Panthera tigris (Felidae) tigers and COVID-19

I got many questions about the report of a tiger in the Bronx zoo with COVID-19.  I will confess I was intrigued but also a bit impatient that it took over the media for a day. We do not want to get too distracted by outliers in a pandemic and not keep our eyes on the ball. 

Yet, wait, maybe tigers with COVID-19 is a part of the center of the story because COVID-19 is a “spillover” event. It is another example of the interconnections of this living world and the notion of “One Health”.   One Health is the frontier of public health and is an ecological vision of health that includes animals, humans, and the environment.  Throughout the last few decades, diseases that spill over from animals to humans have been on the rise.  Most of the notable pandemics started as spillover events including HIV/AIDS, Ebola, avian influenza, and now COVID-19.

I went to one of my favorite One Health experts Vanessa Grunkemeyer DVM MPH faculty at University of New Hampshire and I asked about the tiger and the story and here is what she said.

“Yes, the tigers have gotten a lot of press and are causing quite a buzz even in the vet community. Unfortunately, the data on non-human animals and COVID-19 is sparse and evolving every day (so much about this disease is). One of clearest write-ups I have seen about the tigers came through promed (I included it below) from the zoo vet who oversees these animals. The American Veterinary Medical Association (AVMA) is keeping up to date and posting great information for animal owners/general public on their website (https://www.avma.org/resources-tools/animal-health-and-welfare/covid-19).   However, I particularly love the updates by Dr. Scott Weese a public health vet from Canada, on his Worms and Germs blog (https://www.wormsandgermsblog.com/).

The most notable things about the tiger seems to be that this cat was symptomatic, which has not been true of most if not all of the other cases where virus has been isolated from non-human animals.

Previous to this a very small number of companion animals who lived with COVID-19 positive humans had “tested positive” for the virus; some of these were PCR tests and at least 1 was virus isolation.  I believe 1 of the cats in Europe did seroconvert.

We have every suspicion that animals can act as mechanical vectors for the virus and their leashes, collars, etc. could act as fomites (inanimate objects that can transfer pathogens—like a doorknob). Thus, appropriate precautions should be taken when these animals are kept in contact with known or potentially positive humans -Vanessa “

For those readers that really want to follow this topic one level deeper I have included a few of the posts from ProMed with more specific information that Vanessa sent and I include some of the links.

   1. PRO/AH/EDR> COVID-19 update (84): USA, tigers
      (promed@promedmail.org)
   2. PRO/AH/EDR> COVID-19 update (85): USA (NY) tiger, OIE
      (promed@promedmail.org)
   3. PRO/PL> Begomoviruses, basil – Uganda: new pathogens
      (promed@promedmail.org)
———————————————————————-

CORONAVIRUS DISEASE 2019 UPDATE (84): USA, TIGERS
*************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 6 Apr 2020
From: Dr. Paul P. Calle [edited]

On [Fri 3 Apr 2020], qPCR testing for SARS-Coronavirus-2 (SARS-CoV-2)
on duplicate nasal and oropharyngeal swabs and tracheal wash samples
from a 4-year-old female Malayan tiger (_Panthera tigris jacksoni_)
with respiratory signs living at the Wildlife Conservation Society’s
(WCS) Bronx Zoo was performed at the Animal Health Diagnostic Center
and New York State Veterinary Diagnostic Laboratory at Cornell
University College of Veterinary Medicine and the University of
Illinois College of Veterinary Medicine Veterinary Diagnostic
Laboratory. The swabs yielded presumptive positive results that were
confirmed by the USDA National Veterinary Services Laboratory on [Sat
4 Apr 2020].

The index case was one of 2 Malayan tigers, 2 Amur tigers (_Panthera
tigris altaica_), and 3 African lions (_Panthera leo_) that developed
respiratory signs over the course of a week characterized by a dry
cough and in some cases wheezing, but no dyspnea or nasal or ocular
discharge. Mild anorexia was noted in some cases. All of the cats are
long term residents of the zoo, do not have chronic medical
conditions, and there have been no new animal introductions to these
groups for several years.

All other Amur and Malayan tigers, snow leopard (_Panthera uncia_),
cheetah (_Acinonyx jubatus_), clouded leopard (_Neofelis nebulosa_),
Amur leopard (_Panthera pardus orientalis_), puma (_Puma concolor_),
and serval (_Leptailurus serval_) at the Bronx Zoo remain healthy
without evidence of clinical illness.

