Despite the fact that most countries are currently observing declining trends and low incidence of COVID-19 due to the strong public health response measures adopted, it is expected that SARSCoV-2 will continue to circulate. In order to minimise the risk of resurgence of cases of COVID-19, it is advised to adopt a set of actions including enhanced community-based surveillance with comprehensive testing of possible cases, systematic contact tracing, continuation of certain non-pharmaceutical interventions, and reintroduction of additional measures in case of transmission upsurges.
A set of protocols has been designed to assist the safe and speedy recovery of the rail sector through a harmonised approach. Railway operations present a number of challenges to the response of the COVID-19 pandemic. These include but may not be limited to:
- Rail represents the most frequently used commuting means of transportation and trains transport millions of passengers annually. In contrast to aviation, railways continued to operate throughout the national lockdown measures.
- Railway stations are essential public places and entrance to them cannot be strictly controlled like airports, unless national distancing measures are enforced. The same is largely true for trains.
- The majority of train tickets are not nominal as in the aviation sector and in addition, commuting passengers use frequent traveller cards, which do not allow for passenger identification. On the other hand, contact tracing after an identified COVID-19 case is one of the most important public health response tools and railway stakeholders should be able to facilitate this process as much as possible.
Covid Protocols: Various Difficulties & Challenges
- Preparedness : It is advised to Railway stakeholders to develop preparedness plans if not already available, or standard operational procedures according to existing plans, for the response to the COVID-19 pandemic. It is recommended to appoint one preparedness coordinator to monitor the implementation of the adopted measures and to be the liaison person with the local/regional/national/international public health authorities.
Hot spot analyses and review of passenger flows could be applied by railway companies and authorities to support preparedness planning by enabling identification of critical points on the passenger journey or sites in hubs where transmission risk is potentially increased, therefore relevant measures need to be prioritised. Cross-border aspects should also be taken into consideration in the planning and development of COVID-19-specific protocols, including plans for cross-border contact tracing, which should be developed in consultation with the relevant authorities in various countries operating international trains.
- Training : Training of station, train and all railway employees is needed on the adopted measures and applied procedures. This generally includes information on how COVID-19 is transmitted, physical distancing measures, hand and respiratory hygiene, the appropriate use of the recommended personal protective equipment (PPE) and the management of a possible COVID-19 suspected case in route and any new procedures they need to put in practice. Employees also need to be allowed and advised to stay at home if they have symptoms compatible with COVID-19.
- Coordination : Coordination ensures effectiveness of response. Competent national authorities, railway undertakings, station managers, infrastructure managers and other railway stakeholders should coordinate their actions in sufficient detail. Train operations for long distances, inter-state, sub-urban movement, cross-border and international rail services, measures need to be well coordinated among national authorities responsible for public health as well as for transport for different member states and the rail management operating the rail service in question in order to be effective.
In particular, when adapting recommended measures affecting the common situation of travel companions and passengers with specific needs to local requirements, railway companies should ensure that this is done without unnecessarily affecting the passenger experience. Some specificities of railway assets (e.g. historical or small stations, old rolling stocks) may compromise application of these measures. In that case, alternative solutions should be explored. The implementation of public health and safety measures should be delivered in close cooperation between rail companies and all involved public authorities (including public health) to the best of passengers’ welfare.
- Pro-active Communication : Recommended measures not only need to be effective but also properly communicated and visible. Railways should therefore communicate to their staff and passenger clear rules and procedures, through a variety of channels, in clear and easily accessible language(s).
The information flow should reach all levels of railway staff and as regards the passengers start well before the journey, and stay with them throughout, and a procedure in place to keep all stakeholders updated. Health promotion information should be prominently displayed in stations and on trains. Special attention should be given to passengers with special needs and people who do not speak the local mother tongue; pictograms are strongly encouraged. It is strongly advised for railway competent authorities and companies to adopt the same messages as communicated at various levels to avoid duplication of efforts.
- Promoting Responsible Behaviour : Given the high number of passengers transported daily and the number of stations served, compliance with the general rules for safe behaviour to protect public health, depends on the diligence and sense of responsibility of transport and public health authorities, railway stakeholders and each passenger. The effectiveness of the measures recommended and implemented in trains and stations has to be aligned with those implemented at national, regional and local levels. Promoting responsible behaviour and mutual respect in times of crisis will create trust among customers and staff alike.
