College students across the nation are back on campus, bracing for another tumultuous semester amid the spread of the highly contagious delta variant.

And as their universities grapple with mask recommendations, vaccine mandates and distancing rules, students are charged with making serious health-related decisions. Health experts have some risk-reduction advice to make those tough calls a little easier.

One health expert said that while no public health precaution is 100 percent effective, layering them up offers a solid defense against COVID-19.

“I tell folks: ‘Think of the vaccine like a really good raincoat, but if it’s storming outside you still need an umbrella if you want to stay dry,’ ” said Henry Wu, assistant professor and senior physician at the Emory University School of Medicine. “And I think right now, we’re storming in most of the country.”

More on the COVID-19 pandemic

Do I have to get vaccinated?

Whether the coronavirus vaccine is required depends on the institution.

The American College Health Association, which makes recommendations to colleges and universities, has urged colleges to impose vaccine mandates, when permitted by state law. And a number of them have done it.

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Although the notion has been challenged in court, it appears that, legally, colleges are likely to have this power, as long as they make room for medical and religious exemptions, said Meryl Justin Chertoff, executive director of the Georgetown Project on State and Local Government, Policy and Law.

But even when students are not required to get vaccinated, federal health authorities and most colleges and universities are strongly recommending that students — as well as faculty and staff — get the shots.

David Paltiel, a professor of public health and managerial sciences at Yale University’s School of Medicine, has used mathematical models to map out thousands of COVID-19 scenarios on college campuses. He noted that “by far the most powerful driver of safety on campus is the level of vaccination coverage.”

Although there will still be breakthrough cases, once vaccination coverage exceeds 90 percent, campuses could return to “some semblance of normalcy” without other measures such as frequent testing for the coronavirus, he said.

The bottom line is that, mandate or not, “schools want people to get vaccinated,” said Terry Hartle, senior vice president of the American Council on Education, a trade organization that represents college and university presidents.

“Campus leaders believe the science is clear and unambiguous, and they think that proven public health protocols are the best way to protect the campus and local communities. Sometimes state and local political considerations enter into the decision-making, and that’s just part of the world that campuses live in.

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“But even in places where they can’t require vaccinations, I assure you they are encouraging as strongly as possible students and faculty and staff to get vaccinated,” he said.

Students can contact their campus health department for more information about where to get the free vaccine, or visit Vaccines.gov.

Do I need to wear a mask on campus?

In most cases, yes.

The Centers for Disease Control and Prevention recommends that whether vaccinated or not, people should wear masks in indoor public places in areas with substantial or high transmission rates. And Aaron Milstone, an epidemiologist and an infectious-disease expert at Johns Hopkins University School of Medicine, said that “most places right now are going to fall into that environment where there’s substantial transmission.”

But, much like vaccination mandates, mask requirements vary from one college to another, in part based on the prevalence of the coronavirus in the surrounding community. As far as the legality, though, Chertoff noted that mask mandates are a “minimal intrusion” compared to vaccine mandates, which it appears colleges and universities are likely to have the authority to implement.

Gerri Taylor, co-chair of the American College Health Association’s COVID-19 task force, explained that most colleges have put together a dashboard to monitor the number of COVID-19 cases, hospitalizations and deaths, as well as vaccination rates among the students, faculty and staff.

“If they see that their vaccination level is quite low and their cases begin to go up, then they’ve got to make a decision about whether they are going to tighten their requirements on campus,” she said.

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As for which mask to wear, in most cases, a cloth mask will do, said Wu, at Emory University. The most important thing, he said, is for students to cover their noses and mouths while indoors or in crowded areas — such as in libraries, gymnasiums and cafeterias, when students are not eating.

However, because the delta variant is so transmissible and because campuses are a prime environment for it to spread, students could consider upgrading to high-quality masks such as N95s, KN95s or KF94s, said Linsey Marr, a Virginia Tech professor of civil and environmental engineering who studies viruses in the air.

She discouraged neck gaiters — the loosefitting masks designed to be worn around the neck and then pulled up over the nose and mouth. Gaiters are thin and tend to gape open at the sides and bottom, so they do not provide much protection, she said.

How should I handle study sessions with classmates?

