Recent Studies Renew Call for Sanitizing Surfaces and Handwashing to Control COVID-19 Virus

Two recently published studies demonstrated that the COVID-19 virus can survive on surfaces for long periods of time.  An Australian study found that with "initial viral loads broadly equivalent to the highest titres excreted by infectious patients, viable virus was isolated for up to 28 days at 20 °C from common surfaces such as glass, stainless steel and both paper and polymer banknotes."  A study out of Japan found that the virus can survive on the skin up to 9 hours.

Certainly aerosolized virus is the primary route of infection.  But as these studies show, contact transmission, such as when the SARS-CoV-2 is on surfaces or on the hands, must be considered.  So with this, surface sanitizing and handwashing must be routinely done.  

The focus for many people has been on mask wearing, but there must be renewed attention to sanitizing surfaces including the hands.  My retail operations have reduced their support for this through not having hand sanitizer or sanitizing wipes available.  This needs to improve.

Virology Journal
https://link.springer.com/epdf/10.1186/s12985-020-01418-7

The effect oftemperature onpersistence ofSARS-CoV-2 oncommon surfaces

Abstract Background: The rate at which COVID-19 has spread throughout the globe has been alarming. While the role of fomite transmission is not yet fully understood, precise data on the environmental stability of SARS-CoV-2 is required to determine the risks of fomite transmission from contaminated surfaces. 

OSHA Fines CO Meat Processor for Coronavirus Protection Failures

The US Occupational Safety and Health Administration (OSHA) issued $15,615 in penalties to JBS's Colorado meat processing facility for failing to protect employees from COVID-19 virus exposure.
"OSHA guidance details proactive measures employers can take to protect workers from the coronavirus, such as social distancing measures and the use of physical barriers, face shields and face coverings when employees are unable to physically distance at least 6 feet from each other. Employers are also required to maintain injury and illness logs."

The company has 15 days to respond.

U.S. Department of Labor OSHA News Release
https://www.osha.gov/news/newsreleases/region8/09112020
September 11, 2020
U.S. Department of Labor Cites JBS Foods Inc. for Failing To Protect Employees from Exposure to the Coronavirus

COVID-19 Prevention - The Importance of Controlling Aerosols with Proper Masks and Ventilation

Aerosols are considered one of the primary means for spread of the COVID-19 virus, thus the control of aerosols are critical for reducing risk. Two articles on the topic cover important aspects of control.

First is an article, Face Shields, Masks with Valves Ineffective Against COVID-19 Spread, that looks at a recently published study evaluating face shields and masks with valves. While these face shields are easier for some to use, they are not effective in controlling aerosols. The same goes with the masks that have vents. These are not effective at controlling aerosols from the person wearing them. One could probably figure that these would not be able to control aerosols, but here is research that proves that they are not effective controls for minimizing the risk of spreading virus.

The second was an article in the Wall Street Journal that looks at the need for good airflow in classrooms and other settings where there are a group of people. The article, Key to Preventing Covid-19 Indoors: Ventilation, discusses the importance of air movement with the need for moving air in the room - bringing in fresh air and expelling air from the room without it blowing from one person to another.

The article discusses a few cases where improper ventilation was a problem

"Five people sitting at tables adjacent to an infected but presymptomatic diner inside a Guangzhou, China, restaurant in January later tested positive for Covid-19, despite video that indicates the separate parties didn’t have close contact, according to an April study published on a preprint server. Some patrons who contracted the virus, the authors said, were seated as far as 15 feet away from the infected diner."

COVID-19 - 40% of Cases Asymptomatic May Point to Pre-existing Partial Immunity and Mask-related Lower Infecting Dose

An article in the Washington Post discusses the level of asymptomatic people within the population and the role of partial immunity and potential impact of infecting dose. Clearly here has been uneven transmission, especially with far less children being infected, but when we look at those who test positive, there are a high percentage who are asymptomatic, a number which CDC estimates to be about 40%. One thought is that these people have partial immunity, perhaps acquired from a past infection from the normal cold virus, or from some childhood vaccination. In fact, in samples of blood from people who had not had the disease, there was some immune reactivity to the virus by T-cells. .

Another interesting factor may be the impact of masks on how much virus a person encounters during an infection event. We had discussed infecting dose a few weeks back and now it does seem that this plays a factor. The evidence they provide is when looking at outbreaks among large groups where mask wearing was and was not used. In cases where the level of masking was high, the levels of asymptomatic infection was higher.