- Inclusiveness : The transport of persons with disabilities and/or reduced mobility should receive particular attention during the COVID-19 pandemic. Railways & other rail based transport system should appropriately instruct staff who, in line with various rules on passenger rights, assist persons with needs and provide their staff with adequate health protection equipment.
- Efficient Operation for health & safety : The measures herein should create a healthy and safe environment for railway workers and customers and help build confidence, complicity and trustiness. A culture of compliance with the necessary behavioural etiquette should be promoted by railway companies through available communication channels. At the same time, it is important to enable the railway companies to run their system in a robust and well-functioning way. The movement of people increases the risk of SARS-CoV-2 re-introduction into areas with low transmission or where only sporadic cases are being observed.
The movement of people refers not only to tourists, but also to commuters, business travellers and migrant or seasonal workers. However, virus re-introduction would not necessarily lead to widespread community transmission if strong surveillance, extensive testing and robust contact tracing measures are in place, together with ongoing risk communication about the importance of staying at home if travellers or staff have symptoms, physical distancing, hand and respiratory hygiene.
Various Operational Measures
The various operational measures regarding passengers and staff, regarding maintenance and cleaning of railway coaches and stations, and regarding the rail system and its equipment are outlined in three main sections:
- General measures that should be in place all the time,
- Measures applicable for stations/platforms and on board trains, referring to both staff and passengers, and
- Measures applicable for train stations and on board trains.
Railway station managers and railway undertakings should take appropriate actions to ensure that passengers and railway staff follow the measures described below.
Measures that should be in place at all times
Passengers and railway staff entering stations or boarding platforms or trains should respect public health instructions to reduce the risk of spreading SARS-CoV-2.
- Health promotion messages: Should be displayed prominently throughout stations and on board trains emphasising the main public health advice including:
- Physical distancing (at least 1.5 metres, ideally 2 metres) – Current scientific studies confirm that, in general, the distance that large respiratory droplets can travel in the air is 1.5 metres for normal speech and up to 2 metres when coughing and sneezing. Further evidence indicates that the physical distancing should be of at least 1.5 metres and ideally 2 metres. For this reason, during the journey and during the waiting time at the platform, passengers and staff should ensure that 1.5-metre physical distancing is maintained wherever this is operationally feasible. In whatever situation, risk-mitigating measures are essential, and should be emphasized thus meaning hand hygiene and respiratory etiquette. If because of operational constraints physical distancing cannot be guaranteed, the use of face mask should be implemented.
- Respiratory etiquette – Strict respiratory etiquette should be advised: nose and mouth should be covered with a paper tissue when sneezing or coughing. If tissues are not available, coughing or sneezing into the elbow is recommended. Paper tissues should be disposed of immediately after use, ideally into bins with covers, and hands should be washed/sanitised immediately after disposal of the used tissue. Health promotion material that promote the importance of respiratory etiquette should be available in different areas of the train.
- Meticulous hand hygiene – SARS-CoV-2 is believed to be transmitted mainly via respiratory droplets and by direct contact. However, indirect contact with contaminated fomites is also playing a role in transmission. Therefore, frequent and meticulous hand washing and disinfection plays a key role in mitigating the risk of SARS-CoV-2 transmission. Health promotion material (e.g. posters, videos, etc.) that promote the importance of hand hygiene and explain how to perform effective hand hygiene should be available in different areas of the train. Easy access to hand washing facilities with soap for passengers and staff, single use paper towels, and alcohol-based hand rub solutions (containing at least 70% of alcohol). Rigorous hand hygiene should be advised; especially after contact with frequently touched surfaces, before eating, drinking, and after using the toilet.
- Appropriate use of face masks – Face masks are recommended mainly as a means of source control for persons who are symptomatic in order to prevent the spread of the respiratory droplets produced by coughing or sneezing. There is increasing evidence that persons with mild or no symptoms at the pre-symptomatic and early stages of the infection can contribute to the spread of COVID-19.
