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COVID-19 and cars: Not a good medical mix, as it can harm drivers and passengers

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President Trump makes surprise visit in SUV outside Walter Reed

President Donald Trump left the hospital minutes after tweeting that he was going to surprise supporters outside Walter Reed.

President Trump’s Sunday ride at Walter Reed National Military Medical Center can be a teachable moment for drivers and passengers, experts say.

If you know or think you are sick, they say, you shouldn’t get into a vehicle unless it’s unavoidable.

Any person known to have or suspected of having COVID-19 should “isolate themselves at home except if he or she needs to get medical care,” said Sonja Rasmussen, a professor of pediatrics and epidemiology at the University of Florida College of Medicine and College of Public Health and Health Professions.

If they have to travel in a vehicle to get care, the driver and passenger should wear masks and the person with COVID-19 should sit in the back seat, or further back if in a larger vehicle, such as a van, she says. “The car windows should be opened and the car vents should be used to bring in outside air.”

And Trump, who was being medically cared for at the Bethesda, Maryland, hospital Friday after revealing his testing positive for COVID-19, on Sunday left the hospital grounds in the backseat of a black SUV, with windows closed, to cruise by and wave to supporters gathered outside the hospital. Inside the SUV, Secret Service agents could be seen in the front seat donning masks and other protective gear.

Experts have expressed concern for the safety of the agents in the vehicle because the SUV is thought to be hermetically sealed and the lack of in-vehicle ventilation could increase the danger of COVID-19 exposure. “They might get sick. They might die. For political theater,” tweeted Dr. James P. Phillips, an attending physician at Walter Reed. All those who were in that SUV should be quarantined for 14 days, he wrote.

Trump campaign advisor Corey Lewandowski told NBC’s Today show the Secret Service agents in the SUV volunteered, “and there was a piece of Plexiglass, I believe, between the president and the two Secret Service agents who were in the vehicle.”

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Even if you are wearing a mask, riding in cars puts you in a position where “you can’t maintain 6 feet and you are in a closed environment. That is concerning,” said Neysa Ernst, nurse manager of the Johns Hopkins Biocontainment Unit in Baltimore, Maryland.

Vehicle travel differs from air travel, for instance, in that airplanes have better air exchange. If you are in a car, you can open the windows to get more air exchange, and “that is certainly going to be more beneficial than a closed environment,” Ernst said. “But if you feel symptomatic, then you should probably not get in the car with your friends.”

The Centers for Disease Control and Prevention recommends that those with COVID-19 stay home except to get medical care. And those who are sick – or have had close contact (closer than 6 feet for at least 15 minutes) with a person with COVID-19 – should avoid using transportation such as ride-sharing or taxis that may put them in close contact with others, the CDC says.

Not following those recommendations is a reason the U.S. has such a high number of cases and deaths, tweeted Dr. Craig Spencer, director of global health in emergency medicine at Columbia University Irving Medical Center in New York.

The CDC on Monday updated its guidelines on social distancing to suggest that the virus can spread through the air beyond six feet. “There is evidence that under certain conditions, people with COVID-19 seem to have infected others who were more than 6 feet away,” the CDC says on its website.

That is “not surprising,” Ernst said. “Just by human nature if you say six feet, I will stay three feet from you. If you say nine feet, I will stay six feet.”

Typical drivers and passengers can learn from the precautions that ride-sharing companies and taxis take. Face masks should be worn by drivers and passengers in ride-sharing vehicles and taxis, the CDC suggests.

And the CDC suggests that drivers avoid using vehicle’s recirculated air option while transporting passengers. Instead, the CDC says, “use the vehicle’s vents to bring in fresh outside air and/or lower the vehicle windows.”

There’s no exact science on each vehicle’s air and heating systems, car sizes, and various patients’ characteristics. But there is some findings in a recent study from the Harvard T.H. Chan School of Public Health and Portland (Ore.) State University’s Maseeh College of Engineering and Computer Science that aerosol particulates from a coughing person in a closed vehicle accumulates in a vehicle over an hour-plus car ride. But cracking the window open just three inches helps prevent that build-up.

“If you have got somebody else in your car, it is extremely important that you have a mask on and the car has some ventilation,” said Marc Cannon, executive vice president at car dealership chain AutoNation. “Opening a window, making sure your air is moving and making sure your filters are clean (are important). But most important is making sure that mask is on and making sure that you are continuously sanitizing the vehicle.”

Even before the coronavirus pandemic ensued, AutoNation worked with Clorox to develop a treatment to disinfect new and used vehicles being sold and serviced at its 325 locations. “We have a detailed protocol,” Cannon said. “Customers like it. Our employees like it. And we feel it’s a way of making sure the customer has the confidence we are doing the right thing for them.”

Since the COVID-19 crisis, customers have come looking to buy a vehicle because they “want to be able to control my environment,” as opposed to using public transportation, taxis or ride-sharing services, he says.

Both major ride-sharing services, Uber and Lyft, have programs focused on disinfecting vehicles and guidelines requiring drivers and riders to wear masks. 

Vehicle safety precautions come down to “common sense advice,” said Brian Sansoni, a spokesman for the American Cleaning Institute, which has safe commuting advice online.

“Clearly the driver should be regularly cleaning and disinfecting the vehicle – the steering wheel, door handles, seatbelts, those kind of things,” he said. “And if you are a passenger, try to avoid touching as many surfaces as possible. Take along hand sanitizer or hand wipes for after you get out of the car.  And wash your hands as soon as you get to your next destination.”

But if you are someone who has tested positive or COVID-19 or has symptoms, “you shouldn’t be traveling around unless it’s absolutely critical,” Sansoni said.

Follow USA TODAY reporter Mike Snider on Twitter: @MikeSnider.

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