'Keep gatherings as small as possible': 6 experts give advice about how to celebrate Thanksgiving safely

• The US is experiencing a record-breaking surge of coronavirus infections.
• According to Anthony Fauci, small indoor gatherings are driving new spread, so people should consider avoiding them.
• That means tweaking Thanksgiving and holiday traditions.
• Public-health experts suggest people avoid large indoor gatherings if possible, wear masks when mingling with family, and get tested before and after any travel. 
• Visit Business Insider's homepage for more stories.

Thanksgiving is less than a month away, and winter holidays come in six weeks. But global coronavirus cases have hit record daily highs, and the US is staring down its third, and perhaps worst, surge of infections to date.

Holiday celebrations are likely to further fuel the virus' spread.

Already, small indoor gatherings are driving new transmission in the US, according to Dr. Anthony Fauci.

"You get one person who's asymptomatic and infected, and then all of a sudden four or five people in that gathering are infected," Fauci told JAMA editor in chief Howard Bauchner in a conversation on Wednesday. "That's the exact scenario that you're going to see in Thanksgiving."

Business Insider collected advice from six public-health experts about how people can celebrate holidays with caution this November and December. The consensus: It's understandable to feel a need to gather with loved ones, but be smart about it — plan to quarantine and get tested before traveling, wear masks, and keep gatherings small.

"I think people need to see their family after 11 months of this. So, I encourage family gatherings," Monica Gandhi, a professor of medicine at the University of California, San Francisco, told Business Insider.

But she added, "traditions will definitely have to be tweaked."

Gather small, stay socially distanced, and eat outdoors if possible

Emma Hodcroft, a scientist from Basel, Switzerland who tracks coronavirus mutations, said big group meals are simply too risky.

"Now isn't the time to get the extended family together. Keep gatherings as small as possible," Hodcroft told Business Insider. "Larger family units can break into smaller, separate groups so that nobody spends the holidays alone."

She also advised against house-hopping: "Do away with the holiday tradition of Christmas eve at Memaw's and Christmas dinner at Granny's."

Sticking with one group at one location reduces your total number of contacts, thereby lowering the chances of virus transmission.

Whoever you gather with, the same principles apply as for any other social interaction: Everyone should stay at least 6 feet apart. And if it's possible to celebrate and dine outdoors, opt for tweaks to holiday traditions that facilitate that.

Wear masks when not eating or drinking, and ensure good ventilation

To prevent unnecessary transmission, Gandhi recommends wearing a mask while mingling with people you don't live with. Good airflow is also key to preventing the transfer of viral particles. This is especially crucial when masks come off, like during dinner.

"If possible, outside is better, but if inside, ventilation should be maintained," Gandhi said.

That means keeping windows open and investing in an air purifier with a HEPA filter.

Limiting the amount of time a group spends together also decreases the risk of transmission. If your family usually spends the entire Thanksgiving day watching TV and snacking, you should rethink that this year, according to Amanda Mae Simanek, an epidemiologist at the University of Wisconsin-Milwaukee.

"Instead, gather for a shorter meal or even just dessert and keep the group size smaller than normal," she told Newsweek.

Drive if you can

Airplanes are well-ventilated and should be fairly safe if everybody onboard wears a mask for the entire flight, according to Gandhi. But there's no guarantee that will happen.

Trains don't have the same airflow as planes, but they can allow passengers more space to distance from one another.

Still, you're safest in your own car, since you have full control over your exposure risk.

"Make as few stops as you can, and be careful of mask wearing, hand hygiene, and indoor spaces," Hodcroft said of road trips. She recommended that drivers get drive-thru food or takeout instead of going inside anywhere.

If you do take a plane, train, or bus, wear a mask and wash your hands diligently.

Get tested before and after travel

If you're traveling to see family, experts recommend that you plan in a quarantine period ahead. The CDC advises a 14-day quarantine, but Hodcroft knows that may not be feasible for everyone. She said five days should be the minimum, since that is likely long enough to test positive if you're infected. Isolate as long as you can ahead of any gathering, though.

Then at the end of that quarantine, and before you travel, get a test.

Hodcroft recommended repeating this process of isolating and testing after you arrive at your destination but before you see anybody, in case you were exposed to the coronavirus while traveling.

"If you develop any symptoms or test positive, don't be afraid to cancel plans and stay put to protect those you love. You can be the one who prevents a spreading event," Hodcroft said.

She recommended having a quarantine back-up plan in place — a hotel you know has space or a designated separate room in a house — in case a person falls ill and needs to separate from the family.

Some experts cancelled their plans entirely

The Fauci family isn't gathering for Thanksgiving this year. His three daughters, scattered across the country, will not fly to the East Coast to celebrate with their parents.

Francis Collins, director of the National Institutes of Health, also cancelled his extended family's Thanksgiving for the first time in 27 years.

To really play it safe, people shouldn't gather with anyone outside their immediate household, according to Michael Osterholm of the University of Minnesota's Center for Infectious Diseases Research and Policy.

"Unfortunately, these events far too often end up with one of the people more at risk for severe disease, dying. Grandma, mom or dad, aunts or uncles," Osterholm told STAT News.

That's why New York Gov. Andrew Cuomo is urging New Yorkers to celebrate virtually.

But Hodcroft said the idea of canceling holidays just isn't realistic for most families.

"I do think that stopping people entirely from visiting family, particularly over holidays like Christmas and Hanukkah, which have a lot of deeply held meaning and importance to many, is probably not practical," she said. "Instead, I think we need to be realistic in what we can expect of people, help make them make smart decisions, and give them tools to be the safest they can be."

That said, Hodcroft added, "if you're able to do a small family or housemate holiday period this year, that's still the best choice."

Fauci said it's important to assess risk and change traditions accordingly based on who you'll share your Thanksgiving meal with. Elderly people and those with underlying health problems are at increased risk for severe cases, so more precautions would be necessary.

"You don't want to be the Grinch that stole the holidays, but I think one family group and individual has to take a look at what the risk is to your particular situation," Fauci said.

Hilary Brueck contributed reporting to this story.