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."

FDA and USDA Issue Guidance to Help Make PPE Available to Food Establishments During COVID-19 Pandemic

 FDA and USDA has developed the following recommendations shortages in PPE, cloth face coverings, disinfectants, and sanitation supplies during the COVID-19 pandemic.  As a critical infrastructure, food facilities need access to these items.    "If suppliers are unable to provide for your needs, and the PPE and/or cloth face coverings are urgently required, submit a request for assistance to your state emergency management agencies. If the state is unable to address the PPE and/or cloth face covering shortfall, the state should submit a request for support to their FEMA Regional Response Coordination Center."

https://www.fda.gov/food/food-safety-during-emergencies/food-and-agriculture-considerations-prioritization-ppe-cloth-face-coverings-disinfectants-and
Food and Agriculture: Considerations for Prioritization of PPE, Cloth Face Coverings, Disinfectants, and Sanitation Supplies During the COVID-19 Pandemic

Purpose

The purpose of this document is to share recommendations for addressing shortages of personal protective equipment (PPE), cloth face coverings [1], disinfectants, and sanitation supplies in the food and agriculture industry in order to help maintain employee safety, continuity of the food supply, food safety, and employee/consumer confidence.

Frozen Meals Recalled Due to Complaints of Small Rocks in Product

Conagra Brands, Inc., Russellville, Ark. and Marshall, Mo. establishments, are recalling approximately 276,872 pounds of not ready-to-eat chicken and turkey bowl products because the products may contain extraneous material, specifically small rocks,   This release is being issued as an expansion of the April 10, 2020 recall to include additional products (to include Healthy Choice Power Bowls Chicken Feta & Farro Bowls, Healthy Choice Power Bowls Unwrapped Burrito Scramble Power Bowls, and Healthy Choice Power Bowls Turkey Sausage & Egg Scramble Power Bowls produced on various dates. The products were produced at two different establishments.)  The problem was discovered when the firm received additional consumer complaints about rocks being in the products and the firm then notified FSIS of the issue.

"In a statement sent to USA TODAY, Conagra spokesman Dan Hare said a limited amount of the bowls was being "voluntarily recalled due to the potential presence of small rocks that likely remained from harvesting ingredients contained in the product."

https://www.fsis.usda.gov/wps/portal/fsis/topics/recalls-and-public-health-alerts/recall-case-archive/archive/2020/recall-007-2020-exp-release

Conagra Brands, Inc. Recalls Frozen Not-Ready-To-Eat Chicken and Turkey Bowl Products due to Possible Foreign Matter Contamination
Class I Recall
007-2020-EXP
Health Risk: High
May 22, 2020

Curry Spice Recalled Due After FDA Testing Finds Salmonella

New Hoque and Sons, Inc. of Maspeth, NY is recalling Radhuni Curry Powder, contained in 400g plastic bottles, because it has the potential to be contaminated with Salmonella.  "The recall was as the result of a routine sampling program by the FDA, which revealed that the finished products contained the bacteria. The company has ceased the distribution of the contaminated products and has also physically removed the contaminated products from stores as FDA and New Hoque and Sons, Inc. continue their investigation as to what caused the problem."

https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/new-hoque-and-sons-inc-recalls-radhuni-curry-powder-because-possible-health-risk
New Hoque and Sons, Inc. Recalls Radhuni Curry Powder Because of Possible Health Risk
Summary
Company Announcement Date:  May 21, 2020
FDA Publish Date:  May 21, 2020
Product Type: Food & Beverages   Spices, Flavors & Salts
Reason for Announcement:  Salmonella
Company Name:  New Hoque and Sons, Inc.
Brand Name:  Radhuni
Product Description:  Curry Powder

FDA Guidance to Allow Minor Label Modifications During Pandemic

The FDA issued a guidance document to provide additional temporary flexibility in food labeling requirements to manufacturers and vending machine operators.  Manufacturers can make minor formulation changes in certain circumstances without making conforming label changes, such as making a change to product ingredients, without updating the ingredient list on the packaged food when such a minor change is made.  The goal is to help move into the retail sector that was geared to go to the foodservice or other sector.
The change or modification cannot have an impact on the following:

• Safety: the change cannot affect safety, so allergens still must be correct  - "the ingredient being substituted for the labeled ingredient does not cause any adverse health effect (including food allergens, gluten, sulfites, or other foods known to cause sensitivities in some people, for example, glutamates);" 
• Quantity: The same amount must be there - "generally present at 2 percent or less by weight of the finished food;"
• Prominence: The product must still be the same - one can't label pepperoni pizza as sausage pizza - "the ingredient being omitted or substituted for the labeled ingredient is not a major ingredient in the product;"
• Characterizing Ingredient: one can't leave the pepperoni off the pepperoni pizza - the ingredient being omitted or substituted for the labeled ingredient is not a characterizing ingredient; for example, omitting raisins, a characterizing ingredient in raisin bread;"
• Claims: an omission or substitution of the ingredient does not affect any voluntary nutrient content or health claims on the label;  
• Nutrition/Function: an omission or substitution of the labeled ingredient does not have a significant impact on the finished product, including nutritional differences or functionality. 

https://www.fda.gov/food/cfsan-constituent-updates/fda-announces-temporary-flexibility-policy-regarding-certain-labeling-requirements-foods-humans
FDA Announces Temporary Flexibility Policy Regarding Certain Labeling Requirements for Foods for Humans During COVID-19 Pandemic
Constituent Update
May 22, 2020

CDC Report - Hepatitis A Cases Among Food Handlers as All Those Infected with Hepatitis A

In a CDC report, investigators looked at the uptick of Hepatitis A in many states across the country.  Those regarded as high risk is where "infections are spreading primarily through close contact among persons who use drugs and persons experiencing homelessness, as well as among men who have sex with men (MSM)"  Of interest in the report was the percentage of food handlers, and overall, the percentage of cases associated with food handlers was low (3.8%).  Looking at food handlers, a high percentage of them were people in the high risk - people use drugs, have unstable housing or are homeless, are active in MSM, or had been incarcerated.

