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Opinion How to assess the covid-19 risk from holiday gatherings? Here are four things to consider.

Turkeys on a farm in Orefield, Pa., on Nov. 10. (Hannah Beier/Bloomberg News)

After weeks of steady decline, covid-19 cases are on the rise again. Much of the United States is in the highest-risk category for transmission, according to the Centers for Disease Control and Prevention.

As Thanksgiving, Christmas and other winter holidays approach, here are four factors to consider when assessing risk to decide which gatherings to attend.

1. Vaccination status of attendees. The main reason this holiday season is dramatically different from last year’s is the availability of coronavirus vaccines. A vaccinated person is six times less likely to be infected with covid-19 compared with an unvaccinated individual. Events with only vaccinated people will have lower risk than those with attendees of mixed vaccination status.

Level of vaccination also matters. Children 5 to 11 years old are newly eligible to get their shots. Unless they participated in clinical trials, younger kids are unlikely to have received both doses before Thanksgiving. Those with partial vaccination have inadequate immunity and should be considered at similar risk as the unvaccinated. On the other end of the spectrum, people who have received boosters are even better protected than those who were inoculated more than six months ago. I’d feel more comfortable gathering with individuals who are not only vaccinated but also boosted.

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2. Level of community transmission. Most of the United States is awash in the coronavirus, though there are major differences across regions. Parts of the South and Southeast that were hit particularly hard by the delta wave are experiencing a respite, while covid-19 is surging in areas such as the Mountain West. In Montana, 44 percent of intensive-care beds are filled with covid-19 patients, and Colorado has reactivated its crisis standards of care.

I’ve likened the vaccine to a good raincoat. It will keep you dry in a drizzle, but in a downpour, you could get wet unless you also have an umbrella. The higher the rate of infection in your community, the more likely you will encounter covid-19. Just as you would consult the weather forecast with your exact location, you should also look to the CDC’s website for updated information on local infection levels. If your county’s rates are low, you could attend a large gathering with few precautions; if they are high, you might not go without more layers of protection, such as masking and testing.

3. Medical risk of household. If everyone in your household is vaccinated and generally healthy, the risk is relatively low. But living with immunocompromised family members or unvaccinated young children is a very different situation. Because the vaccines provide such excellent protection against severe disease, many who are inoculated and in good health can reasonably decide that they don’t want to limit social interactions. Others will make more conservative choices to protect medically frail loved ones.

4. Setting of the gathering. Outdoor settings remain by far the safest option. Indoor masking is an effective protective measure, too. If it’s unclear from the invitation, I would ask about the proportion of indoor vs. outdoor activities. This is particularly important when food and drink are involved. An event that supposedly requires masks but also has people eating and drinking indoors is not as safe as one where food and drink are served outdoors only.

If the activity is primarily indoors, ask how many people will be there. The higher the number, the greater the risk. Will they all be from your area, or will there be visitors from parts of the country that have higher covid-19 levels? Will hosts add layers of protection, such as required testing and improved ventilation?

How can we celebrate the holidays safely? Dr. Leana S. Wen will answer your covid-19 questions at 1 p.m. ET on Nov. 18.

Here’s how my family is approaching our decisions. My husband and I are both vaccinated. I’ve received my booster, and he is considered to be boosted, as he had the coronavirus and then received two doses of the vaccine. If it were just us two, we would probably accept the same invitations we would have pre-pandemic. But because we have kids too young to be inoculated, we are being extra-cautious and declining most indoor gatherings while our community is at a high transmission level.

That doesn’t mean we are forgoing holiday celebrations. For Thanksgiving, we are getting together with 15 people. Because there will be unvaccinated and partially vaccinated kids, nearly all the festivities, including all eating and drinking, will be outdoors. For the rest of that weekend, we will see two families both indoors and outdoors. All the adults are vaccinated and boosted. Everyone has committed to reducing our exposures for several days before and taking daily rapid tests while together.

Other families will make different choices, and that’s exactly my point: There is no one-size-fits-all answer. Everyone must gauge his or her individual circumstances. Thankfully, we finally have excellent tools that help reduce risk, and this upcoming holiday season will show us how Americans can — and must — live with covid-19.