QUERY: CORONAVIRUS, COLD CHAIN AND CLEAN CHAIN
By Adam Corson-Finnerty, March 19, 2020
This article is a Query. That means it poses one or more questions and invites feedback.
First of all, I want to say that the Corson-Finnertys are sheltering in place. Neither Susan (age 73, with asthma) nor myself (age 75) is engaging in direct contact with any other person, including our grandson (age 5) and his mother/our daughter (age 38). We have cancelled all non-essential doctor and dental appointments. I went shopping two weeks ago, wearing disposable gloves, and I haven’t been in a store since then — or any other shop. When I used an ATM and pumped gas, I used disposable gloves. I even sprayed my credit card with Lysol after each use. I sprayed the mail and left it out overnight. We go for walks in our wooded neighborhood and when we see neighbors out walking we stay at least 6 feet away while we visit.
I mention this because this query speculates about safe interactions and commerce. Some years ago, while working in international development, I first heard the term “cold chain.” Here’s how Wikipedia describes it:
A cold chain is a temperature-controlled supply chain. An unbroken cold chain is an uninterrupted series of refrigerated production, storage and distribution activities, along with associated equipment and logistics, which maintain a desired low-temperature range. https://en.wikipedia.org/wiki/Cold_chain
An example would be keeping a vital medicine cold all the way from its manufacture, through transport, through offloading, through jeep ride to a refugee camp 12 hours away by dirt road. If the medicine isn’t kept cold as it passes through many hands, it becomes ineffective.
So, in this period of coronavirus pandemic, how would you create a “clean chain?” By that, I mean taking a product from the plant to my front door — and keeping it contamination-free the whole time? Just yesterday, a deliverywoman arrived at my front door with a package. She wasn’t wearing gloves. She clearly expected me to open the door so she could hand it to me with a smile. She was young; I have a full white beard and look my age. I smiled back and asked her to set it on the porch. I yelled thank you through the glass storm door.
Coronavirus stays infectious on surfaces. Cardboard packages, stainless steel, cloth, plastic, and so on. How long? It depends on the material, temperature and humidity, and the viral load (handling a box versus sneezing on a box). A March 18, 2020, letter to the New England Journal of Medicine — from a group of researchers with the National Institute of Allergy and Infectious Diseases — says that they tested SARS-CoV-2 (novel coronavirus) and SARS-CoV-1 (SARS) on a variety of surfaces. Here is what they found:
SARS-CoV-2 was more stable on plastic and stainless steel than on copper and cardboard, and viable virus was detected up to 72 hours after application to these surfaces (Figure 1A), although the virus titer was greatly reduced (from 103.7 to 100.6 TCID50 per milliliter of medium after 72 hours on plastic and from 103.7 to 100.6 TCID50 per milliliter after 48 hours on stainless steel). The stability kinetics of SARS-CoV-1 were similar (from 103.4 to 100.7 TCID50 per milliliter after 72 hours on plastic and from 103.6 to 100.6 TCID50 per milliliter after 48 hours on stainless steel). On copper, no viable SARS-CoV-2 was measured after 4 hours and no viable SARS-CoV-1 was measured after 8 hours. On cardboard, no viable SARS-CoV-2 was measured after 24 hours and no viable SARS-CoV-1 was measured after 8 hours (Figure 1A). https://www.nejm.org/doi/10.1056/NEJMc2004973
So how long should I have left that package on my porch? I am not going to suggest a figure because this is only one study, and the general messages from the CDC are inconclusive. One gets the impression that transmission-through-objects is not high on their list of concerns — as compared to transmission through contact, and transmission on room surfaces and medical equipment. We have adopted 72 hours for mail and packages. And cash.
But that’s not why I am writing this query. I am specifically interested in commerce. For example, my package (which contained cooking sherry and hand lotion). Or how about pizza delivery? Chinese food? Grocery delivery from your local supermarket? Prescription medicine? Cat food? Two cheeseburgers with a side of Caesar salad?
All of these businesses, from my local Pizza Hut to Amazon, should start right now to figure out and publicize a “clean chain” for their products. The ones that do will get my business, showing that in every crisis there can be opportunity. But this is not about competitive advantage, this is about keeping commerce alive. Jobs. Small businesses. Large Businesses.
Here’s a good example: telemedicine. Yesterday my wife had a 40-minute intake with a Sleep Doctor. It was all by phone. He told us that his medical center — Penn — was rushing to develop video consulting. It looks like Medicare will start allowing such visits. That’s smart. That’s safe. But how will my dentist convince me that an office visit is safe? My dermatologist?
But let’s take my supermarket. Suppose I want to order milk, fresh vegetables, and fresh fruit? How far back does the market need to go in order to create a clean chain? Should they start at the food distribution warehouse? Or start with delivery to their store? How do they protect the shelf-stockers, and how do they protect me from the shelf-stockers? And the shelf pickers? And the delivery person? Not to mention the delivery person’s truck?
I am sure there is a way for Pizza Hut, and the Giant, and Staples, and the House of Pho to manage this.
What do you think? How can these clean chains be created, and how can they be trusted? If Amazon develops a clean chain and promotes it, I will probably trust the company. But my local Dunkin Donut franchise? My local Walgreens?
And in case you are wondering, I donned disposable gloves to bring in my Amazon package of sherry and hand cream. I sprayed the box with Lysol. I cut it open with scissors that I later washed and put into rinse water with bleach. I used the same scissors to cut away the plastic bubble wrap. I took the box and the bubble wrap out to the trash. I took off my gloves and put them in a sealed bag for disposal. I used my hands to put the sherry in my cabinet. Ditto for the hand cream. Then I washed my hands with soap. Only then did I rub the itch in the corner of my eye. (My wife wonders if I was careful enough. Maybe not.)
Adam Corson-Finnerty, Bucks County, Pennsylvania
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