A face mask may help reduce the spread of the infection in the community by minimising the discharge of respiratory droplets from infected individuals who may not know they are infected and before they develop any symptoms. The use of face masks outside health or social care settings can be considered, especially when visiting busy, confined spaces, or when using public transport — conditions that apply in the context of train transport. The use of face masks should, therefore, be strongly recommended for both staff and passengers on trains and at the train platforms, with particular emphasis when the ideal 1.5 to 2-metre physical distancing is not feasible.
The use of face masks should be considered only as a complementary measure and not replace the preventive measures put in place, mainly respiratory etiquette, physical distancing, meticulous hand hygiene, and avoiding touching the face, nose, eyes and mouth. In general, face masks should be replaced when they become wet or soiled, or after being worn for 4 hours. For long distance travels, passengers should be reminded that they should ensure they have a sufficient supply of masks for the entire duration of their travel.
There are three main caveats associated with the use of face masks.
- Their correct use (how to wear and remove them, and how to manage the face mask while wearing it),
- the proper disposal of the used face mask, and
- the false sense of security that the use of a face mask can give.
A face mask should completely cover the face from the bridge of the nose down to the chin. Before wearing and removing the face mask, hand hygiene with soap and water or alcohol-based hand sanitiser should be observed. When removing the face mask, it should be removed from behind, avoiding touching the front side. The false sense of safety that can be given by wearing a face mask should be considered: the face mask works mainly as a means of control for exhaled droplets, and not as a means of protection for the wearer.
Passengers should be informed about this and about the importance of observing physical distance and frequent hand hygiene, together with the proper respiratory etiquette, to reduce the risk of infection. A used face mask as well as other waste from symptomatic patients can be treated as regular waste.
- Recommending the use of mobile contact tracing applications (apps).
Information should also outline instructions for any person, who develops symptoms compatible with COVID-19 while at railway stations or travelling by train.
- Strategies to reduce overcrowding : Strategies to reduce overcrowding are advisable, particularly in areas with on-going community transmission of SARS-CoV-2, in collaboration with the local/national public health authorities. Floor markings indicating the appropriate distance are advisable, where crowding is expected (e.g. ticketing, platforms, restaurants). Encourage and request that passengers purchase tickets in advance before departure (online or at ticket machines). For passengers that travel cross-border electronic tools may be available to directly collect passenger locator data for contact tracing purposes. Railway operators should ensure that passengers are informed about this requirement before their travel. Moreover, station managers should liaise with retail providers within stations, to ensure that the same principles are applied throughout the station area and to coordinate social distancing measures, e.g. the location of queues.
- Facilitation of hand hygiene : With the maintenance of working hand washing stations in public toilets and the availability of hand sanitizer dispensers throughout the stations and on board trains. Hand sanitizers must be clearly visible for passengers and accessible for people with reduced mobility. They must also provide enough amount of fluid to perform a correct hand hygiene. In the toilets, ensure the availability of soap and disposable tissues to dry hands.
- Enhance the cleaning of public areas in terms of depth and frequency: Procedures are needed to ensure that cleaning and disinfection is performed in a consistent manner following the principles and guidance in stations, platforms and on board trains, subject to train schedules as per standard SoP & protocol. Equipment of common use used by railways personnel such as computers, tablets, radio stations, headsets, etc. should also be disinfected before being used by another staff member. The maintenance of toilets in stations and inside vehicles may need to be adapted to ensure the proper cleaning and disinfection. Open or no-touch bins should be available at stations and on board trains for the safe disposal of used face masks and tissues.
- Heating, Ventilation and Air conditioning (HVAC) system: Train operators and station operators should consult with the manufacturers of the HVAC systems in place in stations and on each of their train types on proper maintenance and applying COVID-19 related revisions, if needed, to minimise a potential risk of contributing to the spread of small droplets or aerosols containing SARS-CoV-2.
It includes ensuring the cleaning of HVAC system parts and changing or replacing of filters according to recommendations of the manufacturer. Increasing the number of air exchanges per hour will reduce the risk of transmission in closed spaces. This may be achieved by natural or mechanical ventilation of indoor or carriage air, depending on the setting. Direct airflow should be diverted away from passengers or staff to avoid potential pathogen dispersion from asymptomatic persons.
There is currently no scientific evidence that airborne SARS-CoV-2 would be effectively inactivated by means of electrostatic air purifiers. The application of the above guidance should be achieved based on information provided by the manufacturer or, if not available, to seek advice from the manufacturer. All COVID-19-related revisions should be performed in accordance with national and local regulations (e.g. health and safety regulations, technical recommendations of respective national or supranational associations) and appropriate to local conditions.
