We get it. The holidays are typically filled with joyful gatherings of friends and family. What do we do now during a pandemic when family gatherings and events have been linked to clusters of cases and even deaths?


Many families are having tough conversations and having to uninvite people from the yearly gatherings.


These gatherings are "an unsafe thing that can have real consequences," says Dr. Sarmistha Hauger, infectious disease specialist at Dell Children's Medical Center of Central Texas. "There are so many clusters that have been implicated with large groups."


Dr. Stanley Spinner, vice president and chief medical officer at Texas Children’s Pediatrics & Texas Children’s Urgent Care, agrees. With big gatherings of 20 to 30 people, he says, "every single time, we see people getting infected. ... It can go like wildfire."


"The safest thing to do is to not have these gatherings," says Dr. Brian Metzger, medical director of infectious diseases at St. David’s Medical Center. "I know it's terrible, and we want to go on with our lives as best we can. ... It seems like it’s best to sit this one out."


Does that mean we just need to close our doors, not gather and shout "Bah, Humbug!" at the top of our lungs? (Don’t do that. Shouting spreads the virus farther.)


The threat of the coronavirus needn’t be the Scrooge or Grinch that stole Christmas, but we have to weigh the risks, take precautions and make a sensible plan.


The safest way to enjoy the holidays is with only the members of your household in person and the rest through virtual platforms such as Zoom or FaceTime, says Darlene Bhavnani, an epidemiologist at the University of Texas Dell Medical School.


You can gather as a family virtually and even do fun things, like everyone makes the same dishes and cooks together and eats together over Zoom.


She realizes, though, that saying that doesn’t mean people are going to do that.


"That’s not likely when people have the itch to travel and the pull of loved ones to celebrate with," Bhavnani says.


If you are expanding your circle to those beyond your household, ideally everyone you want to spend your holiday with would quarantine for two weeks and get a COVID-19 test right before the holiday, she says. They also would travel to see you in a way that allows them to maintain physical distance from fellow travelers.


Part of making your plan is looking at what the current state of the virus is in Central Texas as well as where your guests are coming from.


"As for Thanksgiving and Christmas, I think a lot will depend on the level of transmission in the community in the months to come, and the risk tolerance of each family member," Bhavnani says.


Check your local coronavirus dashboards for key factors such as new cases, positivity rates and hospitalizations. Metzger says if the positivity rate (the number of positive tests compared with all tests given) hits above 10%, that’s a red flag.


Look at the graphs on the dashboards: Are cases starting to rise again? Do the numbers look like they did in June and July, when Central Texas saw a spike?


What you decide to do also depends on whom you might want to spend your holidays with this year. Your decisions have to take into account if people in your family have risk factors such as being older than 60, being immunocompromised or having chronic diseases such as diabetes.


"The two biggest risks we’ve seen are obesity and diabetes," Metzger says. "Age is another big risk factor because the mortality rate goes up significantly."


Before you decide what your game plan is, have a conversation with everyone involved about what their risk factors are, what their daily activities have been since March and what their comfort levels are.


Try to limit the number of different households invited. "The more people you have, the more people can bring that virus and spread it," Spinner says.


For those who want to celebrate with an older family member or someone with increased risk factors, consider dropping off food instead and visiting with them outside with masks on or through the window, or through the magic of Zoom.


If you do have a family meal gathering with more than one household, take these precautions:


• Make sure everyone knows in advance the game plan and can agree to your safety measures.


• Make sure everyone understands to not come if they are feeling ill or have been around someone who has symptoms or has tested positive.


• Have any gatherings outside.


• Sadly, no hugging, handshakes, head patting, etc.


• Everyone wears a mask as much as possible, taking them off only to eat and then putting them back on immediately. Everyone’s masks must be worn correctly (over the nose and mouth) and not with big gaps at the side.


• Separate households into their own distinct tables spread at least 6 feet from another household. If you do have people with higher risk factors, keep them even more physically separated.


• Wash/sanitize hands before eating and after eating. Each table needs its own bottle of hand sanitizer.


