Hospitals across the country are reporting conditions that are urgent and serious. Pressure in hospitals is always an indicator of pressure throughout systems of health and care. In hospitals where people in the most serious of conditions are all in the same place, the challenges faced are acute. At the same time, people and services are strained in the care provided for people at home, in residential care, through General Practice, by the ambulance services. This tests the limits of capacity at a critical moment in the country’s efforts to come to terms with COVID-19.

A lot is expected of vaccination. By starting with vaccinations for the elderly and most vulnerable, lives will be protected. This will reduce the pressure involved in acute health care. Those most at risk of severe and life-threatening symptoms will gain a measure of safety. It will be some months before a sufficient proportion of the wider population has been vaccinated and there will be sufficient population immunity to reduce incidence of new cases. This may not be straightforward if variants of the virus continue to emerge at intervals and some are capable of causing disease in vaccinated individuals. The vaccines may need to be adapted so as to be able to contain them, and then re-administered. Another reason for revaccination is a possible limitation in the duration of immunity following infection or vaccination.

It is vital to apply the lessons we are learning as the pandemic continues to unfold. The strands of the nation’s response need to remain connected, retain their emphasis, and be implemented as effectively as possible. Basic public health messages that shape population behaviour need to be clear and consistent. Testing needs to result in tracing and effective isolation. Vaccination needs to reach the people who need it most; particularly the elderly and vulnerable.

Are there lessons for the vaccination process from test and trace? Test and trace focused on a large scale, nationally directed approach. Where such approaches work, and work well, they enable considerable volumes of people to be reached in short timeframes. Where national approaches are more challenged is in reaching specific communities sufficiently quickly, particularly more deprived communities. People on erratic patterns of employment and thus income, living in low quality housing, need a wrap-around of support if they are to be able to isolate when contacted. The centralised approach to test and trace takes time to get to these communities, doesn’t necessarily provide what is needed for people to help them effectively isolate, and this can lead to difficulty with interrupting transmission and suppressing clusters.

It is important that take-up of the vaccination programme is high in the areas of our towns and cities where the virus is widespread and is proving stubborn to suppress. If the vaccination programme is to move quickly and in the most effective manner, there is clear learning to take on board. A nation-wide and well-planned approach is essential as it is able to scale-up rapidly. It must be embraced by groups who may be harder to reach. Local operators know these groups already and have many avenues to reach them. If the national programme connects well to local authorities, then targeted approaches can connect communities effectively with the facilities that are made available.

To learn the lessons from earlier phases of the pandemic means that a multi-level approach to vaccination can be helpful.

It starts with the scale and capacity of national approaches which should be fully exploited. Alongside the scale, there is a need for precision. Local government is the critical layer in getting this right.

With the unique relationships local government holds, both with national and regional organisations, as well as with particular communities, it can play a vital role in connecting groups with varying needs. As local government connects with the honeycomb of faith, sporting, business, and geographic organisations, be they commercial, voluntary or the local part of the larger national infrastructure, it is able to access their collective intelligence and be much more effective at reaching people in greatest need. The selection of vaccination sites, the messages that are crafted and the means through which those messages are passed on, leads to a programme that is more likely to reach those at greatest risk and who need vaccination early.

This is all about tapping into local know-how about how to get things done. If knowledge is about what needs to be done, that is not enough. What is really helpful is know-how; ways to get it done, right here, right now, in this place. While national debates may rage on the efficacy of testing, the nature of new strains of the virus, or the components of the vaccination strategy, it is the know-how of local government that has kept a focus on what is needed in their places and sharpened the effectiveness of each intervention.

It is this know-how of the stakeholders who are active in local government, often unseen and unheard, that continues to play a vital role in suppressing the virus. As COVID-19 continues to swirl, spike and surge around the country, it is vital that the learning from test and trace is carried forward into the vaccination programme. This will balance the need to reach high volumes of people with know-how on how best to reach those who live and work in a wide variety of settings. Local government’s capacity to connect, convene and communicate locally will be critical.

