There is perhaps no place in America harder to escape crowds than the New York City subway, which, as the nations largest transit system, carries more than five million people every weekday.
During rush hour, commuters squeeze in to find any available space, with hands sharing poles and faces separated by inches.
As cases of coronavirus increase in the United States and public health officials urge healthy Americans to avoid contact with those who are sick, many people who live and work in New York wonder how they can do that given the heavy reliance on public transit.
The Metropolitan Transportation Authority, which oversees the subway, buses and two commuter railroads, said late Monday that it had started a major cleaning of all equipment that called for an industrial-grade disinfectant to be applied to everything from train cars to MetroCard machines every 72 hours.
The authoritys announcement came a day before Gov. Andrew M. Cuomo said that the state had its second confirmed case of coronavirus, heightening public health concerns.
The patient, a man in his 50s, commuted regularly by Metro-North from Westchester County to a law firm in Midtown Manhattan, officials said. He had not traveled recently to any place with large concentrations of the virus and had not come into contact with an infected person, suggesting that the pathogen was spreading locally.
Health officials have warned that the virus seems to spread easily, traveling through the air in tiny droplets produced when a sick person breathes, talks, coughs or sneezes. The public is being urged to follow basic precautions like frequent hand-washing and staying home when sick.
As you get ready to jostle with strangers aboard a jam-packed subway car, heres what you need to know.
On the list of places where New Yorkers could contract the virus, the subway might seem to pose a high risk: millions of people filling stations and train cars where coughs and sneezes are familiar sounds and countless strangers put their hands on seats and poles.
But epidemiologists said that the risk of transmission connected to using public transit is hard to accurately assess.
Dr. Stephen S. Morse, an epidemiology professor at the Mailman School of Public Health at Columbia University, said that, generally speaking, two main factors determined the likelihood of contracting a virus in any given place: how crowded it is and how much time one spends there.
Yes, subway riders often stand shoulder to shoulder, which increases the chances of being on the receiving end of a sick persons cough or sneeze. The federal Centers for Disease Control and Prevention says that standing within six feet of a sick person could carry a risk of exposure.
But New Yorkers tend to spend less time on subways and buses than they do in other crowded spaces, like classrooms or offices, reducing the risk of being exposed to a virus during their daily commute.
The risk is probably as high as any other high-density setting, but the time of exposure is shorter, Dr. Morse said.
Although research on the coronavirus is still in the early stages, a 2011 study on a possible influenza outbreak in New York City found that only 4 percent of infections would occur on the subway.
More aggressive disinfecting of subways and buses is important, but the steps that people take to protect themselves and others are even more critical to safeguarding public health, epidemiologists say.
Human behavior is one of the most important factors in the transmission of these viruses, Dr. Morse said.
To protect yourself from any viral droplets you may have picked up on your commute, wash your hands with soap and water for at least 20 seconds, or use hand sanitizer, once you get off a train or a bus.
You should also avoid touching your face with your hands because the viral droplets must enter through the eyes, nose or mouth to cause infection.
Be sure to cover any cough or sneeze with a tissue. And if you feel sick, you should certainly stay away from public transit.
People have to start being really considerate and not going out and about when they are infected with anything, whether its the flu or coronavirus, said Dr. Robyn R. M. Gershon, a professor of epidemiology at New York Universitys School of Global Public Health.
Preliminary research suggests that particles from the virus may be able survive on hard surfaces, like a metal pole in a subway car, for a few hours, according to the World Health Organization. (Scientists are uncertain whether a surface like a metal pole could carry enough of the virus to cause a person to become sick.)
If there are more confirmed cases in New York, those riding the subway should avoid directly touching a pole, turnstile or a seat with their hands, Dr. Gershon said. If you need to hold onto something, put a tissue between your hand and the pole or clean it with an anti-viral wipe before touching it, she suggested.
On Monday, the transportation authority announced that it was increasing its efforts to sanitize the subway, buses and commuter rail lines, Metro North and the Long Island Rail Road.
The authority said it would begin disinfecting all train cars and buses every three days with bleach and disinfectants typically used in hospitals and nursing homes. Cleaning crews will also scrub subway stations, including turnstiles, benches and ticket-vending machines, once a day with disinfectants.
The safety of our customers and employees is our first priority as we continue to monitor the coronavirus, said Patrick Warren, the authoritys chief safety officer. The M.T.A. is enhancing its cleaning regimen across all our operating agencies to ensure the system is safe for everyone.
Authority officials have also contacted their counterparts at public transit systems in Japan and Europe and in other parts of the United States to explore other ways of disinfecting train cars and buses, officials said at a news conference on Tuesday.
From Monday evening to midday Tuesday, transit workers disinfected nearly all of the systems 472 subway stations, over 1,900 subway cars and nearly 2,000 buses, officials said. The authoritys entire fleet of subway cars and buses would be disinfected within 72 hours. After that, officials said, the cleaning process would begin again.
New Jersey Transit, which operates its own vast commuter rail and bus network, is also strengthening its cleaning regimen, using bleach or other anti-viral cleaning supplies to disinfect equipment and public facilities.
The agency recently formed an internal task force, which includes workers from its medical staff, to monitor news about the virus, officials said.
In other major cities experiencing outbreaks, transit officials have taken similar precautions. In Tehran, public health officials have said they are disinfecting buses at least four times a day and cleaning trains in the citys subway system at the beginning and end of each line. In Italy, buses, trains and ferries are also being disinfected regularly.
If the outbreak becomes more serious, health officials may recommend that public transit officials adopt more drastic measures.
They could suggest steps to reduce crowds like limiting peoples use of subways and buses to travel that is absolutely essential, like going to and from work, or changing train schedules to discourage travel during peak hours.
Even in a severe pandemic, the C.D.C. recommends that essential services like public transit continue to operate so that health care workers and other emergency responders can get to work.
It is more likely that city officials would try to reduce the use of public transportation by asking businesses to stagger working hours, as happened during the 1918 influenza pandemic, or letting their employees work from home.
In other cities around the world, some officials have taken more stringent steps to contain the viruss spread by effectively quarantining entire cities.
In China, government officials suspended public transit to and from Wuhan, the epicenter of the coronavirus outbreak. In Italy, officials have set up roadblocks in at least 11 towns in the northern part of the country, which is among the most infected regions, to prevent people from leaving or entering the area.
What we saw in Wuhan and elsewhere is really a last resort, Dr. Morse said. At that point theres little else they can do to contain it.
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Worried About Coronavirus on the MTA Subway? Heres What We Know - The New York Times