The source of infection is presumed to be transmission from a keeper
who, at the time of exposure, was asymptomatically infected with the
virus or before that person developed symptoms [i.e., presymptomatic].
The cats have received antibiotics and supportive care as needed, and
all of the affected cats are doing well with no worsening of their
clinical signs and daily gradual improvement. Enhanced PPE [surgical
masks (not N95 masks), face shields, gloves, coveralls] use has been
implemented for staff caring for all non-domestic felids in the 4 WCS
zoos.

SARS-CoV-2 is a World Organization for Animal Health (OIE) reportable
disease with country-specific mandatory reporting requirements by
national governments of positive results, and national and
international veterinary and public health agency notifications. We
will provide more technical details and answer questions as we can,
but as I’m sure you can imagine it is quite challenging right now to
keep up with everything that is going on. We will also be publishing
this information in peer-reviewed scientific venues.
—
Paul P. Calle, VMD Diplomate ACZM & ECZM (Zoo Health Management)
WCS Vice President for Health Programs
Chief Veterinarian Director,
Zoological Health Program Wildlife Conservation Society
<pcalle@wcs.org>

By the end of March, the cat of a woman with COVID-19 tested positive
in Belgium (see post# http://promedmail.org/post/20200327.7151215).
This cat presented clinical signs: diarrhea, vomiting and difficulty
breathing. A few days later, a cat in Hong Kong, owned by a COVID-19
infected patient, also tested positive (post#
http://promedmail.org/post/20200403.7179945), although in this case no
clinical signs were detected.

A recent experiment carried out in China, so far published as a
pre-print
(<https://www.biorxiv.org/content/10.1101/2020.03.30.015347v1>), found
that cats and ferrets exposed by SARS-CoV-2 by intranasal inoculation
develop active infection, replicating efficiently. Moreover, in cats
it was shown that the virus can be transmitted via droplets, as
sentinel cats housed next to infected ones also became infected. Dogs,
pigs and birds, on the contrary, proved to be poor hosts, with limited
replication (although it is noteworthy that 2 dogs became infected
from their owners in Hong Kong).

Cats are in the _Felidae_ family, and so are cougars, lions, tigers,
jaguars, and all the other wild felids. This report in tigers and the
other observations and experimental results alert us to the fact that
felids (and maybe also mustelids) may become infected by SARS-CoV-2.
The significance of this is yet to be established (conservation
concern?; source of transmission for humans?; role in propagation?).
In the meantime, cautionary measures should be taken so that domestic
and wild animals are not exposed to patients with COVID-19. – Mod.PMB

CORONAVIRUS DISEASE 2019 UPDATE (85): USA (NEW YORK) TIGER, OIE
***************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

SARS-CoV-2/COVID-19, USA
————————
Information received on [and dated] 6 Apr 2020 from Dr. from Dr Mark
Davidson, associate administrator, USDA-APHIS, United States
Department of Agriculture, Washington, United States of America

Epidemiology
Source of the outbreak(s) or origin of infection: suspected human
transmission.

Epidemiological comments: 5 tigers and 3 lions were housed in 2
enclosures at a zoo. The 1st tiger showed clinical signs of disease on
[27 Mar 2020]. By [3 Apr 2020], 3 additional tigers and all lions were
showing clinical signs. Clinical signs consisted of a dry cough and
some wheezing; one animal had inappetence. None of the animals were in
respiratory distress. The lions and tigers were isolated and no other
animals at the zoo have shown any signs of respiratory disease.
Samples were collected from the 1st affected tiger and it was
confirmed positive for SAR-CoV-2/COVID-19. The other animals with
clinical signs are also presumed to be infected. All animals are
stable and are recovering. It is assumed that an asymptomatic zoo
employee infected the animals.