Frank Luntz, noted Republican pollster, released a survey this week on words that will work best in persuading Americans to change their behavior as Covid-19 spikes again. He found that lockdown is a no go, stay at home is a winner. Mandate is a bad word, protocol works. National duty fails, personal responsibility wins. Science-based achieves little, fact-based is best. The number of infected is less effective than the number of deaths. Covid-19 is a loser, pandemic a preferred option. We need to de-emphasize the rapid development of vaccines because speed turns off people who assume the worst on political motive or insufficient supervision.

All of this comes as the winter season begins in earnest and cases rise exponentially, especially in the U.S. where more than 200,000 people were infected yesterday, and one million cases are expected this week. I spoke to our clients and our colleagues over the past two days with Dr. David Nabarro, World Health Organization Special Envoy for Covid-19. He sees three patterns of response by nations in the wake of Covid. First is ‘Keep It Away, Hold It At Bay.’ There are at least 20 nations doing this including Australia, China, Japan, Korea, New Zealand and Singapore: they account for about 20 percent of the world population. There is a whole-of-nation focus on trusting people, detecting cases quickly, isolating promptly, and interrupting transmission. Response systems are locally integrated with emphasis on localized testing, movement restriction and contact tracing. The second pattern is ‘Surge and Ebb,’ where—as cases build up—governments impose restrictions, eventually moving to lockdown. Then the incidence of disease gradually reduces, and restrictions are relaxed. People move around more and some weeks later there is another surge of cases, followed by movement restrictions and lockdown again. This is the case in as many as 100 nations perhaps containing 60 percent of global population, notably in Europe and the Middle East. The third pattern is ‘Surge and Surge Again.’ This is the U.S., Mexico, Brazil, as well as some nations in other regions, perhaps accounting for up to 20 percent of the world’s population. Levels of infection continue to rise in many locations. There are repeated spikes of infection increasingly widely spread across countries (beyond urban centers): not everywhere, because of some excellent sub-national responses. There will be a major long-term challenge to gain control of the infection in coming months. National politics do get in the way of public health: this leads to a confrontational attitude to national and global institutions (such as WHO).

Mask wearing, physical distancing, voluntary isolation if symptomatic, and frequent testing will likely be with us for the entirety of 2021. Dr. Nabarro believes that the vaccine will reach the necessary 70 percent of population by late fall next year. “We cannot afford to slack off. Business will be particularly important in the Surge and Surge Again regions, filling the void left by government. Trust is the key; people are the solution. Initially, the numbers of people who take the vaccine will not be enough to stop the pandemic; it will reduce disease but not control transmission.” He also insisted on public health education in the vaccine space, most notably transparency on clinical trials. “This must begin immediately because time is the key to acceptance. We cannot force it.” We must also demystify the rapid development of the vaccines by demonstrating that there has been a unique level of collaboration among scientists to get to the end product. There are still unresolved questions on the vaccine that must be answered by further trials, including the length of time of immunity afforded by the first vaccine (when to get a booster shot?).

I posed four challenges for business as we enter this dark period before the vaccine is available to a wide swath of the population. First, what should be our role in vaccination of employees? I argued that our job is education, not persuasion. We need to give people the facts and let them decide when to take the injection and which one to select. Second, what is our approach to return to work? I suggested that we leave it to employees, as they are performing well thus far in work from home. There may be sectors such as finance, where traders are better off together at their desks, but there needs to be proof of that necessity. Third, what can be done for employees whose companies will come under further pressure in the coming months, such as restaurant chains or amusement parks. I recommended that there be transparency on financial condition and effort to out-place those affected. Fourth, what is the basis of a return to more normal operations in travel and tourism or entertainment? Evidence of a longer-term problem was Warner Brothers’ announcement today that its entire 2021 roster of upcoming films will be released simultaneously in theaters and on the streaming service HBO Max, signaling a shift from relying solely on theaters. I said that we need to start now to persuade consumers to overcome fears, as Edelman has done for the State of Hawaii, which announced last week a mandatory testing protocol before any visitor steps on a plane to the island. Aside from posing these questions, I urged business to continue to lead in partnering with others—to work with NGOs on coordinating local relief efforts and vaccine education; and to work with Governments to help solve the social problems laid bare in 2020.

