A few dozen people wearing homemade and medical masks sit waiting for taxis as drivers spray hand sanitiser on commuters and tell them where inside of the ubiquitous Toyota Quantum minibus taxis they may sit to keep the appropriate distance.

The scene on this Friday morning is eerily quiet for Bosman taxi rank, usually one of Pretoria’s busiest and loudest spots.

“The mood is very sombre,” says Macdonald Makata, public relations officer of the South African National Taxi Council (Santaco) in Tshwane. 

Only about a fifth of the rank is operating, with vehicles filled to a maximum of 70%, sanitised regularly, and deep-cleaned twice a week.

All commuters are meant to wear masks, although only about half do, says Charles, who has been a taxi driver for about five years. 

“It’s very difficult… but we have to follow,” he says of the regulations. Makata agrees that while the health measures are important, they are not easy to implement, since some commuters do not take them seriously and it is having a great financial impact on the industry. 

“In a way it is helping to flatten the curve,” he says, “but pocketwise it is not helpful at all.” 

Similar health and safety regulations are in place across the board in the different modes of private and public transport that are allowed during Level 4 lockdown, with some buses and the Gautrain slowly resuming operations.

Transport Ministry spokesperson Ayanda Allie Paine says that they are testing the state of readiness and the viability of instituting the health measures at scale before reopening the Metrorail system during Level 3 or 2. While the ministry is exploring a variety of future scenarios, Paine says the economy and budgets will have to be considered, “so one is fearful of saying that this is what we’ll do and for how long and whether or not it will be sustainable”. 

The risk 

Despite the practical implementation being challenging, the need for health measures in public transport is undeniable. Professor Taryn Young is the head of the Department of Global Health and the director of the Centre for Evidence-Based Health Care at Stellenbosch University, where she and a team recently conducted a rapid review of research linking public transport and respiratory viral infections like influenza. 

She says, “The risk of transmission within public transport comes from the fact that it is large numbers of people that will be very close to each other.”

The studies confirmed that using public transport significantly increased your chances of influenza. This risk is based on factors such as the proximity of commuters, the time spent travelling, and the inadequate ventilation in these spaces. Young notes that this may especially relate to people who are infected but not yet tested or showing symptoms. She says another risk factor is that public transport, particularly over longer distances, can bring viral infections into new areas. 

The common interventions to mitigate this risk fall into four broad categories: environmental controls, respiratory etiquette, hand hygiene, and mask usage. Young reminds that “it’s about a combination of strategies, it’s not just about doing one of these”. Encouragingly, these areas are already being addressed or planned for in South Africa.

Environmental controls 

Since SARS-CoV-2 spreads through airborne droplets that may be inhaled or touched, surface sanitisation is a key environmental aspect to control in public transport. Hand sanitisers and deep cleaning seem to already be widely in place and Gauteng Public Transport MEC Jacob Mamabolo is launching a provincial taxi disinfection programme aimed at increasing compliance with regulations. 

Sanitisation or health screening booths, like the ones recently installed by the Gautrain, are another option that is being considered by the ministry for larger-scale rollout. Paine says these may be used more widely because “they not only check your temperature, but they also spray with sanitisers that stay on your clothes and body for an hour while you’re commuting”.

Paine says they are also considering cashless systems in taxis as a way of increasing hygiene. “We are not there yet, but these discussions have already begun.”

Responding to Spotlight about larger changes in the system, Transport Minister Fikile Mbalula says that “yes, structural innovation must be the new thing”. He emphasises that the chosen changes must be value for money and says that he is also looking at changes made in countries such as Turkey. Mbalula uses the example of the sanitisation booths as something that can be implemented in larger transport spaces such as the rail network. 

“It is innovative, it is highly convenient, it is proper. That is what we want to see,” Mbalula says. 

Fresh air 

The other important and perhaps underrated environmental control mechanism is adequate ventilation. Young says the studies they reviewed showed that influenza risk dropped when air was filtered or ventilation was improved in trains. 

Freelance biomedical engineer Munyaradzi Matose has researched how airborne tuberculosis is affected by ventilation in taxis in South Africa. He found that opening the two front windows in an average minibus met the World Health Organisation’s minimum recommendations for ventilation rates in general wards and outpatient departments. He says this “reduces the risk by removing all the particulates in the air – almost 95% of that – within an hour”. This is a cost-effective and easy way to drastically reduce the risk of infection from airborne disease. 

In his research, Matose monitored taxis driving to higher tuberculosis risk areas such as Gugulethu and Khayelitsha, and while drivers may open windows to call out to potential passengers, “consistent open windows throughout the journey didn’t happen much”. 

He acknowledges that while it may decrease the health risk, wide-open windows are often impractical because of the noise levels, possible safety risk and discomfort at higher speeds. 

Matose says that air conditioners may bring in a little fresh air, but this may not be enough, and may not be a feasible and affordable solution for drivers. 

When told of Matose’s research as a possible solution, Makata at the Pretoria taxi rank laughs and says, “In summer, yes you can afford to open windows, but in winter you can’t”. 

An additional precaution to clean the air regardless of the windows would be the use of ultraviolet germicidal irradiation lamps and similar devices. These can be used directly on surfaces, as long as there is no human contact, but Matose says hospitals use an air filtering version in fan cabinets. 

“In conjunction with ventilation it would be the ideal solution,” he says, and this would be a risk reduction measure when windows cannot be opened. The lamps can run continuously for about two years, but safety concerns would have to be evaluated. 

“There is potential for it to work, it’s just the willingness of either the taxi associations or the car manufacturers themselves to jump on board for disinfecting the air for their passengers.” 