• Have one masked person who has washed and sanitized their hands serve everyone by making a plate for each person, or give every family group their own bowl or plate of each food item and their own set of utensils.


• Avoid buffet lines, putting the food out on one big table and passing food.


Considering traveling?


Travel by car rather than by plane if that’s an option.


By car, make as few stops as possible, and when you do, wear your masks and use hand sanitizer. Avoid crowded indoor spaces like convenience stores and restaurants. Instead, use drive-thrus, pay for your gas outside, and use less-crowded rest stops for bathrooms.


If you are going by plane, maintain distance from other people as much as possible. Wear your mask at all times and use hand sanitizer and wipes to clean your area. Spinner recommends three-layer masks and eye protection or an eye shield as well.


For the family, "getting there and back is the biggest risk area," Spinner says.


Once you get to where you are going, rent a car instead of using a ride-hailing app. Wipe it down with sanitizing wipes before driving it.


If you are visiting family, know what levels of precautions they have taken and how they have interacted with people during the pandemic.


Staying at a hotel might actually be a good choice because you can socially distance yourself from other people, unlike at a relative’s house. Rooms are also cleaned between guests and, because of vacancies, often there is time between guests in each room.


"If you stay at a family’s house, you’re going to have a large group of people congregating for a long time," Metzger says.


What about Santa?


Sitting on his lap? Not this year, because you don’t want to get Santa sick. If you can physically distance from Santa, see him from afar, write him a letter, etc., that would be best, or can someone in your household rent a Santa suit and be Santa?


If you do go see Santa, everyone wears a mask and is standing 6 feet apart. "It doesn’t make for great pictures, but it is 2020," says Dr. Renee Higgerson, medical director for pediatric critical care at St. David’s Children’s Hospital. "It will be a reminder of what this Christmas is like."


Once you see Santa, wash everyone’s hands.


What about church?


That’s a personal decision, Spinner says, about what level of risk you are willing to accept.


Congregants in different households should be seated at least 6 feet apart, and everyone should be wearing masks. Also, singing has to be discouraged because of the way the virus spreads farther when air is forced through acts like singing and shouting.


If you can attend virtually, that is the safer option, even though it’s not the same.


What about holiday events?


Many public holiday events like the Turkey Trot are going virtual this year. Others like the Chuy’s Children Giving to Children Parade are not happening. Still others like the Trail of Lights are still working through their plans.


If an event is happening, do your research before you go. Can you safely distance from other people?


Instead, think about touring neighborhood light displays from the car or walking around less crowded areas in a socially distanced way.


Invest in your own holiday happenings at home such as decorations, movie watching and finding that Elf on the Shelf.


What about kids coming home from college?


"Kids coming home from college is the biggest infection risk," Higgerson says.


For that reason, a lot of schools have adjusted the schedule to end in-person classes at Thanksgiving to avoid college kids coming home at Thanksgiving, then back to college for exams, and then back home for Christmas. It limits the community transfer of germs to one event instead of three events.


Know your kids’ college infection rates to assess what your risk might be. Many schools have online dashboards that you can check.


Consider getting your child home by car instead of by plane to reduce their risk. If they do need to take a plane, remind them to always wear their mask and eye shield and sanitize their hands often.


If you can get your child a COVID-19 test when they get home, that will help reassure you that it is safe to hug your kid.


Until you know those results, Metzger recommends physically distancing within the house and wearing masks for the first 14 days. Why 14 days? Metzger explains that 90% of the people exposed to the virus that get symptoms get them within 10 days, with a few going as far as 14 days before symptoms emerge.


Keep those college kids away from the people in your household who are most at risk.


Think about the long game


"People are going to make their own decisions," Spinner says. "It’s not just themselves; it’s their family and others as well. You are out there spreading it or getting it. Think about others."


All the doctors recommend getting the flu vaccine by Halloween. It helps prevent the double immune system whammy of both the coronavirus and influenza and lessens the strain on hospitals.