Background: App-based drivers face work disruptions and infection risk during a pandemic due to the nature of their work, interactions with the public, and lack of workplace protections. Limited occupational health research has focused on their experiences.Methods: We surveyed 100 app-based drivers in Seattle, WA to assess risk perceptions, supports, and controls received from the company that employs them, sources of trust, stress, job satisfaction, COVID-19 infection status, and how the pandemic had changed their work hours. Data were summarized descriptively and with simple regression models. We complemented this with qualitative interviews to better understand controls and policies enacted during COVID-19, and barriers and facilitators to their implementation.Results: Drivers expressed very high levels of concern for exposure and infection (86%-97% were "very concerned" for all scenarios). Only 31% of drivers reported receiving an appropriate mask from the company for which they drive. Stress (assessed via PSS-4) was significantly higher in drivers who reported having had COVID-19, and also significantly higher in respondents with lower reported job satisfaction. Informants frequently identified supports such as unemployment benefits and peer outreach among the driver community as ways to ensure that drivers could access available benefits during COVID-19.Conclusions: App-based drivers received few protections from the company that employed them, and had high fear of exposure and infection at work. There is increased need for health-supportive policies and protections for app-based drivers.The most effective occupational and public health regulations would cover employees who may not have a traditional employer-employee relationship.

Through a survey of emergency medical technicians in the Puget Sound region of Washington, we found that 67.5% of respondents reported high stress, and 35.0% had scores indicating that major depressive disorder was likely. Job demands were significantly associated with both stress and depression.