Thomas Paine, American patriot, wrote in December 1776 after the Americans were routed in their defense of New York City and fled south into New Jersey away from the pursuing British. “These are the times that try men’s souls. The summer soldier and the sunshine patriot will, in this crisis, shrink from the service of their country. But he that stands by it now deserves the love and thanks of man and woman…Let it be told to the future world that in the depth of winter, when nothing but hope and virtue could survive, that the country, alarmed at one common danger, came forth to meet and to repulse it. …I love the man that can smile in trouble, can gather strength from distress and grow brave by reflection.” We can do this together.

Richard Edelman is CEO.

Covid-19 is surging back, threatening to overrun hospitals, cause long-term illness and more deaths. The disease will be with us for the foreseeable future. Unless it is contained, there will be more misery and the increased risk of serious social disruption.

In many countries, containment strategies involve restrictions on people’s movements and lockdowns. These have serious economic and social consequences and should be applied sparingly.

But how can we avoid another rise in cases when the current lockdowns end? And how can further lockdowns be avoided next year? Assuming the positive news about vaccine development is sustained, efforts will be made to ensure that those most at risk can access a vaccine in 2021, but it will be some months before vaccination programmes will slow the spread of infection. In the meantime, all nations in western Europe – including the UK – need to be sure that they have better-functioning and resilient localised Covid-19 response systems. Implementing these systems should reduce the need for a third period of restrictions early in 2021.

Here, we offer a plan that would enable societies to defend themselves, while maintaining public confidence and sustaining economies.

1

Involve people everywhere. It might seem self-evident, but success happens when more people do more of the right things more of the time. In shops, schools, universities and workplaces, millions of people are figuring out how to stay safe. They are creating “Covid-ready” environments. They are ensuring good hygiene, physical distancing, mask-wearing, and self-isolating when sick. They are also paying special attention to those who, because of age, occupation, vulnerabilities or living conditions, are at high risk. This is the heart of the response.

2

Earn people’s trust through honesty, authenticity and consistency. Unambiguous messaging must be delivered to all in meaningful language. Ensure that everyone appreciates the need for all-round compliance and understands what has to be done and when. Respect people and gain their trust. Do not apologise. Be clear on the rationale for restrictions and rules for isolation.

3

Ensure communities are supported through nationwide networks. The ability of societies to keep Covid-19 at bay depends on the quality of connections between people, the extent to which they are supported and local capacity. People at risk of or affected by Covid-19 should know where to go to for assistance. They depend on existing community organisations for support. For such support to be available and meaningful, community organisations need to be linked and the support on offer must be explicit. The honeycomb of links between community groups should be activated everywhere without delay.

4

Develop public health capability to interrupt transmission. Local public health teams are the experts in investigating outbreaks, tracing contacts and interrupting chains of transmission. Their actions stop spikes, clusters and surges of infection running out of control. Teams need to be led by public health specialists with the full involvement of GPs and pharmacists. They should be adequately funded and regularly updated on evolving knowledge.

5

Suppress outbreaks through integrated incident response teams at local level. As disease outbreaks build up, they must be suppressed rapidly and robustly. Efficient leaders must engage faith groups, businesses, the hospitality sector, public health, schools, colleges, universities, sports clubs, the media, police, hospital services and more. Advertisement

Each group becomes an integral part of the response team that is activated as needed, meets frequently and agrees on direction and actions. Response team members inform their constituencies and communicate with national agencies. Teams will usually be led from local authorities under chief executive oversight.

6

Ensure the resources and powers of national government are used where most valuable. Responders are dealing with unprecedented challenges. They need high-quality, up-to-date and immediate information on key events. National resources, eg around testing for Covid-19 and contact-tracing, need to be put in service of the local need. Legislation may be required to support enforcement. Proper funding must be allocated to ensure that those who are sick, shielding or on furlough do not lose out.

7

Connect all the elements and ensure the system works: people, communications, community-based support, professional capability, integrated incident teams and supportive national authorities should not be thought of as separate. Communication, mutual support, finance and regulation are critical to the success of every element. For the response system to function effectively, all of its parts must be connected. Good and trusting relationships between them are key to success. Covid-19 will exploit any gaps or weaknesses in the system.

