If you’re planning a traditional Thanksgiving dinner — turkey, stuffing, pie and a whole house full of extended family members — you might want to reconsider this year.

Amid rising COVID-19 caseloads, the holiday threatens to not only spread the coronavirus between family members, but potentially contribute to the overwhelming of an already-stressed health care system.

Last week, amid high hospitalization levels and record-setting COVID-19 deaths, the Minnesota Department of Health scolded Minnesotans for not following public health guidance. Through COVID-19 case investigations, the department has linked many cases to friend and family gatherings where precautions to prevent transmission are not being taken.

Those gatherings are getting more dangerous for a couple of reasons: First, as the weather turns cold, hosting an outdoor gathering — where free-flowing air makes transmission less likely — is less viable.

Second, higher levels of transmission across the state make it more likely someone at a gathering has the virus — even unwittingly, since people can transmit the virus without exhibiting any symptoms. In an August peak, Minnesota had a seven-day average of 14 new cases per 100,000 residents at peak. That metric has been going up since September, and while there is more testing now than there was then, recent data show Minnesota with a seven-day average of 59 new cases per 100,000 residents, plus more hospitalizations and deaths, indicating the virus is more widespread than it was in the spring or summer.

COVID fatigue may be playing a role in higher rates of transmission as well, said Kumi Smith, an assistant professor in the University of Minnesota School of Public Health’s division of epidemiology and community health.

“If you have made it this far in the pandemic without being affected by COVID or it not affecting too many people in your family, I think some people are just allowing their cautiousness to abate,” Smith said. “It’s sort of like positive reinforcement that if you’re OK after a certain number of hangouts you just sort of assume the risk for me may be low.”

Thanksgiving dinner poses some particular risks when it comes to COVID-19, especially if guests include grandparents, parents and children. Multigenerational gatherings are risky because older family members and those with underlying health conditions have a higher statistical chance of developing severe complications due to COVID-19. While school children do not seem to be a huge source of transmission, they aren’t ruled out as potential spreaders of the virus, Smith said.

If you’re considering gathering this year, given the risk, it’s not a bad idea to play through how it would feel if someone in your family became infected with COVID-19 — because it can happen, and has, Smith said — pointing to the many accounts of family get-togethers that have resulted in coronavirus spread.

“I think we do tend to exercise a huge amount of caution when we’re near or possibly exposed from strangers, but we do really let our guard down when we’re with our loved ones,” she said. “It’s natural that we tend to quote unquote trust the ones closer to us, but this virus is really nefarious and it takes advantage of our willingness to let our guard down.”

Strain on the system

COVID-19 metrics are getting worse not just in Minnesota, but also in surrounding states, and Thanksgiving has the potential to put additional strain on health care systems.

Even being in the hospital for a day adds to strain on the health care system and creates demand for personal protective equipment — masks, gowns and eye protection — that health care workers wear, said Dr. Aditya Shah, a consultant in infectious diseases at the Mayo Clinic

It also affects non-coronavirus medical care, as doctors and nurses are diverted to COVID-19 wards.

Plus, all the COVID-19 in the community strains the health care system by making it more likely doctors, nurses and caregivers will be exposed to coronavirus and need to quarantine, or even get sick.

“Say I am exposed at the DMV: I am exposed and I get a notification that I’ve been exposed and I need to quarantine. That takes me out of the game for 14 days. These are all downstream effects,” Shah said.

When doctors, health care workers, ER and ICU beds are in short supply is when what would be a non-serious case of COVID-19 becomes serious because the patient can’t get timely care, Shah said.

“That’s why we have to make sure we take care of increasing numbers now,” Shah said.

And it’s not just COVID-19 that’s a concern, he said: it’s also flu. Every year, starting around now, flu and other respiratory viruses begin to spread, filling hospitals near to capacity and causing many deaths. This year, it’s not clear how a combo COVID-19 and flu season could affect the healthcare system, but it could cause a lot of strain.

Thanksgiving alternatives

Just because COVID-19 makes it more dangerous to gather this year doesn’t mean Thanksgiving has to fall by the wayside completely.

Given that COVID-19 is not going away by Thanksgiving, Shah suggested families consider finding creative ways to celebrate the holiday, like downsizing to household-only in-person gatherings or switching to virtual ones.

Smith proposed some nontraditional options that are safer than gathering around the table indoors, including having a socially distanced Thanksgiving outdoors or in a highly ventilated space (though watch the fire hazards if you’re using heaters).

Given a forecast for colder weather, “I salute those who are going to try to do [safer gatherings], but I also really admire and respect the resilience of families that might be tending to abstain this year from in-person family gatherings,” she said.

Centers for Disease Control guidance on Thanksgiving can be found here.