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Transcript: Episode 38
Is public transport safe?
Vivienne Parry
Hello and welcome back to Coronavirus, the whole story and award winning podcast that's been documenting the extraordinary work of the UCL community in understanding and combating Coronavirus. My name is Vivienne Parry. I'm a writer broadcaster and proud to UCL alumna, and each week I sit down with UCL staff and students to talk about their research and how it relates to the pandemic. This week, we're investigating public transport. Now perhaps in the first lockdown, many of us were able to batten down the hatches and stay indoors. But as lockdown continues, it's important to stay informed about the best precautions to take if and when we do need to leave the house. And one day one happy day, we're going to have to return to public transport on mass. So is it safe? How can we protect ourselves when on it? What do we need to know when making longer journeys? And yes, of course, we've got the expertise to understand that within UCL. What kind of a question is that? So, let me introduce our three expert guests this week. My first guest is Dr. Paul McGovern, an honorary senior teaching fellow in the department of primary care and population health in Institute of epidemiology and health, and a senior lead occupational physician at Transport for London. I'm also joined by Dr. Richard Peters, Chief Medical Officer at Network Rail. Richard is also an honorary clinical senior lecturer at UCL medical school, and chair of the rail safety and Standards Board occupational health specialist Advisory Committee. And last but not least, my final guest is Tara bill, a PhD researcher in the UCL Institute of Health Informatics, who's here to give us an update on her work with virus watch, led by professors Andrew Hayward and Rob Aldridge and Andrew has been a frequent guest on this pod, which listeners may remember is a study monitoring the spread of COVID-19 across England. So I'm going to start with you Sarah to get an idea of how much Coronavirus is spreading and through what vectors
Sarah Beale 2:03
Well Coronavirus, as I'm sure we've all heard has been really picking up and kind of the amount that it's been spreading within UK communities over the last few months. And it's become really quite an acute emergency situation over the last month or so, which is why we're in such kind of intense measures to limit social contact. So like post acute respiratory infections Coronavirus, spreads, as I'm sure we're all quite familiar now by contact between other people. The more people that you come into contact with some of whom might be infected either with or without symptoms, the more likely you are to potentially contract the virus. Now, it can be challenging to kind of map the risk of catching Coronavirus to specific activities in general, for example, public transport, but that's something that we're working on within the virus watch study and something that we're really interested in. Now, we know that people don't all kind of catch Coronavirus and don't unfortunately suffer the ill effects of Coronavirus, like hospitalisation, and sadly for some death, and kind of the same way across the whole population. And that people have different socio economic status tend to suffer differently with higher rates of both infection. And sadly, negative outcomes in people of lower socio economic groups. Something that we've been looking at recently within virus watch is differences in activities in which you may come in contact with other people such as public transport in relation to people socio economic groups. And recently we did an analysis looking at two key periods where COVID transmission was really picking up within the UK community. And the first one was at the beginning of the second national lockdown, which is when this current wave really began to accelerate in England. And the second was during the December holiday period, sort of the 23rd to the 27th of December, where there was a change in some areas of the country in terms of the stringency of regulations, and there was concern about increased levels of mixing. So we asked people about their activities during this period, particularly public activities, but they were likely to come into contact with other people. And then we looked at the local area deprivation in the region in which they left. And we found that when you controlled for people's age, sex and overall region, so for example, the tears they were under, that people in lower socio economic groups were dramatically more likely to report essential activities, including public transport is. So this is quite important from a public health perspective, because it means that securing these essential activities in particular for this podcast public transport is a very important kind of element to reducing the inequalities that we're seeing and infection and mortality rates between socio economic groups. But Sarah can't just stop you there for a second.
Vivienne Parry 5:00
And ask you how you can separate out the socio economic bit from the transport bit.