We all play our part in making all this happen. People’s health and local economies are intimately connected. Covid-19 is not seen as a problem for “someone else”; we recognise that all of us must adapt and evolve. Containing Covid-19 will give us all the confidence to take on other challenges, which will augur well for future generations.

Do it without delay. A further lockdown may be essential when the disease is surging strongly. Without one, it may spiral out of control. But because lockdowns are damaging, Covid-19 must be contained differently. This means setting up strong, community defences and implementing responses rapidly, robustly and with compassion. Well-functioning defences keep case numbers low. That is why it is urgent to establish them everywhere. The time for action is now.

Cold food processing facilities have been featured as particularly high-risk environments for COVID transmission, with outbreaks localized to these plants occurring in the US, UK, Germany, Australia and other countries. This note examines what factors – environmental and social – may be contributing to this higher risk and proposes some approaches to risk mitigation. Specifically:

• Recent research indicates that temperature and humidity can affect COVID transmission risk: dry, cold environments see greater transmission.
• COVID is more likely to be transmitted indoors, where air circulation may be less robust. Mechanical ventilation (often referred to as heating, ventilation and air conditioning (HVAC)) systems that are well designed and maintained can be an important factor in preventing COVID from spreading indoors by increasing clean air flow and maintaining indoor conditions (temperature and humidity) that discourage virus survival.¹
• When indoors, people are often closer together than they might be outside. This is common in food processing facilities where physical distancing has not traditionally been a feature, either on the production lines or in staff break/relaxation areas.[1]
• In addition to temperature and ventilation, factors that may impact COVID transmission in indoor facilities include person density, line speeds, implementation of the recommended suite of public health prevention measures and worker conditions (e.g., encouraging reporting symptoms, providing paid sick leave and ensuring medical support for those who are ill).

Critically, the COVID pandemic has played a role in revealing and underscoring societal inequities. Some of these have been highlighted in the context of cold food processing plants, where there have been cases of crowded workplaces, inadequate prevention measures and poor working conditions (both physical and regarding employment terms). Businesses in this sector can go a long way to reducing the risk of COVID transmission by:

• reducing crowding (e.g., by staggering shifts, slowing line speeds, creating “pods” of work shifts who only ever work with each other);
• ensuring universal public health precautions (i.e., requiring face masks, ensuring the placement of adequate hand washing stations, accommodating necessary physical distancing and enabling isolation of people who are ill);
• improving the operation and safety of ventilation systems; and
• establishing employment conditions that minimize dependence on subcontracting and other forms of indirect employment, pay attention to the living and travel circumstances of the workforce, maintain constant communication with worker representatives, incentivize the reporting of symptoms and provide support to workers who are ill.

Early recognition of outbreaks in all contexts, but particularly in those that have been identified as high risk like cold food processing facilities, requires strong local surveillance systems. Local health authorities, businesses and trade unions need to work in partnership.⁸ Businesses should engage with their communities in reducing COVID transmission, cooperating with authorities when closures are required and supporting employees who feel ill and require paid leave and/or medical care.¹⁰

Ambient temperature and humidity impact on COVID transmission

Dry, cold environments have been documented to encourage greater COVID transmission. A review of 14 studies examining the role of ambient conditions on the transmission of COVID indicate that:²

• Weather conditions appear to influence the transmission of COVID, although evidence is not sufficient nor sufficiently consistent to allow causation to be inferred;
• Higher temperatures are associated with fewer cases;
• Higher relative or absolute humidity is associated with fewer cases;
• Dry conditions seem to favour viral spread; and
• Exacerbating effects include high levels of pollution and low wind speed.