From the report, "Among 22,825 hepatitis A outbreak cases reported from these 26 states during July 1, 2016–September 13, 2019, 871 (3.8%) were among food handlers; 587 (67.4%) hepatitis A–infected food handlers reported one or more risk factors (i.e., drug use, unstable housing or homelessness, MSM, or incarceration) during the 15–50 days before symptom onset. "

https://www.cdc.gov/mmwr/volumes/69/wr/mm6920a4.htm
Notes from the Field: Assessing the Role of Food Handlers in Hepatitis A Virus Transmission — Multiple States, 2016–2019
Weekly / May 22, 2020 / 69(20);636–637
Megan G. Hofmeister, MD1; Monique A. Foster, MD1; Martha P. Montgomery, MD1; Neil Gupta, MD1 (View author affiliations)

COVID Times - News Shorts for Week Ending May 23, 2020

CDC Changes Wording on COVID-19 Guidelines Regarding Surfaces - "[CDC] appears to have recently changed its guidelines from early March that initially said it “may be possible” to spread the virus from contaminated surfaces. The CDC now includes "surfaces or objects" under a section that details ways in which the coronavirus does not readily transmit"

Individuals Who Recovered from SARS-CoV-2 Virus Likely to Have Immunity - In a study published in Cell, researchers found that individuals who had been exposed to the virus had a significant immune response, which bodes well for developing a vaccine to the virus.

Nearly Two Hundred FSIS Inspectors Have Tested Positive for COVID-19

Temporary reduction in daily global CO2 emissions during the COVID-19 forced confinement
"The estimated decrease in daily fossil CO2 emissions from the severe and forced confinement of world populations of –17% (–11 to –25%) at its peak are extreme and probably unseen before. Still, these only correspond to the level of emissions in 2006."

FDA Issues Guidance for Using Refer Trailers That Once Held Human Remains

FDA issued a guidance document - Returning Refrigerated Transport Vehicles and Refrigerated Storage Units to Food Uses After Using Them to Preserve Human Remains During the COVID-19 Pandemic - that allows those refrigerated trailers that once held the remains of those who passed from COVID-19 to be used for food transport, provided proper sanitation.

According to the guidance, "Refrigerated food transport vehicles and refrigerated food storage units used for the temporary preservation of human remains during the COVID-19 pandemic subsequently can be safely used for food transport and food storage under certain circumstances.  It is important that food is protected during transport and storage to ensure food is safe for humans and animals and that conditions do not exist that may adulterate the food.  Before returning to service to transport or store human or animal food, refrigerated food transport vehicles and refrigerated food storage units used to hold human remains during the COVID-19 pandemic should be thoroughly cleaned and disinfected."

I just have a problem with this.  You?

USDA Issues Report on 2017-2018 Listeria Outbreak Associated with Country-Cured Ham

USDA-FSIS issued an After Action Review Report on a 2018 Listeria Outbreak associated with country-cured hams.  The case involved product sold by Johnston County Hams of Smithfield, N.C. and in this outbreak, 4 people become infected with one death.  The company recalled close to 90,000 pounds of product.

In the report, the issues involving the product are discussed.  The product supposedly received a cook-in-bag process to eliminate listeria.

• One issue was the product was exposed to the environment  - "The implicated product was considered [by the facility] to have not been exposed to the processing environment after undergoing an initial cook-in-bag lethality step to inactivate vegetative pathogens, including L. monocytogenes. However, the investigation revealed that the product was, in fact, exposed to the processing environment after cooking, which may have allowed the product to become contaminated with L. monocytogenes.:
• "After an initial cooking step in a sealed bag, the ham was removed from the bag, drained of its juices, and placed into a second bag; during this process, the ham may have been cross-contaminated from the processing environment."
• "After being placed in the second bag, the ham and bag were placed into metal molds, the top of which was pressed down to form the ham, then re-cooked. In some instances, this process led to tears in the bag, which allowed the cooked ham to be exposed to the processing environment again."
• The other issue is that the heat treatment used for the product may not have been sufficient considering the product had a low Aw - "Before being cooked multiple times, the ham was salt-cured and dried, thus lowering its water activity. Additionally, the draining of juices may have resulted in drier conditions during cooking. The establishment used FSIS cooking guidance (“Appendix A”) as scientific support that the cooking process achieved lethality of pathogens, including L. monocytogenes. However, Appendix A guidance was not intended for lower water activity products cooked under dry conditions or for products cooked multiple times. L. monocytogenes may survive cooking under these conditions. Hence, the process may not have been lethal to L. monocytogenes."

https://www.fsis.usda.gov/wps/portal/fsis/topics/recalls-and-public-health-alerts/foodborne-outbreak-investigation/outbreak-lm-ham-2018
Listeria monocytogenes Illness Outbreak Associated with Ready-to-Eat, Country-Cured Ham, 2017–2018
After-Action Review Report 2018-16
May 13, 2020