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With coronavirus cases in the United States ticking up before  Thanksgiving despite the proliferation of vaccines, many state and local health officials say Americans' Thanksgiving gatherings cannot go back to normal – whether they are vaccinated or not, but especially if they are not.

Los Angeles County Public Health is advising people to avoid traveling if unvaccinated, see as few other families as possible, and mask up around people from different households. 

"Keep your gathering small. Avoid mixing with many different families," it says in its official Thanksgiving COVID guidance. "Don’t be afraid to ask about people’s vaccination status and recent risks before joining a Thanksgiving gathering."

"Wear face masks when gathering indoors with people not from your household, except when eating and drinking." the Los Angeles County guidance continues. "Bring a mask to wear outside if the gathering is crowded, especially with people who are unvaccinated or are at increased risk of severe disease."

A child wears a face mask on the first day of New York City schools, amid the coronavirus disease (COVID-19) pandemic in Brooklyn, New York, U.S. September 13, 2021. REUTERS/Brendan McDermid/File Photo

A child wears a face mask on the first day of New York City schools, amid the coronavirus disease (COVID-19) pandemic in Brooklyn, New York, U.S. September 13, 2021. REUTERS/Brendan McDermid/File Photo

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The guidance also tells people to "Keep distance while eating, unless everyone is vaccinated" and to test guests before gathering. 

The City of Pasadena put out nearly identical guidance. The state of Vermont also had a similar message, with a warning that even those closest to you could be vectors for COVID-19. 

"Keep it small. The more people and households, the higher the chance that someone could have the virus and expose other people," it said in its Thanksgiving guidance. "Even people you trust the most can have the virus and not know it."

Even people you trust the most can have the virus and not know it.

— Vermont Department of Health

The state and local recommendations come as the COVID-19 pandemic is approximately in its 20th month, and its second holiday season. Over 770,000 Americans have died from the disease, according to numbers compiled by Johns Hopkins

But highly effective vaccines are now available to nearly every single person in America, and boosters available to older people most vulnerable to the disease. Negative effects of pandemic mitigation measures are piling up as well, including increased drug overdoses, learning loss and social problems in schoolchildren, and more. 

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Many states and local governments are no longer enforcing any kind of mitigation measures or are pushing back against things like mask requirements by local school districts. But others, like Illinois, still have mask mandates in place and are dispensing stern advice to their citizens on how they should hold Thanksgiving. 

Stuffed Turkey for Thanksgiving Holidays

Many state and local governments are telling Americans they should keep their Thanksgiving gatherings small in 2021. (iStock)

"Keep indoor gatherings small," Illinois' Thanksgiving guidance says. "Arrange seating and other areas to allow for physical distance… Avoid having people congregate, such as in the kitchen or at the buffet."

Sonoma County, Calif., issued similarly strict advice. 

"At all times, unvaccinated people should wear a mask indoors and maintain social distancing of 6 feet when meeting with people outside their immediate family," it said. "The mask, which should be at least two-ply and preferably three-ply, should cover your nose and mouth."

Virginia's Department of Health also appears to be encouraging masks at Thanksgiving. 

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"Planning Thanksgiving with care and love this year means adding masks, hand washing, and vaccinations to your list," it said in a tweet. 

Delaware recommends hosting a gathering outdoors if possible, and keeping the guest list down because "[s]maller gatherings… enable you to social distance from those who are not vaccinated."

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, speaks during a Senate Health, Education, Labor, and Pensions Committee hearing on Capitol Hill, Thursday, Nov. 4, 2021, in Washington. Fauci said Americans who are vaccinated should feel good about celebrating Thanksgiving, but did not address what unvaccinated people should do in an ABC interview Sunday. (AP Photo/Alex Brandon)

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, speaks during a Senate Health, Education, Labor, and Pensions Committee hearing on Capitol Hill, Thursday, Nov. 4, 2021, in Washington. Fauci said Americans who are vaccinated should feel good about celebrating Thanksgiving, but did not address what unvaccinated people should do in an ABC interview Sunday. (AP Photo/Alex Brandon)

Officials, including the Centers for Disease Control and Prevention, and Dr. Anthony Fauci, President Biden's top coronavirus adviser, are telling people that they can gather with less fear if they are indeed vaccinated and have received their boosters. 

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"If you're vaccinated, and hopefully you'll be boosted too, and your family is, you can enjoy a typical Thanksgiving meal, Thanksgiving holiday with your family. There's no reason not to do that," Fauci said on ABC's "This Week" on Sunday. 

But Fauci didn't directly address Thanksgiving for unvaccinated people in those comments, and health officials like Washington Secretary of Health Umair Shah say those people especially should be modifying their celebrations. 

"There is still risk if you are not vaccinated. We want people to understand that risk. Traveling, gathering, families that may have people who are not fully vaccinated who are coming together, those are people who may be putting themselves or others at risk," Shah said last week. 

Fox News' Megan Welsh contributed to this report.