Ventilation and COVID transmission

HVAC is an important factor in preventing COVID from spreading indoors. The evidence has driven the following recommendations/conclusions:

• Air conditioning, ventilation, or other climate control systems that are well-maintained and operated should not increase the risk of transmission.¹ If designed and well maintained, HVAC systems can increase clean air flow, which may reduce transmission risk; if not well-maintained, they can contribute to transmission by recirculating contaminated air and/or could create indoor conditions (temperature and humidity) that support virus survival
• Natural ventilation (i.e., fresh air circulating) is considered safest. If using HVAC, it may be best to run it at maximum outside airflow for 2 hours before and after spaces are occupied. Total airflow should be maximized in occupied spaces.
• If HVAC systems are not well maintained and operated, there are two potential mechanisms through which it could contribute to virus transmission: the system itself could recirculate contaminated air; and/or could create indoor conditions (temperature and humidity) that support virus survival.
• Care should be taken if HVAC systems are set to “cold” temperatures (below 70 F/ 21C)⁵ and “dry” humidity settings (below 40%) as these are optimal conditions for the virus. ^6,7
• Buildings with central HVAC systems should use the most efficient filters. In healthcare facilities, a HEPA filter captures viruses effectively.⁸ However, air filtration should only be as high as possible without diminishing airflow.
• Clean-to-less-clean air movements can be generated by positioning supply and exhaust air diffusers and/or dampers and adjusting zone supply and exhaust flow rates to establish measurable pressure differentials. Staff should work in “clean” ventilation zones that do not include higher-risk areas (e.g., visitor reception or exercise facilities).

COVID in cold food processing plants

Cold food processing plants, and in particular slaughterhouses and cold food processing plants, are favourable environments for COVID transmission. ^9,10 In Germany, outbreaks in meat plants led to local lockdowns with the local R₀ rising to 2.88.¹¹

The increased risk is due to:

• A dense production of aerosols combining dust, feathers, and faeces being produced in the plants, and intense water use that carries materials extensively over surfaces.
  • Crowded workplaces where physical distancing is difficult, both on the work floor and in break rooms. Workers often must speak loudly or shout, which has been shown to release more droplets and spread them further.¹²
  • Metallic surfaces retaining live viruses for longer than other environments.^7,13
  • The virus thriving in lower temperatures and very high or very low relative humidity.
  • Other environmental issues that should be explored urgently, including the possibility of airborne spread¹⁴ and the role of air filtration systems—as implicated in the outbreak in the meat processing plant in Gütersloh, Germany.¹⁵
• Cold food processing companies should conduct urgent risk assessments, in conjunction with trade unions and workplace occupational health and safety representatives, and implement measures to prevent further outbreaks.^9,10 Such prevention measures include:
  • mandating face coverings, handwashing and physical distancing;
  • introducing enhanced cleaning and disinfection regimens;
  • staggering start, finish, and break times;
  • grouping employees in “pods”, whereby a group of workers are grouped and will only work with each other to limit contact and potential transmission points;
  • reducing crowding by adding outdoor breakrooms;
  • installing barriers between workers, especially on production lines;
  • installing touch-free time clocks and foot operated door openers;
  • reducing speed of production which could both allow for physical distancing (including physical barriers between stations) and may also reduce the amount of particulate in the air, which reduces respiratory difficulties;
  • screening workers for symptoms on arrival at work;
  • encouraging workers not to attend if ill, declare their symptoms, and self-isolate (before and while awaiting the outcome of testing);
  • isolating people who develop symptoms while at work and providing adequate support for them to get tested and stay home if they continue to feel ill; and
  • incentivizing reporting by providing adequate sick pay for illness-related all work absences.
• Health education and infection prevention training for employees is critical. Materials for staff explaining COVID and the measures taken for prevention must be culturally appropriate and available in all local languages. Short videos, posters, social media groups and other similar innovative approaches, particularly those designed for specific language and/or ethnic groups, tailored to the targeted work environment have been met with great acceptance.

A note on hot, humid food processing

While this note focuses on cold food processing, in many cases food producers, particularly meat producers, have both cold, dry environments and also very hot, humid environments (e.g., as part of abattoirs). COVID can be transmitted in hot, humid environments,²⁰ and appropriate precautions, including physical distancing, hand and cough hygiene and personal protective equipment remain critically important. However, implementing best practice in personal protective equipment in these very hot environments is challenging. For example, when wearing a mask, it is common for glasses to steam up, which can degrade vision quality which can increase the possibility of making mistakes when using sharp knives and other dangerous equipment. These employees need to be protected in their work environments, just as those in the cold processing, with institutionalized COVID-prevention measures and employment terms that encourage reporting and self-isolation when appropriate.

