key: cord-0889230-6632vcxw
authors: Tomasi, Suzanne E.; Ramirez‐Cardenas, Alejandra; Thiese, Matthew S.; Rinsky, Jessica L.; Chiu, Sophia K.; Luckhaupt, Sara; Bateman, Russell; Burrer, Sherry L.
title: COVID‐19 mortality among Amalgamated Transit Union (ATU) and Transport Workers Union (TWU) workers—March–July 2020, New York City metro area
date: 2021-08-03
journal: Am J Ind Med
DOI: 10.1002/ajim.23281
sha: 4a4f3b02445aa56b18940cfbb5152320d4593ed5
doc_id: 889230
cord_uid: 6632vcxw

BACKGROUND: Transit workers have jobs requiring close public contact for extended periods of time, placing them at increased risk for severe acute respiratory syndrome coronavirus 2 infection and more likely to have risk factors for coronavirus disease 2019 (COVID‐19)‐related complications. Collecting timely occupational data can help inform public health guidance for transit workers; however, it is difficult to collect during a public health emergency. We used nontraditional epidemiological surveillance methods to report demographics and job characteristics of transit workers reported to have died from COVID‐19. METHODS: We abstracted demographic and job characteristics from media scans on COVID‐19 related deaths and reviewed COVID‐19 memorial pages for the Amalgamated Transit Union (ATU) and Transport Workers Union (TWU). ATU and TWU provided a list of union members who died from COVID‐19 between March 1–July 7, 2020 and a total count of NYC metro area union members. Peer‐reviewed publications identified through a scientific literature search were used to compile comparison demographic statistics of NYC metro area transit workers. We analyzed and reported characteristics of ATU and TWU NYC metro area decedents. RESULTS: We identified 118 ATU and TWU NYC metro area transit worker COVID‐19 decedents with an incidence proportion of 0.3%. Most decedents were male (83%); median age was 58 years (range: 39–71). Median professional tenure was 20 years (range: 2–41 years). Operator (46%) was the most reported job classification. More than half of the decedents (57%) worked in positions associated with close public contact. CONCLUSION: Data gathered through nontraditional epidemiological surveillance methods provided insight into risk factors among this workforce, demonstrating the need for mitigation plans for this workforce and informing transit worker COVID‐19 guidance as the pandemic progressed.

to MTA workers. 8 The public was required to wear face masks while riding on public transportation starting April 15, 2020 when the Governor of NY issued a mandate for New Yorkers to wear face masks in public when unable to socially distance. 9 Occupational data about persons with COVID-19 among essential worker populations can help improve local, state, and federal public health guidance for worker safety and health. Collecting occupational data can also help protect spread of infection among the community and improve public health. Collecting timely data on occupation and industry of ill persons may not be feasible during a public health emergency. To overcome the challenge, we used nontraditional public health surveillance methods including monitoring of media reports and review of union records to track COVID-19related deaths among NYC metro area transit workers.

In addition to working in positions with close public contact, transit workers face multiple occupational hazards, which can affect their health and safety and put them at increased risk of infection for SARS-CoV-2. [10] [11] [12] [13] [14] [15] [16] [17] [18] Previous studies have quantified the burden of a range of injuries and illnesses associated with transit worker jobs, including chemical, safety, ergonomic, emotional, psychological, and biological hazards; these hazards can affect workers' health individually and synergistically. 15, 16, [19] [20] [21] [22] [23] Furthermore, transit workers are commonly male, aged >50 years, people of color, and almost onefourth have incomes below the poverty level. 24, 25 All of these demographic and socioeconomic groups are disproportionately affected by COVID-19. [24] [25] [26] [27] [28] [29] [30] Both the occupational hazards faced by transit workers and their demographic characteristics may increase their risk of exposure to SARS-CoV-2 and COVID-19 complications. Here, we present information collected through nontraditional public health surveillance methods to describe COVID-19-related fatalities among transit workers in the NYC metro area early during the pandemic.