Sarah Beale 5:07
So what we did in this part of the study was we mapped so people report where they live at the baseline of virus watch. And we use this using an Office of National Statistics linkage to find out local area deprivation. And then we map this on to people's responses about using public transport in the two periods that we measured. It's difficult to of course, for example, people's occupations and their ability to, for example, use public versus private transport is influenced by the socio economic status. But in kind of splitting these out by considering socio economic status and looking directly at the use of public transport, it's acknowledging kind of how much of a product use of public transport is, but putting numbers on it, if that makes sense.
Vivienne Parry 5:52
And we have got some indications, haven't we bus drivers, for instance, are in the groups that are most likely to be infected?
Sarah Beale 6:01
Yes. So what we did not directly address in this study was that the amount of contact that was happening on public transport, so we're inferring in these findings, that simply because you're on public transport with other people that you're likely to come into contact or close contact. But that is something that's really important, particularly for people who work in public transport sectors, and so are really exposed to it is just kind of the frequency, the intensity, and the protective measures that are taken in terms of coming into contact with people in public transport settings. And this is something that we're hoping to look at in the virus watch study in more detail soon.
Vivienne Parry 6:39
There's something very odd that however, that's going on in Japan, so in Japan, where they're all, you know, very good about wearing masks in Japan, they squashed like sardines on the bullet trains. And yet, they don't seem to have had the spreads that that we've had. Is that something you can comment on? Sarah?
Sarah Beale 7:00
I won't comment specifically on kind of the mechanisms in Japan because we haven't I mean, I haven't directly studied this, but the amount of risk associated with your exposure during public activities depends on the amount of Coronavirus that is within the community at any given time. So if there's lots and lots of communities spread of Coronavirus, ongoing, and that depends on how previous measures were able to get the rates down, then this will influence how risky different activities for example, getting on a crowded train on. So Japan does have to the best of our knowledge, Japan does have a lower infection rate, meaning that if you do go out into a public place, you are less likely, for example, that the people you'll come into contact with will be infected. Whereas Britain has unfortunately at the moment of high high rate of infections within community settings, which means that going out and doing public activities will be riskier because it's more likely that you will come into close contact with somebody who is infected.
Vivienne Parry 8:01
So as we've so often heard before with Coronavirus, it's an extraordinarily tangled web. But let's now hear from Paul and Richard about how to stay as safe as we can when travelling poor, our trains and other similar kinds of transport safe.
Paul McGovern 8:20
It's a really good question and I think we can say with a reasonable degree of certainty obviously there's there's always evidence that we can collect but yeah, public transport is is safe. And to be able to say that quite a lot actually feeds into what what Sarah was saying earlier, if you are on a very packed train, carriage bus or anything like that, and Coronavirus is is very prevalent. There's a lot of Coronavirus in the community, you're closer to people for a longer period of time and so you have an increased risk of viral spread. But there are measures that we take in transport sector to minimise the risk for people both workers in the in the transport sector and for customers. So first of all, people need to stay away from each other. That whole concept of social distancing that we've been hearing about since the beginning of the pandemic is really, really important and if you're crammed in with people, your risk goes up. So say for example, and Transport for London with running at full service for virtually all of the pandemic which means that as ridership is very low. We have a lot of capacity on the service for people to social distance. We are also encouraging people to travel off peak so that when you do get on bus, train tram, you are doing your very best as a customer as a commuter to avoid other people. Another really important thing is face masks face mask wear is just another way to reduce the chance that Coronavirus can spread between people in the community and along with the social distancing along with the cleaning efforts that go on, on public transport throughout
The country and along with hand hygiene, all those measures contribute to keep public transport safe I travel and public transport when I have a clinic article or the weekend went over to to to my clinic. And I think it's something which is going to become as you said earlier, more important as lockdown measures release, people are going to start taking public transport more frequently and keeping people apart is is a key part of them.
Vivienne Parry 10:29
Richard, what about longer journeys? Can you travel longer distances safely when you know you are with people for a much longer period of time, I have to say that I've been hugely enjoying rail travel recently, because every time I've travelled, I've had a whole carriage to myself, and I'm gonna get used to it. And I am.