Most health experts agree that students should definitely mask up in study groups where classmates are sitting close to one another, such as at a table inside the college library. However, those who are studying alone in a room of that library or even with a small group of classmates in a dorm room should be fine to unmask — assuming all of those classmates are fully vaccinated.

Of course, the safest option is to cram for that test together outside, in the fresh air and sunshine, the experts said.

“Once you go inside, it’s, ‘Are people vaccinated?’ ‘Are they wearing a mask?’ ‘Are they spread out?’ ” Milstone said.

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“Everyone is going to have to decide what their own threshold is for getting COVID-19. It’s like, how much do you want to protect yourself and how willing are you to risk getting sick?” Milstone added.

Can I hang out with my friends and go to parties?

Yes, and students should socialize — but they should do so safely.

When hanging out with friends or going to parties, again, the safest venue is the great outdoors, even though the delta variant is so transmissible it can still spread. If indoors, put on a mask — and keep it on, the experts said.

Stefan Baral, an epidemiologist at the Johns Hopkins School of Public Health, said it’s impossible to create a risk-free campus. But taking advantage of the nice weather while it lasts will be important, he said.

Health experts said it is also up to those who are organizing the events to choose a spot that will help minimize risk.

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“What I’m really trying to stop is 150 kids meeting in a poorly ventilated basement and doing Jell-O shots in each other’s grills in the frat house basement,” Paltiel said.

“Let’s have the keg party. Let’s just have it under a tent on the quad,” he added.

Beyond vaccines and masks, what precautions can I take?

Although the vaccine is considered the best way to prevent severe illness, hospitalization and death, health experts say it is not a get-out-of-jail-free card. Students can still experience breakthrough infections and transmit the virus to others — including faculty and staff members who may have elderly parents or unvaccinated children at home.

In addition to vaccination, the American College Health Association recommends face-masking, social distancing and frequent hand-washing, taking special care to avoid potentially contaminated surfaces once hands are clean.

And when outdoor activities are not feasible, Taylor suggested students seek out spaces indoors that are well ventilated — opening windows, turning on fans or, for those who can afford it, using air purifiers with HEPA filters.

The American College Health Association has also recommended that colleges and universities conduct regular coronavirus testing for all students, faculty and staff members to help detect the virus before it starts to spread. School policies vary across the United States in terms of when to test and how often depending on their vaccination rates and other precautionary measures that are enforced on campus.

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What should I do if I feel sick?

Even before the coronavirus pandemic, sickness was often just part of the college experience as students were exposed to so many new people and their germs. Various viruses have been spreading aggressively since schools started opening back up, and many share symptoms with the coronavirus.

That’s why experts say it’s important for students to familiarize themselves with their school protocol and to inform campus health authorities immediately to get tested if they experience any potential symptoms, which may present only as a runny nose and some congestion. Other symptoms may include fatigue, headache, fever or chills, cough, sore throat, trouble breathing, a loss of taste or smell or gastrointestinal issues, according to the CDC.

“In the past, if you had a cold, you took a tissue and you went class,” Milstone said.

“I think the first priority is kind of resetting people’s understanding that, ‘OK, if I’m sick, I need to get checked out and get a test,’ ” he added.

In addition, schools need to create welcoming environments for students to disclose their symptoms, Baral said. When students see others being uprooted and shuttled off to guarded isolation dorms for two weeks, it could make them less likely to want to report potential COVID-19 symptoms.

“What are some ways that are going to be safe for them but not feel like jail?” he said.

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Baral said he encourages universities to work with their students to come up with these kinds of plans.

“These are smart kids,” he said. “I would really sit down and start talking with them rather than at them.”

Are classes expected to continue in person?

Although the spread of the delta variant is a concern that is being monitored closely on college campuses, experts said it doesn’t preclude the hope to keep students on campus.

“I believe you can have a safe fall on campus with in-person engagement, in-person education, even in the context of delta,” Baral explained.

That said, Paltiel said he is concerned that if there is a spike in cases, campuses may no longer have the physical capacity they had last year to isolate infected students.

That’s why, experts said, it’s partly up to students to help keep each other safe.

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Can I travel?