Control measures
Measures applied: quarantine; disinfection; vaccination permitted (if
a vaccine exists), no treatment of affected animals
Measures to be applied: no other measures

–[See Also:
COVID-19 update (76): China (HU) animal, cat, owned, stray,
seropositive http://promedmail.org/post/20200403.7179946
COVID-19 update (75): China (Hong Kong) cat, OIE
http://promedmail.org/post/20200403.7179945
COVID-19 update (70): China (Hong Kong) cat, pets & stock
http://promedmail.org/post/20200402.7173286
COVID-19 update (58): Belgium, cat, clinical case, RFI
http://promedmail.org/post/20200327.7151215
COVID-19 update (57): global, re-using PPE, DR Congo, more countries,
WHO http://promedmail.org/post/20200327.7149046
COVID-19 update (56): China (Hong Kong) animal, dog, final serology
positive http://promedmail.org/post/20200326.7146438
COVID-19 update (45): China (Hong Kong) animal, dog, 2nd case PCR
positive http://promedmail.org/post/20200319.7112693
COVID-19 update (37): China (Hong Kong) animal, dog, prelim. serology
negative http://promedmail.org/post/20200312.7081842
COVID-19 update (30): China (Hong Kong) dog, susp, serology pending
http://promedmail.org/post/20200306.7057595
COVID-19 update (25): China (Hong Kong) dog, susp, OIE
http://promedmail.org/post/20200302.7040373
COVID-19 update (22): companion animals, dog susp, RFI
http://promedmail.org/post/20200229.7036661
COVID-19 update (17): China, animal reservoir, wildlife trade &
consumption http://promedmail.org/post/20200225.7024245
COVID-19 update (11): animal reservoir, intermediate hosts, pangolin
susp http://promedmail.org/post/20200220.7009213
COVID-19 update (08): companion animals, RFI
http://promedmail.org/post/20200218.7002276
COVID-19 update (06): animal reservoir, intermediate hosts
http://promedmail.org/post/20200217.6997782
Novel coronavirus (42): China, global, COVID-19, SARS-CoV-2, WHO
http://promedmail.org/post/20200211.6979942
Novel coronavirus (40): animal reservoir, pangolin poss intermediate
host, RFI http://promedmail.org/post/20200210.6972104
Novel coronavirus (28): China (HU) animal reservoir
http://promedmail.org/post/20200201.6943858
Novel coronavirus (22): reservoir suggested, bats
http://promedmail.org/post/20200129.6930718
Novel coronavirus (20): China, wildlife trade ban
http://promedmail.org/post/20200127.6922060
Novel coronavirus (18): China (HU) animal reservoir
http://promedmail.org/post/20200125.6915411
Novel coronavirus (15): China (HU) wild animal sources
http://promedmail.org/post/20200123.6909913
Novel coronavirus (03): China (HU) animal reservoir suggested, RFI
http://promedmail.org/post/20200114.6887480
Novel coronavirus (01): China (HU) WHO, phylogenetic tree
http://promedmail.org/post/20200112.6885385
Undiagnosed pneumonia – China (HU) (07): official confirmation of
novel coronavirus http://promedmail.org/post/20200108.6878869]
………………………………………….pmb/ao/lm

Make sure everyone counts: Change the way we define COVID-19

This is what the public health officials need to do to provide more order in this catastrophe and to more accurately reflect the size of the pandemic.

Rather than only counting “confirmed” cases as we do in the U.S., we should adopt the COVID-19 case definitions recommended by WHO and the European CDC.  In those settings there are three tiers or types of cases depending on the degree of certainty.

Suspect case

A. A patient with acute respiratory illness (fever and at least one sign/symptom of respiratory disease, e.g., cough, shortness of breath), AND a history of travel to or residence in a location reporting community transmission of COVID-19 disease during the 14 days prior to symptom onset;

OR

B. A patient with any acute respiratory illness AND having been in contact with a confirmed or probable COVID-19 case (see definition of contact) in the last 14 days prior to symptom onset;

OR

C. A patient with severe acute respiratory illness (fever and at least one sign/symptom of respiratory disease, e.g., cough, shortness of breath; AND requiring hospitalization) AND in the absence of an alternative diagnosis that fully explains the clinical presentation.

Probable case

A. A suspect case for whom testing for the COVID-19 virus is inconclusive.1

OR

B. A suspect case for whom testing could not be performed for any reason.

Confirmed case (this is the only category that we have now in the US)

A person with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms per WHO technical laboratory guidance.

https://www.who.int/publications-detail/global-surveillance-for-human-infection-with-novel-coronavirus-(2019-ncov)

What does this approach offer us?

At this point with such limited testing available in the U.S., we are missing many cases. This means that our public health tools—including quarantine and isolation—are being used in limited circumstances and are confusing. 

Every question I got today—from community members and health workers—represented people trying to navigate the instructions for self-isolation and quarantine in the midst of this chaos. It does not have to be chaotic (or not this chaotic). Having more categories in the COVID-19 case definition, based on the degree of certainty, is how we epidemiologists usually do it.  That is how we did it with Ebola and cholera.  I don’t know why we are not using the usual approach in the U.S., but it is ill-considered.

