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College Kids Coming Home COVID-19 Chronic Illness

When college students return home for the holidays during COVID-19, it presents a difficult dilemma. They’re your immediate family, but they’re not technically part of your household anymore. And they may not be able to (or want to) stay in their college dorms over winter break.

Of course, you can’t wait to see your kids — but it’s important to think about the safest way to do so as coronavirus cases surge across the country. That may involve taking steps that feel uncomfortable or odd at first (like wearing masks around each other indoors for a period of time), but that will keep you safer in the long run.

About 40 percent of COVID-19 transmission is driven by people who don’t have symptoms, per the U.S. Centers for Disease Control and Prevention (CDC). What’s more, a study conducted by CDC researchers between April and September found that people sick with COVID-19 can infect about half of their household.

“It’s important for our college-aged kids to know that we can’t tell who’s sick or not, so we assume everyone is sick and everyone has the virus, and we move and act accordingly to decrease the chance of transmission,” says Sophia Tolliver, MD, Clinical Assistant Professor of Family Medicine at The Ohio State University Wexner Medical Center.

If you are have underlying health issues that put you in a high-risk group for COVID-19 complications, it’s especially important to think about how you can best protect yourself when your child comes home. Here are five important steps to take to help lower your risk.

1. Discuss the possibility of celebrating virtually

This can be incredibly difficult for families who have never spent a holiday apart, but if you have a high risk of poor outcomes from COVID-19, it’s worth discussing with your child what your best options are for celebrating together but socially distanced — even if it means doing so virtually.

“Right now, the case numbers are increasing so much, that while it’s really difficult to spend the holidays separate from your family, it might be the best option to do that,” says Deeba Minhas, MD, a rheumatologist at the University of Michigan Institute for Healthcare Policy & Innovation. “It’s been so much worse in the past couple weeks that I know people have been changing their plans in terms of their children coming home to see them.”

Celebrating virtually or only with members of your own household is the safest way to spend the holidays, per the CDC. (College students returning home from school for the holidays should be considered part of different households.) According to the agency, in-person gatherings that bring together family members or friends from separate households, including college-aged kids coming home, pose varying levels of risk.

Although many college dorms may close over winter break, celebrating virtually may be an option if your child lives off-campus. Some universities may also make exceptions for students who want to stay on campus for the holidays this year.

2. Discuss how your college student will reduce their risks before traveling home

If your college-aged kid is coming home for the holidays, have a serious discussion with them about how they will limit exposure to the best of their ability before coming home.

“It’s important for people who will be traveling to come home to essentially try to quarantine for up to two weeks before coming home,” says David Aronoff, MD, Director of the Division of Infectious Diseases at Vanderbilt University School of Medicine in Nashville, Tennessee. “That provides an opportunity to await any symptoms that might creep up, in case they are infected, and to also let an asymptomatic infection run its course — so the chances that they are contagious is minimized.”

Although it may be difficult to know for sure what your child does before coming home, have a heart-to-heart with them about how their actions can lead to serious implications for your health.

“I’ve been having these conversations with my patients, and a lot of them have talked to their kids about social distancing and not partying before coming home, and what the impact is on their health,” says Dr. Minhas. “If students really want to say goodbye to friends before break, they should keep it short and sweet and at a distance.”

And of course, your child should be following general guidelines for preventing the spread of COVID-19:

  • Maintain a social distance of six feet or more from people outside of their household whenever possible.
  • Wear face coverings when out in public and when they can’t be socially distant.
  • Wash or sanitize their hands frequently and disinfect commonly touched surfaces.
  • Avoid large groups or situations when it will be hard to be socially distant.
  • When spending time with others, being outdoors is safer than indoors.

3. See If your college student can get tested before coming home

Getting tested before coming home could help your student detect a potentially asymptomatic case of COVID-19, but it’s not a guaranteed clean bill of health.

“There are certain colleges that are actually requiring or encouraging their students get tested for COVID-19 before leaving campus, so if there is an option to do that, I highly recommend it,” says Dr. Tolliver. “If you can’t do that, I recommend a very structured quarantine where the student can isolate themselves — either before they come home or at their parent’s home if it’s not possible to quarantine on campus.”

For example, Indiana University offered all students a free COVID-19 test the week before they left for Thanksgiving break.

