Editor’s Note: Céline Gounder is an internist, infectious diseases specialist, and epidemiologist at the New York University Grossman School of Medicine and Bellevue Hospital Center. She’s the host of the podcast “Epidemic” and a member of the Biden/Harris COVID-19 Transition Advisory Board. Ben Michaelis is a clinical psychologist, co-founder of The Decency Pledge and the author of Your Next Big Thing. Robert Cialdini is the Regents’ Professor Emeritus of Psychology and Marketing at Arizona State University and the author of Influence and Pre-Suasion. The opinions expressed in this commentary are their own. View more opinion on CNN.
The United States set a new record for new daily coronavirus cases, smashing right through one after another after another. Yet, the winter cold, flu, and, this year, Covid season, has only just begun. Though we’re tired of masks and social distancing, we’ve gotten better at it. But our greatest test is yet to come: Thanksgiving.
Thanksgiving is as much about the centuries’ old tradition of celebrating bountiful harvests as it is about reinventing those traditions. Two hundred and thirty-one years ago, President George Washington declared Thursday, November 26 a day of “thanksgiving,” a day for Americans to recognize the “opportunity peaceably to establish a form of government for their safety and happiness.”
In 1863, when President Abraham Lincoln made Thanksgiving a national holiday, only a couple of months after the Battle of Gettysburg, he proclaimed, “the blessings of fruitful fields and healthful skies in the midst of a civil war of unequalled magnitude and severity … They are the gracious gifts of the Most High God, who, while dealing with us in anger for our sins, hath nevertheless remembered mercy. It has seemed to me fit and proper that they should be solemnly, reverently and gratefully acknowledged as with one heart and one voice by the whole American People.”
2020 will also be remembered as a year of great sorrow and hardship in our nation’s history and the world’s. Americans are again at war – with one another politically and with the virus. And, as in 1863, all too many will be missing from this year’s festivities – over 240,000 at last count, dead from the coronavirus. We all need time to mourn and heal with those we love. But the coronavirus keeps testing us by keeping us apart.
Small indoor gatherings are driving the recent spike in coronavirus cases. Family and friends are getting together without masks because they look “fine.” It’s not just that asymptomatic people are driving much of this spread. It’s also that we don’t want to think ill of our loved ones. We want to trust them and believe that they’re not going to harm us. And this makes many of our Thanksgiving traditions – whose comfort and consistency we crave – particularly dangerous in the midst of a pandemic.
Each family will need to weigh the risks of celebrating Thanksgiving in person or virtually. That calculation should be informed by community transmission rates, local access to healthcare, age and underlying medical conditions. While our advice and the safest option is to celebrate the holiday within our household bubbles or virtually, some Americans will attend large holiday gatherings. For those families, there are ways to lessen the risk.
Setting ground rules
We all know that talking politics at the Thanksgiving table is sure to end in conflict, and sadly, public health measures to control the pandemic have been politicized. It’s better to acknowledge this in advance and set some ground rules. The goal here is to have a fun and safe Thanksgiving; not to change anyone’s mind. In order to set ground rules among people with different risk profiles, you need to leverage behavioral rather than public health science.
Whether you’re hosting or a guest, know your level of comfort with being indoors versus outdoors, social distancing and mask-wearing. Ask everyone else who’ll be joining you to consider this, too.
Let everyone know what others are doing. Teens aren’t the only ones who are susceptible to peer pressure. We all are. Most Americans have been wearing masks since the spring, and mask-wearing has gone up since then (from 78% in April to 89% in June, according to the US Centers for Disease Control and Prevention). And a majority of adults, according to the CDC, have also been keeping six feet apart, avoiding crowded places, washing their hands, avoiding restaurants and canceling social activities to reduce their risk of Covid. While not everyone did all of these things consistently or adequately, people are trying. Your family members probably are, too. Let them know you’ve noticed and appreciate their actions.
Thanksgiving gatherings this year will be a bit like taking a family road trip. Everyone who gets into the car needs to feel safe throughout the trip. Even if you’re an excellent driver who usually drives 10 mph over the speed limit, if grandma doesn’t feel safe at that speed, then you need to slow down in order to help her feel comfortable.
On the holiday, consider offering everyone a gift bag of hand sanitizer, a mask and other treats. Make it personal. Pick a mask that shows them you care – maybe it’s branded with their hometown sports team or in a stylish print or their favorite color.
If someone at your Thanksgiving table is acting in ways that make you feel unsafe, try to get them to change their behavior using a Cognitive Dissonance technique. Cognitive Dissonance Theory holds that people feel uncomfortable when their beliefs and behavior don’t align.