- Risk communication strategies for passengers and railway staff : Should be adapted locally, if necessary, and aligned with ongoing national and local risk communication efforts to remind citizens that the pandemic is ongoing. Information should be easily accessible, accurate, timely, frequent and available to all travellers through different channels (e.g. websites, travel apps, screens, announcements, leaflets, posters). Passengers should be regularly informed via visual and audio messaging, as well as other appropriate means, about the preventive measures in place at the station and on the trains and should be reminded about the importance of hand and respiratory hygiene, of staying at home if experiencing any COVID-compatible symptoms, and of complying with any other recommendations from the national/local public health authorities. Fixed visual messages should preferably be in the form of pictograms wherever possible. In addition, if travelling cross-border, passengers should be made aware of the measures in place in the destination country.
- Thermal screening as exit or entry screening in stations and trains is not supported by scientific evidence as an effective or efficient measure to detect COVID-19 cases and prevent the spread of the virus in areas with low transmission. Railways need to liaison with various authorities regarding the current protocols for the provision of general first aid, including cardiopulmonary resuscitation, applicable to passengers in the context of the COVID-19 pandemic.
Measures applicable to Train Stations
In addition to the measures stated in the section ‘Measures that should be in place at all times’, wherever staff members interact with passengers from a fixed location such as, but not limited to, ticketing and information counters, protective screens should be installed in such a way as to allow the handover of the required documents but provide protection to the staff member from the respiratory droplets of passengers, and vice versa.
To reduce overcrowding in stations dedicated lanes or otherwise separate passenger flows at the station and on the platforms are advisable. In addition, remove, where possible, facilities that encourage crowding (e.g. benches, tables) at stations or, re-arrange them to ensure adequate distancing; allow seating in every other seat in stations. Moreover, liaise with the retail providers in stations to apply the same principles and coordinate physical distancing measures. Implement adequate measures at embarking, at eventual security checks, disembarking (e.g. openings of doors without passenger intervention if possible, disinfection of surfaces) and other measures that help to minimise contact. Station managers could ensure availability of face masks for purchase in the stations (e.g. through vending machines or in station shopping areas).
Measures applicable on board Trains
In addition to the measures stated in the section, ‘Measures that should be in place at all times’, overcrowding on board trains should be avoided as much as possible. Where possible, passengers should be encouraged to travel off peak hours to prevent overcrowding of trains. Where operational capacity exists, increasing the number of trains serving popular routes and/or limiting the number of passengers in each train car is advisable by allowing seating in every other seat. When possible, minimising passenger crossing between carriages and queuing in the galleys or in front of toilets. Where physical distancing cannot be ensured on board trains, use of face masks is recommended. Limit contact with compartment surfaces to the extent possible, not reducing safety functions (e.g. decrease the need for use of push buttons and door handles by central door opening where it is safe and feasible). Ensure safe and hygienic on-board services, including restaurant car/bar services. Ensure functioning public toilets in the train cars; frequent water level checks to ensure the functionality of as many toilet facilities as possible inside the train for the entire journey.
Reduce staff-passenger interactions and physical contact to the sheer minimum necessary. Adapt assistance and on-board service for persons of reduced mobility to ensure their comfort and wellbeing giving proper consideration to the duration of the travel on the train. Preferably, ticket control should be organised such that no exchange of documents between passengers and train staff will be needed. Electronic solutions can be explored.
Few other important measures
- Contact Tracing : Contact tracing is an essential measure to limit the spread of COVID-19 and the most important public health tool along with testing and isolation of cases, particularly in this phase of adjustment of measures and increasing movement of persons at the regional, national and international levels. The purpose of identifying and managing the contacts of probable or confirmed COVID19 cases is to rapidly identify secondary cases and prevent further spread. In most situations, contact tracing starts only after a COVID-19 case has been laboratory-confirmed.
The assessment of whether persons are high- or low-risk exposure contacts is performed by public health professionals through a case-by-case assessment of risk. Guidance on contact tracing defines high-risk and low-risk exposure contacts and gives advice for follow up. Each country will need to adapt their response to the local epidemiological situation and according to available resources.
