Impact of occupational exposure to COVID-19 on the physical and mental health of an essential workgroup: New York City transit workers


  • Robyn R. Gershon, MHS, DrPH
  • Alexis A. Merdjanoff, PhD
  • Gabriella Y. Meltzer, BA
  • Rachael Piltch-Loeb, MSPH, PhD
  • Jonathan Rosen, MS, CIH, FAIHA
  • Ezinne M. Nwankwo, MPH
  • Patty Medina, MPH
  • David Vlahov, PhD, RN, FAAN
  • Martin F. Sherman, PhD



transit workers, COVID-19 pandemic, fear, mental health, disaster planning


Background and purpose: Early on in the COVID-19 pandemic, New York City (NYC) vowed to “keep the subways running” despite the lack of plans in place for protecting the health and well-being of transit workers. This study was designed to assess the impact of employment during the early phase of the pandemic on this essential frontline workforce.

Methods, settings, and study participants: A convenience sample of members (stratified by job title) of the NYC Transport Workers Union, Local 100, was recruited in August 2020 to participate in an anonymous, cross-sectional, internet-based survey.

Results: The demographics of the sample participants (N = 645) reflected union membership, ie, 82 percent male, 29 percent Black; 27 percent Hispanic, and 59 percent ≥age 50 years. At the time of the “NYC Pause” (March 22, 2020) when mandatory stay-at-home orders were issued, transit workers had limited worksite protections. Many reported a lack of such basics as face masks (43 percent), hand sanitizer (40 percent), and disposable gloves (34 percent). A high proportion (87 percent) were concerned about getting infected at work. Lack of certain protections was significantly associated with both fear of contagion at work and mental health symptoms. Nearly 24 per­cent of participants reported a history of COVID-19 infection. Self-reported infection was significantly correlated with lack of certain protections, including respiratory masks (p < 0.001), disposable gloves (p < 0.001), and hand sanitizer (p < 0.001). Infection was also significantly associated with mental health symptoms (p < 0.001). By August 2020, despite participants reporting that many worksite protections were then in place, 72 percent of workers were still fearful for their safety at work, eg, because of potential exposure due to passengers not wearing masks, and risk of verbal abuse and physical assault by passengers angered when asked to wear face masks. Workers who were fearful for their safety at work were more than six times more likely to report mental health symptoms (p < 0.001).

Conclusions: Lack of worksite protections before “NYC Pause” (March 22, 2020) was significantly associated with self-reported infection, fear, and mental health symptoms in TWU, Local 100 members. To reduce the risk of adverse impacts associated with bioevents in all essential work groups, and across all essential occupational settings, infection control preparedness, early recognition of risk, and implementation of tailored risk reduction strategies are imperative. Pandemic preparedness is fundamental to protecting the health and well-being of essential workers and crucial in controlling the spread of disease in the community. Bioevent preparedness for all essential frontline workgroups will also help reduce occupational health inequities. Workers at risk, regardless of setting, deserve and have the right to equal protections under federal and state law.

Author Biographies

Robyn R. Gershon, MHS, DrPH

Clinical Professor, Department of Epidemiology, New York University School of Global Public Health, New York, New York, New York

Alexis A. Merdjanoff, PhD

Clinical Assistant Professor, Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, New York

Gabriella Y. Meltzer, BA

Doctoral Candidate, Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, New York

Rachael Piltch-Loeb, MSPH, PhD

Preparedness Fellow, Division of Policy Translation & Leadership Development, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Associate Research Scientist, Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, New York

Jonathan Rosen, MS, CIH, FAIHA

Industrial Hygiene Consultant, AJ Rosen & Associates, Schenectady, New York

Ezinne M. Nwankwo, MPH

Doctoral Student, Department of Community Health Sciences, University of California Los Angeles Fielding School of Public Health, South Los Angeles, California

Patty Medina, MPH

Research Assistant, Department of Epidemiology, New York University School of Global Public Health, New York, New York

David Vlahov, PhD, RN, FAAN

Professor, Yale School of Nursing; Orange; Professor, Department of Epidemiology, Yale School of Public Health, New Haven, Connecticut

Martin F. Sherman, PhD

Professor Emeritus, Department of Psychology, Loyola University Maryland, Baltimore, Maryland


Gershon RR, Magda LA, Canton AN, et al.: Pandemic-related ability and willingness in home healthcare workers. Am J Disaster Med. 2010; 5(1):1 5-26.

