Can I see my friends and family for Thanksgiving if I quarantine for two weeks?

Due to the rise in COVID-19 cases, Philadelphia’s pandemic guidelines have changed since this article first published. As of November 13, all public and private indoor gatherings are banned, and food and drink are prohibited at outdoor gatherings. The Pennsylvania Health Secretary Rachel Levine has since also advised that residents not hold holiday gatherings with anyone outside their household.

Pennsylvania’s first case of coronavirus was announced in early March, also when the World Health Organization declared the rapidly spreading virus a pandemic. By Thanksgiving, we’ll have lived with this for more than eight months. We’re tired. We want normalcy to return. We want to be together. And yet, COVID-19 is still here.

So what does that mean for planning a holiday gathering, especially as cooler weather steers us indoors?

“Obviously the safest thing to do is to set up a virtual dinner,” says Eric Sachinwalla, a doctor and medical director of Infection Prevention and Control at Einstein Medical Center Philadelphia. “It’s an option, but I’m sure there are families who don’t find that very fun.”

As with any in-person gathering right now, the decision to host or attend one is personal. With loved ones involved, especially older relatives, making that decision can feel unbearably hard. We asked experts to share advice on how to approach the upcoming holiday season, along with strategies you can take to decrease risk.

Self-quarantining is ideal. But it’s rarely realistic.

“In theory, that’d be great, but does everyone in the family have the ability to quarantine for two weeks? And how confident are you that someone won’t break the quarantine contract?” says Sachinwalla. “All it takes is one person to mess it up.”

If everyone is able to stay home for 14 days, and you can trust them to do so, experts agree it’s the safest approach. How you define the “quarantine” is up to everyone involved, who will need to agree on ground rules. For example, you may decide masked visits to the grocery store are OK but socially distanced picnics are not.

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But for most, weeks-long quarantining isn’t practical, which means considering other strategies. Start by doing an honest risk assessment with everyone who plans to gather. What do their social circles look like? Are their kids going to school? Is anyone high-risk? Is travel involved? How large is the group? You’ll need to weigh everyone’s tolerance for risk, too.

Once you shape a situation that feels comfortable for everyone, think about how to make it safer. Even if you’re going to an in-person job or can’t quarantine, you can minimize unnecessary exposure for two weeks.

“Avoid gyms or going out to eat or really anywhere where you’re inside a building for an extended period of time,” says Thersa Sweet, an associate professor of epidemiology and biostatistics at Drexel University.

The coronavirus’ incubation period makes testing tricky.

“If you were exposed the day before you get tested, and you test negative, you could still develop symptoms a few days later,” says Patricia Henwood, associate professor of emergency medicine at Thomas Jefferson University’s Sidney Kimmel Medical College and leader of the Emergency Medicine COVID-19 Task Force at Jefferson Health.

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The incubation period ranges from two to 14 days, with a median time of 4 to 5 days from exposure to the onset of symptoms. Henwood advises quarantining for a week prior to testing. It won’t make your test results foolproof, but it’s a reasonable option if one week at home is possible, while two weeks just aren’t

If you do get a test, you need to be very careful leading up to the gathering, otherwise the results are useless. Tests obviously don’t prevent you from getting exposed to COVID-19 in the days that follow.

If you choose to plan an indoor event, make it small, and make sure masks and social distancing remain part of the plan.

It doesn’t completely eliminate risk, “but if you’re stuck inside and it’s only five people instead of 30, it makes it easier to space yourselves out, and the more time you have a mask on, the lower the risk of transmission occurring,” says Sachinwalla.

Keep the windows open to improve ventilation. And skip the annual family karaoke session. Anything with singing or shouting increases risk of transmission. Be mindful of alcohol consumption, too, which often elevates the volume in the room and lowers your safety radar.

Any kind of travel increases your chance of getting and spreading COVID-19, according to the Centers for Disease Control and Prevention. Inviting family members from out of town requires weighing the risk versus benefit, for everyone involved.

“If people are flying, there’s obviously risk. If it’s a long enough trip where that person can quarantine for a certain amount of time before seeing family, I think that’s a reasonable approach,” says Henwood.

Experts recommend looking at case numbers both where people are coming from and also where the event is happening. The lower the percentage of positive cases in the area, the better.

“If it’s 1%, I’m less concerned. But I’m still concerned at 3%,” says Henwood.

Some experts advise against gathering altogether.

“If you ever wanted an excuse to avoid your uncle whose political beliefs you don’t agree with, now is the time," says Henry Raymond, associate professor and epidemiologist at Rutgers University.

The thought of giving a close loved one the coronavirus is terrifying. Meanwhile, the holidays aren’t easy for everyone, and some may find it important to be with family, even if it means taking on some risk.

“Particularly for elderly who live alone, holidays can feel even more lonely,” says Sweet. “You have to balance the risk of COVID and the risk to mental health.”

Have honest conversations up front. Everyone should understand everyone else’s risk factors, what safety precautions people are taking, and how comfortable everyone feels with risk.

And each person should still remain prepared to cancel.

“You can think about doing all of this, but you also can’t get caught up in the holiday momentum,” says Henwood. “If someone’s child wakes up with a runny nose, it makes sense for them to cancel.”

Err on the side of caution, says Henwood, or you could potentially expose the whole family.

Eating turkey in front of a screen isn’t glamorous. But if you want to join the whole extended family together or friends from across the country, a virtual dinner may actually be easiest for everyone. It not only eliminates travel, but allows you to bypass the uncomfortable conversations that in-person gatherings require.

You can also think outside the box, especially if your family is local.

“Is it the year for a turkey barbecue outside and you all bundle up?” says Henwood. “Or do a family football game during the day where people can be together, but it doesn’t require removing your mask or talking around a dinner table.”