State and city governments are warning Americans to downsize their Christmas gatherings, mask up around family members they don't live with and even shun their unvaccinated relatives just days before the holiday, as cases of the omicron COVID-19 variant spike nationwide.
Some are even imploring citizens to cancel their gatherings altogether.
"The safest option is to gather in-person only with members of your household and to celebrate virtually with other family and friends," Los Angeles County said in its winter holiday guidance. The county is also telling people to avoid singing indoors, "wear a mask when gathering indoors" and to set tables grouping only people from the same household.
Louisiana's government issued similar guidance, telling people to "mask indoors when not with your everyday household." Washington, D.C., Mayor Muriel Bowser recommended the same, telling people to "wear masks indoors, even at small gatherings."
The strict advice comes nearly two years into the pandemic and one year after state and local governments went as far as to ban gatherings over a certain number, or of different households. This is despite the proliferation of vaccines and vaccine requirements and the continued wearing of masks by many Americans.
And the advice from cities and states is often conflicting.
Chicago says that "[f]ully vaccinated people can gather indoors with others who have been fully vaccinated without restrictions" while the unvaccinated "should consider not attending gatherings over the holidays."
But Philadelphia Health Commissioner Cheryl Bettigole said nobody should be gathering for Christmas, regardless of vaccination status.
"Please do not hold or attend holiday parties indoors, it's just too dangerous," she said.
Nearby Delaware County, Pennsylvania, was just as stern.
"Limit in-person holiday gatherings to only people you live with or limit to a small group of individuals with whom you are regularly in contact," its newest guidance says.
California, meanwhile, says everyone should "[k]eep gatherings small," but "[i]f everyone at an indoor gathering is vaccinated, masks are optional." Among unvaccinated guests, the state recommends gatherings that are only "short, and outdoors" with mask-wearing.
The spike in U.S. coronavirus cases comes as the omicron variant is now the dominant variant in the country. Millions of Americans are attempting to get COVID-19 tests ahead of the holidays, but there is a major shortage that President Biden said he aims to address by creating a process by which the government will send Americans at- home tests if they request one. But that effort almost certainly won't make a difference in the shortage before Christmas.
The White House is warning that unvaccinated Americans are "looking at a winter of severe illness and death." And some cities are urging vaccinated people to shun gathering with the unvaccinated altogether.
"With the holiday season quickly approaching, many people are planning to gather with loved ones to celebrate. The Milwaukee Health Department urges those who are gathering to do so safely. This means gathering with only fully vaccinated friends and family," the Milwaukee Health Department says in its guidance.
Illinois recommends social-distancing and small groups for holiday gatherings and that people "[c]onsider wearing a well-fitted mask when indoors, even if fully vaccinated."
Santa Cruz County in California is reminding people to "[r]emember to always wear a mask whenever indoors with persons from outside your household and ask guests to do the same." In fact, the county reinstated a mandate for mask-wearing in private homes with members of other households last month.
Wisconsin doesn't require masking in private homes. But it is recommending it for Christmas when around family members who live in different households.
"Wear a well-fitting mask in indoor spaces when others are present who do not live with you," Wisconsin's Christmas coronavirus guidelines say.
These guidelines for distancing, masking and avoiding traditional holiday gatherings for the second straight year follow news that Americans' mental health is significantly deteriorating – a phenomenon many attribute to the virus mitigation measures.
U.S. Surgeon General Dr. Vivek Murthy earlier this month issued a warning of a growing youth mental health crisis. And new government data, analyzed by the group Families Against Fentanyl, shows overdoses of the drug are now the leading cause of death among people between 18 and 45 – above COVID-19, car accidents and any other cause of death.
There are also emerging therapeutics for COVID-19, though there is not yet a major effort by the federal government to make them broadly available, even as vaccine breakthrough cases become more common.
Fox News' Audrey Conklin contributed to this report.