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Is It Safe Carpool High-Risk COVID-19

It’s no secret that carpooling can make a world of a difference when you’re a parent juggling your family’s busy schedule. It may also be incredibly helpful if you live with a chronic illness and are prone to fatigue or flares that make driving your kids to school or activities difficult.

What’s more, if your child’s school is reopening for in-person learning this year, you may wonder if carpooling is a safer bet than sending them to school on a bus during COVID-19. Of course, all of this is balanced with your own health concerns if you’re in a high-risk group for COVID-19 complications.

The Global Healthy Living Foundation and CreakyJoints recently conducted a poll of our members to understand what risks people living with chronic illness are willing to take. It’s clear that respondents were concerned about public transportation in general: They were less likely to take public transportation like a bus than to do several other activities, including eating inside at a restaurant or getting a manicure or haircut.

But what does that mean for carpooling with kids, which is essentially a hybrid between personal and public transportation? Here’s what to keep in mind when weighing the benefits of carpooling — whether that includes you driving other people’s kids around or letting other adults drive your children — with the risks of contracting COVID-19, and what you can do to make essential carpooling trips safer.

Carpooling Risks During COVID-19

The virus that causes COVID-19 mainly spreads through respiratory droplets that travel from one person through coughing, sneezing, or talking and infect a person nearby. This is why the U.S. Centers for Disease Control and Prevention considers social distancing — remaining at least six feet from other people — one of the most effective strategies to avoid being exposed to the virus right now.

However, that’s virtually impossible when you’re in a car with individuals from outside of your household.

“The biggest concern with carpooling is that when kids and their friends are in the car, it’s not possible for anybody to be more than six feet apart, so they can’t social distance well,” says James Schneider, MD, chief of pediatric critical care medicine at Northwell Health in New York. “That close proximity, along with being in an enclosed space, puts you at higher risk [of contracting COVID-19] during carpooling.”

Although the CDC doesn’t currently provide guidelines for carpooling with kids, it recommends that companies encourage individuals who commute to work to use transportation that minimizes close contact with others, such as biking, walking, or driving by car either alone or only with household members.

“Carpooling or sharing any kind of public vehicles is discouraged at this point, especially for people with high-risk conditions,” says Ashlesha Kaushik, MD, medical director of pediatric infectious diseases at UnityPoint Health in Sioux City and board member for the Iowa American Academy of Pediatrics (IA AAP).

Not only is there the risk of infected respiratory droplets spreading easily in a car, but there are also several shared surfaces like door handles and seat belt buckles. COVID-19 may spread when an infected individual touches a surface or object that has the virus on it, then touches their mouth, nose, or eyes, per the CDC.

Your level of risk may depend on the size of the vehicle being used and the level of local community spread.

“If the high-risk individual resides in a current ‘hot spot’ or zone with high prevalence of COVID-19, the potential of contracting coronavirus from an asymptomatic child passenger may be too prohibitive of a risk to take at this time,” says Brian Lima, MD, a cardiac surgeon who regularly works with chronic illness patients at the Sandra Atlas Bass Heart Hospital at North Shore University Hospital in New York. “It’s simply impossible to definitively gauge exposure risk, especially in children from other households.”

Of course, experts acknowledge that it may not be possible for every family to avoid carpooling. If you can’t drop your child off in your own vehicle, keep in mind that it may actually be possible to create more physical distance between seats on a bus — one that’s not filled to capacity — than in a carpool, says Dr. Kaushik.

How Children Spread COVID-19

More research is needed to fully understand the role children play in COVID-19 spread. Some studies have shown that young children are less likely to spread it than adults, but it’s still possible — and anyone can get severely sick as a result.

“We do know that kids generally have a less severe infection or symptoms related to infection than adults,” says Dr. Schneider. “But this is an infection that does not spare any age group, from newborns to senior citizens, and anyone can have serious complications.”

Children under the age of 10 were about half as likely as adults to spread the virus to others in a July 2020 study of nearly 65,000 people in South Korea. Although the exact reason is unclear, this could be because they exhale less air in general, exhale air closer to the ground, or socialize less outside of school than older kids. However, the study found that children and teens ages 10 to 19 can spread the virus at least as efficiently as adults.

Because researchers traced contacts of children with symptoms, it’s still uncertain how efficiently asymptomatic children spread the virus.

“It’s unfortunately very difficult to ascertain if a child may be unknowingly sick or had recent exposure to a sick contact at home,” says Dr. Lima. “Many children may not have appreciable symptoms.”

