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As it gets colder, and harder to gather outdoors, some of Kenzie Billings' conversations with her loved ones are feeling a bit more fraught.

"It's felt frustrating at times. You know, you can feel energy from people in terms of wanting to be together," the 29-year-old from Portland, Ore., says. 

Her sister, who is pregnant, has been taking social distancing rules 

, she says, but others in the family are more eager to get together indoors. And she has found it especially hard to navigate these negotiations without being face to face.

"So there's a lot of push and pull there in terms of, 'OK, where are my boundaries?' And then exerting those boundaries is actually really hard, with the people that you love," Billings says.

Hospitals in many parts of the country are reporting 

 in coronavirus patients. That follows the Thanksgiving holiday when many 

The spike in COVID-19 numbers, coinciding with the holidays, is forcing many people to have difficult conversations with friends and family about whether and how to gather.

They ask whether it’s safe to disagree during a pandemic

For Desiree Middleton, 50, in Los Angeles, the pandemic has also been hard on some relationships. Middleton says the 

 around the coronavirus has complicated discussions about the need for mask-wearing and social distancing. She's even lost some friends.

"I have people that don't believe the virus is real; they feel like it's a government conspiracy," Middleton says. "These are friends that I've known since middle school. One friend, I was in her wedding."

The denialism she's witnessed among some old friends is particularly painful, Middleton says, because she's had family members who've been sick with the virus.

Twitter to remove or place warning labels on COVID vaccine conspiracy tweets

Even for a physician, asking loved ones to wear masks and stay distant from each other can be difficult, says Dr. 

, an epidemiologist in Colorado and the state's former chief medical officer. Ghosh says she's had difficult conversations in her own family, and she advises keeping the focus on the desire to keep everyone safe and healthy.

"One of the things that I think is important to acknowledge upfront is that you care about them and you don't want anything to happen to them, and it's not just about you," Ghosh says. "I think putting that out there upfront, especially with older parents, is important."

Ghosh advises looking for safer ways to connect, such as eating a holiday meal separately and then going for a walk together, or even meeting up in different cars for a tailgate party.

Offering creative alternatives can help soften the impact of conversations about social distancing, says Alise Bartley, a 

"Is it about saying 'no'? Or, is it about trying to figure out what to say 'yes' to?" Bartley says. "Based on each person's level of comfortability, how do we discern, 'Yes, I can do this, but I can't do this?' "

‘We're actually sharing the deep, painful parts of our lives’

The pandemic, and the social distancing it's necessitated, have strained some social connections. But they've forced others to become deeper and more genuine.

"In this specific time, it feels so much more important that we have those conversations," says Thomas Davidson, 18, who lives near Philadelphia with his parents and two siblings. "When we see the political headlines, when we see the news about COVID, it feels like these are conversations we can't just push to the side and focus on our family dynamic. It feels like these are conversations that need to be had."

Davidson says it's been frustrating to witness some of his family members' skepticism about the need for social distancing, but the stress of the pandemic also made him appreciate them more.

Some people agree to disagree over what's safe

"It can be hard, but at the end of the day, they're still family," he says.

For Middleton, in Los Angeles, it's also been a time to communicate more honestly with some of her friends.

"I think before the pandemic, a lot of us were just on surface-level friendships," she says. "And now we're actually sharing the deep, painful parts of our lives with each other, and saying things that last year I was like, 'Oh, I never would have told you this because I'd never want you to think this about me.' "

Middleton recently had to turn down an invitation to visit another close friend because she didn't feel safe getting on a plane — and her friend's response made her feel closer, she says.

"She was like, 'OK, when that vaccine comes, you're gonna be here,' and I'm like, 'Absolutely,' " Middleton says. "Because that's what friends do — we understand each other — that's what real friends do." 

Health

COVID-19

Sarah McCammon

Author

With a spike in COVID-19 cases colliding with cold weather and the holidays, many Americans are facing difficult decisions about whether and how to socialize. 

'What real friends do': How to navigate tough conversations about COVID-19

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