Additionally, international public health organization (WHO, ECDC, etc.) are exploring the use of mobile applications (apps) to complement regular contact tracing efforts. For contact tracing operations to be successful and effective, it is important that the public health professionals have prompt access to passenger locator data, particularly if transportation has taken place between regions or countries. This enables public health authorities to identify promptly and notify contacts of an infected case for active follow-up and the provision of relevant advice.
Although the railway sector presents particular challenges, it is important that transport authorities and railway stakeholders collaborate with public health authorities to identify the most efficient and feasible way to collect and communicate passenger locator data, particularly for inter-regional and cross border routes to assist public health professionals.
- Thermal Screening : Thermal screening of passengers, particularly at international points of entry (PoE), is frequently considered as the go-to measure to implement for health safety in order to safeguard regions or countries from the introduction of a communicable disease. These procedures usually include some type of thermal screening (contactless thermometers, thermal scanners/cameras and others) to detect exiting or entry passengers with fever (e.g. body temperature >38°C). Additional (secondary) screening is frequently added to this procedure using a health declaration form or a health questionnaire, potentially administered and assessed by a health professional to determine the need to test for the particular pathogen.
Historically, reports reviewing entry screening procedures based on temperature screening from several countries at the time of the SARS outbreak (2003), the A(H1N1) pdm09 influenza pandemic (2009) and the Ebola virus disease (EVD) in West Africa (2014- 2016) consistently show that screening using temperature control is a high-cost, low-efficiency measure. As regards COVID-19 available scientific knowledge, several of its characteristics make it unlikely that temperature screening alone, will be an effective and/or efficient procedure to promptly detect COVID-19 on board. This assessment is based on the following:
- Many individuals who have been infected with the virus could be in the incubation phase when travelling and not yet showing symptoms; SARS-CoV-2 has an incubation period of 2-14 days, with 75% of cases developing symptoms after 4-7 days. These passengers will not be detected by temperature screening, even in a scenario assuming high sensitivity equipment.
- Since the beginning of the pandemic, evidence has accumulated indicating that asymptomatic (or pre-symptomatic and mild) cases play a significant role in the transmission of COVID-19 (maybe up to 40%) and it is currently established that transmission starts before the onset of symptoms (peaking 0.7 days before).
- In the case of COVID-19, fever is frequently, but not consistently, reported in symptomatic cases. According to ECDC’s weekly epidemiological report for week 26/2020, fever was reported in 53% of over 160 000 laboratory-confirmed COVID-19 cases entered in The European Surveillance System (TESSy). In addition, fever is a symptom that can be temporarily concealed by using antipyretic drugs.
- The large variety of screening equipment (contactless thermometers, thermal scanners, etc.) commercially available requires that particular care istaken in calibration and the setting of thresholds for categorising people as screen-positive. The performance of devices is difficult to compare because of different targets and modes of operation. In addition, their performance is affected by the choice of the cut-off value set for screening (e.g. 37.5 or 38.0°C). In general, performance is reported as follows:
- Sensitivity: 80–99%, meaning that between 1 and 20% of febrile passengers will not be detected (false negative).
- Specificity: 75–99%, meaning that between 1 and 25% of non-febrile passengers will be incorrectly detected (false positive).
Some reports suggest that taking the average of several readings improves accuracy; however, this increases the resources necessary to perform the task.
- Vaccination : Vaccination for SARS CoV is available now. It is a matter of great relief to the people and travellers across globe. Railway system in almost all nations having a robust rail transport network have made Covid Vaccination Certificate a compulsory document for people to travel across distances through trains, metros and other rail based transport system. This has helped in easing the public transportation through rails amidst strict covid protocols.
Unlike an year ago, most of the rail transport system including India seems to return to normalcy at pre-covid levels. However, still a number of challenges and precautions need to be addressed for smooth and flawless train operations ensuring passenger safety to highest degree and organised mobility. Government of India and Ministry of Railways in India is also making continuous efforts for smooth train operations adhering to standard protocols towards safety and security from the pandemic.
The above topic ‘Covid Protocols: Difficulties & Challenges in Rail Transportation’ is one of the many topics which will be covered in the InnoMetro event. This 2-day event is an insightful expo and conference on the metro and rail industry and would definitely open doors of possibilities.
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