Washington Post - Health
https://www.washingtonpost.com/health/2020/08/08/asymptomatic-coronavirus-covid/
Forty percent of people with coronavirus infections have no symptoms. Might they be the key to ending the pandemic?
New research suggests that some of us may be partially protected due to past encounters with common cold coronaviruses.

CDC Report - Characteristics of Meat Processing Facility Workers with Confirmed SARS-CoV-2 Infection — Nebraska, April–May 2020

In CDC MMWR, an article was posted on the investigation of an COVID-19 outbreak in a meat processing facility. There were 1,216 facility workers tested with 375 (31%) having positive results. They were able to question 241 of those who were infected.

• Approximately one third (78; 32%) of respondents reported no symptoms. Among the 163 symptomatic respondents, two were hospitalized, and no deaths were identified.  Only 24% had a cough and 34% had a measured fever.
• Close contact† with a visibly ill person (or person with diagnosed COVID-19) at work was reported by 70 (29%) workers; the most frequently reported close contact locations were production areas (74%) and cafeteria/break areas (51%).
• Most (87%) reported always having their temperature checked upon entry to work, fewer (41%) reported always being asked about symptoms.
• Thirty of 235 (13%) workers reported close contact with a visibly ill person (or a person with diagnosed COVID-19) outside of work.

What is striking in the report is the difficulty in preventing through just watching for cough and fever.   There will be many who are asymptomatic or just have minor symptoms.  In the end, screening is important (checking temperature and asking about the minor symptoms and potential exposure), but distancing and mask wearing are also very important.

Lawsuit Filed Against Meat Processor for COVID-19 Deaths

A lawsuit against Tyson Foods was filed by the families of 3 workers who died from COVID-19 alleging that "Tyson concealed information about the extent of illness among the workforce at its pork processing plant in Waterloo, Iowa, and that it failed to institute adequate safety measures."

Food Processing Magazine
https://www.foodprocessing.com/industrynews/2020/suit-blames-3-covid-deaths-on-tyson-foods
Lawsuit Blames 3 COVID Deaths on Tyson Foods
By Pan Demetrakakes, Senior Editor
Jun 26, 2020

Tyson Foods is being sued by families of three workers at one of its Iowa plants who died after contracting COVID-19.

CDC Report - Survey Indicates Some People Using Unsafe Disinfection Practices Including Using Bleach on Food

CDC published a report indicating that a good number of people feel that using bleach on food products to remove potential COVID-19 virus was okay.  It isn't okay to use disinfectants on food

In April, CDC reported that there as an increase in chemical-related health issues caused by the misuse of disinfectants by people trying to reduce the risk of COVID-19.

A survey was conducted, and while a good portion of people had the basic understanding for use of chemicals, "Thirty-nine percent reported intentionally engaging in at least one high-risk practice not recommended by CDC for prevention of SARS-CoV-2 transmission (2), including application of bleach to food items (e.g., fruits and vegetables) (19%); use of household cleaning and disinfectant products on hands or skin (18%); misting the body with a cleaning or disinfectant spray (10%); inhalation of vapors from household cleaners or disinfectants (6%); and drinking or gargling diluted bleach solutions, soapy water, and other cleaning and disinfectant solutions (4% each)."

"These practices pose a risk of severe tissue damage and corrosive injury (8,9) and should be strictly avoided. Although adverse health effects reported by respondents could not be attributed to their engaging in high-risk practices, the association between these high-risk practices and reported adverse health effects indicates a need for public messaging regarding safe and effective cleaning and disinfection practices aimed at preventing SARS-CoV-2 transmission in households."

https://www.cdc.gov/mmwr/volumes/69/wr/mm6923e2.htm?s_cid=mm6923e2_w
Knowledge and Practices Regarding Safe Household Cleaning and Disinfection for COVID-19 Prevention — United States, May 2020
Early Release / June 5, 2020 / 69
Radhika Gharpure, DVM1,2; Candis M. Hunter, PhD1; Amy H. Schnall, MPH3; Catherine E. Barrett, PhD1; Amy E. Kirby, PhD1; Jasen Kunz, MPH1; Kirsten Berling, MPH1; Jeffrey W. Mercante, PhD1; Jennifer L. Murphy, PhD1; Amanda G. Garcia-Williams, PhD1 (View author affiliations)

The Importance of Masks in Reducing the Risk of COVID-19

An article in the journal Science details the importance of masks in reducing transmission of the SARS-CoV-2 virus.  Social distancing may not be sufficient by itself, especially in indoor conditions., so masks help to reduce aerosols, the leading method of spread, especially from asymptomatic or pre-symptomatic individuals.  Even the act of speaking can emit aerosols.  And any properly fitting mask will help reduce the risk.   (Of course, wearing a mask down around your chin, with mouth and nose exposed, does nothing).

