Recently, I've had a lot of folks ask me whether it'll be possible to safely visit loved ones during the 2020 holiday season. In the US, #COVID19 will likely still be with us then – but "merging bubbles" may be an option (if done responsibly).

Let's discuss what that means. 1/X

The concept of "merging bubbles" involves bringing two or more households together such that they can interact with each other (indoors and in person). In this thread, I'll be offering my own personal views on how to minimize #coronavirus transmission risk while doing this. 2/X

Let me preempt this by saying that the advice I offer today is based off of the best available knowledge at present and is subject to change between now and the holiday season. If it does, I'll be adding an addendum to this thread – so be sure to bookmark and check back then! 3/X

Now, let's get started.

First and foremost, the choice to "merge bubbles" will (by design) increase risk of #coronavirus transmission – but doing so may be essential for emotional well-being in the months ahead. Thus, our goal is to decrease this risk as much as we can. 4/X

One of the best ways to decrease the risks associated with "merging bubbles" is by being very selective about the households we choose to merge with. In general, the fewer households (and people) involved, the lesser the risk – but numbers are just one piece of the process. 5/X

Risk is not uniform across our population. For example, some of us are more likely to contract #coronavirus because of the jobs we work, and others are more likely to have severe outcomes if they contract it. We absolutely must consider these risks before "merging bubbles". 6/X

However, even for young and/or otherwise healthy people who work from home, risk isn't uniform – and IMHO, this is the piece that often catches folks off guard. The reality is, we all have different #COVID19-related "risk behaviors" – and these deserve consideration as well. 7/X

Some of us wear face-coverings whenever we step out of the house (no matter the purpose); others don't. Some of us are still washing our hands with soap and water for 20 seconds every time we bring in the mail; others aren't. Some of us have groceries delivered; others can't. 8/X

The list goes on – and ascertaining where another person (let alone an entire household!) sits on the spectrum of #COVID19-related "risk behaviors" is made trickier by how divisive and moralistic some of the aforementioned behaviors have become.

So, where does this leave us? 9/X

To me, it's all about communication and trust.

In order to "merge bubbles" with another household, we need to communicate openly not only about our occupation- and demographic-related risks, but about our risk behaviors too – and what we share needs to be the whole truth. 10/X

For young and/or otherwise healthy folks who can work from home and are poster children for #COVID19 prevention when they (rarely) leave the house, "merging bubbles" with another household that can be trusted to have a similar risk profile could be done quite safely IMHO. 11/X

In these situations, I would advise that both households quarantine themselves for 14 days before engaging in free movement between households. To minimize risk further after "merging", I'd also assign the lowest risk person within the "bubble" to any "higher risk" chores. 12/X

(For example, chores like going to the supermarket or pharmacy in person are "higher risk" because they're indoors and require interaction with people outside of our "bubbles". IMHO, assigning these tasks to a single low risk person can minimize overall "bubble-wide" risk.) 13/X

(But folks who can afford it can certainly have their groceries and prescriptions delivered to minimize risk even further. I'm providing this alternative because delivery services can be cost-prohibitive even to those who are fortunate enough to be able to work from home.) 14/X

That said, it's important to acknowledge that many Americans (including members of my own family) aren't young and/or otherwise healthy and/or can't work from home – and "merging bubbles" in these situations is without question less safe than in the aforementioned situation. 15/X

How much less safe depends in no small part on the #COVID19-related "risk behaviors" I mentioned earlier in this thread and is also contingent on the risks that are present. This further cements why honest communication about these risks is critical before "merging bubbles". 16/X

There are many loved ones in my own life with whom I can't safely "merge my bubble"... But I only know this because I've had frank (and often difficult) conversations with these individuals – and because I had those conversations, I can continue keeping my own "bubble" safe. 17/X

We can't assume that our loved ones all have the same risk profiles that we do – but some aspects of these profiles (e.g., wearing face-coverings, hand washing, etc.) can be nudged in the right direction if we start the conversation now, a few months before the holidays. 18/X

Ultimately, we all need to make decisions about what risks we can or can't tolerate. "Merging bubbles" will inevitably increase risk of #coronavirus transmission, but to what extent is dependent on the occupational, demographic, and behavioral (etc.) risks of those involved. 19/X

I'll pause here for now, but I should mention that I'll be putting this thread to the test next month as my husband and I prepare to close on our new house. Due to the scale of the move, we'll be "merging bubbles" with a few trusted loved ones. More soon on that front. 20/20

ADDENDUM 1: Just in case it wasn't clear, I want to mention that the safety of "merging bubbles" absolutely depends on the form (and distance) of transit used by individuals to move freely between households. I'd personally place this under the "risk behaviors" category. 1/2

Similarly, local epidemiological risk is an important consideration as well, and how important it is depends on individual risk (i.e., how frequently folks venture outdoors). That said, "merging bubbles" is safer in places with less local transmission. (HT: @KrutikaKuppalli) 2/2

ADDENDUM 2: Adding another clarification because I realize it wasn't explicit in the original thread.

When discussing #COVID19-related "risk behaviors", I don't just mean face-coverings, hand washing, and grocery shopping. I mean out-of-bubble social visits (etc.) as well. 1/2

The lowest risk option is for folks not to socialize outside of their "bubble", period. If it's necessary however, a critical risk behavior to consider and discuss is whether such visits are conducted outdoors, with face-coverings and 6-feet+ distance. (HT: @DiseaseEcology) 2/2