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EP108 Protecting Our Essential Workers with Dr. Robyn Gershon
Aman: Folks, are you interested in learning more about disaster health, healthcare safety, and risk assessment and management? Well, today's guest on the I AM GPH podcast is gonna be a treat for you. I'm excited to have Robyn Gershon, Clinical Professor of Epidemiology at the NYU School of Global Public Health. Dr. Gershon is currently working on transit workers safety, but before that, she's played an instrumental role in a variety of projects ranging from evacuation of high rise buildings after the World Trade Center attacks, to hearing loss risk on subway ridership, and noise exposure in urban populations. Additionally, she has been a professor for over 30 years, and I'm sure she will be providing current and prospective students with a whole lot of golden nuggets on this podcast. Dr. Gershon, it's a pleasure to have you here.
Dr. Gershon: And thank you so much. It's my pleasure to be here. It's great to be with you and the other students, and to tell you a little bit about my work. The way it sounds when you first introduced me, it sounds like it's all over the place, but actually my work is very, very focused. It has to do with disaster preparedness and response. And even before I started in the world of public health disasters, which was actually in the year 2001 when I started with the World Trade Center and then the anthrax attacks here in New York city, but even before then, I am and have been trained at Johns Hopkins as occupational and environmental health and safety specialist, and because of that, my work can take me almost anywhere, anywhere where there is a threat to the health and safety of workers, which is predominantly most of us. So I've been very fortunate in my career to have had some wonderful opportunities to conduct research, not only in this particular field I'm in now and have been for the last 20 years or so, but in these other earlier fields, including needle stick injury. So my work is always very, very applied. The doctoral program I was in at Hopkins really stressed the application of our research to make a difference in the lives of people in the community. And because of that, I always wanted to do research that at the end would make a difference on people's lives, and so my work on needle stick injuries and healthcare workers, which was done very, very early on in the AIDS epidemic, actually was in the late 1980s, so it was extremely early when we really didn't know all that much about needle stick injuries, but in any case, I was fortunate being in Baltimore to be able to go down to the OSHA headquarters about once or twice a month, and I would share with them my findings, and because of that, I was able to influence the brand new OSHA needle sticks standard. These are the standards that help define how we conduct business in our workplaces, and in that case, it was about the healthcare workplace, which is enormous in the US. So having that chance very early on in my career really gave me that impetus to stay with it, and everything I've done since then, I want to be very, very targeting of some risks that we can reduce the impact of, and that takes us now to this remarkable study on the transit workers. Now, many people have asked me, well, how did you get started? How do you even work your way into a unionized group like that? How do you find your sample? How do you study populations? That takes us back to when I was on faculty at Columbia University in the Mailman School of Public Health. So as with many of my colleagues in academic research, it often makes sense for us to move our careers where the jobs are. And many people don't know that, or don't understand that, but academics at a certain level means that you will be going where there's an opportunity, opportunity for advancement, opportunities for more different colleagues, different part of the country. So my career has taken me so far from Baltimore in Johns Hopkins to Columbia, which is, of course, New York city at the Mailman School, and from there, I went to UCSF, University of California, San Francisco, and that was part of a two career move, me and my husband. He was going to become the dean at one of the schools there, and I needed to take my whole career of research and move it to a whole new institution, and UCSF was the place. Now, while I was there, I had this great opportunity to meet colleagues at Berkeley. And at Berkeley, they were developing their very first for anyone in the US, the very first, fully online MPH. At that time, I was only teaching. I was teaching very little 'cause mainly I was doing research, but my classes were in person. That's all I knew and that's all I was used to, and I said, oh, no, I don't think I know how to do that, that sounds too hard. They said, no, no, no, it's easy. We'll teach you. Don't worry. I said, okay. I might as well learn something new. I'm here in California. Let me act like a Californian. So I worked with them for six, seven months, we developed my first course, then the second course. These courses turned out to be remarkably important to their whole program because they were focused on disaster preparedness. First one on public health disasters, second on global, the third one on healthcare disasters, which I developed at NYU. After my stint in California, I was coming back to the East Coast where I'm from, and I was lucky enough to land this position at NYU. And I took my courses with me online and my whole research portfolio. And I just had to start again. And, you know, is that hard to do? You know what? Change is good. Change keeps us moving forward, not backward. We're moving forward. So that worked out well, but in any case, the research that I was doing in, I guess it was a little after the World Trade, which was a tremendous area of research for me, and lasted well, well over five years and had tremendous implications in New York city and every other large city, and I'll tell you how. I was very fortunate to become the principal investigator of the World Trade Center evacuation study. That was the study of all the evacuees of the towers of the entire complex on 9/11. So these are the survivors, right? These are the people who got out, who worked there and who got out. And our study was designed to identify the factors that helped or hindered their evacuation that day. And there were many, many things that helped them, especially and most importantly, including that they knew where the exits were. For such a large building, each of which had over 50,000 occupants normally there, and then another 25 to 30,000 visitors every single day, it was a huge complex. Most people don't understand the magnitude of it, but each building was so large, it had its own zip code. So thousands of acres of office space and lots of people, lots of movement, but only two fire exits, three fire exits.