Basta NE, Edwards SE, Schulte J: Assessing public health department employees’ willingness to report to work during an influenza pandemic. J Public Health Manag Pract. 2009; 15(5): 375-383.

Irvin CB, Cindrich L, Patterson W, et al.: Survey of hospital healthcare personnel response during a potential avian influenza pandemic: Will they come to work? Prehosp Disaster Med. 2008; 23(4): 328-335.

Balicer RD, Omer SB, Barnett DJ, et al.: Local public health workers’ perceptions toward responding to an influenza pandemic. BMC Public Health. 2006; 6(1): 99.

Masterson L, Steffen C, Brin M, et al.: Willingness to respond: Of emergency department personnel and their predicted participation in mass casualty terrorist events. J Emerg Med. 2009; 36(1): 43-49.

Mackler N, Wilkerson W, Cinti S: Will first-responders show up for work during a pandemic? Lessons from a smallpox vaccination survey of paramedics. Disaster Manag Response. 2007; 5(2): 45-48.

Syrett JI, Benitez JG, Livingston WH, 3rd, et al.: Will emergency health care providers respond to mass casualty incidents? J Healthc Prot Manage. 2007; 23(2): 27-40.

Katz AR, Nekorchuk DM, Holck PS, et al.: Hawaii physician and nurse bioterrorism preparedness survey. Prehosp Disaster Med. 2006; 21(6): 404-413.

Katz AR, Nekorchuk DM, Holck PS, et al.: Dentists’ preparedness for responding to bioterrorism: A survey of Hawaii dentists. J Amer Dent Assoc. 2006; 137(4): 461-467.

Dimaggio C, Markenson D, G TL, Redlener I: The willingness of US Emergency Medical Technicians to respond to terrorist incidents. Biosecur Bioterror. 2005; 3(4): 331-337.

Qureshi K, Gershon RR, Sherman MF, et al.: Health care workers’ ability and willingness to report to duty during catastrophic disasters. J Urban Health. 2005; 82(3): 378-388.

Alexander GC, Wynia MK: Ready and willing? Physicians’ sense of preparedness for bioterrorism. Health Aff (Millwood). 2003; 22(5): 189-197.

Crane JS, McCluskey JD, Johnson GT, et al.: Assessment of community healthcare providers ability and willingness to respond to emergencies resulting from bioterrorist attacks. J Emerg Trauma Shock. 2010; 3(1): 13-20.

Gershon RR, Magda LA, Qureshi KA, et al.: Factors associated with the ability and willingness of essential workers to report to duty during a pandemic. J Occup Environ Med. 2010; 52(10): 995-1003.

Sepkowitz KA, Eisenberg L: Occupational deaths among healthcare workers. Emerging Infect Dis. 2005; 11(7): 1003-1008.

Nienhaus A, Kesavachandran C, Wendeler D, et al.: Infectious diseases in healthcare workers: An analysis of the standardised data set of a German compensation board. J Occup Med Toxicol. 2012; 7(1): 8-8.

Santos CD, Bristow RB, Vorenkamp JV: Which health care workers were most affected during the spring 2009 H1N1 pan¬demic? Disaster Med Public Health Prep. 2010; 4(1): 47-54.

Gershon R, Dernehl LA, Nwankwo E, et al.: Experiences and psychosocial impact of West Africa Ebola deployment on US health care volunteers. PLoS Curr. 2016; 8: ecurrents.outbreaks. c7afaae124e135d122da139ee127e07291b07296b07295.

Wu P, Fang Y, Guan Z, et al.: The psychological impact of the SARS epidemic on hospital employees in China: Exposure, risk perception, and altruistic acceptance of risk. Can J Psychiatry. 2009; 54(5): 302-311.

Cabarkapa S, Nadjidai SE, Murgier J, et al.: The psychological impact of COVID-19 and other viral epidemics on frontline healthcare workers and ways to address it: A rapid systematic review. Brain Behav Immun Health. 2020; 8: 100144-100144.