Richard Peters 10:47
You know, it is a very interesting situation at the moment. And I think you know, to mirror everything that Paul and Sarah have spoken about what we need to consider that there's there's a significant individual contributing factor here, that if individuals follow the necessary guidance that's been published by government, that they take the necessary steps to self isolate, if they've got symptoms and remain at home, then obviously, the the the the the risks in travelling are reduced significantly, because we know that whilst there are people who may have COVID, there's there's a significant number of people that are also asymptomatic. And there obviously is possibilities that those people that asymptomatic are actually potentially could spread the virus less. But there's obviously a lot of research that still still on underway at the moment. What I would say, though, is that the rail safety standard steering board did some research back in August time, obviously, when the levels were were a little bit lower, they use some very interesting modelling to look at the various parts of the journey. And when you travel on a train, you have the entrance and exit, of course, you have the shopping and dining area, the seating waiting area, the ticket sales, you then move on to the platform, and how'd you get to the platform, or you have to travel on the escalator or in a lift, then you wait and you queue by the platform doors. And then you'll sit on the train. And during that time on the train, it's very possible that you make up to get a drink if you're on a longer journey. And you may also go to the toilet or even to a shop. And what they did was they used some interesting models with with interesting variables that were involved. So they looked at the different types of train type, for example, they looked at how many people were sitting per row. And using the model and this is published report at the moment is that the risk of infection without a face covering was estimated to be one infection in 11,000 journals. And then if you had a face covering, you know that that the the chances of infection is decreased significantly to one infection per 19 20,000 journals. Therefore, what they stated was that there was sort of a less than point 01 percent chance based on an hour long journey of contracting COVID. Now, it's all modelling at the moment. But there's also been a lot of modelling that was done in Europe as well. And based on the increasing sanitization processes, in stations and around trains, the additional mitigations that have been put in place such as the mandatory use of face coverings, staff members, you know, following strict guidance in the stations around social distancing, and making sure that people don't turn up to work on Well, obviously, all of this combined together, makes travelling safe. And I think it's important to remember that you know, that the railway has continued to run and continue to transport people to and from places and especially a critical workforce to make sure that people can continue to get into work. And that's what we've managed to do.
Vivienne Parry 13:35
It's interesting, isn't it, because the perception is it's public transport, that's not safe. And yet people think of their homes are safe. And yet we know an awful lot of transmission is going on within people's homes, homes may be the least safe place. So there's a great deal of kind of misperception I guess, about what's safe and what's not. And I wonder what changes are temporary? And what kind of measures will be kept long term? pool? What do you think on that
Paul McGovern 14:06
thing, one of the things that we've experienced in occupational health and across Well, all of us have experienced in the country is this sort of sensation of of waves and waves of different things coming to challenges with COVID, not not just the waves of the pandemic, but the challenges that we face as employees as employers, in the healthcare sector and in all sorts of other sectors. And so, ultimately, that the situation is changing constantly. And I think we're getting better sort of as a society sort of anticipating that things are not going to be as they are today for very long, and they're going to be different in a few weeks time. In terms of short to medium term. You know, we're just at the beginning of February. Now we're still in a lockdown situation and the government I think, quite rightly has said, Look, don't don't hold your breath for this to be released in the next you know, few weeks. And that's right because we have to get on Are the transmission rate down, and we have to get the number of infections in the community down as the vaccination effort ramps up. But I think we're coming to a point, when we have a risk that people will start to relax a little bit, thinking maybe of vaccinations out in the community, I know, three or four people who've had the vaccine, I might have had one myself, don't need to wear my face mask don't need to be so worried about maintaining social distance. And I think when we have this period of time, when complacency sets in, and herd immunity has not yet set in, we've got a real risk of losing the gains that we've had through this very difficult lockdown and having another spike. So in terms of what will change, what hopefully won't change, I expect that we'll still be wearing face masks on public transport for several months, several months at this point, and we'll still be encouraging people to social distance, the measures that will be taken will need to be taken we'll be encouraging people to take we the same probably for most of this year could be could be less could be more it depends on how we respond to the vaccine. But going forward, I think much depends on the effectiveness of the vaccine in in the community and its impact on spread. And then we've got more societal changes, which will come about as people come back into into offices, if they do come back to offices, many businesses are saying people can work from home for a good period of time. But there are lots of operational staff in all sorts of roles, who will be coming back to what they do day to day. And as society opens up again, I think we may see some, some challenges in in in maintaining social distance. And I think it's going to be really important for employers, for organisations for the media, as well, to try and help communicate those messages as they change as they develop, so that people have the clear message and a clear understanding of what is needed so that we all as a community can do what we need to do to keep spread under control and keep us this whole situation under control.