Science
https://science.sciencemag.org/content/early/2020/05/27/science.abc6197
Reducing transmission of SARS-CoV-2

Kimberly A. Prather1, Chia C. Wang,2,3 Robert T. Schooley4 1Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA 92037, USA. 2Department of Chemistry, National Sun Yat-sen University, Kaohsiung, Taiwan 804, Republic of China. 3Aerosol Science Research Center, National Sun Yat-Sen University, Kaohsiung, Taiwan 804, Republic of China. 4Department of Medicine, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, CA 92093, USA. Email: kprather@ucsd.edu 

Masks and testing are necessary to combat asymptomatic spread in aerosols and droplets

Excerpts:

"Recent studies have shown that in addition to droplets, SARS-CoV-2 may also be transmitted through aerosols. A study in hospitals in Wuhan, China, found SARS-CoV-2 in aerosols further than 6 ft from patients with higher concentrations detected in more crowded areas (8). Estimates using an average sputum viral load for SARS-CoV-2 indicate that 1 min of loud speaking could generate >1000 virion-containing aerosols (9). Assuming viral titers for infected super-emitters (with 100fold higher viral load than average) yields an increase to more than 100,000 virions in emitted droplets per minute of speaking."

"The World Health Organization (WHO) recommendations for social distancing of 6 ft and hand washing to reduce the spread of SARS-CoV-2 are based on studies of respiratory droplets carried out in the 1930s. These studies showed that large, ~100 μm droplets produced in coughs and sneezes quickly underwent gravitational settling (1). However, when these studies were conducted, the technology did not exist for detecting submicron aerosols. As a comparison, calculations predict that in still air, a 100-μm droplet will settle to the ground from 8 ft in 4.6 s whereas a 1-μm aerosol particle will take 12.4 hours (4). Measurements now show that intense coughs and sneezes that propel larger droplets more than 20 ft can also create thousands of aerosols that can travel even further (1). Increasing evidence for SARS-CoV-2 suggests the 6 ft WHO recommendation is likely not enough under many indoor conditions where aerosols can remain airborne for hours, accumulate over time, and follow air flows over distances further than 6 ft (5, 10)."

"Overall, the probability of becoming infected indoors will depend on the total amount of SARS-CoV-2 inhaled. Ultimately, the amount of ventilation, number of people, how long one visits an indoor facility, and activities that affect air flow will all modulate viral transmission pathways and exposure (10). For these reasons, it is important to wear properly fitted masks indoors even when 6 ft apart. Airborne transmission could account, in part, for the high secondary transmission rates to medical staff, as well as major outbreaks in nursing facilities."

"After evidence revealed that airborne transmission by asymptomatic individuals might be a key driver in the global spread of COVID-19, the WHO recommended universal use of face masks. Masks provide a critical barrier, reducing the number of infectious viruses in exhaled breath, especially of asymptomatic people and those with mild symptoms (12) (see the figure). Surgical mask material reduces the likelihood and severity of COVID-19 by substantially reducing airborne viral concentrations (13). Masks also protect uninfected individuals from SARS-CoV-2 aerosols (12, 13). Thus, it is particularly important to wear masks in locations with conditions that can accumulate high concentrations of viruses, such as health care settings, airplanes, restaurants, and other crowded places with reduced ventilation. The aerosol filtering efficiency of different materials, thicknesses, and layers used in properly fitted homemade masks was recently found to be similar to that of the medical masks that were tested (14). Thus, the option of universal masking is no longer held back by shortages."

"From epidemiological data, countries that have been most effective in reducing the spread of COVID-19 have implemented universal masking, including Taiwan, Hong Kong, Singapore, and South Korea."

Two Eastern PA Facilities Rocked by COVID-19

Two Pennsylvania food processing facilities rocked by COVID-19. Cargill's facility in Hazleton and JBS facility in Souderton, PA both closed after numerous cases.