A rare, serious condition called multisystem inflammatory syndrome (MIS-C) that’s linked to COVID-19 has also been reported in children and some teenagers. MIS-C causes inflammation in parts of the body like the heart, blood vessels, kidneys, brain, digestive system, skin, or eyes, per the Mayo Clinic.

Many children with MIS-C test negative for a current infection with the virus that causes COVID-19, but several have been infected with it in the past and have positive antibody test results. Although most children who get MIS-C eventually recover with medical care, it can be life-threatening.

What If Your Child Is at High Risk for COVID-19?

While children have been less affected by COVID-19 compared to adults, children with certain conditions may be at increased risk for severe illness, according to the CDC. These include:

  • Children who are medically complex
  • Children who have serious genetic, neurologic, metabolic disorders, and with congenital (since birth) heart disease
  • Children with obesity
  • Children with diabetes
  • Children with asthma and chronic lung disease
  • Children with immunosuppression

If your child has an underlying condition, you may need to take extra precautions to limit risk of exposure to COVID-19.

Talk to your child’s pediatrician for best practices specific to your child’s condition and local community spread of the virus.

How to Reduce Risk During Carpooling

If you do need to team up with other parents to carpool, it’s best to follow the general safety measures the CDC recommends for using shared or personal vehicles:

  • Have everyone 2 years and older wear a cloth face covering over their nose and mouth
  • Have everyone avoid touching surfaces and each other
  • Limit the number of passengers to only those necessary
  • Avoid riding with individuals from multiple households, if possible
  • In larger vehicles, try to space passengers apart from each other
  • Improve ventilation in the vehicle by opening the windows or setting the air ventilation/air conditioning on non-recirculation mode
  • After leaving the vehicle, have all passengers use hand sanitizer containing at least 60 percent alcohol or wash their hands with soap and water for at least 20 seconds
  • Regularly clean and disinfect frequently touched surfaces, such as door handles and seat belt buckles

Consider Forming Carpooling ‘Pods’

Also try to team up with just one other family — rather than multiple families — if possible.

“We’ve heard since the beginning of the pandemic that we should all try to limit our social circles, which is admittedly very challenging,” sayd Dr. Schneider. “But if you can carpool with only the same two to three kids and limit the number of kids, that’s clearly the safest way to go.”

When you spend time around individuals from multiple households, you dramatically increase the number of indirect contacts you’ve had. That, in turn, puts you at higher risk of contracting COVID-19.

Set Rules About Masks and Sanitizing

It’s also important to remind passengers to keep their masks on for the entire duration of the ride, and to discourage kids from touching each other or sharing items. It can be helpful to keep sanitizing wipes in easy-to-reach spots in the vehicle for passengers.

“All age groups need to take precautions as best as we can, and balance those precautions with recommendations provided by local authorities,” says Dr. Schneider. “To me, carpooling is a fairly risky activity based on the close proximity of passengers and enclosed space, and I would recommend avoiding it altogether if possible.”

Speak to your child’s doctor or your own doctor for help assessing risk level of complications due to COVID-19, and for more safety precautions that may be specific to your particular city or condition.

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Interview with Ashlesha Kaushik, MD, medical director of pediatric infectious diseases at UnityPoint Health in Sioux City and board member for the Iowa American Academy of Pediatrics (AAP)

Interview with Brian Lima, MD, a cardiac surgeon who regularly works with chronic illness patients at the Sandra Atlas Bass Heart Hospital at North Shore University Hospital in New York

Interview with James Schneider, MD, chief of pediatric critical care medicine at Northwell Health in New York

Multisystem inflammatory syndrome in children (MIS-C) and COVID-19. Mayo Clinic. June 12, 2020. https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/mis-c-in-children-covid-19/art-20486809.

Park YJ, et al. Contact Tracing during Coronavirus Disease Outbreak, South Korea, 2020. Emerging Infectious Diseases. July 16, 2020. doi: https://doi.org/10.3201/eid2610.201315.

People with Certain Medical Conditions. Coronavirus Disease 2019 (COVID-19). U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html.

Protect Yourself When Using Transportation. Coronavirus Disease 2019 (COVID-19). U.S. Centers for Disease Control and Prevention. U.S. Centers for Disease Control and Prevention. May 26, 2020. https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/using-transportation.html.

Social Distancing. Coronavirus Disease 2019 (COVID-19). U.S. Centers for Disease Control and Prevention. July 15, 2020. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/social-distancing.html.

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