Fall was always going to be a difficult period of the pandemic. The season brings with it brisker air and shorter days, which drive people to spend more time inside -- where coronavirus is thought to transmit more easily.
The pandemic also coincides with the onslaught of the flu and other respiratory infections that, when coupled with coronavirus, can overwhelm the healthcare system and our own immune systems.
Much of the guidance for avoiding coronavirus is the same as it's been for months: Wash your hands frequently and thoroughly; keep at least six feet of distance from other people and wear a cloth face mask when distance isn't possible.
But the features of fall require a new vigilance from Americans, many of whom are tired of exercising the caution it takes to live in a pandemic, physicians say.
Here's their advice for staying safe and coronavirus-free this fall.
How to go about your daily life
The autumnal chill might make people rethink where they gather, but outside hang-outs are still safer than those indoors (with the exception of large, crowded events that don't leave room for social distancing).
There's more room to spread out and steady air flow, so even though it's getting colder out, people should still limit their interactions at indoor venues, said Dr. David Aronoff, director of Vanderbilt University Medical Center's Division of Infectious Diseases and professor of medicine.
But before you go anywhere:
Get your flu shot. Health experts, including Aronoff, say this year's flu vaccine may be the most important one you ever get. Relieving a burden from the healthcare system with one less infectious respiratory illness to contend with could mean fewer people die from both flu and Covid-19. The US Centers for Disease Control and Prevention suggests getting your flu shot by the end of October.
Stay warm outside. Invest in ways to keep gatherings outdoors, even when it's chilly, be it a fire pit, a warm coat or a heat lamp, suggests Dr. Leana Wen, an emergency room physician and visiting professor at George Washington University's Milken Institute of Public Health. This keeps meetings in a safer locale and helps prevent social isolation, too.
You don't always have to wear a mask outside. If you're outside and can maintain at least six feet of distance from people you don't live with, then you don't need to wear a mask, Wen said. For instance, if you're on a solo walk around your community and won't run into a neighbor, it's not necessary to wear a mask.
But you definitely should wear a mask around others. But if you're outdoors at a crowded area or on streets where it's tough to avoid strangers, do wear a mask, Aronoff said. Cloth masks prevent you from breathing out the virus if you're asymptomatic, he said, and they can prevent "silent transmission" of the virus.
How to celebrate fall holidays
The pandemic will certainly complicate the celebration of holidays like Halloween and Thanksgiving, which all revolve around community and family.
"We know by now that much of Covid-19's spread is actually driven not by formal settings with strangers, but by informal gatherings of family and friends," Wen said. "Some individuals may be letting down their guard with loved ones."
It's tempting to skirt Covid-19 prevention tips to gather loved ones on those days, but holidays shouldn't be considered exceptions, Aronoff said -- the virus won't stop infecting people on those days.
The virus that causes Covid-19, he said, "is just capable of being transmitted whenever people get together.
"I think people need to take these holidays very seriously. This is not going to be a season of being able to get together the way we used to."
If you take a risk to travel, cut down on exposure. Some may be willing to risk coronavirus transmission to see their loved ones, Wen said. But making that decision requires that you cut down on your cumulative risk, she said.
For example, If you decide to fly to visit family or friends for Thanksgiving, Wen said, you shouldn't also dine indoors at a restaurant or attend a sporting event during that time. You've chosen the risk you're willing to take and have potentially exposed yourself once -- continuing to expose yourself only increases the likelihood that you'll come down with Covid-19.
Create alternate holiday plans. Trick-or-treating or gathering for a communal meal come with additional risks during the pandemic. Aronoff suggested trading them for less risky fun.
The CDC ranked typical fall activities by their risk of Covid-19 exposure, and the safest activities per their standards involve only members of one's household. Carving pumpkins or doing a Halloween scavenger hunt among immediate family is safer than traditional trick-or-treating, the CDC said. And instead of Thanksgiving dinner with extended family, the lowest risk version of Thanksgiving, per the CDC, gathers only the people you've been isolating with and skipping Black Friday shopping for virtual sales.
How to vote
Both Wen and Aronoff agreed that voting is essential, even during a pandemic, and shouldn't be skipped. Whether you're voting ahead of or on November 3, it's possible to limit your exposure to Covid-19 at the polls.
If you can, vote by mail. The safest way to vote during the pandemic is to mail in your ballot, Wen said, bypassing the polling place entirely. (Read more about how voting by mail works in every state.)
If voting in-person, vote early. Early voting dates and hours vary by state, but polling places are typically less crowded ahead of Election Day.
Learn about your polling place if you're voting in-person. Learn as much about your polling place as you can before you go, Wen said. What precautions are poll workers taking? How much time will you have to spend indoors when you're there?
Bring the essentials. When you go to vote in-person, Wen said, wear a mask, bring hand sanitizer and be conscious of what you touch and the distance you keep from others.
How to beat pandemic fatigue
We're over six months into the pandemic. We've lived with masks mandates, travel restrictions, closures and cancellations and an upheaval of life as we knew it for over half a year. Over 200,000 Americans have died from Covid-19. It's jarring and upsetting, and it's natural for some to react to these changes with rebellion.
But we must continue to take the precautions that we know work, or we'll continue to live this way for far longer, Aronoff said.
"We're all tired of Covid-19, which is certainly a predictable effect of a horrible pandemic that seems to keep going and going," he said. "But we are not out from underneath it yet ... and it's up to us, in the absence of a vaccine, to continue to do our part to protect one another from this potentially fatal virus."
Wen likens it to drinking and driving without serious incident. Just because you don't end up injured or arrested, doesn't mean those behaviors are sustainable or safe -- and the same goes for people who flout mask requirements or social distancing guidelines.
"It's possible someone can get lucky multiple times," she said.
But the more often someone engages in risky behaviors, the more likely they are to wind up ill with coronavirus.
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