College Kids and COVID: 10 Tips for Healthy Holidays

Okay, parents, it’s T-minus 14 days till Thanksgiving week, when most of our college students will be heading home for an extended winter break. Will this be the perfect storm as nearly 20 million college students in the US pack up and head home, potentially spreading COVID19 to their families and communities? Beyond masking, physical distancing and handwashing- which of course, are ALL IMPORTANT- here’s what you need to know:

1. What can we all do right NOW?
   • Get a flu shot this week
   • Optimize your respiratory tract (because an irritated nose/mouth make it easier to pick up ANY respiratory virus, including COVID & flu):
     • Start treating for seasonal allergies ahead of time if you usually have winter issues at home; nasal steroids won’t provide their full benefit till you’ve been on them a week or two
     • Stop vaping/smoking (tobacco & pot)
   • Consider a daily Vit D supplement– studies observe that people low in Vit D (which is around 40% of Americans) may have higher rates of COVID or worse outcomes.
   • Optimize your overall health– more veggies and fruits, more aerobic exercise (walking counts!) and likely more sleep

2. What can you do at home to prepare?
   • Create an OUTDOOR socializing space on your deck, in your yard, or if weather restricts this- consider making space in your garage (where people will visit outside/inside, with the garage doors open for better ventilation.) Set out chairs in physically distanced couplings and purchase fire pits, heaters or blankets now to make it EASY for you and your kids to more safely connect with home-town friends.
     • Focus on adding games or sports more than food and beverages (since eating/drinking require mask removal.) This is a great excuse to bring back games like ping-pong tables, darts, corn-hole and horseshoes!
     • Plan outdoor “dates” of neighborhood walks, golf or tennis in temperate areas. In snowy climates, skating, cross-country and/or downhill skiing should pose minimal risk.

• • If you choose to have extended family gatherings, the KIDS’ TABLE will take on a whole new meaning this Thanksgiving! Seriously consider separating people by generations or risk categories into different rooms (or indoor/outdoor) for any meals, to help minimize risk while inside and unmasked.

• • Plan for a quarantine room/area– if you have the luxury of extra space, consider a basement rec room or that “storage” room at the end of the hallway, ideally with its own bathroom- so if someone turns positive for COVID, you’re set up to easily isolate. Stock up on everything you’d need for that family member: paper plates, disposable utensils, Kleenex, and meds to treat symptoms of COVID (Tylenol, Advil, cough drops, cough syrup, and some form of electrolyte drink such as Pedialyte, Gatorade or Powerade.)

3. Should students get tested before they come home?
   • Many colleges are now strongly encouraging (or requiring) students to get tested AND know their results in 7 to 14 days before they head home; bonus points for colleges like Univ. of Illinois who tests all undergrads twice/week. I would encourage all students (who have not already been diagnosed with COVID19) to get at least one test in the week or two before they come home.

4. Which test should your student get?
   • If they have symptoms, they should start with a rapid antigen test (because they are faster, cheaper and often more readily accessible.) However, note that because of a higher rate of false negatives with this type of test, if they have symptoms and a negative rapid test, they should still quarantine and consider testing with the more sensitive test, a COVID PCR test.
   • If they have NO symptoms, a PCR test is a better choice because it is more sensitive, meaning it does a better job at detecting COVID.

5. If they test POSITIVE, when can they travel?
   • After a positive test, you are considered INFECTIOUS with COVID until ALL THREE of the following conditions are met:
     • 10 days have passed after the onset of symptoms (or 10 days after a positive test if no symptoms)
     • 24 hours FEVER-FREE without any use of fever-lowering meds like Tylenol or Advil
     • Any symptoms that you do have are improving

• • Quarantine housing varies dramatically among  universities, with some able to provide housing, meals, and other necessities, while others simply advise students to self-quarantine on or off campus. A few schools have already announced they will provide temporary quarantine housing on campus or in nearby hotels through the Thanksgiving break if students test positive during their “exit” testing. Please advise your student to check their university’s COVID dashboard to see what is available for their school.

6. IF their test is negative one or two weeks before they come home, are we all set?
   • It’s reassuring but not a green light. Remember that a negative COVID test simply tells us that there were no (or not enough) COVID viral particles detected at the time of the test, meaning the person is likely not infected, but they might also be in that early time frame between exposure and symptom onset, where you have the virus inside you but do not test positive yet. Take home message here is that unless your student is getting tested AND quarantining the two weeks prior to coming home AND traveling home low-risk, you shouldn’t assume they are COVID-free.

