During Thursday’s debate, Democratic presidential nominee Joe Biden had an ominous warning about the coming months.

“We are about to go into a dark winter,” he said.

The former vice president’s comments echoed concerns voiced by experts about the looming combination of colder weather and holiday gatherings, which have the potential to contribute to a massive rise in coronavirus infections.

Covid-19 cases are rising across nearly 75 percent of the country — a “distressing trend,” Dr. Jay Butler, deputy director for infectious diseases at the Centers for Disease Control and Prevention, said Wednesday.

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“I am really worried that we are facing some of the toughest times in this pandemic in our country,” Dr. Carlos del Rio, executive associate dean of the Emory University School of Medicine in Atlanta, said last week during a “Doc to Doc” interview with NBC News senior medical correspondent Dr. John Torres.

“Between Thanksgiving and New Year’s,” del Rio predicted, “I see potentially six weeks of superspreader events.” A superspreader event refers to a situation in which a gathering of people results in a large number of infections.

Oct. 22, 202003:09

It’s a distressing outlook for the millions of Americans who are trying to figure out whether it’s safe to gather with friends and family for the holidays.

And it’s why Dr. James McDeavitt, senior vice president and dean of clinical affairs at the Baylor College of Medicine in Houston, developed a “holiday bubble checklist” for families to help reduce the risk of Covid-19 spread this winter.

His plan was inspired in part by physician colleagues who are around Covid-19 patients “all day, every day” but remain healthy, as well as the success of the NBA’s “bubble” in Orlando, in which the league’s players were sequestered throughout the basketball season. All players followed strict rules. As a result, not a single player became infected.

“The NBA did not say, ‘OK, guys, be real careful.’ They had a very deliberative process that was monitored carefully. Everybody was fully committed to it,” McDeavitt said.

That level of commitment is where his holiday bubble checklist begins. He advises designating one person as the “bubble commissioner” — an organized person to take responsibility for encouraging the entire family to get on board with mitigation efforts well in advance of any significant holiday gathering.

Every single person to be included in the gathering should be aware of the guidance, and pledge to adhere to it. This cannot be done halfway, McDeavitt said. “There is harm in that,” he said. “It gives a false sense of security.”

The checklist also advises getting a flu shot as soon as possible. “This will decrease the likelihood of developing a flu-related illness around holiday time, which could disrupt your plans,” he wrote in a blog post detailing the checklist.

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The guidance also advises self-quarantining as much as possible for 14 days ahead of any family gathering.

But a 14-day quarantine is either impractical or downright impossible for many people, especially if adults must work outside the home or if children are physically in school.

That’s why Dr. Leana Wen, an emergency physician and former health commissioner for Baltimore, advises outdoor-only gatherings.

There is this magical thinking that occurs with our loved ones, but we need to be aware that our family and friends are just as likely to have coronavirus as strangers.

“We know that up to 50 percent of people who are spreading coronavirus may not have symptoms,” Wen said. “There is this magical thinking that occurs with our loved ones, but we need to be aware that our family and friends are just as likely to have coronavirus as strangers.”

To minimize risks, families may want to employ other practical mitigation efforts, according to McDeavitt’s checklist, such as packing snacks for road trips, contact-free grocery shopping, daily symptom checks and testing about a week ahead of a gathering.

It’s important to note that the checklist is not foolproof. It is only a list of ways to minimize the chance of spread. And gatherings with those who have severely weakened immune systems or are older may not be feasible. Families must take into account those who are at greater risk for complications of Covid-19.

“The more meticulous you are with your preparations,” McDeavitt said, the more comfortable families may be with “co-mingling, singing songs, laughing — all the things you like to do during the holidays.”

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