Today, a person who tested negative last week returned to a local health care facility and was hospitalized with severe symptoms and a positive test. The nurses involved wondered why the early symptoms that the patient exhibited last week could not have been used to have the person start quarantine rather than have them moving about in the community and potentially exposing others.

At the very least we should combine the suspect and probable case definitions into one category and include everyone in it who meets one of those WHO definitions.  In addition, we cannot ignore clinical signs and symptoms and health worker judgment. Chinese doctors and public health officials complained mightily about the limited case definition they were forced to use. If you review the Chinese data, you will see that the day the number of cases spiked was when doctors revolted and treated COVID-19 clinically compatible cases in spite of negative test results or lack of available testing. They began to use their experience with cases and chest CT scans to advise their treatment and provide care.

This approach would not cause problems with analysis because suspect and probable cases would be counted separately—stratified—from the “confirmed” cases that have a positive laboratory test.  It would be better if we could follow persons as they changed from a suspect to a confirmed case definition and then re-categorize their status. At this time, when they are “suspect” cases and simply ignored and not counted.

Moreover, current limitations of much of the SARS-CoV-2 testing —relatively poor validity—are important. The RT-PCR-based testing has high specificity but low sensitivity.  Thus, it can miss a lot of cases.  In fact, based on consistent data in China and Italy, it is estimated that at least 30% of COVID-19 patients may have a negative test.  The reasons for this are not certain, but based on other diseases we can speculate.  Timing matters. For example, a person needs to have the viral infection long enough to produce enough virion-babies in the throat and nose to make a positive test. A test done too early may produce a false negative result.  Similarly, a test done late in the illness, as the patient is recovering, may also be too late to produce a positive result.

Specimen collection quality is also an issue. The RT-PCR test is performed using a swab specimen from the nose (best) or throat, and the swab must hit the right spot to provide an adequate sample. So, variation in specimen collection quality can be important.

Finally, characteristics inherent to the test may affect its sensitivity (the proportion of people with the infection that it actually picks up). Hopefully with time and further study, we will learn more about testing and be able to address these limitations.

As more testing becomes available, we need to be clear about which people are likely to have a false negative result because this information is needed to guide decisions about who can return to work and who should be quarantined or isolated.

At this point with so much community transmission and relatively poor testing performance, we cannot rely on it as the sole source of information. 

What are the costs of not doing this?

In the U.S. the instructions given to persons without a confirmatory laboratory test are not well enough defined.   Community members need to know when their contact with a COVID-19 case—suspect, probable or confirmed—or their symptoms warrant self-quarantine and when they can be released from it. 

Ultimately, perhaps not much longer from now, we will have more tools to use in our decision making.  When we have more testing available, we can more easily decide which patients we think should be tested; however, we cannot use the test results as the only factor in deciding whether patients should be in quarantine. In addition, when a test for antibodies to SARS-CoV-2 is available, suspect and probable cases can be given clear information about whether they are now immune and what precautions, if any, they might need as they go about their lives.  This information will continue to be important over the years to come. We want an army of known immune people to help us move through this crisis.

Finally, the psychology is important here, and it is dispiriting to those in NYC, Seattle, and soon, many other cities and states, to not be counted or validated.  By counting only persons with positive tests as cases, we are participating in a kind of “abandonment” of individuals who could not get tested or who might have had a false negative test. They are also building our experience and our herd immunity, and they deserve to be recognized and counted. 

This is not that hard, people. Whoever makes these decisions— please, just do it.

Using Syndromic Surveillance to find the COVID-19 epidemic in front of us and behind us

Written by Helen Perry PhD and Sharon McDonnell MD MPH

What is syndromic surveillance? 

Public health surveillance is the use of data for action.  It is how we can monitor health problems that occur in our communities, states and countries.  Health care providers like many doctors, urgent care centers and hospitals participate in their State’s notifiable disease reporting system. They report important public health diseases like tuberculosis, measles, meningitis, influenza and respiratory viruses.  Then the public health department can follow up and help contain further transmission to the public. 

Surveillance is really a continuum of approaches for using health data for action.  It starts with a very general awareness that a problem is occurring or an outbreak is suspected. This early warning leads to more specific steps for investigating the cluster or unusual cases, obtaining specimens for laboratory confirmation, and planning actions for an appropriate response in the community.  Each of these steps involves looking at the data collected for that step so that we can monitor how – and if – transmission of the illness or event is being controlled and limited.

