Independent review into the deaths of London bus drivers from Covid-19 suggests earlier lockdown would have saved lives Institute of Health Equity

The independent review into the deaths of London bus drivers from Covid-19, led by the UCL Institute of Health Equity, has suggested that an earlier lockdown would have saved lives and that many of the drivers who died had underlying health conditions that put them at greater risk during the pandemic.


The independent review was commissioned by Transport for London (TfL) as an urgent response to understand more about the factors relating to the tragic deaths of colleagues in the bus industry.


The review finds it is likely that the front-line nature of bus driving contributes to the risk of death from COVID-19 nationally and in London. The mortality rate in London bus drivers aged 20-64 was in fact 3.5 times higher than men of the same age in all occupations in England and Wales from March to May, likely due to London being an early centre of the pandemic.


Given the dramatic effect of lockdown on reducing the risk among London’s bus drivers it is not possible at this stage to evaluate the protective measures that bus operators took – those will be examined in the second stage of the review.


Additional risks identified include where the bus drivers lived (for example, in areas with above average levels of deprivation) and their ethnic background. Many of the London bus drivers who died from COVID-19 were suffering with underlying health conditions particularly high blood pressure (which is also associated with cardiovascular disease). Of the 13 death certificates provided by relatives, high blood pressure was identified as a contributory factor to the driver’s death in seven cases.


Cardiovascular disease has been known since the 1950s as a health risk among bus drivers and the first studies finding a link between the sedentary nature of bus driving and heart disease were published in 1953, with high blood pressure shown to be the link in 1966.


This first stage of the independent review examined the pattern of coronavirus deaths among London’s bus workers. Stage two, which is due to be completed in autumn, will inform understanding of how best to protect bus drivers in the future.


The review makes a number of recommendations at this stage. It suggests TfL should work with the bus companies to provide clear guidance on rapid and simultaneous implementation of measures in the event of COVID-19 spikes to protect bus drivers, particularly those with multiple risk factors.


It also says London bus companies should identify the most vulnerable drivers using  an occupational risk assessment tool and, with the support of TfL, act to reduce their risk of exposure to and acquisition of COVID-19. This would include TfL and bus operators introducing criteria for staff to ensure that those now known to be most vulnerable are protected.


Improved engagement with health promotion initiatives and uptake of preventive interventions are also identified as essential, to reduce the risk of diseases such as hypertension, diabetes and cardiovascular disease.


As BAME staff are more at risk of becoming severely ill and dying from COVID-19, the authors also say recommendations in PHE’s recently published report “Beyond the data: Understanding the impact of COVID-19 on BAME groups” should be implemented.  


Other key findings:


  • Among the 10 bus companies operating for TfL, 34 of the 30,000 employees are reported to have died of COVID-19. Of these deaths, 29 were to the 25,000 bus drivers. However, one driver who died went on sick leave for other reasons before February 2020 and another death occurred in June 2020.


  • Among the bus drivers who died, most stopped work in the 10 days either side of lockdown on 23 March, suggesting most of them became infected before lockdown. The review finds that after lockdown, death rates came down among drivers reinforcing evidence that lockdown was effective measure in saving lives.


  • The review also shows a high proportion of drivers who died lived in the quarter of London Boroughs with the highest COVID-19 death rates in April 2020. A high proportion of those who died were from BAME backgrounds.


Professor Sir Michael Marmot, Director, UCL Institute of Health Equity said:


“Driving a bus, coach or taxi is among the front-line occupations associated with increased risk of death from Covid-19. The mortality rate in London bus drivers aged 20-64 was 3.5 times higher than men of the same age in all occupations in England and Wales between March and May. Because London was an early centre of the pandemic, it is likely that the increased risk among London bus drivers is associated with exposure.


