One of the hardest things during this pandemic — for kids and adult children — has been staying away from their parents and grandparents.
People 65 years and older are at higher risk for getting a severe case of COVID-19, according to the Centers for Disease Control and Prevention. And about 80% of deaths in the U.S. from COVID-19 have been in people older than 65.
So it's been especially important for older people to practice social distancing — even from family members — to reduce the risk of infection.
But the summer is here, communities are reopening and with many families living miles apart, a trip to see parents and grandparents is tempting. Here are some things to consider before you go.
Assess the risk
Remember, the risk of becoming severely ill with COIVID-19 increases with age, says Dr. Ravina Kullar, an epidemiologist and spokesperson for the Infectious Disease Society of America. So the older the parent or grandparent, the higher the risk. And if your relative has an underlying health condition, like diabetes, lung disease, hypertension, or if they are immunosuppressed, "that puts them at even higher risk," Kullar says. So before the visit, assess the age and health of the person you are visiting — and consider whether the trip is worth the risk.
Plan ahead, by two weeks
If you decide to make the trip, the two weeks leading up to the visit are key, says Dr. William Miller, an epidemiologist at Ohio State University College of Public Health. You want to reduce your chance of infection as much as possible. While complete quarantine may not be practical, limit outings or social gatherings, and take maximum precautions when going out. Practice social distancing, wear a mask, and work from home if possible, to reduce your chances of getting infected. Complete quarantine would mean staying entirely home except for necessary medical care.
Another factor to consider is what the infection rates are where you live, says Kullar. You have more risk of infection if you live in a place which is reporting a lot of new cases every day, than if you live in an area where no cases have been reported for several weeks. You can use NPR's coronavirus tracker to find out how many cases there are in your state.
To find detailed information about your county, check your state's health department web site — many states publish county-level data, or look up your area in a national tracker like the Dartmouth Atlas of Health Care.
If you can, make it a road trip
Traveling by car will be safer than traveling by plane or train, Miller says. The main risks in a road trip are the stops along the way, such as restaurants or public restrooms.
"I would recommend you do anything you can to limit your exposure," Kullar says. "If you have to fill up the gas tank, put gloves on and use hand sanitizer. Pack your own food so there are no additional stops at restaurants."
The main risk from restrooms are from those that are small, busy and poorly ventilated — like "those restrooms in a gas station off the highway where the restroom is outside," Miller says. Try to choose a bathroom that looks clean and is well stocked with supplies. Avoid bunching up in a line, or staying in the restroom long, if you are within 6 feet of others. Wear a mask, wash your hands after you go, and use hand sanitizer if you touch any surfaces after that.
If it's a long trip and you need to stay overnight in a hotel, "make sure you sanitize everything," Kullar says. Take disinfectant, wipe down surfaces, limit time spent in indoor public spaces and wear a mask.
Think twice before you fly
"Planes are a major concern," Miller says, despite the high level of air filtration on most planes. In planes you are exposed to people several rows ahead and behind, for an extended period of time. It can also be hard to social distance as you navigate the airports. Trains and buses likely have similar exposure, Miller says.
If you do take a plane, bus or train, "choose routes that are less populous," says Dr. Emily Landon, a hospital epidemiologist and infectious diseases specialist at University of Chicago Medicine. "Make sure you are wearing a mask and using hand hygiene," she says. And look for an airline, train or bus company that is enforcing rules like universal masking.
If you do fly, or take public transportation, you need to quarantine on arrival, Miller says. Stay in a hotel or rental, and socially distance for 10 to 14 days, before visiting your parents or grandparents. "This means a true quarantine — no visits to theme parks, museums or restaurants," Miller says.
Should you get tested?
Kullar suggests getting a PCR test before you travel. That's the diagnostic test to determine if you are infected with the virus that causes COVID-19. People who are asymptomatic or presymptomatic can spread the virus, without even knowing they are infected. If your test is positive you should cancel your trip and quarantine yourself for 14 days and get retested. Also, it is important to tell anyone that you have been around of your positive test result, Kullar says.
But if your test is negative, you still need to take precautions. Tests are not always accurate. According to the CDC, it's possible you could still have COVID-19, even if your test result is negative.
"It's important to remember testing is not perfect," Miller says. "A test is a snapshot in that moment." If the test is taken too early after infection, there may not be enough virus present to be detected by a test.
So if you do get a negative test before you travel, you must still make sure you've put in two weeks of strict social distancing before the visit.
Where should you stay?
Given that many people won't be able to fully quarantine, you want to be really careful, "get an Airbnb" or a hotel room, advises Kullar, and just drop by and visit. "Sit outside, greet without touching. Keep your distance. Wear a mask and stay outdoors," she says. "Transmission is a much lower probability outside, as long as you are keeping a good 6 feet distance apart, thanks to the constant airflow," she adds.
If you've been able to quarantine for 14 days, it's reasonable to stay with your older relatives in their home. But, remember, you need to remain vigilant. "Your risk is tied to the risk of the people that you spend time with up close and unmasked," Landon says.
So once you've arrived where your older relatives live, "you want to keep your bubble intact," Miller says. You may want to limit any other social contacts during the visit and just focus on quality time with the grandparents or a few close relatives. Anybody that you are going to hang out with up close and without your mask, especially indoors, could potentially spread the virus. So, keep the circle small, and expand it only with people who have been practicing social distancing and taking precautions.
And if you're adding more people to the mix for a gathering, it's best if you can stay outdoors, and tell everyone to BYOB — and BYO-everything (bring your own everything) to limit the touching of shared surfaces.
Limit activities when you get there
What you do during the visit also matters. Avoid crowds, and stick to outdoor activities as much as possible.
"Don't go out to theme parks and museums [or other crowded places], even if the grandparents don't go along," Miller says. That's because most transmissions of the virus are thought to happen in household settings. So if you get exposed outside the home you could bring that home and infect your relatives.
"If you're sharing the house, everything you do is shared with the elderly folks," Miller says.
If you are taking young children to visit their grandparents, talk to them before you go, advises Kullar, tell them why it's not a good idea to hug their grandmother or grandfather. "Really have a solid discussion with them about that because they may have trouble adhering to the social distancing measures." Miller agrees: "Limit hugs and close contact, unless you have done a full quarantine" — which means not leaving the house for anything except necessary medical care.
Consider staying home
Unless, you can rigorously follow all the guidelines above, it may be that the best way to be really safe is to forego the family visit this year and stay home, Miller says. Find creative ways to engage with your parents or grandparents by phone or video. Play games by video, read books together, watch a movie at the same time.
"This is a time to embrace some virtual tools," Kullar says, to make sure your loved one doesn't feel socially isolated. She lives in Los Angeles, her mother in North Carolina, so they meet for morning coffee using face time and have dinner together maybe once a week.