Philadelphia Inquirer
https://www.inquirer.com/business/meat-plants-pennsylvania-cargill-jbs-souderton-covid-20200409.html
Hazleton meat-packaging plant closes with 130 workers testing positive for COVID-19. Union leader at Souderton plant died last Friday.
by Bob Fernandez, Updated: April 9, 2020- 5:07 PM

Cargill Meat Solutions, a 900-worker plant in Hazleton, Pa., that packages meat in plastic for supermarket shelves in Pennsylvania and surrounding states, shut down temporarily on Tuesday as 130 hourly workers have tested positive for COVID-19 and a rash of employees called out sick, a union leader said.

Workers Petition PA Fulfillment Center as COVID-19 Cases Increase

An Amazon fulfillment center in Hazlton PA was petitioned by workers after 9 workers in the facility were diagnosed with COVID-19.   The petition aims at a shutdown and deep cleaning.   It is interesting to note that the COVID-19 positive cases in Hazleton spiked to 300 in the last few days, which for a city of 25,000, is very high, roughly 1.2% (as of yesterday, Pennsylvania was about 0.06%).

This where it becomes so important for facilities to manage COVID-19 within the facility.  With a high pressure of positives from the local community, there is increasing risk within the facility of wide-spread infection.

Citizens Voice
https://www.citizensvoice.com/news/workers-say-amazon-must-clean-hazleton-facility-1.2613885
Workers say Amazon must clean Hazleton facility

Food Handlers and COVID-19 Guide - Handout

Food Employee Guide for COVID-19 - a poster / handout providing information on COVID-19 for employees.  Can be used as a poster or handout to remind employees about safeguarding against the COVID-19 virus.

Download PDF
https://extension.psu.edu/food-handlers-and-covid-19

COVID-19 - People Shed Virus for Week After Symptoms Disappear

In research presented on the Amercian Thoracic Society website showed that individuals diagnosed as having the COVID-19 virus continued to shed the virus for up to eight days after symptoms disappeared.  It is critical for those who had the virus to be tested per CDC guidelines before resuming normal activities.

The CDC guidance - Discontinuation of In-Home Isolation for Immunocompromised Persons with COVID-19 (Interim Guidance)
Possible Strategy to Discontinue Home Isolation For Immunocompromised Persons with COVID-19 When A Test-Based Strategy is Feasible and Desired:
Maintain home isolation until:

• Resolution of fever without the use of fever-reducing medications and
• Improvement in respiratory symptoms (e.g., cough, shortness of breath) and
• Negative results of an FDA Emergency Use Authorized molecular assay for COVID-19 from at least two consecutive nasopharyngeal swab specimens collected ≥24 hours apart (total of two negative specimens)[1]. See Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for 2019 Novel Coronavirus (2019-nCoV).

When a test-based strategy is not feasible or desired, healthcare providers and public health officials should follow the non-test-based strategy outlined in the guidance for non-immunocompromised persons.

For Non-Immunocompromised Persons, see Interim Guidance on Discontinuation of Home Isolation for Persons with COVID-19

American Thoracic Society
https://www.thoracic.org/about/newsroom/press-releases/journal/2020/some-covid-19-patients-still-have-coronavirus-after-symptoms-disappear.php
Some COVID-19 Patients Still Have Coronavirus After Symptoms Disappear

The Role of Asymptomatic and Presymptomatic in Spread of COVID-19

(Updated 4/1/20) In CDC's MMWR articles, they provide evidence in the difficulty for control of COVID-19 with people who are asymptomatic or presymptomatic.  These people do not have symptoms but are infected and can spread the virus.

In a US study, they looked at two nursing homes in Washington state in early March.  

A "facility-wide testing identified a 30.3% prevalence of infection among residents, indicating very rapid spread, despite early adoption of infection prevention and control measures. Approximately half of all residents with positive test results did not have any symptoms at the time of testing, suggesting that transmission from asymptomatic and presymptomatic residents, who were not recognized as having SARS-CoV-2 infection and therefore not isolated, might have contributed to further spread. Similarly, studies have shown that influenza in the elderly, including those living in SNFs, often manifests as few or atypical symptoms, delaying diagnosis and contributing to transmission (6–8). "

Another study in Singapore was posted.  "Investigation of COVID-19 cases in Singapore identified seven clusters (clusters A–G) in which presymptomatic transmission likely occurred. These clusters occurred during January 19–March 12, and involved from two to five patients each (Figure). Ten of the cases within these clusters were attributed to presymptomatic transmission and accounted for 6.4% of the 157 locally acquired cases reported as of March 16."