Syndromic surveillance is part of this early warning surveillance system.   A syndrome is a collection of symptoms called a prodome, or the early stage of an illness before it is diagnosed.  Sometimes a syndrome may not fit into an existing diagnosis, and so health providers keep track of and report that syndrome because it does not yet have a known cause.  Examples of past public health problems detected through syndromic surveillance include opioid overdoses, vaping-associated lung disease, Zika virus disease, and natural disasters.

Syndromic Surveillance and Influenza-like-illness (ILI) as a tool for COVID-19 tracking

A target of syndromic surveillance that we are hearing a lot about in this pandemic is called influenza-like illness or ILI.  ILI as a syndrome is collected routinely as part of the flu surveillance each season.  When a patient presents with fever (100*F or greater), and a cough and/or sore throat and has no other cause for these symptoms, this is an influenza-like illness and is included in the count of cases reported to the health department.  The ILI data can be reviewed to see if there are unusual patterns or clusters that should be further investigated. For example, are more cases coming in this year than the last few years?  Are people in a certain age group unusually affected more than others such as young adults or people 65 and older? While the same viruses that cause influenza do not cause Covid-19, unusual spikes in ILI visits can be an early warning that the unusual activity in respiratory illnesses is due to another cause.

CDC’s Influenza-like Illness Syndromic Network focuses on emergency departments (ED) because this is where many people seek care for these kinds of illnesses.   All 50 states, Puerto Rico, the District of Columbia and the U.S. Virgin Islands participate in reporting ILI to the Network.  By tracking ILI symptoms of patients in EDs – before a diagnosis is confirmed – local, state and national health departments can use ILI surveillance as an early warning system for public health concerns, including detection of novel influenza or novel respiratory viruses.  

In fact, it was a similar syndromic surveillance system in China that picked up the COVID-19 illnesses—set up after SARS – that raised the alarms in December and gave them a jump on the idea that something was happening.

These systems are still important.  In an article from The Hill (3/202020), Dr. Anne Schuchat, the principal deputy director of the Centers for Disease Control and Prevention (CDC) said “We’re looking at our flu syndromic data, our respiratory illness that presents at emergency departments. Across the country there’s a number of areas that are escalating.” (1)

The CDC is using one of its most reliable indicators to provide early hints about where the next epidemics might spring up. A surveillance system designed to detect sudden upticks in patients who report flu-like symptoms at emergency rooms across the country, built over decades into a system that presents data in almost real time, was the first alarm bell that rang in New York. Those who reported flu-like symptoms, it turned out, were instead victims of COVID-19, the disease caused by the coronavirus.”  Here’s an example of that graph (see next page).  It shows the ILI surveillance data from emergency departments between October 2019 and March 17, 2020.  This year’s data is shown with the red line and is compared with the information from the past 3 years.  The large increase over previous years’ ILI visits started in late December and continued for the next several weeks into January and early February.  In March, EDs were seeing an unusual increase in ILI visits.  This increase was unusual because this was a time when the trend would have been historically expected to decrease.

Now, that same surveillance system is flashing red lights in many states, a potential sign that coronavirus patients are already visiting hospitals, even if their symptoms are not severe enough to warrant overnight stays.

“There’s just dozens of places we’re watching,” Schuchat said. “We really need to expect that the whole country’s at risk here, and we have to look across our health care system within each jurisdiction to have them be as strong as possible.” (1)

The ILI system augments the COVID-19 surveillance by helping us to look ahead where things are “happening” in the US particularly when our testing capacity is so low. (2) At the end of this post there is a graphic of the data from NYC showing an unusual rise in ILI cases.

Data from Maine CDC showed a similar increase in ILI cases even before our first confirmed COVID-19 cases. The ILI system may be a tool that helps us look ahead for hotspots as well as to look behind when we are telling the story of this epidemic. For an excellent description of the ILI system in COVID refer to the link by Abe Stanway in the Medium.