Students will probably be able to travel home for the holidays, experts say, but they should be vaccinated and take precautions, being mindful not only about the risk of exposure during travel but also about the potential risks at their destination.

To travel more safely, once students are vaccinated, Wu recommended that they stay within a trusted social bubble for about two weeks before the trip to limit potential exposures — and then get a negative coronavirus test before departure.

When in airports and other crowded places, students should keep their masks on and maintain a safe distance from others. And once they have arrived at their destination, Wu said, it is not a bad idea to get tested again to make sure they have not picked up the coronavirus along the way.

The CDC states that fully vaccinated people do not need to get tested or self-quarantine after domestic travel but recommends those who are unvaccinated get a test and isolate themselves for a week after traveling.

Wu said people are in a much better place than they were the last holiday season because of the protection afforded by vaccines, but it’s still important to take the proper precautionary measures — especially as health authorities continue to learn about the delta variant.

“Rather than cause a scare and a lot of worry when you come home and then potentially infect a family member, I think it’s a good idea to take some precautions to minimize that chance,” he said.

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What do international students need to know?

Students traveling internationally should check travel restrictions for their destinations, Wu said. All air passengers entering the United States are required to either show that they have recovered from COVID-19 in the past three months or have tested negative for the coronavirus no more than three days earlier.

He advised students traveling internationally to be careful, not only to protect themselves and their families but also because they may not be able to return to their colleges if they test positive before departure.

“You don’t want to infect yourself and your family, but you also don’t want to risk having to come back to school two weeks late,” he added.

Health authorities recommend that all students, including international students, get vaccinated. For students who were vaccinated in their home countries, Milstone said many colleges are still deciding how to manage situations for those who have received vaccines that are not currently authorized or approved by the Food and Drug Administration, such as Britain’s AstraZeneca vaccine or China’s Sinovac vaccine.

The CDC does not recommend mixing coronavirus vaccines. However, in certain situations, such as when an individual has received a vaccine that is not available in the United States, the person may be offered a Pfizer-BioNTech, Moderna or Johnson & Johnson vaccine, according to the agency.

What about mental health?

Students are returning to campus carrying an array of different experiences from the past year and a half. Some have lost family members, some are dealing with isolation and loneliness, and others have been working on the front lines.

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Mental health struggles have been created or exacerbated by the pandemic, and health experts say colleges and universities need to recognize that and treat students accordingly.

Active Minds, a national group that supports mental health awareness, surveyed high school and college students and found that 80 percent said COVID-19 negatively affected their mental health. Twenty percent of respondents said their mental health significantly worsened over the course of the pandemic.

However, there is a flip side, said Claude Mellins, a professor of medical psychology in the departments of psychiatry and sociomedical sciences at Columbia University Irving Medical Center: “Young people are unbelievably resilient.”

Mellins and other experts said universities need to give students safe options to socialize. College is a crucial time to make social connections, she said, and the pandemic took away many of those opportunities. She encouraged students who feel isolated or like they do not have touch points on campus to join a club that aligns with their interests or reach out to a residential adviser for support.

“Any of these groups that brings people together in a way where there’s something that they’re focused on but then allows them the space to actually bond become really important,” she said.

Taylor, with the American College Health Association, also recommended socializing with friends outdoors, taking long walks, going for runs and practicing yoga in the fresh air.

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Students who notice their normal coping strategies aren’t working or have thoughts of harming themselves should seek professional help, experts said.

But Mellins added that there also needs to be a focus on promoting effective preventive measures and coping strategies beyond therapy.

One method that has attracted attention over the pandemic is grounding, which is finding ways to focus on the moment instead of the past or the future. Grounding can involve things like feeling an ice cube in your hand, counting something or paying attention to your breath.

Mellins said it is also important for colleges to recognize that when students work virtually, they often feel like they are online all day without informal coping strategies such as walking to class with friends or having dinner in the cafeteria with others.

Ultimately, Wu said, college students need to remember that “the more precautions, the better, because it’s an additive effect.”

“Vaccines aren’t perfect, masks aren’t perfect, distancing is not perfect,” he said. “But if you do everything to the extent possible, as much as you can, you really can reduce your risk of getting infected.”

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