The first wave of the Covid-19 pandemic was a steep learning curve for all employers, but in particular bus and train companies. Firms had to manage the sudden drop-off in passenger numbers alongside risk managing employee health and return to work. OH support was critical, explains Dr Mark Hall.
When Covid-19 first became prevalent in the UK in early 2020, its presence within the population was initially insidious but, by spring, the effects of the infection had wide reaching consequences for many sectors of the economy, including transport.
Train and bus companies responded rapidly to government advice but in different ways as they sought to balance the safeguarding of employees with providing a service to the public.
Not since the days of British Rail (1948-1997) have train companies been nationalised but they virtually become so as passenger numbers quickly collapsed (currently 10-20% from pre-Covid-19 days).
This continues to be the position to date (the beginning of 2021) as they remain heavily reliant on government subsidies to provide a public service, which has cost the government between £10.5bn to £12.5bn and counting so far.
As each company struggled to provide a service, they each took different approach to safeguard their employees and public.
This article intends to look at some of the different responses to the Covid risk by several rail and bus companies during the first wave from March onwards to July 2020.
Clearly, the second and third waves of infection that the UK experienced over the autumn and winter led to further challenges but, for the purposes of this article, I am solely going to examine the response to the first wave when the learning curve about the virus was the steepest.
As most occupational health practitioners will by now be well aware, Covid-19 infection can occur in all age groups but its severity and death rate is highly related to age and associated with underlying health conditions.
The illness therefore particularly affected the non-working population (those aged 70+) although the consequences of the pandemic of course had a dramatic and changing effect on all aspects of working life.
Covid-19 was the highest cause of death in March, April and May 2020 but, with the country-wide lockdown, it quickly become the third most frequent underlying cause of death by June (after the usual causes of dementia and Alzheimer’s disease and ischaemic heart disease). Covid infection deaths accounted for 21.6% of all deaths during the spring peak months but had reduced to 7.1 % by June.
Road transport drivers had some of the highest rates of death involving Covid-19 for men during this time but this group also included taxi and cab drivers and chauffeurs who all had close unrestricted contact with the public. By comparison, train/tram drivers are relatively isolated from the public during their working day.
It is therefore not surprising to see the highest death rate in taxi and chauffer drivers (65.3 deaths per 100,000; 134 deaths), medium rates in bus and coach drivers (44.2 deaths per 100,000; 53 deaths) and very low rates in train and tram drivers (two recorded deaths) and rail operatives (six deaths). This demonstrates the risk from Covid is related to exposure to the public.
Of the 17 ONS-specific occupations among men in England and Wales found to have higher rates of death involving Covid-19 (data from its Annual Population Survey), 11 occupations have statistically significantly higher proportions of workers from Black and Asian ethnic backgrounds. This is particularly relevant among bus companies, with 14% classed Black, African, Caribbean, Black British and 10% Asian, Asian British employees.
How bus companies responded to Covid-19
All bus companies continued to provide a service during the lockdown with the support of government, with various measures being implemented to safeguard the driver and the public.
These included one-way bus systems, improved shielding for drivers, contactless payments and increased cleaning regimes.
These measures were independently assessed and demonstrated the bus environment had become a low Covid risk to the driver. Risk reduction procedures were also implemented at bus garages to reduce the interpersonal contact, social distancing and one-way systems.
Along with these changes, some bus companies were still concerned their bus drivers were at risk of severe Covid infection because of their age, underlying health issues and/or being a member of the BAME community.
This was particularly a concern in the London area and was highlighted several times by Sadiq Khan, the mayor of London, at the time.
It was therefore decided to assess bus drivers’ individual risk from Covid, which would then advise management of their fitness to work.
To do this quickly and efficiently a driver self-completed a health questionnaire, which was based on the ALAMA (Association of Local Authority Medical Advisers) Covid age medical risk assessment toolkit.
Management ensured each driver completed their form, which was then forwarded to a nurse to assess who, in turn, produced a “Covid age” for that employee.
At the time, the advice to the company was either fit to work or to shield at home. The ALAMA workplace advice for the very high risk (shielding) group was: “Unsuitable to return to work until the risk of contracting Covid was significantly reduced.”
