MTA worker_sanitizer

ADDED CONCERNS: The coronavirus death rate among Metropolitan Transportation Authority workers has remained frozen at 131 for the past couple of months, but Transport Workers Union Local 100 said that some of those who have recovered from the disease and returned to work are feeling lingering effects from it, and researchers say that in addition to the heart conditions some have reported, there are signs that scarring of the lungs occurs in some cases.

The Metropolitan Transportation Authority and Transport Workers Union Local 100 are each closely tracking the public's compliance with the transit system's mandatory mask requirement, yet their findings are sharply divergent, and the union is also concerned about members struggling with lingering symptoms.

Since April 17, riders have been required to wear a mask. The difference in findings—MTA CEO and Chairman Patrick Foye said Aug. 3 on NY1 that 9 out of 10 bus and subway riders were in compliance, while the union said that on some bus routes barely more than 60 percent of passengers rode maskless—comes as the debate over how best to open the city's public schools intensifies and the safety of the transit system is an essential consideration for parents, staff and decision-makers.

Good News Too Good?

"The good news is that 90 percent of our customers, based on physical counts, on subways and buses are wearing masks," Mr. Foye said. "We have a mask force which is distributing 4 million masks donated by the state and the city. We want to make [the compliance rate] even higher, and the news to our riders is you're not welcome on public transit if you're not wearing a mask, period."

But Local 100's survey of several bus routes showed poorer results, including a finding that on the B45 in Brooklyn, 39 percent of riders were not wearing a mask.

"We have been advocating for mask enforcement," said Tony Utano, Local 100 president in a statement. "It's in our 10-point plan. The MTA has adopted many of our points, so this is another step in the right direction. Local 100 will continue monitoring mask compliance and bring our findings to the MTA, the membership and riding public."

"Even if 90 percent of riders are complying, if you have a million riders, that's 100,000 people that are not," Local 100 Vice President for TA Surface J.P. Patafio said in a phone interview. "This has to be like Vision Zero."

Lingering Symptoms

More than 90 of the 131 MTA employees who have died from the virus were members of Local 100. Thousands of workers were sidelined by it but have returned to work, yet an unknown number are dealing with health complications that clinicians are trying to understand.

It is that cohort of workers suffering lingering effects that union officials are concerned about as persistent symptoms keep them out for protracted periods and they come up against deadlines for reporting back to work.

"I have a member with a serious case, who also lost his wife and mother-in-law to COVID-19, and now he has to retire because of the permanent damage done to his heart," Mr. Patafio said.

Michael Carrube, president of the Subway Surface Supervisors Association, which lost 13 members to the virus, said what his members are seeing in terms of customer mask-compliance tracks closely with what the TWU has documented.

"They are seeing 40 to 45 percent non-compliance with the buses, and with the subway system it is really hard to say but it is probably even lower," he said.

More Heart Conditions

"What I am seeing is that I have a few members that are recuperating from COVID, but they are still showing respiratory issues and there are other members now have heart conditions," Mr. Carrube said.

The SSSA president conceded that as a medical matter, it's often hard to know what level of disability is attributable to the virus or a pre-existing condition. "Were these underlying issues that the virus made worse?" he said.

Last month, Local 100 and the NYU School of Global Public Health announced the launch of a series of studies of the impact of the coronavirus on the physical and mental health of the MTA workforce.

City-based occupational health experts and disability lawyers have compared the circumstances of essential workers who had to continue coming to their work locations to those of first-responders and clean-up workers who toiled in lower Manhattan after 9/11 and subsequently developed cancers and other ailments.

Early in the pandemic, many believed that only older people and those with pre-existing conditions were likely to die from the virus. In recent months, the rate of survival for patients who have been hospitalized has improved, particularly in cases requiring time in intensive care or on a ventilator.

Tip of the Iceberg?

But at the same time, research published by the U.S. Centers for Disease Control and Prevention and the Journal of the American Medical Association indicate that the nation's infection rate is likely 10 times higher than what is being reported. The findings are based on tests that flagged the presence of COVID-19 antibodies in 19,000 routine blood tests that include individuals who likely were neither tested for the virus nor displayed symptoms.

The finding of a wider prevalence of the virus came even as research remained inconclusive about whether the presence of antibodies provides someone with an immunity, and if it does, for how long.

Dr. Fiona Havers, a member of the CDC seroprevalence task force, told NBC News, "We don't know if antibodies represent protection from the virus. And there may be some suggestion that antibodies wane over time, so we don't know if herd immunity is achievable."

Studies have showed that COVID creates scarring on the lungs for those who survived a bout with the virus, as well as on the lungs of individuals who were asymptomatic.

"One thing we didn't anticipate was that the virus seems to accelerate a great deal of scarring in the lungs," wrote Dr. John Swartzberg, from the University of California-Berkeley-UCSF Joint Medical Program. "And if lung tissue is replaced with scar tissue, it is no longer functional as regular pulmonary tissue, which translates to poor gas exchange."

'What We Really Fear'

He continued, "What we really fear is long-term shortness of breath that could extend anywhere from being very mild to severely limiting. There is also a disturbing report looking at computerized tomography (CT) scans of asymptomatic people that found they were left with some scar tissue. So, this could even be happening on a subclinical level."

In the same analysis Dr. Swartzberg noted that "the virus can directly attack heart muscle cells, and there's also evidence that the cytokine storm that the virus triggers in the body not only damages the lungs but can damage the heart. We don't know what the long-term effects of that may be, but it could be that we will have a population of people who survive COVID-19 only to go on and have chronic cardiac problems."

And that's not all.

"The third organ system that we're now pretty clear about is the central nervous system," he wrote. "There is evidence of direct involvement of the virus with neurons, and also the cytokine storm and inflammatory mediators can cause damage to the central nervous system."

Clots Among Other Worries

He warned that in addition to "neurologic clinical findings," attending physicians are "seeing patients post-discharge struggling with psychological challenges, almost like PTSD. And, we're also seeing some cognitive defects in some people that are very disturbing."

And as previously reported, COVID-19 infections can cause "abnormal clotting of the blood in some people. This has led to pulmonary emboli, which are blood clots that travel to and damage the lungs, and strokes, which are blood clots in the vascular system of the brain. Both pulmonary emboli and strokes may have long-term consequences for these two organs."

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