CISA, Cybersecurity & Infrastructure Security Agency: Guidance on the essential critical infrastructure workforce. Available at Published 2021. Accessed April 18, 2021.

Levenson E: New York City keeps schools and subways open during coronavirus but cancels large events. Cable News Network. Available at Published 2020. Updated March 12. Accessed April 16, 2021.

CDC, Centers for Disease Control and Prevention: General busi¬ness frequently asked questions. Available at Published 2021. Updated February 11. Accessed April 16, 2021.

United States. Occupational Safety and Health Administration. Guidance on Preparing Workplaces for COVID-19. OSHA 3990-03 2020.

Guse C: MTA reported first COVID death a year ago: And at least 156 transit workers have died since as disease ravaged agency. New York Daily News. Available at Published 2021. Updated March 26. Accessed April 18, 2021.

New York State Website. Amid ongoing COVID-19 pandemic, Governor Cuomo announces results of completed antibody testing study of 15,000 people showing 12.3 percent of population has COVID-19 antibodies [press release]. New York State Governor Andrew Cuomo, 2020.

Parascandola R: MTA bus driver spat on, knocked unconscious with wooden plank by angry Brooklyn passenger. New York Daily News. Available at Published 2021. Updated February 10. Accessed April 18, 2021.

Qualtrics [computer program]. Provo, Utah, USA, 2020.

Kroenke K, Spitzer RL, Williams JB, et al.: An ultra-brief screen¬ing scale for anxiety and depression: The PHQ-4. Psychosomatics. 2009; 50(6): 613-621.

IBM SPSS for Windows, Version 27.0 [computer program]. Armonk, NY: IBM Corp, 2020.

Stata Statistical Software: Release 16 [computer program]. College Station, TX: StataCorp LLC, 2019.

Romano SD, Blackstock AJ, Taylor EV, et al.: Trends in racial and ethnic disparities in COVID-19 hospitalizations, by region: United States, March–December 2020. MMWR Morb Mortal Wkly Rep. 2021; 70(15): 560-565.

Sami S, Akinbami LJ, Petersen LR, et al.: Prevalence of SARS-CoV-2 antibodies in first responders and public safety personnel, New York City, New York, USA, May–July 2020. Emerg Infect Dis. 2021; 27(3): 796-804.

Nguyen LH, Drew DA, Graham MS, et al.: Risk of COVID-19 among front-line health-care workers and the general community: A prospective cohort study. The Lancet Public Health. 2020; 5(9): e475-e483.

Levenson M: 11 Days after fuming about a coughing passenger, a bus driver died from the coronavirus. New York Times Corporation. Available at Published 2020. Updated April 4. Accessed April 18, 2021.

Brand MW, Wiskur B, Rojas JI: Assessing fear of COVID-19 at an academic medical center. J Emerg Manage. 2020; 18(7): 91-98.

Maunder RG: Was SARS a mental health catastrophe? Gen Hosp Psychiatry. 2009; 31(4): 316-317.

Lai J, Ma S, Wang Y, et al.: Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Network Open. 2020; 3(3): e203976-e203976.

Young KP, Kolcz DL, O’Sullivan DM, et al.: Health care workers’ mental health and quality of life during COVID-19: Results from a mid-pandemic, national survey. Psychiatr Serv. 2021; 72(2): 122-128.

Lee AM, Wong JG, McAlonan GM, et al.: Stress and psychological distress among SARS survivors 1 year after the outbreak. Can J Psychiatry. 2007; 52(4): 233-240.

The US Government & Global Emerging Infectious Disease Preparedness and Response. The Henry J. Kaiser Family Foundation. 2014. Accessed July 15, 2021.


How to Cite

Gershon, MHS, DrPH, R. R., A. A. Merdjanoff, PhD, G. Y. Meltzer, BA, R. Piltch-Loeb, MSPH, PhD, J. Rosen, MS, CIH, FAIHA, E. M. Nwankwo, MPH, P. Medina, MPH, D. Vlahov, PhD, RN, FAAN, and M. F. Sherman, PhD. “Impact of Occupational Exposure to COVID-19 on the Physical and Mental Health of an Essential Workgroup: New York City Transit Workers”. Journal of Emergency Management, vol. 19, no. 9, July 2021, pp. 133-46, doi:10.5055/jem.0599.