By: Alex Quistberg, PhD, MPH
Assistant Research Professor
Dornsife School of Public Health

COVID-19 has highlighted many of the vulnerabilities of Latin American and Caribbean (LAC) cities. One of the key challenges that LAC cities face under the pandemic is ensuring safe mobility, especially for public transportation users. Public transportation is one of the primary modes of transportation in many LAC cities, and is one of the safest modes of transportation in terms of risk of road traffic injuries to its users and others. It also provides benefits to users in the form of physical activity to get to and from transit stops and by reducing individual motor vehicle transport modes it is a more sustainable form of transportation that can reduce air pollution.

Due to increased contact and exposure from overcrowded vehicles and inadequate waiting spaces, long trips, and polluted air, however, public transportation users and drivers are likely at higher risk of infection than people using other modes of transportation because of the known transmission dynamics of SARS-CoV2 and other infectious respiratory diseases. A recent rapid review by investigators at the Instituto Nacional de Salud Publica (INSP), including some members of the SALURBAL team (currently in pre-print), examined existing literature on potential infection risk in public transportation. From 13 published studies that they included in the review, those studies indicated that respiratory disease infection risk (influenza) was significantly higher for regular users compared to those with low or non-use. Compared to influenza viruses, SARS-CoV-2 may have an even higher risk of infecting co-users in public transportation due to potential airborne spread, as well as spread during the asymptomatic period prior to symptoms. The INSP investigators also found from the prior studies that the length of a trip in public transportation can substantially increase risk of infection compared to shorter trips in a mathematical modeling study, as well as natural ventilation. Finally, their findings also suggest that reducing the number of passengers per vehicle can also potentially reduce transmission risk.

Because public transportation is the only or main mode oftransport for many economically vulnerable people, protecting them as best as possible during this pandemic should be a high priority for cities. This will also help ensure that public transportation can survive the pandemic, as well, and to prevent potential increases in traffic, road traffic injuries, pollution from increased personal transportation (e.g., personal car or taxi trips) by helping those who have the means to use more expensive modes to feel safe enough to continue using public transportation. What specific actions can individuals, public transportation agencies and companies and cities do to reduce the risk of transmission to their drivers and users? While the risk of transmission cannot be eliminated completely, once cities and countries begin lifting travel restrictions, these evidence-based and expert-recommended actions may help reduce the risk of transmission for public transportation users and workers (see sources below).

Individual public transportation users and workers can take a number of important actions to reduce their risk, including:

• Wearing a facial cover that completely covers their mouth and nose
• Avoid going out in public if you have symptoms or suspect that you have been exposed to someone with COVID-19
• Wash your hands frequently or use hand sanitizer
• Avoid touching your face
• Keep at least a 2-meterphysical distance from others
• Limit speaking to other users
• Educate users about the requirements to protect themselves and others

Public transportation agencies and companies can take the following actions:

• Limit passengers per vehicle to ensure users can maintain physical distances
• Frequently disinfect and sanitize vehicles
• Protect the driver with a physical barrier if possible
• Implement natural ventilation
• Provide hand sanitizer for users in the vehicle
• Implement contactless payment systems
• Provide sufficient waiting space
• Increase service frequency
• Increase frequency of stops
• Expand service zones to more areas of the city
• Frequently screen workers for symptoms and test for infection
• Increase service in traditional non-peak hours to accommodate flexible schedules
• Screen passengers
• Paid sick leave for public transportation workers
• Educate and train workers about how to protect themselves and provide protective equipment

Cities can take the following actions:

• Prioritize public transportation by providing dedicated travel lanes to accommodate increased frequency
• Increase the space at bus stops for users to wait
• Support public transportation expansion and frequency
• Implement contact tracing and surveillance of cases to determine if infection origin was from public transportation

Employers

• Allow more flexible employee schedules to reduce peak travel crowds
• Allow more telecommuting when possible
• Paid sick leave that allows users to stay home when they feel ill and don’t feel obligated to work while sick

There are other actions that some cities and transportation agencies are taking that do not yet have evidence backing their use, but may have potential include:

• Allowing only essential workers to use public transportation during high community transmission
• Allow scheduling and reservation on public transportation trips to manage demand

Many public transportation users, if they have the option, will likely choose other modes of transportation during the pandemic and may permanently change their mode. If these users change mode to personal vehicle modes, this could have major negative consequences for other aspects of health, thus cities should consider how to prevent or reduce this shift. Encouraging and supporting bicycling in addition to public transportation support could help prevent users shifting to personal vehicles. In order to attract people to cycling, safety and access to bicycles need to be greatly improved. Implementing or expanding bike share programs can help increase access to cycling that besides the benefits during the pandemic have demonstrated safety, economic and health benefits for cities that have implemented them.  Another important step that cities can take is improving the safety of cyclists by creating infrastructure to protect them from getting struck by motor vehicles, such as protected bike lanes or cycle tracks, increasing their visibility at intersections, and slowing motorist speeds through design and enforcement.

In summary, cities need public transportation in order to be achieve long-term sustainability, road user safety, and equitable mobility, thus it is even more important for them during the COVID-19 pandemic to ensure public transportation endures by appropriately managing the risk of infection and protecting vulnerable populations.