Conclusions

There is great interest in how ambient temperature and humidity affect COVID transmission. Data on these conditions are of interest for a number of reasons, from planning for cold and flu season during the pandemic to managing transmission in indoor, controlled environment facilities, in particular cold food processing facilities, where there is a particular challenge as the conditions required for maintaining food safety are often those that are most conducive to COVID transmission (e.g., guidelines advocate below 10C/50F in processing and below 3C/37F in storage).

At the same time, it is often the case that food safety standards call for more physical cleaning and disinfection than required to kill COVID. If food safety hygiene standards are combined with added standards for inter-personal infection issues specific to COVID, it could provide extra layers of protection. Putting these combinatorial COVID (i.e., human infectious disease mitigation) and food hygiene safety measures in place can also lay the foundation for legacy infection, prevention and control strategies that may translate to influenza and other diseases having less impact on the sector.

In summary:

• Temperature and humidity affect COVID transmission risk: dry, cold environments see greater transmission. This does not, however, mean that protective measures do not need to be taken in hot, humid working environments.
• COVID is more likely to be transmitted indoors, where people are often closer together and air circulation may be less robust.
• HVAC systems that are well designed and maintained can be an important factor in preventing COVID from spreading indoors by increasing clean air flow and maintaining indoor conditions (temperature and humidity) that discourage virus survival
• The conditions at cold food processing plants – environmental, employment, socioeconomic – contribute to COVID transmission.
• Workers with symptoms that could be COVID should be incentivised not to come to work.  Staff with pre-existing conditions that increase their risk should be reassigned to less risky duties.
• Plants across the sector can reduce the risk of transmission by reducing crowding, ensuring universal public health precautions, improving ventilation, providing employment terms that incentivize reporting illness and provide support to workers who are ill.
• The meat processing sector and local health authorities should work together to have surveillance and response plans to identify cases early, isolate people with symptoms and track and trace all contacts.
• The pandemic is revealing longstanding inequalities in health, with migrant and other ethnic minority workers facing a high risk of infection.^16,17 The Leicester, UK outbreak, for example, exposed the overcrowded working conditions and ultra-low wages experienced by some groups.¹⁸
• Early recognition of outbreaks requires strong local surveillance systems. Local health authorities, businesses and trade unions need to work together.¹⁹ Businesses should engage with their communities in reducing COVID transmission, cooperating with authorities when closures are required.³ To support this kind of cooperation and partnership, it is critical to find opportunities for engagement before and during outbreaks. For example, simulations of “pressure tests” where businesses and public health units run through a scenario (facilitated by experts) have anecdotally been reported to be remarkably beneficial to both sides, building mutual understanding and trust.