Aman: Wow.
Dr. Gershon: Two that were only 44 inches wide, and one that was only 56 inches wide. So for that volume, that magnitude of people, if you didn't have access to elevators, all you would have would be those fire stairs, but many people didn't know where they were. And it was early in the morning when the buildings were hit, a lot of people weren't at their desk yet. And so it wasn't that easy to transfer information and what's happening? They didn't know what was going on. What's going on? They could see paper falling outside the windows and they could see flames and they could smell smoke. They certainly smelled the jet fuel, but they didn't know what happened. They felt an impact, but if they hadn't seen the plane, they had no idea what happened. So they were spending time trying to figure out, but all the electricity was out, their computers were down. There weren't really cell phones then, there were really just Blackberry. So communications was very hard, but the few people in that building who knew where the exits were gathered those around them and said, follow me, I know how to get out, follow me. And those are the people that made it out. Now, we also found out that day that anybody with any kind of disability whatsoever, including that morning they woke up with a backache, they had a bad headache, they had migraines the night before, they had a broken leg that week, they had diabetes, they had a heart disease, they had this, they had that, any single thing at all, not only slowed them down dramatically, but this is the interesting part. People with any type of disability or any kind of problem with their health that day were much more significantly statistically likely to have PTSD 2 1/2 years later. That's pretty remarkable. That's because they were at increased risk and they knew it. So anyway, that study was remarkable for me and for high rise buildings in general, the business buildings in general, because in the middle of it, I started meeting almost, I guess it was weekly at some point, I was meeting once a week at the downtown fire department, which is in downtown Brooklyn. Actually I think it's kind of near where Tandon is. It was in that MetroTech park campus. I went every week and I was meeting with the people at the fire department at the very highest levels who were redoing the high rise building fire safety codes. And that was the first time they were redoing the high rise fire safety codes in 30 years. The World Trade Center event was so great of a magnitude that it absolutely demanded that we change the way we do business in our high rise business building. So we met, I told them my findings and I helped them craft those changes. They passed those new laws. Those new laws were picked up by Boston and Chicago and LA, and every other place in the country, and then eventually to other parts of the world. And so now they have much more rigorous high rise building codes in part because of the results of that study, and that's why I love my kind of work 'cause it's so applied and it can impact thousands, millions more than who's actually in the study. Now, to get us to today and the transit workers. I was doing a study after the World Trade, maybe about five or six years after. A whole bunch of transit workers came to visit me one day in my office at Columbia and they said to me, Dr. Gershon, we are very concerned about our hearing. We think all of the conductors and all the transit workers are losing their hearing 'cause it's so noisy. And I said, well, that's interesting. It's a little outside my area, but I have some good colleagues who do noise research. Let me speak to them. Let's see what we can find out. And I, of course, was instantly interested because I rode the subways. I still ride the subways all the time. I knew they were noisy, I knew they were way over the OSHA limit, and I also knew we had a huge ridership. Millions of millions of people. It's the largest system in the country, one of the top in the world. Millions of people use that every single day. And I suspected that some people rode it for quite a long time, so it would be lengthy and loud. And so we started our studies, we got very close to the union, the Transit Workers Local 100, Transport Workers Local 100. And we did those studies, we published a lot of papers, we got grant money for it. The MTA was very uncooperative. The MTA is the kind of legal, it's kind of like a public-private legal entity that runs the transit system in New York city, all of it. So they're very, very powerful. And actually they really wanted the best in the world, but they are loathe to work with researchers, and it's unfortunate because we could be wonderful partners and the best results we ever get is when we're in partnership with unions, workers, and management, but it may come yet, we'll see. But anyway, that gave me an in with the transit workers. I stayed in touch with them, I really liked them. They knew me, they trusted me. As soon as COVID happened and I, you know, I was in the middle of my global disaster course, right? And right when things started happening in February, I knew this was going to be very, very serious. I mean, I felt that even in January as soon as we started hearing about the cases in China, I knew it would be very bad. I mean, I'm a public health disaster specialist, so I could definitely see the writing was gonna be not good. I got hold of my contacts at the Transit Workers Union and I said, I'm very interested. I knew that they were already having trouble and they were already getting sick. Very soon after they started getting sick and going in quarantine, a lot of them started dying. To date, they've had over 175 deaths. Now it is a very large workforce of over 40,000, but they took a very bad hit. And when we did our first pilot study last summer, not this summer of 21, but 2020, the summer of 2020, before we had any grant money or anything, we did a pilot study. And in that pilot study, we found that almost a quarter of them reported that they had been positive with COVID. We also found out at that time that over 70% knew someone who had died of COVID, not necessarily at work, but knew someone who had died and 90% knew somebody who had been infected. They were badly, badly impacted. And our whole question was this, and I think you and your listeners could appreciate this. The question for us with all these essential workers, and