Editor's Note: CNN Medical Analyst Dr. Leana S. Wen is an emergency physician and a visiting professor at George Washington University Milken Institute School of Public Health. Previously she served as Baltimore's health commissioner. Follow on Twitter: @DrLeanaWen.
(CNN) - My family's holiday plans usually involve a patchwork of flights: Do we visit the family on the Monterey Peninsula in California? Miami? Or Western North Carolina? Where will we toast the New Year?
Thanks to pandemic restrictions and Thursday's US Centers for Disease Control and Prevention guidance, we'll only go celebrate masked, outdoors and 6 feet apart if my city, state, country and continent aren't in quarantine.
Right now, South Australia has begun one of the strictest lockdowns worldwide and several countries in Europe including France, Germany and Italy are in the midst of a second lockdown, while many states in the US are on the verge of tightening restrictions. As I try on my winter coat and snow boots, I asked CNN Medical Analyst Dr. Leana Wen how to see family and friends safely.
CNN: Can we visit family this holiday season?
Dr. Leana Wen: No, not the way that we would normally visit family, staying in one another's homes and having holiday dinners around the dining table. That's because Covid-19 is surging all across the country to the point that most communities within the United States are coronavirus hotspots. It is not safe to gather indoors with extended family and friends.
That said, you can still visit family by socializing outdoors. People not in the same household must stay 6 feet apart at all times. Bundle up, like people do when they play outside in winter, and you can do it.
If you do want to get together indoors, the safe way to do this is by everyone quarantining for 14 days and then getting tested. That's going to be very difficult for most people, in which case you should see extended family and friends outdoors only.
I know this is very hard but getting Covid-19 could be worse. So many people have suffered a lot already, and it's during times of stress that we want to be with our loved ones more than ever. Remember that help is coming. There is very promising news about vaccines, and by spring or summer 2021, we could well have a vaccine and better therapeutics. We need to get through this winter.
CNN: What factors do we need to take into account when deciding whether to get together?
Wen: We know that those who are more likely to have severe effects from Covid-19 are those who are older and with chronic medical conditions. The risks are additive, meaning that someone with advanced age with multiple conditions will have higher risk than someone with one risk factor.
Those who are higher risk should certainly stay away from settings that increase their likelihood of contracting coronavirus. However, at this point, I would urge everyone to stay away from indoor gatherings. Younger people can also get very ill from Covid-19. They could transmit the illness to others. If they become ill, they can also strain an already overwhelmed health care system.
Another important factor to consider is whether you need to travel in order to get together with someone. If it's a short drive and you can socialize outdoors, it's fine to see them. If it requires an overnight stay, I'd hold off for now, unless you are able to follow all the steps above (quarantining for 14 days and get tested).
CNN: My kid misses her grandparents so much. Can my family please visit her grandparents this coming weekend?
Wen: I really understand. My toddler hasn't seen his grandparents for more than a year. And the grandparents have yet to meet my baby, now 7 months old. This has been really hard on all of us.
Whether they can visit depends on how far you all live from one another. If you live pretty close together and can get there within, say, an hour's drive, then see each other outdoors. If it requires longer travel -- as in the case of my family -- we would all need to take long flights to see one another -- I'd recommend holding off travel for now. Coronavirus is surging across too much of the country, so it's best to hold off on nonessential travel.
CNN: Say a couple has a new baby who hasn't met their family yet. They can't even meet to introduce her?
Wen: I wish I could say yes. This, too, depends on how far you live from one another. If you all live close, you can definitely socialize outdoors. Some families also decide to quarantine for 14 days and then get tested. If you all do that, the grandparents can be with the new baby indoors and can spend as much time snuggling and holding the baby as you'd like.
Once again, I advise against extended travel. How you define extended travel and where you draw the line is up to you. I'm actually less concerned about the travel itself than the exposure before the travel. Driving with a couple of rest stops in between is pretty safe. Just make sure to always wear a mask when in public restrooms and use hand sanitizer even after you leave. Flying is also relatively safe, though with increased holiday travel, I do worry about keeping physical distancing and length of exposure waiting in lines.
If grandparents are traveling to see the grandkids, they should wear at least a three-ply surgical mask while in public places like restrooms and small enclosed areas like planes. The key is for everyone to quarantine for 14 days in advance of that trip.
CNN: But they really want to visit them! Do they have to quarantine first?
Wen: Yes, you do. Newborns have little immunity of their own -- their immunity comes from the antibodies passed from their mothers. They are susceptible to all infections, including Covid-19. Grandparents, too, may be at increased risk due to age and other underlying conditions. It is best for everyone to reduce your risk as much as you can in the 14 days before seeing one another.
CNN: You said to quarantine and then get a test. What if we can't get a test because too many people are getting sick in our area?
Wen: That's a sign that you should be extra careful, if the testing capacity in your area is getting overwhelmed. If you quarantine only and don't get a test, there is a risk -- though a small one. This is actually better than if you just get a test, with no quarantine.
CNN: Wait ... why? Why not just get a test -- why is the quarantine necessary?
Wen: A test only measures whether you have Covid-19 at the time of the test. The incubation period, or the time between exposure to having symptoms, for this coronavirus is two to 14 days.
Let's say you were exposed to someone with coronavirus and you got infected on Monday. If you take the test on Tuesday, Wednesday or Thursday, it's very likely the test will be negative, because you haven't produced enough virus to be picked up by the test. You may not test positive until a week or more after you were first exposed, but you could still be positive and infect others.
That's why the 14-day quarantine period is so important. By quarantine, I mean reducing risk in every way you can. You can take one trip to the grocery store, but it's even better to get your groceries delivered. Definitely don't go to an indoor bar or have dinner indoors at a restaurant. Do not socialize indoors with anyone else during that period.
CNN: OK, we can't do all that. How do we safely see one another outdoors?
Wen: If you're the host, set up chairs and tables in advance. I like to have a big table in the middle, where I put all the drinks and plates. I also have chairs set up so that every household is spaced at least 6 feet apart. I'll pour drinks and then have people come up, individually, to pick them up. Food should be plated separately; no buffets or people reaching into a common bowl. We won't share food or drinks.
Make sure to keep an eye on the kids. To be safe, put masks on the kids if they're playing together, though be sure to enforce physical distancing. If they are sharing toys, apply hand sanitizer frequently. We try to do it every 30 minutes.
Designate a bathroom for guests. Guests should go indoors, one at a time. No gathering indoors. Everyone should wear masks while using the restroom. Open windows and doors leading to the restroom if possible.
CNN: Is it OK to say no to a visit?
Wen: Absolutely. You need to do what's necessary to protect your health and the health of your family. If you're invited to something that you don't feel is safe to attend, or if someone else is wanting to visit you, talk about how you are worried about your health. You can explain why you are worried, and that we have to get through this winter.
Next year, things will be different. Maybe you can celebrate Christmas in July! But we must all get through this difficult winter ahead.