References:

(1) https://thehill.com/policy/healthcare/489684-exclusive-top-cdc-official-warns-new-yorks-coronavirus-outbreak-is-just-a

(2) Stanway, A. “Real Time COVID-19 tracking”. March 14, 2020. https://medium.com/@astanway/real-time-covid-19-tracking-e6b92001edb

(3) For more information about the National Syndromic Surveillance Program

https://www.cdc.gov/nssp

(4) For information on influenza surveillance and specific information on CDC’s Influenza-like Illness Surveillance Network (item 2 on the page) that includes all 50 states, Puerto Rico, the District of Columbia and the U.S. Virgin Islands.

https://www.cdc.gov/flu/weekly/overview.htm

Clinical trials for COVID-19

International Clinical Trials for COVID-19 – April 2, 2020

Ok geeky friends and those with a curious mind here is something you have been asking yourself,  “what research is happening?”

Here is a link to the US NIH and the National Library of Medicine that describes all registered clinical trials.  You can go look at what is happening all over the world with epidemiology and clinical trials. Very fun.

https://clinicaltrials.gov/

Then, in the box condition or disease type COVID

You can add another word in the box “other terms” such as antibody, sensitivity, vaccine, symptoms etc. Then, choose a country, or not.

Then you can click on the search box.

Up will come a list of studies that are being conducted, planned or finished. Note few are in the latter category.

Here is a shortcut to all clinical trials relating to COVID

https://clinicaltrials.gov/ct2/results?cond=COVID-19

Enjoy! You are welcome. It beats Netflix for awhile.

How do we handle the world? – Everyday practices for COVID prevention

COVID-19 update

I am writing this for our Emergency operations staff in the call center and for people delivering food in the community from the grocery store as well as all of us trying to find out how to live in this newly dangerous world.

1. Assume most COVID transmission happens by direct close contact with someone with COVID-19. It is a matter of probability. What are the odds that droplets with virus can get into your mouth, nose, eyes?  The efficiency of transmission for any contact relates to the amount of virus and the type of contact.  Think of a range between high levels of virus in a sick person with kissing contact with you versus lower levels of virus in a person without symptoms at 6 feet distance as a range.  Aim towards the less probable range.  Stay at 6 feet distance and short (<15 min) contact.  Do not trouble yourself too much about the teeny-tiny details in the arguments between virologists and epidemiologists. You are a practical person and there is a level of too much worry that is not helpful. Your life is not a surgical suite. There is a balance between caution and just too much worry that becomes paralyzing and irrational and a life that is unlivable.

2. The next less common, but possible, method of transmission is via droplets in the environment that can get onto your hands and can be transferred by your fingers into your mouth, nose, and eyes.  These relatively fragile little viral buggers can land in moist droplets onto surfaces and survive for awhile—the time of survival (of the virus) varies. Apparently these viruses in droplets survive longer on hard surfaces and are more concerning on things we touch like doorknobs tables, pens, countertops. They are less likely to survive on porous surfaces like cloth or hair.   So, you want to wash your hands with soap after you touch things in the environment. Have sanitizer or bleach in the car that you can use.

3. Make a “zone” around you where you live. It is “home” and “us/we”. Everything in that zone is “clean” as possible and should be kept safe.  As you come in to your zone then you (and everyone else in your zone habitat) should immediately wash your hands or hand sanitize at the door.  Make a way so that you think of that first before you start doing other things.  Do something at the doorway or before anything else.

4. When you go out in the world keep washing your hands or use hand sanitizer. Do not touch your face. You can use gloves or fingers in the world but do not touch your face (mouth, nose, eyes). I wear gardening gloves a lot because with them on my hands I don’t touch my face, I don’t scratch my eyes, I don’t pull a cat hair out off my tongue. When I get into my car or arrive home I put them in my little plastic baggie. I wash them every so often. I watch people every day with gloves on touching their faces constantly.

We are going to be more scared next week because what we predicted would happen (exponential rise in cases and their detection by increased testing) will happen and actually seeing it will scare us, rightly so.  But keep steady, stay 6 feet distance and make your zone good.  Be kind to each other and patient.  Wash your hands.

Question: How is this virus transmitted? I am wondering about bringing things into my home—like food and mail—nothing extravagant.

This evening, in keeping with questions we get every day, there was an interview on PBS Newshour with Greg Ferrara the President National Grocers Association.

He was discussing grocery store supplies at national level.  In short, your TP and butter will be there for the long haul. There is plenty of food and plenty in the supply line. They just need to restock.

He suggests buying enough groceries to last for 1- 1.5 week at a time.  This will leave plenty for your neighbor to get some too.

