situation is quite good here. Just 5.0 cases per day per 100,000 people, with just 1.1% of tests coming back positive. This puts San Francisco in California’s lowest risk tier, so most businesses can be open with modifications, and even some elementary schools are open. Even so, the city is keeping a close eye on the numbers, and restrictions could kick in quickly if cases start to rise. Just this week, 11 California counties were downgraded into higher risk tiers.

How about Colorado, where two of our kids live? Here’s the dashboard for Denver County:

First of all, I’d like to give a shout-out to Colorado for a super-clear and intuitive communication framework. You can see exactly what tier you’re in and what trends are putting you there. In Denver’s case, while hospitalizations are stable, the number of cases is rising rapidly and the percentage of positive tests has risen over 10%. So the news is not so encouraging right now, putting Denver in Colorado’s “High Risk” tier—just below the level that would require a new stay at home order. The situation in Broomfield County, where another of our kids live, is similar.

How about the Seattle area, where my brother lives? Here’s King County’s dashboard:

Yikes—the number of cases per 100,000 people in King County is 190! Almost three times the rate in Denver, and almost 40 times the rate in San Francisco. My brother has been super-careful, so the risk he’s infected is very small, but I’d be a little reluctant to spend any time at the Seattle airport with numbers that high.

And finally, what about San Marcos, Texas, where our third child and his family live? Well, I have to tell you, it’s pretty darn hard to find out. As you’ve seen, California, Colorado, and Washington have clear public-facing data reporting systems and well-defined risk levels that are accompanied by guidelines on what businesses can be open and how large gatherings can be given the risk level. (If you want to find out about your area, the quickest bet is to search for your state or county name plus “COVID dashboard.”) There appears to be no such state guidance in Texas. This is what I found for San Marcos (after considerable digging around):

Frankly, I’m not quite sure what to make of this. I cannot figure out whether the number of cases is rising, how many tests are being administered, or what the positivity rate of those tests might be. The dashboard reports a running total since the pandemic began, so trends are tough to discern. It looks like there was a big surge in June that has since been declining, although the total number of cases continues to rise. You can zoom in on any part of the graph, but it’s still not that illuminating. So, bottom line, it’s impossible to tell what’s going on there.

I also could find no data-driven guidelines from the state of Texas for how to determine a local community’s risk level, what can and can’t be open, or what size gatherings are permitted. This is pretty stark evidence that when it comes to this pandemic, each state is on its own to decide what data it wants to collect, what it reveals, and what it does with the results.

So back to Thanksgiving. If one way to reduce the risk of getting together is determining that virus levels are low in all the places people would be traveling from, that path appears closed. There is a reasonable possibility that one of the seven people traveling might be infected. (Plus they might become infected while traveling.)

But let’s say we decided to go for it anyway. How could we reduce the risk as much as possible?

• Everyone quarantines for 14 days before traveling. Basically, that means not leaving their houses for two weeks, starting right about now.
• When they arrive (preferably having come by car), each family unit stays in its own hotel room or Airbnb.
• We gather outside, with everyone wearing masks and social distancing.
• Each family unit sits together, six feet apart from other units.
• We avoid buffets: all food is plated in the kitchen.

I think that you can see why we decided against this approach. Spending two weeks in isolation, taking the risk of traveling, and paying for four separate living spaces just to “gather” six feet apart from each other in the driveway just doesn’t seem worth it.

Did I mention there’s a two-year-old involved? Just try to keep that little dude from running from aunt to uncle to grandma for hugs and kisses. Not a chance.

So we’ll have Thanksgiving next summer, or next fall—whenever it’s safe.

Obviously, every family’s situation is unique, but anyone can follow the same risk assessment: how many households are you hoping to bring together; what’s the risk someone is infected; and, if that risk is non-trivial, how do you design your activities to be as safe as possible? If you have a family member in a high-risk group, you’ll have to be especially strict. Maybe your family members all live within driving distance in a part of the country where the number of infections is low. Good luck with that. The only U.S. states and territories where case numbers have not risen in the last seven days are American Samoa, the Northern Mariana Islands, Montana, and the Virgin Islands. Cases are up by more than 50% over last week in 21 states.

If you do decide to gather in person, public health officials are begging you to do so carefully. They know that you’re sick and tired of not being able to spend time with your family. But you don’t want anyone in your family to actually, you know, get sick, so take it seriously. Here is a good article with more detailed guidance for planning a safe gathering. And here is some advice for the special case of having a college student come home for the holiday.

As I mentioned, two of our kids live in Colorado, where The Shining was set. Hey! That hotel would be a perfect place to get your family together for Thanksgiving! After all, it’s empty, right? Take it from someone who has never been able to watch more than the first 10 minutes of that movie: you do not want to stay in that hotel. You do not want to go down in the basement, venture into the cemetery at night, or buy that house with the funny stains on the living room wall. You do not want Thanksgiving to turn into a horror movie. Play it safe, okay?