As we say in the south: It’s fall, y’all! Temperatures are cooler, leaves are changing colors, and everything seems to be flavored with pumpkin spice. In any other year, we’d be readying holiday plans for parties and get-togethers with family and friends, but this year is different. We’ve been living with COVID-19 for many months, and we will be doing so for many months more. This warrants continued vigilance and caution, but it doesn’t mean that we can’t celebrate, although our celebrations are likely to look a little different this year.

Pulmonary fibrosis patients and their families have for the most part been very cautious about avoiding exposure to Sars-CoV-2, the virus that causes COVID-19, because of the risk of severe or critical illness. As the holidays approach, the same principles apply. Each holiday activity should be thought of in terms of level of exposure risk – outdoors activities are a lower risk than indoors, crowds are a much higher risk than small gatherings. We need to then assess events for ways to reduce risk further, such as wearing a mask or face covering, quarantining prior to family gatherings, or even COVID-19 testing if routine universal testing becomes available in the future. It’s also important to remember that COVID-19 exposure risk is cumulative, and the concept of a “coronavirus exposure budget” may help to prioritize more important and lower risk activities.

The CDC has some holiday-specific guidelines with suggestions on how to apply safety principles to different situations.

Halloween is a bit of a paradox in terms of COVID-19 risk. Sure, many costumes come with masks, but haunted houses and traditional trick-or-treating door to door are considered high risk activities. Celebrate with lower risk events like visiting a pumpkin patch or apple orchard, a neighborhood costume parade, or allowing trick-or-treaters to pick up pre-packaged treats from the end of a driveway or sidewalk while you watch from a porch or patio. You can even build your own candy slide to deliver the treats.

• Normally, Thanksgiving is the busiest time of the year for travel in the U.S., but travel presents a significant risk of COVID-19 exposure. Make sure that anyone traveling to see you follows risk reduction strategies, such as mask wearing, frequent hand washing, and physical distancing while in an airport, on a plane, or if stopped for breaks during car travel. https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-during-covid19.html
• Thanksgiving celebrations generally involve a meal shared with family or friends. Instead of pot-luck or self-serve meals, a safer option would be plated meals served at the dinner table. Spread out when watching those post-feast football games, and get those Black Friday shopping deals online instead of in-store.

Christmas, Hannukah, Kwanzaa, and New Year’s pose similar risks with gatherings of families and friends and shared meals. In addition, outdoor gatherings are less feasible as the weather gets colder, so avoid crowding into smaller spaces and open windows or doors a bit to increase air circulation if weather permits.

For those who find in-person gatherings to be too high a risk to take (and that’s an individual decision), virtual parties on a video platform can allow friends and family to connect and celebrate without being physically together. In the past several months, my own family has had virtual baby showers, play dates, and birthday parties with loved ones across the country.

We’ve all sacrificed a lot for health and safety this year, but with creativity and planning we can still find ways to be merry, joyful and safe in the coming holiday season!