RALEIGH, North Carolina -- As the leaves begin to change colors and the air gets a bit cooler, people should remember that their favorite fall activities may look a little different this year due to the COVID-19 pandemic.
Dr. Lisa Pickett, chief medical officer for Duke Health, said while it may be tempting to bring activities indoors when the temperatures start to drop, making outdoor plans is the best way to keep you, your family and your friends safe this season.
"North Carolina falls are lovely," Pickett said. "As much as we can encourage barbecues, grill outs, and things to be outdoors, as long as the weather holds out, I think that would be safer."
Apple Picking - Low risk
Many delicious fall recipes incorporate apples, and wandering the rows of an apple orchard is a quintessential fall activity.
Pickett said that going apple picking is actually relatively low risk for COVID-19 transmission, as long as only immediate families (people that share a household) ride in the same car and everyone wears a face covering while walking on a narrow path, waiting in line to pay or standing near other families.
"Picking our apples and washing them and enjoying them either as a nice healthy treat or perhaps in a delicious apple pie would be a wonderful fall way to spend time," Pickett said.
Pickett also advised families to check if the orchard or farm stand employees are wearing face coverings and if there are markings on the ground to stay six feet apart.
"If you do come upon a stand and people aren't social distancing and aren't wearing masks, it seems like a different stand might be a better place to go," Pickett said.
Pumpkin Patch Photo Shoots - Low Risk
As the weather cools down, many families will head outside for some picturesque fall photos for their holiday cards. And as long as the photographer rides to the photoshoot location separately from the subjects and maintains distance, Pickett says this activity can be very safe.
"If they do have to get a little bit close, being sure that everyone has a mask on and then take the mask off for the photos," Pickett said.
Pickett added that carving and painting pumpkins are some of her favorite fall activities, and can be done safely among family members and outdoors.
Hay Ride with other families - Medium Risk
Though many fall festivals have been canceled, some communities may still host a hay ride for families and children. And Pickett said this activity can be safe, as long as everyone wears a mask and there's enough room on the trailer for different families to space out six feet apart.
"If multiple families are getting on a ride that don't know each other, I think that might not be as safe," Pickett said. She added that children who are immunocompromised and anyone at increased risk of severe disease from COVID-19 should not participate in this activity.
Bonfire with friends - Medium Risk
While Pickett said outdoor activities are preferable to indoor ones, Pickett cautioned that bonfires could have an increased risk of COVID-19 transmission because in order to eat or drink, people would need to take a mask off. Additionally, people may sit closer together around the fire to be able to hear one another or cook food over the flames.
"It's awfully hard, I think, to wear a mask around there," Pickett said. "And then also just taking into account your personal and family risks. Folks at high risk probably shouldn't do that at all, close to each other without masks."
Pickett also said people should bring their own food and serving utensils, and avoid sharing between households.
"Make sure that they're safe both from COVID and from the usual colds and flu and other things that unfortunately start to pop up this time of year," Pickett said.
Hiking - Low Risk
As in the summer, Pickett said hiking is a great way to get exercise, enjoy the outdoors and spend time with family and friends.
"If you're on a wide, broad path, like some of the paths around, it can be far enough apart without masks on, that's perfect," Pickett said. "Some of the paths in the woods are wonderful, but a little bit more narrow, and if you're going to be right next to someone outside of your family, probably ought to be wearing a mask."
Pickett added that young, healthy people out hiking may be infected with COVID-19 without symptoms, so wearing a mask around others is important to protect them as well.
Trick-or-Treating or Trunk-or-Treating - Medium to High Risk
Pickett said she wears the same Halloween costume every year--Wonder Woman. But this year, she won't be able to hand out candy while dressed to impress.
Pickett said families should talk amongst their neighborhood to determine how the community wants to handle Halloween this year. One thing is for sure, she said, going door-to-door or taking candy from a communal bowl isn't the best idea this year.
However, Pickett said one idea is for the neighborhood to organize a Halloween parade for the community kids to show off their costumes while staying six feet apart.