Our review explicitly suggests that lockdown was the main factor that saved bus drivers’ lives. If lockdown had occurred earlier, it would likely have saved more lives. For those with high blood pressure, exposure to COVID-19 is particularly hazardous, disproportionately affecting drivers of ethnic minority backgrounds. In addition to reducing exposure to the virus, all drivers should therefore be screened for health risk, with those most vulnerable to dying from the virus receiving the most benefit.”


Notes to Editors


All media enquiries: Felicity Porritt, Institute of Health Equity, fporritt@ucl.ac.uk Telephone: 07739419219



The COVID-19 pandemic spread to the United Kingdom in late January 2020 and the first confirmed case of COVID-19 in London was detected on 12 February 2020. The first reported COVID-19 death in England was on 6 March2020. By mid-March, there were almost 500 confirmed cases and 43 deaths were recorded as being due to COVID-19, of which 23 were in London. By early May there had been 46,000 more deaths in England compared to what would be expected in the same period based on death rates in 2015-19, 9,000 of which were in London.


Following the tragic deaths of a number of bus drivers within London, Transport for London (TfL) commissioned the independent review to gain full understanding of the COVID-19 prevention and control measures required to protect the health, safety and wellbeing of bus workers in London. To do this, TfL have indicated their wish to understand the pattern of infection with, and deaths from, COVID-19 in the London bus worker population to inform recommendations on any additional occupational health measures that should be put in place to protect this key-worker population.


To this end, this review presents the results of part one of a two-stage review, commissioned by TfL, of the potential risks for mortality from COVID-19 among bus drivers and related actions and measures that have been implemented to date. The review’s aim is to consider what is working and whether any elements should be amended or further improved. Recommendations for any additional occupational health measures will be considered in stage two of the review.


Risks to Bus Drivers in England and Wales from Covid-19

For deaths in England and Wales, ONS have published occupational mortality from all causes and deaths involving COVID-19 between March and May 2020. The all cause death rate for bus and coach drivers of 128 per 100,000 was greater than that for all occupations (78 per 100,00) and almost double what would have been expected from the mortality of bus and coach drivers in the previous five years. There were 70 more deaths to bus and coach drivers in England and Wales than would have been expected, of which 53 deaths included COVID-19 on the death certificate and 17 did not.


Patterns in London bus driver deaths

Among the 10 bus companies operating for TfL, 34 of the 30,000 employees are reported to have died of COVID-19. Of these deaths, 29 were to the 25,000 bus drivers. However, one occurred to a driver who went on sick leave for other reasons before February 2020 and another occurred in June 2020.


To align with other data available at the time our analyses were performed, this review covers deaths in the three months March to May 2020 and focuses on the 27 deaths to bus drivers who were working since the start of the epidemic in London (February 2020). The IHE estimated the age standardised COVID19 mortality rate among bus drivers in London aged under 65 as 68 per 100,000 in March to May 2020; this compares with an age-standardised death rate involving COVID19 of 19 per 100,000 for all those aged 20 to 64 and classified to an occupation in England and Wales – that’s 3.5 times higher.



About the UCL Institute of Health Equity (IHE)

The IHE is led by Professor Sir Michael Marmot and was established in 2011 following the ‘the ‘WHO Commission on Social Determinants of Health’. The IHE’s aim is to develop and support approaches to health equity and build on work that has assessed, measured and implemented approaches to tackle inequalities in health. This includes the latest publication ‘Health Equity in England: the Marmot Review 10 Years On’, released in February 2020, which assessed health inequalities across England since the government-commissioned review ‘Fair Society Healthy Lives’ (The Marmot Review).


Since 2011, the Institute has led and collaborated on works to address the Social Determinants of Health and improve health equity including the PAHO Commission on Equity and Health Inequalities in the Americas, a Review of Social Determinants of Health and the Health Divide for the WHO European Region, Indicators for Local Authorities in EnglandHealthy Places, Healthy LivesSocial Determinants of Mental Healthlocal practice resources for public health.


www.instituteofhealthequity.org follow @michaelmarmot and @themarmotreview on Twitter



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