Outdoor summer barbecues, socially distanced hikes, and mask-wearing play dates at the park have helped people maintain in-person contact with friends and family during the coronavirus pandemic.

But those outdoor gatherings will become less feasible as the pandemic stretches into the fall and temperatures drop, leaving many grasping for an alternative.

Enter pandemic pods. Also known as quarantine bubbles or quaranteams, they are becoming increasingly popular among families and extended family as a way to socialize safely.

A pandemic pod is a group of friends or families who agree to strict safety rules — both for when they are together and when they are apart — that enable them to socialize while reducing the risk of contracting or spreading the coronavirus. A group of single adults may create a pod for the ability to socialize with others, while families with children may use a pod to share education and child-care responsibilities. Extended family may agree to pod rules to ensure older, at-risk family members are able to remain in close contact with grandchildren or family caretakers.

The approach isn’t without risk, but epidemiologists say that as the pandemic continues, people must weigh the risks of exposure to the virus with the risks social isolation poses to our mental and emotional health.

“Risk exists on a spectrum,” said Melissa Hawkins, an epidemiologist and director of the public health scholars program at American University in Washington. “The longer we’re living in a pandemic, alongside COVID-19, it’s prudent and reasonable to think about how to safely manage risk, and not practical to eliminate all risks.”

Pandemic pods are a “harm reduction” tool for reducing the risk of spreading COVID-19, akin to safe-sex education being more effective in reducing the risk of sexually transmitted diseases and unintended pregnancy than abstinence-only education, Hawkins said.

While pandemic pods can be beneficial, they take careful planning, communication and commitment from all members to follow the rules. Here are the steps to take and questions to ask to create your own.

Who should be in your pod?

Choose families or friends with similar risk and exposure levels, and who are already taking a similar approach to safety as you.

“People have different risk thresholds. Do you let your son climb to the top of the tree? Maybe it’s too risky for you, but someone else allows it,” said Alison Drake, an epidemiologist and assistant professor at the University of Washington in Seattle.

The same is true for the pandemic — some people feel strongly about wiping down all their groceries at home, while others may focus instead on following guidelines for limiting exposure when out and about, she said.

Before agreeing to pod together, have a frank discussion about your family’s risk tolerance and whether you will realistically be able to adhere to rules set by the group. That’s a good conversation to have over video chat, where you can better interpret facial expressions and body language, said Theresa Chapple, a Maryland-based epidemiologist.

How many people should be in your pod?

Chapple suggested families in the Philadelphia area consider sticking to a group of no more than six people. Groups of up to 12 people may be safe in areas where the virus’ spread has slowed the most, she said. Keep tabs on your area’s coronavirus statistics, such as the number of cases controlled for population, rate of positive tests, and whether these numbers are improving or worsening. The size of your pod alone doesn’t dictate its risk level; it also depends on how strict the rules are for pod members.

Establish rules for your pod

Pods will need ground rules for how members interact both when they are together and when they are apart. Some pods may be comfortable with a higher level of risk than others. What’s most important is that everyone is in agreement.

Some topics to consider:

  • Social interaction outside the pod and what precautions members will take. Can pod members interact with other friends and family, or will the pod be their only social contacts? Is it acceptable to go to the grocery store, or will everyone have food delivered? Will members practice mask-wearing and social distancing for any activity outside the pod?
  • Defining what non-pod activities the group should be notified about. For instance, one pod may decide that members can freely go shopping or visit a relative with proper safety protocol without notifying the group, while another may decide that type of activity is acceptable, but that pod members should be alerted.
  • Guidelines for how pod members will interact with each other. Will everyone wear masks? Will gatherings take place outside or inside? Is it acceptable to share food and touch?

Write down the rules and make sure everyone has a copy.

What happens if someone gets sick?

Consider a process to screen for COVID-19 or other illness before gathering, such as taking temperatures or random coronavirus testing, if tests are readily available where you live.

Be specific in defining what constitutes being sick and how the pod will respond when a member meets that criteria. What symptoms should keep a pod member at home? How long will they need to isolate before rejoining? The U.S. Centers for Disease Control and Prevention recommends people who have been exposed to the virus or believe they have been to quarantine for two weeks, the virus' incubation period.

It is helpful to have a plan in place for how pod members can stay connected virtually if they are required to isolate.

Pods may also want to establish extra screening when creating their pod, to ensure everyone is healthy. For instance, pod members may agree to isolate for two weeks or get a COVID-19 test before meeting up for the first time.

Prioritize communication

Honest communication is a pillar of successful pandemic pods. Rules are effective only if everyone follows them — and is honest about when they are unable to.

Establish a plan for how members will reenter the group after an unapproved activity. For instance, if the group agrees that no one will travel outside the state, how will a family rejoin the pod after a vacation? Perhaps they will socially isolate for two weeks.

It’s important that pod members do not feel that they will be penalized or shunned for reporting any signs of illness or departure from the group’s rules. People who think their pod will be angry with them may be more likely to withhold information.

Members should be encouraged to share any instances when they will be going against pod rules in advance to avoid feelings of guilt or shame, Chapple said. A weekly administrative meeting can be a time to share this type of disclosure.

“A majority of time, your weekend plans are set — you know if you’re going to that barbecue. Disclosing up front takes away the shame of being caught,” she said.

Revisit and revise

Public health guidance on how best to protect your family during the pandemic is constantly changing, as researchers learn more about the virus. While infection rates are improving in many parts of the country, including Pennsylvania and New Jersey, doctors have warned that the upcoming flu and cold season, paired with more indoor activity during cooler weather, could lead to an increase in coronavirus cases. Whatever rules you set for your pod, it is important to reevaluate every so often, to be sure the plan you’ve established is still working for all members and remains an effective approach to keeping everyone safe, healthy and happy.