Last year, Debbie Aylward celebrated Christmas by driving alone to New Hampshire, standing by her car and waving to her daughter and son-in-law as they stood on their porch.

After handing them presents, she briefly stepped inside their home wearing a reindeer mask to snap a selfie as the couple, also in masks, stood by the tree 6 feet away. Then, she got back in her car and drove home.

There was no shared meal, no hugs. She left her husband, who has health issues, at home.

“It was hard,” said Aylward, a nurse who lives in Portland. “It’s going to be better this year. But we’re still going to be careful.”

Options for safe holiday gatherings have expanded somewhat since last year, when vaccines weren’t available. But with COVID-19 cases and hospitalizations rising and the more contagious omicron variant now in Maine, get-togethers should be small and precautions should be taken, health experts say. Some traditions, such as large family gatherings with multiple generations, or gatherings at restaurants and workplaces, should be avoided, again.

Aylward won’t attend church in person; she’ll watch the service online. But when she visits her daughter and son-in-law, her husband, Steve Cole, will be with her. She won’t wear a mask. They’ll open presents in front of one another, not on Zoom.

“We’re all fully vaccinated and boostered,” she said. “We’re working hybrid and staying as safe as possible,” wearing masks and trying to social distance when out in public.

Debbie Aylward is planning to spend more time indoors with her family for the holidays this year, but she won’t be attending church in person. “It’s going to be better this year. But we’re still going to be careful,” she says. Ben McCanna/Staff Photographer

With community spread at high levels and hospital staffs overwhelmed with sick patients, any gathering should be small and precautions should be taken, said Dr. Dora Anne Mills, chief health improvement officer for MaineHealth and former director of the Maine Center for Disease Control and Prevention.

If everyone in the family is fully vaccinated, has had a booster shot, is healthy and not at high risk for disease, it might be possible to have a fairly normal, but smaller, holiday, Mills said. But it’s a rare family that can say that, she said.

“If you have high-risk elderly people and young kids who aren’t eligible for the vaccine yet, people have to reconsider whether they should get together or not. In some cases, it’s OK. It depends on the level of risk,” she said, and whether safety precautions, such as ventilation, are feasible.

Much of the population is at higher risk of illness from COVID-19 including those over age 60, people who are overweight or have an underlying health problem like diabetes, cancer or heart disease, children under age 5 who are not vaccinated, and children under 12 who are not yet fully vaccinated, Mills said. A typical extended family might have a 90-year-old grandfather, an uncle recovering from cancer, and young children.

Katie Brunelle of Portland, a mother of two children under 12 and chief executive officer of the public relations firm Muse, said she’s still trying to figure out what to do for the holiday.

“My family is on the cautious side,” Brunelle said in an email.

Last year, they didn’t get together for Thanksgiving or Christmas. Her mother and stepfather are in their 70s.

“We want to keep our precious Mimi and Bucky safe,” she said. “My siblings and I stayed in our own little pods.” The extended family held FaceTime gatherings.

Katie Brunelle and her children, Liam and Nora, outside their Portland home. They’re still trying to figure out what to do for the holiday. “My family is on the cautious side,” Brunelle said. Ben McCanna/Staff Photographer

This year, everyone in her extended family who is old enough has been vaccinated, she said. At Thanksgiving, they got together after taking COVID tests before arriving; they all agreed to stay home if anyone had symptoms. But since then, cases have increased.

“Christmas plans are still in the air as far as gathering,” she said. “We don’t know a lot about the omicron variant and will play it by ear.”

Mills’ biggest rule for Christmas 2021: Don’t get together indoors with anyone who is not vaccinated.

“First and foremost – and this is not popular – ask if they’re vaccinated,” Mills said. If anyone says no, follow up with a conversation about why they won’t be included this season. “Say, ‘I hope you can come another holiday.’ ”

Mingling only with small groups of people who are fully vaccinated and have had booster shots is the strongest layer of protection, Mills said, “like wearing your warmest winter coat in freezing temperatures.” Other layers of protection are, in order of importance: masking, distancing, ventilation and testing.

While health experts agree that any holiday gathering should be small, advice varies on just how restrictive the guest list should be. White House chief medical adviser Dr. Anthony Fauci told NBC Friday that people “should feel reasonably comfortable” having an at-home holiday gathering of family and friends who are all fully vaccinated and have had booster shots.

However, in an interview with CNN this month, Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, advised people to celebrate only within their “pods,” and not with anyone who has had outside exposure, such as children who have been away at college, unless they have quarantined for at least 10 days.

Jay Dufour, an assistant principal at Lewiston High School whose family didn’t get together at all last year, said they’ll have a small gathering on Christmas Eve. Everyone there will be fully vaccinated, Dufour said, and he feels that will be safe.

“The precautions we are all taking (masking, washing hands, distancing) has become the new normal,” he said.

If you live in an area of substantial or high transmission – which now includes all of Maine and most of the country – the federal CDC recommends wearing a mask indoors in public places regardless of vaccination status prior to attending any holiday gathering.

Also, avoid crowded, poorly ventilated spaces, and anyone who is sick or is showing symptoms should not host or attend any gatherings. Those showing symptoms or who have been in close contact with someone who has COVID should get tested. Outdoors is safer than indoors, the CDC says.

At DiMillo’s restaurant on the Portland waterfront, tables are still distanced from one another, and the deck, with heaters, is still open to people who don’t want to eat and drink indoors. Compared to 2019, the holiday parties this year are “smaller, more intimate, 15 to 20 people,” said Steve DiMillo Jr., who works at his family’s floating restaurant.

Bruno’s Restaurant and Tavern general manager Danny Napolitano said private holiday gatherings have picked up over last year, with one scheduled at the Portland restaurant every night during the two weeks before Christmas. But some have been canceled or postponed, he said.

“We’re getting calls from people backing out. People are worried,” he said.

When planning a get-together, ask those invited if they prefer to hold the event outdoors or for guests to wear masks. At indoor gatherings where there’s eating and high-risk people coming together, Mills recommends wearing masks and social distancing.

When it’s time to eat and masks come off, sit people who live in the same household together instead of having everyone at one table. Open windows for ventilation and sit children who are too young to be vaccinated near them, Mills said.

As for hugging, Mills said, it can be OK, but only if both huggers are fully vaccinated. She prefers any hugging – even by the vaccinated – to be brief and done with masks.

Another step to reduce risk is testing – a potential solution if an unvaccinated person is attending, Mills said. But getting tested – by booking an appointment, waiting in line at a test site or buying at-home tests at a store – has become increasingly difficult.

Brunelle, the Portland woman who is still undecided about gathering for Christmas, said everyone is suffering from mask and social distancing fatigue. If people are vaccinated, lack symptoms and get a test before gathering, she feels they can proceed “with our lives with some degree, continuing to keep those at risk as safe as possible.”

But she is all too aware of the severity of the virus.

“A dear friend of mine just lost her dad to COVID-19,” she said. “As much as we want to move on, we have to put some thought into our actions.”