of course, these are essential workers, these are non-healthcare essential workers. The question is this, are they getting infected, exposed and getting sick, and some are dying because of their work exposure, or because of their community exposure? We always would like to tease that apart, right? We wanna know, is this a workplace risk? Can we do something about it? What can we do? Or is this in the community? And even then, what can we do? And it could be some combination of the two. Teasing that out is so hard. And I think I know you're from Tandon and I know that you folks there understand the difficulty trying to get a spatial sense using, you know, zip code or some kind of mapping to try and figure out, are these people all clustering in certain zip codes in Queens? Are they in Brooklyn? Are they in dense neighborhoods? Are they what? And actually from the preliminary work that we did at that time with the zip codes that we had, and we had 645 people in the final sample. It was a big sample over just a couple of weeks. We got a huge response from these workers. It looked like they were getting sick from work and not from their zip code, 'cause they were not living in the highest zip codes, and we knew what those were because they were publishing them. So anyway, so we did that pilot study, and based on that data, we did our first paper, which just came out and I'm happy to send it to anyone who'd like it. And then from there we wrote a grant, which we just found out recently was funded and we'll do a lot more. So why don't I stop there and see, Aman if you have some more questions for me.
Aman: Well, in your journey so far, you have walked us through a lot, and those were actually a lot of my questions as well. So it was very exciting to see how a lot of questions have been answered without me even asking them. You have had such an extensive journey. I'd like to go back to the beginning. This was one of the questions I wanted to really ask you at the beginning of this interview, but later on, but I think it's a good time to address that. Since you mentioned needle sticks, you mentioned the World Trade Center project, fire escapes, and the current transit worker project that you're working on. We started off by saying, it sounds like it's very extensive yet it's very focused. So what are some consistent themes that we have noticed through all these projects that are identical across all of them? What can we learn from these studies? What can we do to notice a certain theme that, Hey, this is a common issue. This was the same thing and that's the same and that. And it's something that we probably don't see, but it's from your experience, there has been that thing that always comes up. What are some of those things?
Dr. Gershon: I mean, that's really a great question. I can't begin to tell you what a great question that is. I bet you don't even realize how great a question that is 'cause that's a million dollar question. You know, what's the secret to life? What's the mystery of life? What is it when we go about our everyday lives, we're constantly adjusting our risk, we're constantly making decisions. Will I eat this? Will I wear that? Will I, you know, take a cab and not wear a seatbelt? Will I go on a bus and not wear a mask? Will I take a vaccine or I won't? Will I smoke that cigarette? Will I take that vapor thing? We're constantly making these risks judgements, and there are wonderful, of course, books written about this really. "Thinking, Fast and Slow" is a great one, but basically in a workplace, it's like this, we expect our employer to create and give us a safe and healthy workplace. That is a minimum expectation. We expect that, we deserve it, and by the way, it's the law. It's the law in the US. We deserve a safe and healthy workplace, whatever it is. Noise, it's anthrax, it's fire exits, it's egress out during a disaster event, it's all of those things. We deserve it. And for the most part, we don't even think about it. We think it'll just be there for us, but we have a role too. We have a very important role. We have to take our own initiative on a lot of things and make sure we avail ourselves of all the things that are available to us. We have to make sure we go to that training when they take us down the fire stairs. We have to make sure we put on those seat belts. We have to make sure we wear the mask. Make sure we take the vaccine. We have agency, we have our own, you know, self efficacy. The study we're about to do with these transit workers actually has a lot to do with self efficacy, because people who feel that they have control, they are much safer, they are much more protected, and so importantly, they are much less likely to have mental health adverse impact, 'cause they are in control. Even the people who got out by the skin of their teeth in 9/11. And I have met literally hundreds of those people personally, in all kinds of ways during the five years of the study. But even those people who made it out literally with maybe a minute to spare, even those people felt like, I'm alive today because of what I did. And they are doing, and I've written papers on this. They are doing so much better than people who felt like they had no control and that it was completely serendipitous. The people who said to me, Dr. Gershon, I almost put my foot in the elevator door and then at the last minute I was debating, should I go in the elevator during 9/11? Should I go, should I not go? And then at the last minute, I said, I'm not gonna go. I took the stairs and they survived. And they were mentally damaged, maybe forever damaged, very depressed, PTSD, anxiety, depression, all of that. And when our study psychiatrist on that study was analyzing, and he said, that's because it was just by chance. People don't wanna live just by chance, they wanna live because they think they had something to do with it. That's why they made it. They purposefully made a decision and that was the right decision, and they made it. And it's the same thing here with these transit workers. We want to give them self efficacy and self agency on how to protect themselves, not just from this terrible event, which hopefully will be over in the next year or so, but for the next one and the next one and everything else. We need to train them up, get them ready so that they can do their part while the MTA and the TWU does theirs. Does that make sense?