Vivienne Parry 17:03
I mean, Richard, I'm gonna bet you here, I'm going to bet you that actually, we'll be wearing masks, not just for a few months, I think we'll be wearing masks a lot more full stop. And that that will go on well into the future, in the same way that when you get to Asia, and most people are wearing masks outside or in busy situations. I suspect that will happen here too. But I wonder particularly given what Paul was saying about people actually not needing to travel as much because they're working from home, is whether all of this is actually sustainable financially. I mean, I know you're a doctor, not an economist or, you know, head of head of the railways. But that actually is a concern, isn't it? Because we know will cheat completely change our patterns? And actually, maybe transport is not going to be how it is anyway.
Richard Peters 17:53
Yeah, I think it's a very good point. And I think there's there's a few things to pick up on there. One is around, you're better, not really a betting man. But I would say to you that I think you're right. Early on in the pandemic, the use of mass was not accepted broadly by society, in the early stages, and there were only a few number of people that would wear them. The other difficulty was there was very limited data and research available, which actually looked at the transmission rates with masks in relation to COVID. Because COVID was was was it was a new virus, obviously, with continued transmission of the virus and it being a respiratory borne virus, we know that the masks or faceless a face coverings are very good at preventing spread to others. And therefore, I think it is likely as you said to be some time before before people stopped wearing or told that they actually can travel without masks, and it's very much dependent on the transmission rates of the virus and what happens in the future. However, all of this has had a significant impact on the numbers that are travelling and has had a knock on effect wider throughout the United Kingdom and globally, financially and on the economy. So there's a lot of discussions at the moment, especially within rail, you know, to look at how do we prepare the infrastructure to be ready for one either a continued slump in the number of passenger numbers to a sudden rise in passenger numbers if the vaccine and other measures proved to be very successful, and three, whether or not rail and the use of rail is going to change, you know in relation to are people going to want to buy season tickets anymore. Will people commute long distances every day to get into work? Or will they say actually I'm going to go travel commuting to London or one of the main city centres once a week rather than three or four times a week. And all of these things will will change rail travel for the future because it may be that we need to focus much more on travel for pleasure and luxurious travel. Maybe we need to focus more on freight operations or Other types of rail. So So for me, I think it's very, very interesting what you say. But I think we went no further forward at the moment to know what rail will look like in the future, because it's still very, very early days with this pandemic.
Vivienne Parry 20:14
And indeed, it could be all of the above or none of the above, because the virus has got yet something else up its viral sleeve to throw at us, that just puts all of our plans into disarray. Once again, I want to ask you specifically for some advice, what can our listeners at home do to stay safe and keep their fellow commuters safe? So Sarah, what do the virus was finding suggests in terms of good behaviour that's helping to prevent virus spread?
Sarah Beale 20:47
I think a key kind of take home message as Paul and Richard said, environments like public transport can be made safe. I However, we do have very high rates in the community of people who are currently ill with COVID-19, many of whom may not necessarily feel very ill or ill at all, and may be out and about in public places. So while it certainly can be safe, and really any situation, especially one like public transport, if you're in kind of an enclosed indoor area, trust other people, even with social distancing, this does confer risk. So sticking to essential journeys, I mean, many people are making journeys, because they absolutely have to which have come across in our findings. And it's really important to try and keep these as safe as possible. So when you or someone else must take a journey on public transport. So I would say avoid situations as avoid unnecessary journeys until we have the situation more under control in terms of our COVID rates.
