Dr. Anthony Fauci, the top infectious disease expert in the U.S., will not be getting together with his family for Thanksgiving.At 79, Fauci is at increased risk of contracting COVID-19, the disease caused by the novel coronavirus. His three adult daughters “were concerned about their, quote, ‘elderly’ dad. I hate to use that word,” he told NBC. They decided on a virtual dinner instead, he said.The COVID-19 pandemic is complicating holiday plans for many families across the country. With more than 240,000 dead from the coronavirus and infections climbing nationwide, according to Johns Hopkins University,  every family will have to make a decision about whether to get together, Fauci said.Especially when gatherings include an elderly family member, or someone with health problems such as diabetes, obesity, cancer or heart  disease that raise their risk of serious illness, “you want to take a couple of steps back and say, ‘Is it worth it for this year to bring those people together when you don’t know what the [infection] status of everybody … is?'” Fauci told JAMA Network.Breaking the bubbleThe holiday usually is the busiest travel period of the year in the U.S. Some 50 million Americans travel 50 miles or more to share a meal with friends and family, according to automotive and travel group AAA.Traditional Thanksgiving gatherings seem custom-made to spread the coronavirus.Experts have been advising people to limit their interactions to one group of people, called a “bubble.” Less contact with people outside the bubble means less opportunity for infection.Thanksgiving smashes bubbles together, bringing in people from far and wide with different and sometimes unknown exposures to the virus.For example, experts note, students returning home from school may carry the virus and not know it. Younger people are more likely to have asymptomatic infections.The act of traveling carries risks.Crowded buses and trains with poor ventilation offer opportunities for infection. The longer the trip, the higher the risk.Airplane travel is less clear.”We’re hearing variable things about airplane travel,” Fauci said. He noted one report that says air inside a plane circulates quickly, is refreshed often and is cleaned with hospital-grade filters.But he also pointed to a recent report in which 13 people came down with COVID-19 after a mostly empty flight to Ireland.The hazards begin before boarding the plane, train or bus, Duke University School of Medicine infectious diseases professor Cameron Wolfe noted.”When you sit in the waiting wing of the airport, that is a busy place with lots of people around,” he said.Hazardous celebrationGathering family and friends indoors for long periods of time raises the chances for the virus to spread.It’s happening already, Fauci said.”If you look around the country now, many of the infections are in small family-and-friend gatherings such as dinner parties and small social gatherings,” he said.”These innocent, family-and-friends gatherings, six, eight, 10 people come together in someone’s home,” Fauci noted. “You get one person who’s asymptomatic and infected, and then all of a sudden four or five people in that gathering are infected.””To me, that’s the exact scenario that you’re going to see in Thanksgiving,” he said.That is what happened in Canada, which celebrated its Thanksgiving on Oct. 12 and saw cases spike shortly thereafter.”In some areas we are learning that gatherings during the Thanksgiving weekend contributed to the elevated case counts we are seeing today,” Howard Njoo, Canada’s deputy chief public health officer, told reporters on Oct. 27. “Our actions matter.”Lowering risksThe safest way to observe the holiday is with a small group of just your immediate household members, according to the U.S. Centers for Disease Control and Prevention.Larger groups with people from outside their bubbles can reduce their risk somewhat by holding gatherings outdoors. Failing that, opening windows to improve airflow can help.Shorter get-togethers are better, the CDC says. Avoid crowding. Stay 2 meters from other people.Wear a mask. Health officials have been stressing that masks protect others from virus the wearer may be exhaling without knowing it. Now, the CDC cites growing evidence that a mask also protects the wearer.Getting tested before traveling might be helpful, but experts urge caution.Most rapid tests do not work well for people who are not showing symptoms, they note. Even the best tests can miss an early infection. And people can get infected in the time between when they get the test and when they arrive for Thanksgiving.“You can’t do testing by itself and expect it will get you out of a problem,” Duke’s Wolfe said.   


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