A safe Thanksgiving during a pandemic is possible, but health experts know their advice is as tough to swallow as dry turkey: Stay home. Don’t travel. If you must gather, do it outdoors.

With a fall surge of coronavirus infections gripping the U.S., many Americans are forgoing tradition and getting creative with celebrations.

For the first time in five years, Atlanta nutrition consultant Marisa Moore won’t travel to South Carolina to see her large extended family. Instead, she plans to video chat with them as she attempts her first home-baked apple pie. When it’s time to eat, they’ll compare plates.

“We’ll talk all day,” Moore said.

On Monday, the Centers for Disease Control and Prevention updated its holiday guidance, noting the virus crisis is worsening and that small household gatherings are “an important contributor." The CDC said older adults and others at heightened risk of severe illness should avoid gathering with people outside their households.

Experts point to Canada, where Thanksgiving was celebrated Oct. 12. Clusters of cases tied to family gatherings followed. “This sucks. It really, really does,” Canada Prime Minister Justin Trudeau said two weeks later.

There’s no need to cancel the holiday. Spending time with loved ones is important for health too, said Lacy Fehrenbach, Washington state deputy secretary of health.

The coronavirus spreads more easily when people are crowded together inside, so Fehrenbach encourages new outdoor traditions such as hiking as a family. Guest lists for indoor feasts should be small enough so people can sit six feet apart while unmasked and eating, she said. Open the windows to keep air circulating.

The more people who attend a gathering, the greater the chances that someone in the party will be carrying the virus, Fehrenbach said, “even someone that you know and love.”

On any other Thanksgiving, dozens of Olga Garcia’s family members would squeeze into her home to make tamales, watch football and tell stories. This year, the 61-year-old professional caregiver will deliver food to family spread along 30 miles of the North Cascades Highway in Washington state.

If the plan works, everyone will sit down at the same time to eat in their own homes and join a group phone call.

“We’re going to be wise about this,” Garcia said. “We’re just crossing our fingers that in 2021 we’ll be able to sit down at our table and get crazy again.”

What about a quarantine? The magic day to start a pre-Thanksgiving quarantine is Nov. 13, according to Lindsey Leininger, who leads the Nerdy Girls, a cadre of scientists collaborating on a website called Dear Pandemic.

A strict quarantine would mean no grocery shopping, no working outside the home and no in-person school for 14 days.

What about testing? The best day to test would be as close to Turkey Day as possible while still leaving enough time to get results. But a test might not catch a still brewing infection so the best plan is the quarantine for two weeks — the time it can take for symptoms to show up.

Instead of that rigmarole, Leininger said her children will see their grandparents via Zoom on Thanksgiving. After dinner, the family will meet neighbors in the driveway for pie.

“We bring our own pie and they bring their own pie,” said Leininger of Dartmouth College in Hanover, New Hampshire. “It’s cold here in northern New England, but pie can be a quick activity.”

When it seems cruel that everything most loved about Thanksgiving is forbidden, finding humor in absurdity can help. In a video on Twitter, New York comedian Matt Buechele offers an increasingly silly list of Thanksgiving precautions, including water balloons filled with gravy and kids' tables for all.

“Before we eat, everyone’s going to go around the table, say one thing they’re thankful for and one thing they scream into their pillow at night,” Buechele said.

That's a joke, but the comedian thinks it could be a cathartic practice. “The thing I continue to scream into my pillow is, ‘Why is it like this? It didn’t have to be this way! And, my God, when will it end?’" he said.

In New Jersey, the nonprofit HealthBarn Foundation usually co-hosts a sit-down Thanksgiving feast for 150 older adults. This year, volunteers prepared and froze individual meals and packaged them in insulated bags. Seniors will be able reheat the food at home.

“No one wanted to cancel it,” said HealthBarn director Stacey Antine. “You want to show that you still love people and honor them. And you want to make sure that they have nutritious food for this important holiday dinner.”

In Washington state, Garcia will get up before dawn to roast a 20-pound turkey and bake capirotada, a bread pudding layered with cheese, bananas, raisins, cinnamon and pecans. Her siblings will prepare other specialties in their homes: tamales, enchiladas, pico de gallo, ceviche, green bean casserole, yams with marshmallows, pumpkin pie and pecan pie. Up and down the route, the feast will be divided into boxes and delivered.

“It’s a sad time,” Garcia said. “But it can also be a grateful time: that we’re all here, that we have a roof over our head, a job to go to and enough food to go around. And for those that don’t have enough, we can say, ‘Here’s a plate.’”

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AP video journalist Kathy Young contributed to this report.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.