"I think if everyone has come together and decided on something that they think is safe and makes sense, like either a costume contest or that folks will agree that they're putting out safe, untouched candy in a bowl or on a table out in their front driveway," Pickett said. "And perhaps the people in the house could sit on the porch at a safe distance and cheer them on."
Pickett also suggested communities organize a Halloween parade around a local nursing home or near the homes of elderly or high-risk neighbors that won't be able to participate in Halloween this year.
"Perhaps thinking about new and different ways that are not the same things we've done before that maybe could bless other people who really could use a smile this time of year would be the very best way we could celebrate Halloween this year."
Pickett also said kids could invite their friends over to join them in their neighborhood festivities, as long as they stay six feet apart and keep their masks on.
"I doubt that many of them remember exactly what they did last year," Pickett said. "As long as you tell them you're going to do something really fun and then do something really fun, I don't think it matters if it was the same thing we usually do."
WATCH: CDC recommendations for Halloween
Haunted Houses - Medium to High Risk
Indoor haunted houses may be spooky for more than one reason this year. Pickett said with people screaming and running and the narrow halls inside haunted houses, they may have to wait until next year.
However, she said haunted forests, outdoor haunted houses, or a haunted corn maze where people can wear a mask, spread out and take hand sanitizer would be safer.
Costume Parties - High Risk
Pickett said in-person and indoor costume parties would be high-risk situations, especially among people outside of your immediate family.
"I think Zoom parties or outdoor parties and thinking about things differently than we did before would be a much safer plan," Pickett said.
If you do wear a costume this year, Pickett said to think about ways in which to incorporate a mask or face covering as part of the ensemble.
Outdoor community dinners - Low to Medium Risk
Many faith communities host "dinner on the grounds" events in the fall, and Pickett said communities still have the opportunity to host these events safely this year.
"I think dinner on the grounds is OK for those places of worship that have enough space outside for family pods to sit together, bring their own food, their own utensils, their own beverages, and be far enough apart while they eat," Pickett said.
Pickett also added that people who are at high risk for severe complications from COVID-19 probably should not attend these events or should sit at the periphery.
She also added that as many faith communities resume outdoor services, she's enjoyed attending while wearing a mask and staying socially distant.
Holiday dinners with extended family - Medium to High Risk
Of course, sitting down to a big Thanksgiving meal with immediate family is a wonderful recipe for a good time, but Pickett said inviting extended family members could be risky.
"Holidays are going to be complicated this year," Pickett said. She added that several key factors will influence how risky it is for a family to gather, including how extended family travels to their destination.
"If you can just drive straight through and get there and really don't have much risk in route, that's easier and better," Pickett said. But air travel, she added, is much riskier because it brings people close together. She recommended wearing a face shield in addition to a face mask when flying.
She also added that families need to consider whether family members are at high risk of severe illness for COVID-19, particularly elderly people or those with pre-existing conditions.
"I think we're all going to have to be very good in our communication with our family, even before we get together to plan, what's the most important part and how can we do this in a safe way?" Pickett said. "I think every family is going to have to make their own decision based upon their goals and their risks."
Going to a Football Game - Medium Risk
According to Pickett, attending sports could be a safe activity for a person at a low risk of getting a severe illness from COVID-19 or flu.
She recommended calling ahead to make sure the stadium is enforcing mask requirements and sitting fans far apart. Pickett also suggested asking if the stadium will allow fans to bring in outside food to avoid long lines at concession stands.
"And then think about the people you might bring any germs home to," Pickett said. "Is there someone else that's high risk in your family? If so, you might want to reconsider that, but I think it will be good for everybody to get out and cheer a little bit for their home team."
In terms of local community football teams and youth sports, Pickett said parents should talk to team leaders to understand what precautions are in place and how they plan to monitor for symptoms and exposures.
"That's pretty complex and requires a conversation between the team leaders and the parents about their practices and their child and family risk."