End notes

1. World Health Organization (WHO), World Meteorological Organization (WMO) Joint Office for Climate and Health and the United States National Oceanic and Atmospheric Administration (NOAA) through the Global Heat Health Information Network “Do air conditioning and ventilation systems increase the risk of virus transmission? If so, how can this be managed?” Updated on 22 May 2020. Available at http://www.ghhin.org/heat-and-covid-19/ac-and-ventilation (accessed on 4 October 2020).
2. Reuben A. Coronavirus: Why have there been so many outbreaks in meat processing plants? BBC News 23 June 2020. https://www.bbc.co.uk/news/53137613
3. UNITE. Employers have “duty” to safeguard staff and public as more meat factory coronavirus outbreaks suspected. 19 June 2020. https://unitetheunion.org/news-events/news/2020/june/employers-have-duty-to-safeguard-staff-and-public-as-more-meat-factory-coronavirus-outbreaks-suspected/
4. Jefferson T, Spencer EA, Plüddemann A, Roberts N, Heneghan C. Analysis of the Transmission Dynamics of COVID-19: An Open Evidence Review. The Centre for Evidence-Based Medicine. Oxford University. Available at https://www.cebm.net/evidence-synthesis/transmission-dynamics-of-covid-19/ (accessed on 4 October 2020).
5. Chin AWH, Chu JTS, Perera MRA, Hui KPY, Yen HL, Chan MCW, Peiris M, Poon LM. Stability of SARS-CoV-2 in different environmental conditions. medRix preprint posted March 27, 2020. https://doi.org/10.1101/2020.03.15.20036673
6. Chan KH, Peiris JSM, Lam SY, Poon LLM, Yuen KY & Seto WH (2011). The Effects of Temperature and Relative Humidity on the Viability of the SARS Coronavirus. Adv Virol 2011, 734690.
7. van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med2020;382:1564-7. doi:10.1056/NEJMc2004973 pmid:32182409 CrossRefPubMedGoogle Scholar
8. Perry J.L., Agui J.H. and Vijayakumar R. Submicron and Nanoparticulate Matter Removal by HEPA-Rated Media Filters and Packed Beds of Granular Materials. NASA report NASA/TM—2016–218224, 2016.
9. Dyal JW, Grant MP, Broadwater K, et al. Covid-19 among workers in meat and poultry processing facilities—19 states, April 2020. MMWR Morb Mortal Wkly Rep2020; 69:557-61. doi:10.15585/mmwr.mm6918e3 pmid:32379731 CrossRef PubMedGoogle Scholar
10. Durand-Moreau Q, Adisesh A, MacKenzie G, et al. What explains the high rate of transmission of SARS-CoV-2 in meat and poultry facilities? Oxford Centre for Evidence Based Medicine, 4 Jun 2020. https://www.cebm.net/covid-19/what-explains-the-high-rate-of-sars-cov-2-transmission-in-meat-and-poultry-facilities-2/
11. Robert Koch-Institut. Täglicher Lagebericht des RKI zur Coronavirus-Krankheit-2019 (COVID-19), 21 Jun 2020. https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Situationsberichte/2020-06-21-de.pdf?__blob=publicationFile
12. Anfinrud P, Stadnytskyi V, Bax CE, Bax A. Visualizing speech-generated oral fluid droplets with laser light scattering. N Engl J Med2020; c2007800. doi:10.1056/NEJMc2007800. pmid:32294341
13. Yilmaz N, Eren E, Kalayci Z, et al. Relationship between ultraviolet, hot and humidity with covid-19 outbreak. [Presentation.] Apr 2020.https://www.researchgate.net/publication/340352717
14. Zhang R, Li Y, Zhang AL, Wang Y, Molina MJ. Identifying airborne transmission as the dominant route for the spread of COVID-19. Proc Natl Acad Sci U S A2020;117:14857-63. doi:10.1073/pnas.2009637117 pmid:32527856
15. Exner M. Coronavirus: “circulating air” may have spread covid-19 to 1500 German meat plant staff. Sky News, 24 Jun 2020. https://news.sky.com/story/coronavirus-circulating-air-may-have-spread-covid-19-to-1-500-german-meat-plant-staff-12014156
16. Society of Occupational Medicine. Occupational health: the global value and evidence. 2018. www.som.org.uk/sites/som.org.uk/files/Occupational_Health_the_Global_Value_and_Evidence_April_2018.pdf
17. Public Health England. Beyond the data: understanding the impact of COVID on BAME groups. 2020. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/892376/COVID_stakeholder_engagement_synthesis_beyond_the_data.pdf
18. O’Connor S. Leicester’s dark factories show up a diseased system. Financial Times 2020 Jul 3. https://www.ft.com/content/0b26ee5d-4f4f-4d57-a700-ef49038de18c
19. Reintjes R. Lessons in contact tracing from Germany. BMJ2020;369:m2522. doi:10.1136/bmj.m2522 pmid:32586833 https://www.bmj.com/content/369/bmj.m2522?ijkey=85333bfd488f3f0e1ec7624c217794960ecc6d2f&keytype2=tf_ipsecsha
20. WHO Mythbusters. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters?gclid=CjwKCAiA4o79BRBvEiwAjteoYJErJR2H4RvlrOt1ALCGHvTkqRToGJsM6zAq3tGs6OXQQ5ERgNrY6RoCYBoQAvD_BwE#climate (accessed 5 October 2020)

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[1] NB: Meat, poultry and fish processing are more labor intensive and have less automation on production lines that other food processing performed in cooler temperatures (e.g., dairy). As such, it has been easier to observe physical distancing in non-meat and fish processing sites without large investments in engineering controls. This does not mean that other cold food processing plants and cool stores are risk free (e.g., see COVID cases transmitted in the Americold facilities in Auckland).