From March 30-July 7, 2020, we monitored a continuous Google ® alert (referred to as media scanning hereafter) for one or more of the following terms: transportation workers and confirmed cases of COVID-19, to identify online reports of COVID-19-related deaths among transit workers in the NYC metro area that occurred between March 1 and July 7, 2020. We defined a transit worker as a worker of public ground transportation including bus, subway, and train systems. Based on the NYC Planning Metro Region Explorer, 31 we defined the NYC metro area as NYC's five boroughs and 26 surrounding counties in New York, North New Jersey, and southwest Connecticut, an area that roughly represents the NYC commuter shed.

Through media scanning, we identified memorial website pages from ATU and TWU. We contacted ATU and TWU national leadership to confirm that according to union records the transit worker decedents identified during the media scanning process reportedly died from COVID-19 and to request total ATU and TWU transit worker population data for the NYC metro area for comparison with media scanning data. Because ATU and TWU were able to provide denominator data for union members who work in the NYC metro area and at least 80% of MTA transit workers are members of ATU and TWU, we limited our analysis to transit worker decedents who were known members of a local union section of ATU or TWU in the NYC metro area. For the local union sections in the defined area, ATU and TWU provided membership lists and information about members who worked in the NYC metro area and reportedly died from COVID-19. We reviewed media reports and information from ATU and TWU to determine demographic and occupational data (including work location) of the deceased workers. Using the internet and each decedent's name and work location as search terms, we found additional information through obituaries and local news reports.

With guidance from ATU and TWU leadership, we grouped transit worker decedent job titles into three worker classifications based on job function: operator (e.g., bus driver, train operator, train conductor); maintenance worker (e.g., bus mechanic, heating and air conditioning maintainer, trackworker); and support staff (e.g., supervisor, station agent, coach cleaner, call center operator). We categorized job titles as either public contact positions or nonpublic contact positions based on the job function and guidance from the Union leadership. We defined public contact as close contact with the public while preforming their job duties.

Although we were able to obtain demographic data for NYC metro area transit workers who died from COVID-19, we were unable to obtain such data for workers who did not die from COVID-19.

Therefore, for comparison, we used published demographic data for all NYC metro area workers. 20,30,32,33 To find such published data, we performed a comprehensive search of the scientific literature to identify peer-reviewed publications describing demographic statistics of NYC metro area transit workers. We searched PubMed, Scopus, CINHAL, Cochrane Reviews, and Google ® Scholar using one or more of the search terms from the following list: transit worker, transit employee, transit operator, transportation worker, transportation employee, and transport worker with no date limits in the databases.

We reviewed up to 500 abstracts from each search engine, up to 2500 total, and identified potentially relevant articles. We reviewed full articles and included those with demographic statistics of NYC metro area transit workers. Through this process we identified demographic data collected in 2002, 2009, and 2020.

We calculated descriptive statistics for COVID-19 deaths among NYC metro area transit workers using mean (standard deviation) for continuous variables and n (%) for categorical variables. We calculated the incidence proportion for COVID-19 deaths among NYC metro area ATU and TWU transit workers over the 129-day period from March 1 to July 7, 2020. We established our denominator for the incidence proportion calculation using the lists provided by the unions of all ATU and TWU transit members as of July 9, 2020 in the NYC metro area. We compared sex and age distributions among decedents and published demographic data for NYC metro area transit workers using chi-squared tests. All analyses were performed using SAS 9.4 (SAS Institute, Cary, NC, USA). This activity was reviewed by the Centers for Disease Control and Prevention (CDC) and was conducted consistent with applicable federal law and CDC policy. a

Through media scanning, we identified 128 transit workers who reportedly died from COVID-19 during March 1-July 7, 2020. We excluded 40 decedents who did not work in the NYC metro area and 20 who were not members of ATU or TWU. Information from ATU and TWU confirmed the transit decedents identified through media scanning and added 50 additional transit worker decedents, bringing the total to 118 decedents ( Figure 1 ). Twenty-two decedents were ATU members, and 96 were TWU members. ATU reported having 9374 members in the NYC metro area, and TWU reported having 37,700. The incidence proportion for death from COVID-19 among ATU and TWU transit workers in the NYC metro area during March

Population included in the current investigation of coronavirus disease 2019 (COVID-19)-related deaths among Amalgamated Transit Union (ATU) and Transport Workers Union (TWU) members in the NYC metro area, March 1-July 7, 2020. *Media scanning is defined as monitoring a continuous Google ® alert for one or more of the following terms: transportation workers and confirmed cases for COVID-19 TOMASI ET AL.

| 725 1-July 7, 2020 was 0.3%. The incidence proportion among ATU members was 0.2% and among TWU members was 0.3%. The majority (83%) of transit worker decedents were male, and the median age was 58 years (range: 39-71 years) ( Table 1 ). The median tenure among transit worker decedents was 20 years (range: 2-41 years).