This enforces the need for social distancing, handwashing, and frequent cleaning, but also tracing personal contact with people who are ill.   As in this case with the nursing home, social distancing can be an issue in addition to having a population that is high at risk.

One interesting note sited in the MMWR report - "Speech and other vocal activities such as singing have been shown to generate air particles, with the rate of emission corresponding to voice loudness (7). News outlets have reported that during a choir practice in Washington on March 10, presymptomatic transmission likely played a role in SARS-CoV-2 transmission to approximately 40 of 60 choir members.*"

CDC MMWR
https://www.cdc.gov/mmwr/volumes/69/wr/mm6913e1.htm
Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility — King County, Washington, March 2020
Early Release / March 27, 2020 / 69

In the Time of COVID-19, Customer Safety Sells

Food retailers including farmers’ markets are working to comply with new guidance on selling product.  Some have moved to some combination of online ordering, pre-order via phone, pre-packed pickup only, or delivery.   For those that have embraced online ordering with either delivery or pre-packed pickup, they have seen huge increases in sales.  Extension hosted a few local market meetings over the past week, and the anecdotal  evidence suggests that for those operations that have fully adopted and communicated COVID safety measures, business has been good....safety sells.

A butcher in Philadelphia that had focused a good portion of their business on supplying the foodservice channel has moved to a delivery, pre-order pickup model.  With good fortune, they had been experimenting with online and had to rush to get it in place for this pandemic.  They have seen record sales over the past days.  They sold to the regular retail customers but also had a number of new customers.  Another Farmers’ Market in SE PA had also moved to online.  They had pre-order pickup and sales were brisk.

But for many, they will have to work out of the traditional model where shoppers will come to the site to purchase and these operations will adopt the state guidance.  One traditional market reported that sales were down, but regular customers did come out.  They had rudimentary safety systems in place including spacing and hand disinfectant, but they did not seem that they did not communicate their plan well.  One market manager whose market had not opened wondered if it was worth the effort against the risk of getting themselves or their volunteers sick.

NIH - Study Looks at Stability of COVID-19 Virus in the Environment

A study in New England Journal of Medicine provided information on the stability of the COVID-19 virus, or SARS-VoV-2, in the environment.

From the report below, "SARS-CoV-2 remained active on plastic and stainless steel surfaces for two to three days under the conditions in this experiment. It remained infectious for up to 24 hours on cardboard and four hours on copper. The virus was detectable in aerosols for up to three hours. These times will vary under real-world conditions, depending on factors including temperature, humidity, ventilation, and the amount of virus deposited."

So basically, there are many factors that come into play regarding stability of this virus including temperature and humidity.  What this does show is that the virus can survive in the environment so actions like hand washing and frequent disinfecting of high contact surfaces are important mitigation practices.

https://www.nih.gov/news-events/nih-research-matters/study-suggests-new-coronavirus-may-remain-surfaces-days
March 24, 2020
Study suggests new coronavirus may remain on surfaces for days

FDA Says Food Supply Safe and Strong in Light of COVID-19

FDA released a statement saying the food supply is safe and solid despite some local shortages during this COVID-19 pandemic.  The statement does not provide any significant new information.  Of course, the food industries are recognized as 'critical infrastructure and "workers in the food and agriculture sector – including those working in agricultural production and food processing of both human and animal food, distribution, retail and food service, and allied industries – are named as essential critical infrastructure workers who are vital to community continuity and resilience."

"If an employee is confirmed to have COVID-19, employers should inform workers of their possible exposure while maintaining confidentiality. Employees exposed to a co-worker with confirmed COVID-19 should follow the Centers for Disease Control and Prevention’s guidance: What to do if you are sick with coronavirus disease 2019 (COVID-19). Employers should consult with their local health department for additional guidance."

https://www.fda.gov/news-events/fda-voices-perspectives-fda-leadership-and-experts/fda-offers-assurance-about-food-safety-and-supply-people-and-animals-during-covid-19
FDA Offers Assurance About Food Safety and Supply for People and Animals During COVID-19