Drive? Fly? Stay home? The hard decisions behind pandemic holiday gatherings

Public health experts are warning Americans to avoid travel because of COVID-19, at a time when many people are desperately missing relatives and tired of COVID-19 restrictions.

Adobe/H. Hopp-Bruce/Globe Staff

In the 1950s, Perry Como planted an idea into the heads of millions that “(There’s No Place Like) Home for the Holidays.” But 64 years after his melodic declaration that “If you want to be happy in a million ways / For the holidays you can’t beat home sweet home,” the singer’s cheery perspective is sounding downright dated — and reckless.

This year, the nation’s top infectious disease specialist, directly contradicting the crooner’s sweet sentiment, told people to avoid travel — much to the disappointment of millions of Americans who are both suffering from COVID-19 fatigue and desperately missing relatives they haven’t seen in months. But with the number of coronavirus cases rising steeply as the long-predicted fall surge arrives with a vengeance, many doctors are warning that even the most careful travelers should step back a moment before finalizing plans.

“The advice I’ve given my patients is that this is the year to be thinking hard about visiting your family,” said Julita Mir, an internist and infectious disease specialist at the nonprofit Community Care Cooperative. “Put it into perspective. Weigh the value against the potential consequences. Even with the best of intentions, traveling to see mom or grandma could be the worst thing you could do. Maybe the best thing you could do is to come up with an alternative celebration.”

Dr. Julita Mir, who specializes in infectious diseases at Community Care Cooperative, gives advice on holiday travel, during the continuing coronavirus pandemic.Pat Greenhouse/Globe Staff

AAA estimated that more than 55 million Americans traveled 50 miles or more for Thanksgiving in 2019. In previous years, travel surveys, polls, and estimates focused on the number of Americans who would be traveling, and not the size or nature of the gatherings themselves. But because of the unprecedented nature of COVID-19, even the travel surveys are different. Gone are worries of when the airports and highways will be most crowded. Instead, it’s how many will see their loved ones and what will the size of those gatherings be. Despite Dr. Anthony Fauci’s warning to Americans that “you may have to bite the bullet and sacrifice that social gathering,” a poll last month by the Morning Consult found that 53 percent of respondents plan to forge ahead with their holiday celebrations. The remainder said they have already canceled or changed their gatherings because of the virus. Another study from Bridgestone tires found that 51 percent planned to gather with extended family.

Dire predictions from scientists are not stopping patients from peppering their doctors with questions such as “What’s the safest mode of travel?” “Should I quarantine before I travel?” “Should I get tested before I leave?” “Should I get tested when I get home?” “Can I get infected again if I’ve already had the virus?”

Dr. Shira Doron, infectious disease physician and epidemiologist at Tufts Medical Center. Jonathan Wiggs/Globe Staff

“I’m an epidemiologist at an organization with 7,000 employees, and every day I get almost every question you can think of related to COVID,” said Shira Doron, an infectious disease doctor at Tufts Medical Center. “When it comes to travel, and pretty much everything else, everyone’s degree of tolerance for risk is different, and there’s no one-size-fits-all answer. What’s clear in all of this is that a lot of people plan to travel.”

Also bear in mind that travel is just one portion of the holiday celebration risk. Indoor parties, where people drop their mask after a drink or two and begin to talk closely and loudly, have become a common breeding ground for the virus.

“It’s probably just not a good idea to have a sizable indoor gathering for Thanksgiving or Christmas this year,” said Abraar Karan, an internal medicine physician at Brigham and Women’s Hospital and Harvard Medical School. “It’s unfortunate, but that’s just how it goes for this season. All you need is one person at that kind of party to be infectious and you’ll have multiple people infected. Then you have people traveling home, and continuing to spread in other parts of the country.”

Dr. Abraar Karan, global health specialist, poses for a portrait on the Harvard Medical School campus. Jessica Rinaldi/Globe Staff

While airports, buses, and trains will be far emptier — and quieter — than in years past, the number of people traveling has been ticking up over the past two months, which creates opportunities for the virus to find hosts in airports, rest stops, and other places where people congregate. Earlier this week, the TSA screened more than 1 million passengers in a single day, the most since March 16. That number will inevitably grow through Thanksgiving and Christmas, but will fall far short of the record 115 million Americans who traveled for the holidays in 2019.