7. How likely is it to get infected traveling home?
   • The good news here is that current evidence suggests that your risk of contracting COVID while flying is low. HOWEVER, this assumes that you wear a mask from the moment you step in to the airport (and deal with crowds through security, boarding, etc.) and leave that mask on till you step outside the next airport. Therefore, plan ahead, and bring mints or other hard candy that you can slip under your mask to help “clear” your ears or abate your hunger, and skip drinks and other snacks.
   • If you’re driving, limit your exposures by stopping as little as possible, and be sure to appropriately mask, especially if you need to use a public restroom! These bathrooms typically have poor ventilation and rarely have windows; they have heavy foot-traffic with people of highly varied mask-wearing and COVID risk-tolerance; and there is concern about flushing toilets spreading plumes of aerosolized COVID into your breathing space. Make sure you’ve got a fresh bottle of sanitizer in your car, and cleanse your hands after pumping gas or bathroom breaks.

8. How soon should my student get tested after they arrive home?
   • WAIT A FEW DAYS! Testing immediately after arriving home will NOT tell you if your student caught COVID in the plane, train, bus or car. COVID can incubate up to 14 days, and we now know that tests are most likely to turn positive AT LEAST 5 DAYS after exposure (and/or a couple days after symptoms begin.) I therefore suggest planning to test near the end of the first week of being home.

9. But what if my student had COVID already?
   • Ah, the million-dollar question! If they had symptomatic COVID in September or October, our current evidence-based belief is that they are at low risk of contracting or spreading COVID over winter break in Nov/Dec. Most clinicians believe immunity will last at least three to six months, but the jury is still out. If your kid was part of the large crop of college students who immediately contracted COVID in August but had minimal or no symptoms…are they still immune?
   • Ongoing questions: Does it matter HOW sick they were? Do people with worse symptoms have better immunity? If antibodies can’t be detected by a blood test, might they still have immunity through non-antibody immune defenses? (Science nerds like me may want to read more here.) We have NOT seen large scale or serious re-infections across the world, and since we are nearing one year from the first outbreaks in China, that’s encouraging!
   • Should my student get tested now just to be sure they “cleared” COVID? No, this is not necessary nor recommended. The trick here is that some people even with mild symptoms continue to shed virus (and therefore test positive) for many weeks. The presence of the virus, however, does not equal being infectious. Again, our best knowledge as of 11/10/20 is that the vast majority of people infected with COVID are no longer contagious by ten days after their initial symptoms or diagnosis, assuming no more fevers and improving symptoms (see above.)

10. What if we have a family member at very high risk- from advanced age, diabetes, high blood pressure, obesity, cancer or other auto-immune disorder? Or perhaps a pregnant woman or a newborn baby?
    • Every family will have to self-examine not only their risk, but their RISK-TOLERANCE. Communication is going to be key, especially between generations. It takes only one “experience seeker” to undo a family’s entire quarantine of risk-adverse behavior.
    • To ABSOLUTELY MINIMIZE risk, the college student (or any other non-at-home family member) should legitimately self-quarantine and get tested two weeks before heading home, with a second test the day or two before travel. Their travel should include full, appropriate masking and physical distancing. Upon arrival home, they should self-quarantine again for another two weeks, which means using their own bedroom and bathroom, wearing a mask when in the same room with others and eating/drinking physically distanced, plus repeating testing during days 5-7 after arrival and possibly again near two weeks. The family should skip in-person gatherings beyond their immediate family and opt for zoom socializing for any extended family members at higher risk, and continue curbside grocery/restaurant deliveries. Check out this advice about creating a holiday bubble from Baylor College of Medicine.

• • Is there a reasonable less restrictive plan? Maybe, but clearly this depends on your family. For example, if no grandparents are involved, or perhaps some family members have already had COVID, and/or none of you have any risk factors, plus all are committed to consistent masking, distancing, and hand washing, and travel involves only a nonstop flight or car-ride, then everyone agreeing to self-quarantine and possibly test the two weeks before getting together may be “enough” for your risk tolerance. Honestly, though, there are too many variables to list alternative strategies here, so let’s focus on the real goal: none of us want to unwittingly spread COVID to another person, especially our family members.

• • It’s not all DOOM and GLOOM! Keep in mind that your college student MAY actually be lower risk than you are! All of this is dependent upon the prevalence of COVID in their university setting, as well as their personal choices regarding physically distancing and masking. While yes, SOME college students are recklessly partying inside bars or houses without masks, many more are consistently choosing low-risk activities. I’ve been following the NYT tallies all fall, watching their university COVID counts across the country. Check it out, and compare these numbers with your own city- you might be surprised.

BOTTOM LINE: I wish we had a magic wand, pill or vaccine to make COVID go away right NOW, but until then, let’s move forward with our shared goal of not spreading this disease. Wishing everyone safe, healthy and peaceful holidays!