Matose has tried to convince manufacturers to invest in this before, to no avail, but says that in the time of Covid-19, the willingness may be higher. He says that in the longer term this may even allow for slightly fuller public transport, since “it opens up a whole new solution for people to feel safe in these packed environments”.

Normalising etiquette 

The other three categories of interventions that Young mentions are more up to the commuters than the transport system. 

Respiratory etiquette and hand hygiene practices, such as coughing into your elbow and avoiding touching surfaces and your face, can be encouraged but not entirely imposed. 

Social distancing is being pushed by indicators on the floors of train stations and public spaces, but not always adhered to. 

Using fabric masks, while mandated by lockdown restrictions, can only be enforced to an extent, and even though homemade masks are often for sale at places such as Bosman rank, not all commuters comply. 

Young says this comes down to engagement with all levels of the public transport community, including commuters: 

“For them to know what the risks are, for them to know how one can reduce this, and for them to come up with strategies for how this can be implemented.” 

Makata echoes this when he speaks of the initial adjustment to the new regulations. 

“We felt very vulnerable, and it was all because there was very little information,” he says. The drivers and owners were unsure about how the virus spreads and could not always explain the importance of the health measures to their clients. 

When discussing the research, such as Matose’s ventilation insights with Makata, he says these are the kinds of things they could implement if they understood the importance. 

“We lack that information, we are clueless.”

Continued or strengthened Covid-19 education specifically in the transport sector could address this. Makata suggests that the regular presence of health officials at ranks could help.

Santaco spokesman Thabisho Molelekwa confirms that they are considering “setting up mobile clinics in bigger taxi ranks” along with other innovations such as “having automated sanitising devices inside taxis, digital messaging facilities with integrated sanitising systems”. 

Structural changes 

While these health interventions are critical in reducing infection rates, the root of the risk is still present. Young says it is linked to a system that puts many different people in close proximity over long periods of time and distances. That cannot be reversed, but perhaps there are structural interventions that could help. 

The most obvious approach so far has been to bring down the carrying capacity of transport, with taxis at 70% and the Gautrain at 50%, but this isn’t financially sustainable or likely to be able to provide the capacity needed once more people can return to work. 

Young says that “it starts with minimising the use of public transport”, but since this isn’t easily feasible in the South African context, a particular focus for this should be on those with symptoms of a sickness. 

The competence area manager of transport systems and operations at the Council for Scientific and Industrial Research (CSIR), Dr Mathetha Mokonyama, reminds that “although we refer to public transport as mass transport service, it is actually individuals who are travelling and not groups”. Therefore, understanding the particular patterns and circumstances of commuters may make the system safer and more resilient, perhaps by making the system more efficient and catered to particular needs. 

Mokonyama says the mobility-as-a-service concept may be useful here. This combines the ideas of smart mobility and integrated transport to allow commuters to use apps to get to their destinations in streamlined ways, often paid digitally. 

He says it “seeks to seamlessly match individual travel needs to services, and to also offer services in ways that respond to travel needs”. 

This heightened level of efficiency and personalisation might have health benefits, because it may reduce travel time and the number of people a commuter comes into contact with. 

Paine also says that system changes where variability – and therefore potentially the infection risk – is reduced are possible and feasible. She says that integrated public transport is of high importance to the ministry and implementation has started, and may even be expedited by the pandemic.

“So, we are already starting to see the different modes of transport speaking to each other.” 

Mokonyama does, however, concede that “given the volumes and complexity of travel patterns we have to invest in computational capabilities,” to implement mobility-as-a-service and that as a country “we have some way to go with information security capabilities and assurances that individual information will not be used for malicious purposes”. 

He says that other practical interventions could work to shift transport habits, such as price incentives for off-peak travel. 

“Working together with employers and schools to stagger working hours and school hours in order to reduce peak travel, will also reduce exposure risks. 

“All these [changes] come at a cost, meaning the way transport is financed needs to be reconsidered,” Mokonyama says. 

“This is very difficult,” says Professor Stephan Krygsman from the Department of Logistics at Stellenbosch University about the feasibility of these ideas. 

“Remember that transport, and public transport, is the lifeblood of cities and that it cannot be stopped or reinvented easily, because work commutes are often at set times and the need for transportation at abnormal times, such as late-night hospital trips, is unpredictable.”  

While he recognises the greater problems in the system, Krygsman says for now the best may be to “keep the system running – just implement these safety measures”. 

However, Krygsman says, the problems in the transport sector that ultimately lead to higher disease risk have a larger cause and therefore need more macro solutions. 

“The irony is that the answer does not lie in transport, it lies in how we design our cities.” 

Krygsman explains that legacy spatial planning has created divides in cities, which makes travelling to and from outlying, often poorer neighbourhoods, more expensive for those who live there. This affects the system, because “to lower the cost of travel, the transport is of very poor quality”. 

Taking a long-term view, he says better designed lower-income neighbourhoods could create less reliance on public transport, possibly enhance system quality, and therefore make the country “more resilient to these types of shocks”.

Commuting in a Covid-19 world 

Researchers and officials can test and implement strategies that not only bring down health risks but might improve the system overall, including making it less crowded, more streamlined and possibly even addressing some of the financial challenges. 

But the public transport system in South Africa is a very large, multi-faceted beast. Adapting to the longer-term risk of Covid-19 will require complex solutions, political will, and careful negotiations. 

In the meantime, for the drivers spraying hand sanitiser at Bosman, and ranks like it around the country, changes are possible, but difficult. 

Charles says that even though some commuters have trouble complying, “we as people, if we can follow the rules, we can win this”. DM/MC

 This article was produced by Spotlight – health journalism in the public interest.

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