He also speaks to how they manage supplies at the grocery store and his view on when you get them home with them.  Notably his interview gave important information and was much more impressive than the preceding interview with our secretary of defense (Espey) who was a tool and a bluffer. Link to Mr. Ferrara:

https://www.pbs.org/newshour/show/despite-empty-store-shelves-grocery-association-says-supply-chain-very-strong

MAIL and Papers:

I sent out my advice for how to avoid droplet spread 3 days ago so I won’t repeat it… yet.  Repetition is the soul of learning and I know everyone is getting so much advice and a lot of it a bit over-wrought.  What viral bits can be taken off a cardboard box in laboratory conditions may not actually be adequate to transmit the illness. Here is my favorite link on this topic today.

https://thewirecutter.com/blog/coronavirus-packages/?utm_source=pocket-newtab

FOOD AND GROCERIES: For food and groceries that we are bringing into our homes I went to the National Association of Grocers site and they worked with CDC and various reliable recommendations to come up with these FAQ’s

Q: Should food facilities (grocery stores, manufacturing facilities, restaurants, etc.) perform any special cleaning or sanitation procedures for COVID-19?

A: CDC recommends routine cleaning of all frequently touched surfaces in the workplace, such as workstations, countertops, and doorknobs. Use the cleaning agents that are usually used in these areas and follow the directions on the label. CDC does not recommend any additional disinfection beyond routine cleaning at this time. Restaurants and retail food establishments are regulated at the state and local level. State, local, and tribal regulators use the Food Code published by the FDA to develop or update their own food safety rules. Generally, FDA-regulated food manufacturers are required to maintain clean facilities, including, as appropriate, clean and sanitized food contact surfaces, and to have food safety plans in place.   Food safety plans include a hazards analysis and risk-based preventive controls and include procedures for maintaining clean and sanitized facilities and food contact surfaces.

Q: Is food imported to the United States from China and other countries affected by coronavirus disease 2019 (COVID-19), at risk of spreading COVID-19?

A: Currently, there is no evidence to support transmission of COVID-19 associated with imported goods and there are no reported cases of COVID-19 in the United States associated with imported goods.

Q: Are food products produced in the United States a risk for the spread of COVID-19?

A: There is no evidence to suggest that food produced in the United States can transmit COVID-19.

Q: Can I get sick with COVID-19 from touching food, the food packaging, or food contact surfaces, if the coronavirus was present on it?

A: Currently there is no evidence of food or food packaging being associated with transmission of COVID-19.  Like other viruses, it is possible that the virus that causes COVID-19 can survive on surfaces or objects. For that reason, it is critical to follow the 4 key steps of food safety—clean, separate, cook, and chill.

Q: Can I get COVID-19 from a food worker handling my food?

A: Currently, there is no evidence of food or food packaging being associated with transmission of COVID-19. However, the virus that causes COVID-19 is spreading from person-to-person in some communities in the U.S. The CDC recommends that if you are sick, stay home until you are better and no longer pose a risk of infecting others. Anyone handling, preparing and serving food should always follow safe food handling procedures, such as washing hands and surfaces often.

Coronavirus (COVID-19) and Independent Grocery

(note scroll down on their site to get to these questions.)

Associated links by video:

1. The Advice given by Dr. David Price in the 50 min video that we sent around provides the same information and it has an empowering and calming effect.

https://vimeo.com/399733860

2. From the Robin Roberts show there is an interview with a virologist that also talks about how to go shopping that is an excellent overview it is also very resonable. Sorry this is a Facebook link that I cannot insert into WordPress. If you search Google for “Robin Roberts how to stay safe while grocery shopping” and it will take you to the link.

Sensible safe grocery shopping.

Pandemic Poetry

Pandemic. A poem by Rev. Lynn Ungar

What if you thought of it
as the Jews consider the Sabbath— the most sacred of times?
Cease from travel.
Cease from buying and selling. Give up, just for now,
on trying to make the world different than it is.
Sing. Pray. Touch only those
to whom you commit your life.
Center down.
And when your body has become still, reach out with your heart.
Know that we are connected
in ways that are terrifying and beautiful. (You could hardly deny it now.)
Know that our lives
are in one another’s hands.
(Surely, that has come clear.)
Do not reach out your hands.
Reach out your heart.
Reach out your words.
Reach out all the tendrils
of compassion that move, invisibly,
where we cannot touch.
Promise this world your love--
for better or for worse,
in sickness and in health,
so long as we all shall live.