Aman: Yeah. Absolutely.
Dr. Gershon: Control. Take back that control of you're in charge of your life and wellbeing, your health and wellbeing. It's kind of philosophical, right?
Aman: Yeah. Very, very, very deep and very introspective as well. We could learn from that consistent theme as well. I'd love to circle back since you have done such great work and we'd love to hear about what you're working on right now and even contribute to it in some way. What have you noticed after the research grant has been with regards to the research and the grant has been, you know, given in this research. Who will benefit from this down the line? What are gonna be the impacts of it?
Dr. Gershon: Well, you know, we have our first advisory board meeting next week, and on that board, we have people representing the International Transport Workers Union. So we are already linked internationally, and of course, there are transit systems all over the world, and to the extent that we can, we would love to collaborate and work with them, and we certainly will. It'll be a two way street, but what we intend to do, and this is really top of my list. We are going to develop a best practices pandemic infection control plan for essential workplaces, and that includes not just transit, but with some tweaking, it would be amenable to grocery workers, retail pharmacy folks, people who are working in Uber, or, you know, any kind of thing like that. So for all those essential workplaces that were just standing around like, oh my goodness, what can we do? How can we protect these people? It's hard to get PPE, no matter what, of course, but, you know, they did not have a clue. They are not a healthcare workplace. They do not have infection control officers. They have no idea how to screen people or triage people, or to quarantine. They didn't know any of that at the outset. Now they know a lot more, but we are going to operationalize it. We're going to immortalize it, we're going to put it into a best practices plan because, and this is what's so awful and scary about what happened. Stringer, who's the, he's the comptroller for New York city or he still is the comptroller. I guess he's changing over a bit. Stringer wrote a scathing report about, it was an audit of the New York city's response to this COVID outbreak. New York city is one of the best departments in health, not just in the country. I'm sure it is number one in the country. It's one of the best in the world. It was ranked up there with WHO. WHO looks to our CDC and our New York city DOH for answers and feedback and information and guidance. We dropped the ball so badly, but even here in New York city, the best, number one with a huge city with so much at stake, so much, just commerce and everything at stake, and yet the plan that was on the books was from 2013 and it had not ever even been finished. That pandemic plan was from 2013 and here we were in 2020, seven years later without a plan. So we are going to take the initiative, and this grant, it'll be one of many things we'll do, but we are going to write a best practices, like not just a template, but the bells and whistles of a plan that will absolutely be useful to our transit, but to all these other populations as well. So we're already linking up with all these other essential work groups.
Aman: It's all so interconnected. It's all so interconnected.
Dr. Gershon: It's totally.
Aman: I'd like to conclude on this one specific question. Since you're involved in so many different areas, if I give you a magic wand right now, what is the one problem you'd love to it's gone in our system?
Dr. Gershon: Oh, that's such a great question. I mean, there are so many public health problems, but for sure, I think issues of equity are top most. One of the studies I'm doing now also is on disabled, disabilities and emergency preparedness. I know firsthand from that World Trade Center study that they were at a tremendous disadvantage that day, and those are just the people who survived, right? All the ones who died were gone from that study. But I think that if we don't address inequities, and there are occupational health inequities, and we saw for sure in these transit and all the other essential work groups, the non-healthcare essential work groups. If we don't address that, we not only can never move forward, but we not only will just be stuck in place, we'll go backwards. The challenges that face us are so enormous that if we don't do it, making sure we are inclusive of everyone and everyone's needs whatever they are and take all that into account, we will never move forward and we will not be up for the challenges that are ahead and there are many. There are many. This climate change challenge facing us, it's not going away anytime soon, even if we did everything right right this minute. So we have to pull together to save ourselves.
Aman: Dr. Gershon has said something that has been a consistent theme on this podcast, and it's been about the power of community. This is a consistent theme as in your work that's coming out in my work when I talk to people like yourself and learn the power of that. So thank you for sharing all your... We haven't even touched the surface of what all we could chat about Dr. Gershon, and I'm sure we'd love to have you back on the podcast to look at this place from a student angle and even get some updates on what you're doing. It's truly been great listening to your entire journey and what's coming next as well in your world and our world to begin with.
Dr. Gershon: Wonderful. It was great to see you and to be with the students, and I wish you all the very, very best. Stay well.