Before you ask them to change their behavior, see if you can somehow make a mention of them being a caring or considerate person. It’s even better if you can do this in front of other people. Then after about 10 minutes, ask the person if they would be willing to change their behavior in order to protect your health.
You’ve primed them to see themselves as considerate, and now they’re faced with a situation where they might have to see themselves as inconsiderate. This dissonance could motivate them to align their beliefs about themselves with their behavior.
Finally, have a plan if someone breaks protocol or an unexpected guest arrives. A 10 minute timeout should be long enough for you to calm down, but not so long that a new social norm has taken hold. Try to speak to that person privately in a way that doesn’t draw attention to the interaction. You want to take extra care not to shame the person because that only makes it more likely they’ll act defensively and argue. Don’t assume malicious intent and lead with empathy. Let them know how their actions are making you feel and provide a solution.
You might say something like, “I’m so glad you’re celebrating with us. I know that we’re all trying to figure out how to be in this new situation, and even though we didn’t discuss this beforehand, it would make me feel more comfortable if all of us wore masks, or ate outside, or kept our distance.” Remind them it’s a challenging time for everyone and that we’re all trying to navigate the new reality of the pandemic.
Thanksgiving week is one of the biggest travel holidays of the year. Most will drive. Cars are like any other enclosed space. Ideally, you’re only taking a road trip with members of your household bubble. But if you are traveling with people outside your bubble, mask up, and keep car windows open to maximize ventilation.
Many also fly. Ventilation on planes is excellent, at least up in the air. But that doesn’t account for transmission while the plane is sitting on the tarmac waiting to takeoff or taxi to the gate or the time spent in airports.
A recent Department of Defense study showed that if travelers wear surgical masks for the entire duration of their flight, the risk of coronavirus transmission in-flight is quite low (note that this study did not undergo the standard review by peer scientists and doesn’t account for other ways travelers could be infected). And the longer the flight and the more crowded the flight, the more likely you are to be exposed to someone with coronavirus.
You might also consider wearing glasses, goggles, or a face shield to protect your eyes from exposure. Bring hand sanitizer. If possible, plan to eat before or after you fly – ideally outdoors and socially distanced – rather than on the plane or in the airport as this will reduce the need to remove your mask while around others. Those traveling into or out of Covid hotspots, including college campuses, risk bringing the virus with them to lower transmission communities, perhaps seeding new outbreaks. Educate yourself about the risk of community transmission where you’ll be.
Quarantine and testing
In order to keep your family and friends safe, refrain from high-risk activities during the 14-day period prior to travel. During this two-week stretch, be meticulous about wearing a mask anytime you’re around anyone outside of your household bubble. Avoid crowded events, including parties. Refrain from going to higher risk places like bars, restaurants, movie theaters, gyms and nail salons. And use common sense. Don’t travel if you have symptoms of Covid. Consider getting tested a couple of days prior to travel; some states will require this of you.
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If we expanded testing to all airports nationwide, we could help Americans feel safer about flying and give the airline industry a big boost. JFK, LaGuardia, and Newark airports all offer Covid testing in collaboration with NYC Health and Hospitals and the New York Tracing Corps. You can get tested whether you’re arriving or departing, and it’s free whether or not you have insurance. Also do some research in advance. Know where you’ll go if you’re exposed or develop symptoms and need to get tested once you get to where you’re going. And get tested five to seven days after you travel, especially if you didn’t consistently wear a mask at social gatherings.
There is no silver bullet against the coronavirus, but we have a lot of partially protective measures that are additive and are highly effective when layered. We now know, for example, that people in poorly ventilated indoor settings can get infected even if they’re wearing a mask. We’ve also seen that being in a crowd outdoors without a mask can be risky. Aim for at least two out of three of mask-wearing, social distancing and ventilation.
Keep social gatherings small. Set up seating or markers six feet apart. Host outdoors, and when that’s not possible, open windows and doors to keep indoor spaces well-ventilated. The combination of social distancing and good ventilation are especially important when people are eating or drinking and can’t wear masks. And remind invited guests to stay home if they’ve been exposed to or have symptoms of Covid prior to the gathering.
Remember to have fun
“You don’t want to be the Grinch that stole the holidays,” says Dr. Tony Fauci, the Director of the National Institutes of Allergy and Infectious Diseases. Holidays provide us with an opportunity for consistency and connection, but they also allow for creativity in how we celebrate.
This Thanksgiving can be a time to both reinvent our traditions and go back to their roots. If you use the day to reflect on your blessings and make choices to optimize for safety instead of habit, you’ll be honoring Washington’s original intent by making Thanksgiving about both “safety and happiness.”