Place of birth was available for 30 (25%) decedents; 23 (77%) were not born in the United States.

Of the 115 transit worker decedents for whom worker classification was available, 54 (46%) worked in a position classified as an operator. Sixty-seven decedents (57%) worked in a job that involved public contact. Decedent data collected through media scanning compared with decedent data provided by the unions reported similar worker classification and public contact information. When comparing worker classification and public contact information among ATU and TWU decedents, the majority (73%) of ATU decedents worked in a position classified as an operator or a position that involved public contact. ATU and TWU unions represent bus, subway, and train system workers in the NYC metro area but, the majority of decedent data were missing work system information and was not analyzed. Hospitalization, symptom, and co-morbidity information was collected, but was missing in the majority of media reports and was not analyzed.

COVID-19 deaths among NYC metro area transit workers followed a similar trend to those among the general NYC population, with a peak in deaths during the week of April 5th followed by a drop in the number of deaths (Figure 2 ). 34 26, 27, 38, 38, 39 However, the MTA Diversity Report did not provide a breakdown of sex by age; therefore, we do not know the percentage of male MTA employees over the age of 50 years. Furthermore, we did not have information about union membership by sex and age, so we were unable to estimate mortality rates within these demographic groups.

Another study that identified COVID-19 deaths among MTA transit workers through May 6, 2020, reported a similar relationship of an increasing mortality with increasing age. 33 The distribution of ages among NYC metro area transit worker decedents was skewed towards older age categories compared with the published age distribution of all transit workers. 33 Tenure among NYC metro area transit worker decedents was higher than tenure identified in the literature search. Our study did not find any information on the decedents race or level of education.

Some underlying conditions are linked to a higher risk of COVID-19

complications or death. 38 Only four transit worker decedent media reports that we reviewed described an underlying condition, and the unions did not have co-morbidity data for union members. This is likely an underestimation of the decedents in this study who had an underlying condition. A previous investigation reported approximately 40% of MTA transit workers had one or more underlying health problems. 40 Previous studies have also indicated bus and subway operators are at higher risk for cardiovascular diseases and abdominal obesity compared with the general population. 11, 16, 23, 41 At a national level, people of color, non-U.S. born persons, and people with household incomes below the federal poverty level are overrepresented among transit workers. 24 Persons in these demographic groups might have higher risk of occupational exposure to SARS-CoV-2, and in combination with other challenges (e.g., health and social inequities), an elevated risk for COVID-19 complications.

We found among the 30 ATU and TWU transit worker decedents with a known place of birth, nearly 77% were born outside the United States. In this study, country of birth is unknown for 75% of our ATU Despite these limitations, this study used a timely data collection approach, captured information on a relatively large number of deaths drawn from a defined worker population, captured a longer reporting period, and was able to examine the occurrence of those deaths with respect to COVID-19 deaths in the community. We found that, in the absence of an active surveillance program, this method-using media scanning through Google alerts to comb publicly available data on the internet for key terms-was an efficient and unintrusive method to identify cases in an essential worker population. Lastly, by recording the specific dates of deaths, we were able to demonstrate that the trend in deaths among this essential worker population mirrored the temporal relationship of COVID-19 deaths in NYC as a whole. 

The authors thank Brendan Danaher, TWU representative who assisted confirming and collecting data, Alexis Grimes Trotter, NIOSH and Sarah Selica Miura, NIOSH for their assistance with data abstraction and SAS coding.

The authors declare that there are no conflict of interests.

John Meyer declares that he has no conflict of interest in the review and publication decision regarding this article.

