Later next month, many families will welcome home a college student for Thanksgiving. This year, however, the holiday promises no communal spoonfuls of cranberry sauce or full-throated hymns of thanks around a tightly packed table. Instead, COVID-19 is on the menu.
The question of how to bring students home safely applies not just to the colleges that have suffered notorious outbreaks, but also to the many colleges that have successfully contained the virus to a small number of infections. Since over 50 percent of transmissions are attributable to asymptomatic and presymptomatic people, we must ensure that colleges do not unwittingly turn students into ticking time bombs unleashed upon the nation’s transportation hubs and dinner tables.
If you plan to welcome home a student, here are a few questions you might ask the student’s college:
Is there a departure protocol? Colleges should reverse the intake procedures that worked so well this past September: For 10 days prior to departure, everyone returns to quarantine, limits exposure, rides out any asymptomatic disease they might carry, and limits the spread of infection to others. Alternatively, colleges might offer a shorter 5-7 day quarantine accompanied by back-to-back COVID-19 tests spaced three days apart and within 72 hours of departure. Neither pre-departure temperature checks nor voluntary measures are adequate to detect disease and control outbreaks, even if both make for good theater. Considering roughly 40 percent of cases are symptom-free, these approaches fail to detect the silent spreaders who may feel perfectly well now, but who may already be shedding large, transmissible quantities of virus.
Are flu shots mandatory? Minimizing flu infection can reduce the strain on our health care system that a new wave of COVID-19 cases will impose. Nobody should head to a transportation hub or home to an elderly relative without having obtained a flu shot. Since the vaccine takes a couple of weeks to trigger an immune response to be effective, students should get a flu shot now.
Is there an explicit reentry policy? At schools where fall semesters extend beyond Thanksgiving, students may still yearn to leave campus for the holiday weekend. These schools should follow the example set by Tufts University: If students choose to travel, they must finish the semester remotely.
Let’s assume for a moment that you get satisfactory answers to these questions. If your student is lucky enough to be going home in a car, you can probably welcome them with open arms. But if your concerns remain unaddressed — or if travel home requires buses, planes, or trains — consider a more conservative plan.
Plainly stated, the safest strategy is for the returning college student to quarantine for at least 3-5 days and then obtain a negative test. Thanksgiving should remain a small-scale affair, with little mingling. And, much as it pains us to suggest it, the generations would do best to stay apart. Without strict adherence to these measures, no returning college student should dine at the same Thanksgiving table as anyone at elevated risk.
We realize this may prove unbearable. Truth to tell, it will be hard to observe these measures ourselves. Why welcome a college student home for Thanksgiving if they will spend it alone in their room, eating food served on a tray left on the floor outside in the hallway? If it is possible to sit comfortably outside, Thanksgiving dinner al fresco offers a less unsafe alternative. So too does shortening the guest list and duration of dinner. And, of course, continued attention to hand-washing and masks. Strategies such as opening windows or putting the young and the old at opposite ends of the table should be viewed as minor, additional precautions and not as substitutes for more proven approaches.
This is not Norman Rockwell’s Thanksgiving. As an infectious disease doctor and a public health expert, we are heartbroken by the advice we’re offering. There are few safe options during a pandemic. But while we cannot in good conscience advise you to opt for perilous alternatives, we can urge you to understand and manage the risks you are consenting to as well as the risks you may be imposing on others.
A. David Paltiel is professor of Health Policy and Management at the Yale School of Public Health and the Yale School of Management. Dr. Rochelle Walensky is chief of Infectious Diseases at Massachusetts General Hospital and professor of Medicine at Harvard Medical School. She also serves as a member of the Massachusetts Governor’s Covid Advisory Board.