The dozen epidemiologists and doctors interviewed for this story had no easy answers for those wishing to travel to see loved ones for the holidays. There are no zero-risk scenarios, unless you plan to hermetically seal yourself in your home and celebrate via Zoom or with your cat. When it comes to modes of travel, there’s no perfect option. According to Diego Hijano, an infectious disease specialist at St. Jude Children’s Research Hospital, traveling in a car with people you live with is perhaps one of the safest ways to reach your destination.

“One thing that’s helpful when you travel by car is to pack your own food before you go to minimize stops,” Hijano said. “If you do have to stop to get gas or use the restroom, make sure you stick to the rules of wearing your mask, social distancing, and washing your hands.”

The exception to the rule of driving is if your destination requires overnight hotel stops. In that case, Hijano said flying — nonstop if possible — is a safer alternative than driving and stopping at one or more hotels.

Since the beginning of the pandemic, many have sworn off air travel, worried that virus particles would be recirculated in a confined space (fresh air comes into the cabin several times a minute and is circulated through hospital-grade HEPA filters) or that they would pick up COVID-19 by touching surfaces. A study earlier this month by United Airlines and the Department of Defense claimed that the risk of COVID-19 exposure on planes was “virtually nonexistent” when all passengers were masked. The study did not take into account passengers removing their masks to either eat or talk. It also did not take into account possible passenger exposure to the virus while getting to the airport or waiting to board a plane.

The study outcome doesn’t have all experts rushing to book seats.

“I think flying is very dangerous,” said William Haseltine, a scientist, author, and philanthropist who is perhaps best known for his work researching HIV and AIDS. He has already written two books on coronavirus, “A Family Guide to COVID” and “A COVID Back to School Guide.” “I tell people to only fly if they have to. I know there are people who would tell you it’s not so dangerous, but there are real, documented cases of people catching COVID on flights.”

Haseltine said another danger with flying is traversing the airport, particularly the TSA checkpoint. In July, it was revealed that more than 1,000 TSA agents had tested positive for COVID-19.

“They’re touching bags all day, they don’t change their gloves very often, and they reach in and touch your personal belongings,” he said. “The answer is to carry as little as possible and wipe down all of your personal belongings with gloves on.”

Despite his wary view of flying, Haseltine said he would choose to take a plane over taking a long car ride with multiple hotel stops along the way. While flying, Haseltine said he would wear an N95 mask, goggles, and gloves. He’s also a proponent of plastic face shields, worn with a mask, both on a flight or in places where you’ll be in close proximity to others.

“There’s good evidence that doctors and nurses who wear face shields in addition to masks reduced their chance of infection to close to zero,” he said. “I don’t think people understand exactly why, but there’s some theories. One is that you don’t touch your face as much. Another theory is that with a shield you’re not going to get infected through your eyes. It’s good for daily use, but very important to have when you travel.”

More questions about holiday travel? The experts say there is no end. Are you immune if you’ve already had the virus? The short answer is probably not. Many have asked their doctors if they should get tested before visiting loved ones, thinking that if everyone is tested, then everyone is safe. Right?

Not true.

Karan said the test is a snapshot of the moment it’s taken. Someone could be exposed to the virus, and if the exposure is a day or two before the test, they may still test negative. Haseltine recommends getting tested three days before departure, and then the day before departure.

Quarantining before departure may be helpful, though Doron said travelers could encounter the virus en route to their final destination. Hijano said you could arrive at a relative’s house to quarantine before a holiday, but what are the chances you’ll be able to stay in a room away from your brother or father for two weeks without hugging them? When you boil it all down, Fauci’s advice to “sacrifice that social gathering” makes more and more sense. If trying to celebrate the holidays in the midst of COVID-19 sounds like a jumbled mess, it’s because it is.

Perhaps the best advice for handling the holidays in 2020 comes from Lloyda Williamson, the head of the Department of Psychiatry and Behavioral Science at Meharry Medical College in Nashville, where she is also a professor.

“We’re all tired, but to get through the pandemic we have to persist,” she said. “It’s about delayed gratification, and as Americans, that’s not a concept we like. We live in a society where we’re used to things moving quickly and changing fast. But this is not something we can control in that way. We’re just going to have to understand that. Like I said, delayed gratification saves lives.”