Vivienne Parry 21:47
Okay, cool. What advice Are you giving to travellers at London Transport.
Paul McGovern 21:53
So, my point is that if you need to use the tube if you have to make an essential journey, not just the tube buses, other means of public transport, that is a safe thing to do if you're taking reasonable precautions. Don't be scared of using public transport if you need to, but also be mindful that there are risks in any situation at the moment with infection high in the community of being near to other people. But we can reduce that risk as we are with the tube the whole public transport network is is cleaned rigorously and frequently. In terms of advice, travel outside peak hours, try and avoid crowded characters. There aren't very many at the moment as you've experienced yourself. But as things get more busy, do your best to travel outside peak time so that you're not on busy public transport. Keep your distance from people so maintaining social distance is really important. And certainly, it's absolutely possible on public transport and the mode at the moment and I think it's likely to be the case for quite some time. face masks really, really important not just on public transport in any public environment. When you're inside supermarket shops anywhere with guidance says that you should wear face masks wear a face mask it really does make a difference.
Vivienne Parry 23:06
Yes or not the hammock wearing which we see quite a lot of people wearing it under their nose as a kind of fashion statement
Paul McGovern 23:13
under the nose that I saw sort of guy once with a face mask on properly, but it had a valve and he cut the valve out. So I mean, it was just it's bizarre what people do. I saw someone else with one of those imass you get on planes they put that over a face and it was covering their nose so it was technically a face mask, but it was just a bizarre thing to do. So yeah, we're a proper face mask and wear it properly if it's under your nose or if it's dangling under your chin. It's no good. So so absolutely. I completely agree do that properly. And the last thing is don't forget the hand hygiene when we've been doing quite a lot of research on the tube just in terms of swabbing and air sampling. We haven't found any Coronavirus on, you know, we're sampling 18,000 litres of air a minute looking for Coronavirus. And we're swabbing places that people touch a lot like bus stop buttons, and we haven't found any which is really good news. But nevertheless observe common sense principles with hand hygiene. Keep keep some gel on you keep your hands clean, avoid touching your face. those messages are still there. But the fundamental thing travel outside peak times Keep your distance and wear face masks.
Vivienne Parry 24:12
Richard, what about employees of both the railway and London Transport? what particular things are you doing for employees?
Richard Peters 24:22
Yeah, I was glad you weren't going to ask me the other question because I actually didn't have very much to add that was that was a good amount of information in the hands face space is really paramount. But from an employee perspective, it has been so important for us to mobilise Network Rail very, very quickly, to be able to keep trains moving, and especially with COVID. I think I think what you've got to realise is we have some signalling centres, which are signalling hubs, for example. And if we were to lose a whole room of signals, that would mean that a whole line would go down, and that and the trains would not be able to run. So we responded incredibly quickly at the early stages. You know why? was around providing very, very clear guidance to staff who are returning to the UK from travelling abroad, we were focusing very much on hand hygiene and infection control procedures. And we produced a lot of guidance for our staff to allow them to maintain their well being at home, and not to do if they ended up getting symptoms of COVID. So the sorts of things that we did was an occupational health support line, we ensured that we were looking after those that were more vulnerable with maybe pre existing medical conditions. we adapted our physiotherapy services to provide virtual assessments and to support people who, at the time when the vulnerable was shielding, and they were able to come back to work to ensure that they were supported on their return. And that's really sort of from a health perspective, there was a lot that went on in the early stages, such as the use of the monitors, using temperature screening when people go into buildings, and then also to ensure that all of our infrastructure and working arrangements were considered COVID secure. But from a sort of a standards perspective, I mean, we produce emergency standards very quickly, there are certain roles that have to be undertaken on the railway as part of your renewal works and your general day to day tasks were working less than two metres apart was previously very, very common. And therefore we needed to put in place changes in relation to our work activity risk assessments, we had to work with our trade union colleagues to ensure that as as collectively, that we put in everything that we could to keep our staff safe, and also to keep the members of the public safe. And that did involve the use of personal protective equipment, and face shields and face masks, and ensuring that that we have the necessary cleaning of our stations, and also of our network rail vehicles, much of what you would know that over the Easter time, for example, we continue to do at Easter work. So it's very important to us ensure that all of our contractors that are working as well, we're following the the necessary guidance to keep all of our staff safe, whilst working. The other things that employers can really think about is things such as flexible working policies, family friendly policies and procedures and and looking at the employee benefits and things that you can do to allow those people who have can work from home to be supported. Because as we know, at the moment, a significant number of people are sitting at home, with their children at home and with their family members. And it's not so easy to continue working. So new ways of working was very, very important for us. And we set up a numerous Task Force cluding, the diversity and inclusion Task Force and turn to work Task Force, there were so many Task Force out there in order to produce the necessary guidance to support our staff.
