Expert Advice on Navigating a Risky Thanksgiving Buffet

As Thanksgiving gatherings take place, unexpected guests like respiratory viruses including influenza, Covid-19, and respiratory syncytial virus are on the rise. There are also foodborne illnesses circulating that can cause stomach upset and other symptoms.

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I interviewed Dr. Leana Wen, CNN's wellness medical expert and an emergency physician and professor at George Washington University's Milken Institute School of Public Health, to address these important questions. Dr. Wen previously served as Baltimore's health commissioner, where she was responsible for overseeing infectious diseases and food safety.

CNN: What kinds of illnesses can be spread during Thanksgiving and other holiday gatherings?

Dr. Leana Wen: I would categorize illnesses into two groups. The first includes respiratory illnesses such as the flu, RSV, and the common cold. If an infected person coughs or sneezes, the virus-containing droplets can land on your nose or mouth. Additionally, if they touch their nose, then a surface, and you touch the same surface and then your nose or mouth, the virus can spread. Some viruses, like the one that causes Covid-19, can also be airborne and transmitted by someone coughing, singing, speaking, or breathing near you.

In Chemnitz, Saxony, on 22 August 2022, a medical-technical assistant is seen preparing Escherichia coli strains for PCR analysis at the laboratory of the Saxony State Investigation Office (LUA). The LUA's focus on food safety, consumer goods, and cosmetics aims to protect consumers from potential hazards related to unsafe food and prolonged contact with the body. The preventive consumer health protection work of the LUA is increasingly important and is detailed in the authority's annual report for 2021, which was recently presented by the Saxon Ministry of Social Affairs. Photo: Hendrik Schmidt/dpa (Photo by Hendrik Schmidt/picture alliance via Getty Images)

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The second category, foodborne infections, is also quite common. According to the US Centers for Disease Control and Prevention, there are around 9 million episodes of foodborne illnesses each year. The most common pathogen causing these infections is norovirus, which can be spread through food and drink, as well as from person to person. Touching an object that an infected person touched and then touching your mouth could result in contracting norovirus. Additionally, using the same utensils or drinking from the same cup as an infected person could also lead to the spread of the virus.

Another subcategory of foodborne infections includes those that result from ingesting the food itself, such as when it is undercooked or spoiled. Pathogens such as salmonella and E. coli can cause these types of infections.

CNN: How should individuals determine the appropriate level of precaution to take?

Wen: While everyone wants to avoid getting sick, certain individuals need to take extra precautions due to their vulnerability to severe illness. This includes older people, infants, young children, pregnant individuals, and those with compromised immune systems or serious underlying medical conditions. They should consider taking additional precautions based on their desire to minimize the risk of infection.

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When planning events, hosts should consider avoiding large indoor gatherings and prioritize smaller get-togethers with friends and family who have taken steps to reduce their virus risks. It is important to spend time in well-ventilated spaces and wear high-quality masks in public areas. Additionally, hosts should ensure that all attendees have their recommended vaccinations and access to antiviral treatment if needed.

Hosts should communicate with their guests to identify if any of them are considered high-risk individuals who may want to take extra precautions. If so, they can discuss additional measures to reduce the risk, such as keeping doors and windows open during meals, advising people with symptoms not to attend, recommending rapid Covid-19 testing before arrival, and providing hand sanitizer for frequent use. These steps can help minimize the risk of respiratory and gastrointestinal illnesses.

CNN: Are buffet tables a good idea?

Wen: Buffet tables could add a bit more risk for three reasons, but there are ways to reduce the risk with some planning.

Firstly, it is common for individuals to gather around a buffet. The high concentration of people in a confined area increases the likelihood of person-to-person transmission. To mitigate this risk, hosts may consider directing a limited number of individuals to serve themselves food one at a time and then promptly take a seat instead of congregating. Additionally, they can promote ventilation by opening windows and doors.

A sign advertises COVID-19 (coronavirus) vaccine shots at a Walgreens Pharmacy in Somerville, Massachusetts, U.S., August 14, 2023. REUTERS/Brian Snyder

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The CDC reports that the Covid-19 vaccination rate is lower than desired. In addition, buffets often have multiple items that are handled by many people, such as serving spoons, pitchers, and lids. To address this, hosts can place hand sanitizer at the end of the buffet line and at dining areas to promote its use after serving oneself and before eating.

Thirdly, buffets often feature food that has been sitting out for a prolonged period of time. This can lead to the food becoming a breeding ground for different types of harmful pathogens, depending on the kind of food. Hosts need to be mindful of the duration perishable items are left out, as a general rule perishable items should not be left out for more than two hours. It's important to remember the age-old saying: Keep hot food hot and cold food cold.

CNN: Would it be preferable to opt for plated meals over buffets?

How else can food safety precautions help prevent the spread of illnesses?

When cooking meat, it's important to ensure that it is not undercooked. There are many valuable online resources available that provide guidelines for the internal temperatures at which different types of meat and poultry should be cooked.

It's also important to be mindful of which containers and utensils have come into contact with raw meat. Vegetables that are meant to be served as salad or alongside cooked meat should not be placed in these containers. Additionally, it's essential to thoroughly wash vegetables and fruit before serving them.

CNN: Finally, what symptoms should people be aware of and how can they determine when it is necessary to seek medical attention?

In this image, CVS MinuteClinic family nurse practitioner Kafayat Ayodele is seen holding a Flucelvax Quadrivalent influenza vaccine at CVS MinuteClinic in Houston on Wednesday, Sept. 22, 2021. (Photo by Marie D. De Jesus/Houston Chronicle via Getty Images)

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Symptoms of respiratory illnesses may include fever, cough, sneezing, and body aches, while symptoms of gastrointestinal illnesses may include nausea, vomiting, diarrhea, and abdominal pain. Those with foodborne infections may also experience body aches and flu-like symptoms.

Individuals should seek medical attention if they experience shortness of breath, severe abdominal pain, or are unable to keep down fluids due to excessive vomiting, especially those at risk for severe illness. Those with symptoms should also distance themselves from others to minimize the risk of spreading infections further.