MedPage Today 2020.11.01
Thanksgiving is just weeks away, with the winter holiday season close behind. College students will be making their way home to visit family and reunite with friends. This will be their first major travel holiday in the age of coronavirus disease 2019 (COVID-19). While homeward-bound students — the same age group that makes up most of the 70,000-plus new U.S. cases now occurring daily — are certain to bring with them joy, love, and stories, they may also unwittingly bring home COVID-19 through asymptomatic or presymptomatic transmission.
An analysis of COVID-19 surveillance strategies at the 1,400 U.S. colleges which offer some degree of in-person instruction found that more than two-thirds either have no clear testing plan or are only testing “at-risk” or symptomatic students. Despite this inconsistent approach to testing, there have been more than 214,000 documented cases of COVID-19 at colleges so far this school year.
With hundreds of thousands of students soon on their way home, there is real concern that new disease clusters will be seeded among friends, siblings, and especially parents and grandparents who are at a substantially higher risk of hospitalization and death should they contract COVID-19. Further exacerbating this risk is the impending uptick in seasonal influenza cases.
No young person wants to infect a family member or friend. However, state quarantine mandates will be tempting to ignore because of their impracticality. To address the absence of unified public health guidance, college administrators, students, and their families must urgently plan a strategy for a safe return home. We have created evidence-based suggestions to help guide that discussion; it’s not possible to reduce the risk to zero and all approaches entail additional personal sacrifice on top of an already difficult year. But we suggest the following relatively simple steps that will likely limit COVID-19 transmission from returning students and save many lives.
We know the coronavirus cannot be reliably detected during the first 5 days after infection. After 8 days, however, it can be detected in most infected people. Hence, the following four-step plan is essential for asymptomatic students wishing to travel home. Students already exhibiting any signs or symptoms of COVID-19 infection should get tested and seek care from a licensed healthcare professional.
Step 1 – Self-sequestration (8 days before leaving for home)
- Avoid going to restaurants, bars, parties, or any place where people gather in numbers.
- Convert to 100% online learning.
- Wear a mask at all times when outside of your own room.
- Maintain social distancing of at least 6 feet between yourself and others.
- Practice frequent hand washing.
- Get your flu shot as early as possible.
Step 2 – Pre-travel testing (2-3 days before leaving for home)
- Get a COVID-19 test, preferably a molecular test for viral RNA using an FDA-approved nucleic acid amplification test (NAAT) on a nasal, nasopharyngeal or saliva sample, acknowledging this will not be perfect (the risk of a false negative result may exceed 20%). Rapid antigen testing has not been thoroughly tested in real world scenarios and its performance in asymptomatic individuals is not comparable to molecular NAAT testing though the FDA has given it an emergency use waiver.
- If your results are positive, self-quarantine at college and make a new plan to “reschedule” the holidays for a later date.
Step 3 – Travel home
- If your results are negative, travel home following CDC guidance, wearing a widely available disposable surgical mask or a cloth mask with at least two layers, as well as (optional) eye protection at all times when indoors with crowds and on planes, trains, buses or other enclosed vehicles. Vented masks that reduce the obstruction to exhaled breath are not appropriate and are not recommended.
- Regularly clean your hands with an alcohol-based hand sanitizer, sanitizing wipes, or soap and water. Use antibacterial wipes on your seat, tray table, armrest, and other areas around you during your travel.
Step 4 – At home (upon arriving)
- Avoid activities in which social distancing cannot be maintained or taking protective measures may be difficult.
- Host outdoor activities rather than indoor activities as much as possible.
- Follow CDC guidelines by asking all guests at holiday gatherings to strictly avoid contact with people outside of their households for the prior 14 days.
- Avoid any self-serve food or drink options, such as buffets, salad bars, and condiment or drink stations. Use single-use options or identify one person to serve shareable items, such as salad dressings, food containers, plates, utensils, and condiments.
- Wash hands with soap and water for 20 seconds before and after preparing, serving, and eating food.
- Isolate from family and friends and get retested if you develop any symptoms (including but not limited to fever, cough, shortness of breath, sore throat, headache, loss of taste or smell) or are notified that you were a close contact with someone who tested positive.
- Find creative substitutes for the hugs and kisses that we all crave when reuniting with loved ones. Remember this is one year in a lifetime of holidays, and with luck, persistence, and science, we will be back to gathering closely again next year.
These strategies cannot guarantee a complete elimination of student-borne COVID-19, but they may significantly reduce the chances of transmission. All it takes is a short period of self-isolation and a COVID test. This virus has asked a lot of all of us, and we are all fatigued from the restrictions, stress, and anxiety of living in a pandemic. But this isn’t the first time we’ve asked our young people to do something difficult for the greater good. This really is a war, against an enemy that has no concern for our wants, needs, or traditions; and the people we are fighting to protect are our parents, grandparents, families, and the neighbors that make hometowns special. With some relatively simple sacrifices, we can all do our part to not bring COVID home for the holidays.