Take it seriously.

The virus that causes COVID-19 is dangerous and easy to underestimate.  It will be an ever-present threat in many communities for the foreseeable future.

My WHO colleagues and I are encouraging everyone to work out how they can go about their lives – continuing to work and earn, be educated, socialize and more – while holding the virus at bay.

The virus is the adversary, people are the solution.

Holding the virus at bay

Holding the virus at bay requires following the well-established disciplines of disease outbreak control.  There are no short cuts and no quick fixes. Different systems need to be woven together at local level and be well supported by both national authorities and international programmes.  There is a need to do it all and do it well.

False choice: economy or health?

Presenting a choice between economy and health is a distraction from the work needed to hold the virus at bay. A strong economy needs a healthy nation and that needs focus on the right activity. The option is not herd immunity or total lockdown. Without a vaccine, herd immunity is not based in scientific evidence. It downplays the challenges of shielding the vulnerable. It ignores the very real challenge of large numbers of people debilitated by long tail covid. Total lockdown freezes the disease in place. It doesn’t address the cause of the spread. It halts the economy, pushing people into poverty. And it creates backlogs of treatment for other important diseases and harms mental health.

Doing all that is needed

The activities needed to Hold the Virus at Bay must all be implemented to ensure economic, social, educational and leisure activities can continue in a modified way.  The spikes and surges of COVID-19 cases will need to be managed, with clusters of cases and outbreaks being suppressed at the same time. The ‘middle way’ between letting the virus go and locking down society means all the following activities are needed:

On movement restrictions and lockdowns

From time to time, localised movement restrictions may be needed as efforts are made to contain local spikes and surges.  They should be implemented with constant dialogue between people’s representatives and the authorities. The goal is that people do what is needed to prevent the virus from spreading because they choose to, and not because of restrictions being imposed on them.  Authorities can support this through making sure that services are organized in the best possible way to interrupt transmission quickly, preventing clusters and outbreaks from emerging.  This means testing strategies that yield data that reveals where the virus is and links directly to an integrated local response.

If clusters and outbreaks do appear, they should be slowed and then suppressed promptly.  That is why localised and targeted movement restrictions, implemented jointly by local actors and national authorities, will be needed from time to time as local outbreaks are detected.  These movement restrictions should be kept as time limited as possible.

Why do I write that everything possible should be done to avoid widespread lockdowns and that their use should be only as a last resort?

Because of the way they impact on people’s livelihoods, mental health, non-COVID-19 illnesses, access to education and more.  I appreciate that as case numbers start to climb the temptation is to “go into lockdown” as a solution.  The only justification for a lockdown is to build up capacity for holding the virus at bay: identifying locations where transmission risk is high, interrupting transmission, suppressing clusters and containing outbreaks quickly. Lockdowns provoke deep frustration among people everywhere; they contribute to extreme poverty.  They should be kept as short as possible when they prove necessary.

Trust, Empathy and local-level leadership are invaluable

There are many examples from around the world of nations and communities successfully doing what it takes to hold the virus at bay.  I am seeing these communities and nations show how by doing all that is needed, they keep the virus at bay and prevent it from welling up again.  This focus requires people-centred, consistent, and empathetic leadership which prioritizes integrated working among multiple stakeholders.  Every attempt must be made to manage conflicts between the groups essential to integrated local responses.

Systematic and successful management of interactions at interfaces will always be helpful. This helps everyone concerned to establish a common purpose for their efforts, to build and strengthen their inter-relationships and to be confident about sharing information with each other – including about their feelings, concerns and uncertainties.

This is critical to build trust among responders: the vital requirement for successful response strategies.

It is trust that what will lead us to a Covid-Ready world where we can once again meet, work and play, free from anxiety and antagonism.