Vivienne Parry 27:37
It's interesting, I used to sit on the Joint Committee on vaccination, which is the independent body that advises government on immunisation policies. And we had a list of key workers and I always remember that signalers were key workers like petrol tank drivers, because they may be very few in number, but they are absolutely critical, because without their knowledge, and expertise, the whole railway system would just grind to a halt. So a shout out for anybody working on the railways, I know how important you are. And finally, I generously hand out my magic wand at the end of these of these podcasts. And you can use it however you wish. And I want to find out from you what you would do to magic people safe and protected on the transport systems. Sarah, what would you do?
Sarah Beale 28:34
Well, with a magic wand, I think I would lower community or eliminate community transmission of COVID-19.
Vivienne Parry 28:43
I'm not sure my magic wand is going to achieve that. But anyway.
Richard Peters 28:48
What about you, if it could be anything, I think it would be fantastic to have some sort of point of screen retina scan or something that literally the moment you walk into any building, it will be able to tell you whether or not you've got COVID. And therefore it could tell you to self isolate immediately. But as we know that, that that's not something that that is possible. But there is a lot of interesting innovations happening at the moment, which you're looking at ways of screening people for COVID-19 in very, very rapid ways. So it may be that we are not actually far off part of that magic wand
Vivienne Parry 29:23
and not least, of course, fitbits and that kind of thing. And isn't it interesting? We started off with people having temporary guns in airports and we now know that that's almost completely useless. Paul, what would you do
Paul McGovern 29:34
my magic wand is is free. It doesn't cost anything. I just if I could magic, anything it would be for everyone to follow the guidance. The guidance hasn't actually changed that much. It's just how much people have been following it. Hands face space, wearing face masks, keeping away from people, unfortunately can't see families we can't see friends and that's a horrible thing, but the more we keep to following the guidance The sooner we will be able to get infection rates down. And the sooner we will be out of this horrible situation that we're in. So that's what I would want from my magic. One waving is for people to follow the guidance and just keep the pressure on just a little bit longer. Don't get complacent when vaccine rates go up. We're still we've still got a little way to go in this. But we are getting there and there's light at the end of the tunnel.
Vivienne Parry 30:25
I think that's a very fine use of my magic wand. Thank you. And thank you to you all. It's been a fascinating episode with you all. So we've come to the end of another session, and you've been listening as you know, to Coronavirus the whole story This episode was presented by myself Vivienne Parry, produced by UCL with support from the UCL Health of the Public and UCL Grand Challenges and edited by the splendid Cerys Bradley I was joined today by Dr. Paul McGovern, Dr. Richard Peters, and Sarah Beale. If you'd like to hear more of these podcasts from UCL Minds, subscribe wherever you download your podcasts or visit ucl.ac.uk forward slash Coronavirus. This podcast is brought to you by UCL Minds bringing together UCL knowledge, insights and expertise through events, digital content and activities open to everyone. Hope to be with you again soon. Bye for now.