As Covid-19 cases rise across the country, there may be an increased risk of infection as families host Thanksgiving. Writing for NPR's "Shots," Allison Aubrey explains five ways to keep your family gatherings safe from Covid-19 during the holidays.

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What Americans have planned for Thanksgiving.

CDC in October released updated official guidance to help Americans safely celebrate the holidays this year, which include recommendations for potential settings, mask wearing, and vaccination.

A CDC spokesperson said the agency "fully expect[s] that families and friends will gather for the holidays this year" and that "[t]he best way to minimize Covid-19 risk and ensure that people can safely gather is to get vaccinated or get the booster, if you're eligible."

According to a poll from Monmouth University, two-thirds of Americans plan to spend this Thanksgiving the way they had before the pandemic—with larger group gatherings than last year. However, Covid-19 cases are once again rising across the country, and holiday gatherings may help fuel a potential winter surge, Axios reports.

With Thanksgiving just a few days away, here are five ways to keep your family safe during holiday gatherings.

1. Remember that elderly relatives are at higher risk of Covid-19.

Covid-19 vaccines offer strong protection against hospitalization and death, but breakthrough infections are still a possibility, Aubrey writes. And while many breakthrough infections are mild, older people are at a higher risk of severe Covid-19 and death from a breakthrough infection.

For example, CDC data found that 70% of breakthrough cases resulting in hospitalization and 87% of those ending in death were among patients over the age of 65. In addition, fully vaccinated people ages 80 or older were 13 times more likely to die from Covid-19 compared to the general vaccinated population.

"This is something we must be conscious of as people are gathering across generations," said William Miller, a physician and public health epidemiologist at Ohio State University. "Grandpa and Grandma are protected relative to if they hadn't been vaccinated, but they are still at risk."

Because of this increased risk, Miller encouraged people to take precautions during travel and in the week before any celebrations with older relatives and friends. "I would absolutely encourage people to continue to wear masks [in crowded indoor places]," he said.

2. If you're eligible for a booster shot, get one.

FDA and CDC last week authorized Covid-19 booster shots for all individuals ages 18 and older, and getting one before any holiday travels or gatherings could increase your immunity against the virus, Aubrey writes.

According to Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, a new analysis shows that an additional vaccine dose significantly increases protection against symptomatic infection. "If you look at the third dose in people whose protection has drifted down to about 63%, you boost it back up to at least 94%, which is really quite impressive," he said. "That's exactly the kind of thing you want boosters to do."

"I would recommend if you are eligible for a boost, go get boosted right now," Fauci said, noting that booster shots can be beneficial for indoor holiday gatherings, especially in areas with high viral transmission.

3. Use rapid tests as another protective measure.

To further reduce the risk of infection, you may want to ask your guests to take a Covid-19 test before any holiday event, Aubrey writes.

"A rapid antigen test is an added layer of protection for everyone," said Judy Guzman-Cottrill, a pediatric infectious disease expert at Oregon Health and Sciences University.

Emily Landon, an infectious disease physician at the University of Chicago, said she recommends taking a test the morning of the gathering, or as close to the time of the gathering as possible, since rapid tests may not pick up an early infection if they're done too far in advance.

Another option is to test before you travel and then again when you reach your destination, depending on the level of risk of the people around you, Aubrey writes.

4. Consider how to include unvaccinated family members.

According to health experts, a group of fully vaccinated guests is the safest situation for the holidays.

"I think it's reasonable for people to require their guests to be immunized," Guzman-Cottrill said, especially if some are too young to be vaccinated or are immunocompromised. "Those are the people who we still really need to make sure we keep as safe as possible because the pandemic is not over," she added.

An alternative option is to ask unvaccinated guest to do a lab-based PCR test at least 24 to 48 hours before an event or a rapid antigen test just before they arrive, Aubrey writes. In addition, Landon recommends asking unvaccinated guests take extra precautions, such as wearing masks in public and limiting exposure to other unvaccinated people the week before a holiday gathering.

"We think with the delta variant, most people are getting sick a few days after exposure, but it can take up to a week, maybe a little longer," Landon said. "I think it makes the most sense to take precautions for one week prior to having close, unmasked contact with someone who's at high risk."

5. Take precautions with children who are unvaccinated or only partially vaccinated.

Around 10% of children ages 5 to 11 have received their first doses of the Pfizer-BioNTech Covid-19 vaccine since it was authorized for the age group earlier this month. However, they will not be eligible for a second dose until after Thanksgiving, Aubrey writes, and it's not clear how much protection one dose of the vaccine provides to kids.

"I know many families find themselves in this annoying state of limbo right now because their kids will not be fully vaccinated by Thanksgiving," Guzman-Cottrill said, adding that "it's really important to keep in mind that this is not the time for those families to let their guard down."

According to Aubrey, one precaution is to have kids wear masks, not only the day of an event, but also the week before, especially in crowded, indoor areas. This decreases the child's risk of infection, and therefore the likelihood of them transferring the virus to older relatives. Other options include having separate accommodations for elderly relatives and hosting gatherings outdoors if possible.

Overall, Landon said that keeping the holidays safe for everyone means people "have to think about the risk of the individuals involved—about what would happen if they got Covid." (Owens/Beheraj, Axios, 11/21; Aubrey, "Shots," NPR, 11/20)