Suzanne Tomasi: data acquisition, data analysis, manuscript preparation, and manuscript review. Alejandra Ramirez-Cardenas: data acquisition, data analysis, manuscript preparation, and manuscript review. Matthew S. Thiese:

literature review, data analysis, manuscript preparation, and manuscript review. Jessica L. Rinsky: study design, data analysis, manuscript preparations, and manuscript review. Sophia K. Chiu: study design, data analysis, manuscript preparations, and manuscript review. Sara Luckhaupt: study design, data analysis, manuscript preparations, and manuscript review. Russell Bateman: data acquisition and manuscript review. Sherry L. Burrer: study design, data analysis, manuscript preparations, and manuscript review. 

who-director-general-s-opening-remarks-at-themedia-briefing-on-covid

First case of coronavirus confirmed in New York State

3. NYC Health. NYC Health Coronavirus Disease

Daily Data Summary. covid-19-daily-data-summary-04162020-1.pdf (nyc.gov). Accessed

Timeline: Tracking the Spread of COVID-19 in Tri-State

US state governors impose tighter restrictions to slow coronavirus spread

Transit Workers Union Local 100. 2020. MTA About-Face on Wearing Masks

MTA allows all transit workers to wear face masks amid coronavirus mania. 2020. NYC transit workers can wear masks amid coronavirus fears

A tale of two agencies: NYC transit workers to receive nearly 250,000 N95 masks to protect against coronavirus

New York Daily News. 2020. NYC transit workers get 250,000 N95 masks for coronavirus-New York Daily News (nydailynews.com)

New Yorkers must wear masks when unable to socially distance

Association between body weight, physical activity and food choices among metropolitan transit workers

Excess risk of sickness and disease in bus drivers: a review and synthesis of epidemiological studies

The back pain of bus drivers. Prevalence in an urban area of California

Psychophysiological stress reactions in female and male urban bus drivers

Musculoskeletal injuries among bus drivers due to motor vehicle accidents and hazardous environmental conditions

Working on the hot seat: urban bus operators

Studies of health outcomes in transit operators: policy implications of the current scientific database

Burden and Costs of Occupational Injuries and Diseases in the United States

Occupational disease and workers' compensation: coverage, costs, and consequences. Milbank Q

Objective measurement of occupational stress factors-an example with San Francisco urban transit operators

Physical and mental health symptoms among NYC transit workers seven and one-half months after the WTC attacks

Steel dust in the New York City subway system as a source of manganese, chromium, and iron exposures for transit workers

Association of occupational and substance use factors with burnout among urban transit operators

Psychosocial job factors, physical workload, and incidence of work-related spinal injury: a 5-year prospective study of urban transit operators

A basic demographic profile of workers in frontline industries

COVID-19 and inequity: a comparative spatial analysis of New York City and Chicago hot spots

Sex-related differences in COVID-19 lethality

Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan

COVID-19 emergence and social and health determinants in Colorado: a rapid spatial analysis

The Lancet. The plight of essential workers during the COVID-19 pandemic

The effectiveness of cognitive behavioral therapy for PTSD in New York City transit workers: a preliminary evaluation

Age-dependence of Mortality from Novel Coronavirus Disease (COVID-19) in Highly Exposed Populations: New York Transit Workers and Residents and Diamond Princess Passengers

COVID-19 Daily Counts of Cases, Hospitalizations, and Deaths

Evaluation of Real-Time Mortality Surveillance Based on Media Reports

Challenges in disaster data collection during recent disasters

Disaster planning and response

Severe obesity, increasing age and male sex are independently associated with worse inhospital outcomes, and higher in-hospital mortality

Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China

Impact of COVID-19 Pandemic on NYC Transit Workers: Pilot Study Findings. NYU School of Global Public Health

Bus workers' experiences with and perceptions of a health promotion program: a qualitative study using a focus group discussion

COVID-19 killing front-line health workers, especially people of color. The Nation's Health: APHA

Consideration of the Aerosol Transmission for COVID-19 and Public Health

Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): a review

COVID-19 mortality among Amalgamated Transit Union (ATU) and Transport Workers Union (TWU) workers