The results for each driver were forwarded to their bus company and, following discussion with their manager, these workers deemed very high risk were sent home until lockdown was removed or the ALAMA advice changed. In this way, a large number of bus drivers were able to be assessed quickly and efficiently, with any nurse queries being reviewed by an occupational doctor.
On review, the bus driver cohort data was divided into low, moderate, high and very high risk from the effects of Covid.
It is noticeable that, for example, one north of England bus company had the majority of its drivers in the moderate risk group decreasing to the very high risk group whilst the opposite was true for one London-based bus company.
This was related to the latter having a higher proportion of older drivers, with more health issues and a higher proportion of BAME workers.
How train companies responded to the first Covid wave
While, as we have seen, some bus companies struggled on after minimising their staff to the likelihood of Covid infection, train companies took different responses to the pandemic.
Grand Central Trains in the north east of England temporarily shut during this period as it received no government support and relied on passenger numbers, which of course fell dramatically.
Northern Rail, on the other hand, sent nearly 1,000 employees home who had any significant health condition while West Midlands Trains continued to work with all its employees at work.
Different companies responded differently depending on their business model, union influence and management view of the situation.
When the Covid risk had reduced sufficiently during the summer for the government to advise workers back to work, Northern Rail then had 800+ employees at home with health issues and needed them to return as soon as possible.
A self-assessment questionnaire was impractical so these workers required a review prior to resuming work.
This was undertaken by a nurse-led 20-minute consultation, again using the ALAMA Covid age assessment tool at the time and dividing the employees into two groups, “fit to work” and “shielding”. Any complex cases were reviewed by an occupational physician.
Fit-to-resume-work employees were informed to strictly social distance, comply with good hygiene practice, use PPE and to keep the risk of Covid as low as reasonably practicable.
Those told to shield at home (in other words those deemed very high risk) were told to remain off work until government advice altered.
On review of the health data collected from the Covid age ALAMA assessments for the 800+ Northern Rail employees, the groups were divided into drivers, conductors and general staff.
Drivers (27%) conductors (25%) and general staff (48%) made up the proportion of each group. Overall, 70% of all consultations resulted in employees being deemed fit to return to work, with the rest continuing to shield at home.
This, however, still left 245 workers unable to work, but this was using the ALAMA recommendations at the time which gradually became more refined along with changes to government recommendations.
Interestingly, despite drivers having thorough medicals three-yearly until the age of 55 and then annually and conductors having them less frequently, there was no difference in the percentage of fit to resume workers in these groups than the general operative group who had no regular medical.
The most common health issues were respiratory, diabetes, heart conditions and BMI >40. The vast majority of workers had one health issue per employee.
By far the most common health issue among these absent workers was the respiratory group, which was largely made up of those with mild asthma. A third were deemed unfit to work and advised to shield as, at the time, there was concern they were at high risk of Covid infection, although this was amended later.
The diabetic group mainly contained those who had type 2 non-insulin-dependent diabetes. Most had mild diabetes but a few had additional health concerns. This resulted in 80% being able to resume work safely.
Of note was the high number of employees with a BMI over 40. Already known to be a significant risk to general health, obesity remains a risk for severe Covid infection.
This suggests 6.25% of the general railway population are in the severe obesity group. With morbid obesity estimated at 3.6% in the adult population, this shows how severe obesity can be a particular issue in the rail industry, and one that needs to be addressed over the longer term.
To conclude, like many other British companies, transport companies that were thrown into the uncertainties of the initial Covid pandemic were forced to balance the health of employees with providing a service to the public.
Each company adapted to what was a quickly changing work environment as best they could under the constantly changing restrictions – and the support of occupational health practitioners and physicians was a vital element within this.
Despite enormous challenges, the buses kept going and the trains kept running, a success that should be celebrated by those needing to continue to use the services.
The work environment is now relatively safe for employees and public, even the despite the new more transmissible form of circulating Covid virus. We can, we hope, see the end of the (train) tunnel this year with the rapid distribution of vaccines.
So hopefully (eventually) 2021 will be a happier experience for transport workers as well as the OH teams that support them!
ALAMA Medical Risk Assessment https://alama.org.uk/covid-19-medical-risk-assessment/