“We’re hoping that testing before people leave campus will give them that extra confidence in their viral status,” Erika Cheng, PhD, Deputy Director for Mitigation Testing and an Assistant Professor of Pediatrics at Indiana University School of Medicine told the New York Times. “We certainly don’t want anyone unsure about their health status to hop on a plane to go visit their grandmother.”

However, keep in mind that a negative test isn’t a pass to ignore normal prevention measures — and it’s not a guarantee that your child isn’t infected.

“Getting a negative test is helpful if it can be done as close to the time of travel as possible,” says Dr. Aronoff. “But people need to understand that a negative test does not rule out infection. It’s somewhat reassuring, but a negative test can be falsely negative, particularly in the very early course of the infection or a little later in the infection when somebody is shedding less virus.”

What’s more, it’s possible that your child could pick up the virus while traveling home, so have discussions about proper travel precautions such as socially distancing from others at airports, wearing a face covering at all times, and even considering adding eye protection like a face shield.

4. Wear face masks at home

Yes, it might feel particularly odd to wear a mask in your own home and around your own child. However, this is an extra step you can take for up to 14 days, especially if your student was unable to quarantine before coming home.

“Even if the student has gotten tested and it is negative, I still think they’re coming in from out of state, they should be wearing a mask,” says Dr. Tolliver. “We don’t know what a COVID-19 infection looks like until you’re symptomatic or your test comes back positive. There are so many unknowns to this disease.”

Dr. Aronoff adds that this step may be somewhat less important if your student has been strictly quarantining.

“If someone really has been isolating or quarantined for all practical purposes, the closer you get to two weeks, the added benefit of a mask is probably fairly low,” says Dr. Aronoff. “So I would probably only do that if the person the student was living with was very susceptible to doing badly with COVID-19.”

Also, as strange as it may feel, don’t rush to hug your child as soon as they get home.

“After they’ve traveled, don’t hug and have them take a shower,” Asaf Bitton, MD, Executive Director of Ariadne Labs at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health, told the New York Times. “Try to find a place in the house where they won’t be in super-close proximity, at least for the first couple of days.”

It can also be helpful to give the student their own bathroom, if possible, and open windows in the home to improve ventilation, Dr. Bitton added.

5. Have shared decision making about socializing while home

As much as your child may miss their hometown friends after being away, this is not the time for them to be socializing in person.

“Unfortunately, your child should not be seeing their friends at home during this time,” says Dr. Tolliver. “I would talk to them about other ways they can engage with their friends while they’re home, whether it’s through social media apps or video chat.”

For instance, the Houseparty app allows your college student to chat and play games with groups of friends via video.

Although this year will involve sacrifices around the holiday season, having these conversations with your college student will keep everyone safe for many holidays to come.

“We can celebrate certain physical distancing now and see each other down the road in person, or we can put chronically ill parents at risk and chance having to spend time in the ICU for Christmas or New Year’s Eve,” says Dr. Tolliver. “It really comes down to expressing the importance of how serious this is.”

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COVID-19 Pandemic Planning Scenarios. Coronavirus Disease 2019 (COVID-19). U.S. Centers for Disease Control and Prevention. September 10, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html.

Grijalva CG, et al. Transmission of SARS-COV-2 Infections in Households — Tennessee and Wisconsin, April–September 2020. Morbidity and Mortality Weekly Report (MMWR). U.S. Centers for Disease Control and Prevention. November 6, 2020. doi: http://dx.doi.org/10.15585/mmwr.mm6944e1.

Holiday Celebrations and Small Gatherings. Coronavirus Disease 2019 (COVID-19). U.S. Centers for Disease Control and Prevention. November 19, 2020. https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/holidays.html.

Interview with David Aronoff, MD, Director of the Division of Infectious Diseases at Vanderbilt University School of Medicine in Nashville, Tennessee

Interview with Deeba Minhas, MD, a rheumatologist at the University of Michigan Institute for Healthcare Policy & Innovation

Interview with Sophia Tolliver, MD, Clinical Assistant Professor of Family Medicine at The Ohio State University Wexner Medical Center

Parker-Pope T, et al. How Can My College Student Come Home Safely for Thanksgiving? The New York Times. November 13, 2020. https://www.nytimes.com/2020/11/13/well/live/thanksgiving-college-students-return-home.html.