Abridged podcast version of this post
Which guidance to follow? And why are there conflicting approaches?
The government’s guidelines for dealing with Covid-19 are not in line with other countries. Although there is guidance from the WHO (World Health Organisation), each individual country’s healthcare system is responsible for and has the capacity to respond to the Covid-19 pandemic, but measures differ.
Countries across the world have had to make political decisions, balancing economic factors with the capacity of healthcare systems and other measures they can take.
If a state has the capacity, and is willing to endure the economic changes it entails, the strategy which decreases cases and deaths in the near term is testing, isolating, tracing contacts of patients with the disease and large-scale social distancing.
This is the strategy which has been employed in China and South Korea where there has been a large number of cases, but also in New Zealand which has kept cases down from the start.
The key benefit to this strategy is that it decreases deaths and gives time for the healthcare system to build capacity, work on vaccines and treatments and understand the disease better. This is what has been talked about as ‘flattening the curve’.
The U.K Government has either not adopted this strategy, or moved to using it too late to avert significant problems for the population. Initially Johnson’s team were talking about small behavioural changes, then shielding older and vulnerable people and finally moved to what we have now, a semi ‘lockdown’ where many industries are still functioning.
As individuals and people participating in mutual aid projects, we need to recognise the contexts we are working in, and be aware of the real limitations on being safe that people’s economic and workplace situations force them into. We should also strive to limit the transmissions we are responsible for especially if delivering food or resources to people isolating due to age/health conditions.
For that reason, our team have spent time looking at standards used across the world by healthcare professionals and community groups for reducing transmission, and assessed when and where they are practical in our project and our daily lives. We welcome constructive feedback.
General guidance for members of the public
1) Self isolation
– We recommend that people who have symptoms isolate for 14 days from the first day they became ill. Likewise for the people living with them. This applies to people volunteering for the project who come into contact with others. Volunteers may return sooner than 14 days only if they have had a medical discharge of a negative test result.
U.K govt advice is 7 days for people who have had symptoms and 14 for those living with them. 7 days is too short and potentially dangerous, because although for a large majority of people with mild symptoms contagion drops after 7 days, it is clear from academic studies that there are outlier cases where contagion is still present for up to 14 days.
There is a difference between overcoming the symptoms and a person stopping being contagious. The government has to balance its prerogative to keep the economy functioning with social isolation and has chosen to set that bar lower than in other countries. For the Solidarity Kitchen, and in general, we want to minimise the chances of ourselves being transmitters, so we are taking the precaution of complying with the longer timespan.
The longer time frame is backed up by guidance from other countries:
– Australia: the self-isolation guidelines are two weeks with or without symptoms.
It also seems that there is a difference between overcoming the disease and stopping being contagious.The WHO and the Ministry of Health in Spain warn that people aren’t cured or stop being contagious until either: after 14 days of self-isolation after the end of symptoms and a medical discharge or a negative test result.
2) Masks & Gloves
There is clear evidence to show that, used correctly, even DIY or cloth masks can reduce the likelihood of transmission from the wearer, and also goes some way to stopping the wearer coming into contact with the virus in airborne water particles.
However, the effectiveness is significantly less than medical masks designed for this purpose. As the crisis has progressed, recommendations for DIY mask usage in community settings have been adopted more widely, for instance the U.S Govt has moved to this position as late as the 4th of April.
The campaign Masks Save Lives is a good starting point for recommendations.
Also the Coronavirus Tech Handbook is great for resources of all sorts.
Medical masks are in very short supply in healthcare settings and must not be used in community settings to prevent using valuable resources.
Finding guides for making masks online is straightforward. If you can’t make one or don’t have access to materials at the very least use a scarf to cover your face.
Users of masks should be aware of the protocols for fitting and removing masks safely.
Gloves
It’s important understand that there are two types nitrile of gloves sterile gloves and non-sterile gloves. Non-sterile gloves primarily protect the person wearing them. Most important for protecting the ill or high risk is good hand hygiene and hand washing procedures, in high risk procedures (such as medical ones) sterile gloves are used.We only have accesses to non-sterile gloves.
We need to make a rational assessment of the best use of these resources. The Queercare guidelines do suggest the use of gloves if available but they’re not a substitute for the good hand hygiene. If there is hand-mouth contact then contamination will spread from a gloved hand just as easily as a bare one
Current supplies outside of healthcare will run out fast if used across the board. There are shortages of gloves both sterile and non-sterile in the NHS. As they are non-essential for safe drop off and there are shortages it would be best that mutual aid groups don’t use any unopened packs and instead contact local NHS trusts and offer them as a donation, even if it’s only a few packs.
Good hand hygiene plays a greater role preventing infection. But packs that can’t be donated should be used to augment infection control protocols, which do not rely on them.
Non-sterile gloves provide protection against some substances by providing a barrier between the skin and a harmful substance. This is not relevant to COVID-19 because infection cannot spread through the skin.
Gloves have value against COVID-19 infection because in some situations they can aid hand hygiene – for instance, if it is not possible to avoid contamination, or to wash hands properly after potential contamination, then gloves can be worn for ‘dirty’ jobs and removed straight away afterwards.
Our glove practice should therefore consist of gloves being worn briefly for particular tasks and then removed. Wearing the same pair of gloves for longer than the duration of one brief task provides no protection – less than no protection if we consider the false sense of security that results from wearing gloves all day.
On the use of gloves in healthcare.
3) Receiving deliveries + Shopping.
– Ask whoever is delivering the items to you to read and follow these guidelines as closely as possible:
https://redirect.is/delivering
– When answering the door make sure the person delivering the items stays 2 metres away from you to give you space to pick up the item/s. It should be possible to pick it up from inside a sanitised bag which has been opened and placed on the floor in front of the door.
– Once you have the item(s) inside your house you will need to clean and sanitise the packaging to remove any viruses from them. We recommend following the sterile technique outlined in this video.
– If you have received a hot food delivery, remove the item from its packaging and put it directly on a plate, without it touching the exterior of the packaging, and if possible reheat it in a microwave. Any packaging should immediately be disposed of, and Tupperware cleaned in hot soapy water and if possible put through the dishwasher.
This procedure will be verbally confirmed with recipients and also explained on a flyer accompanying the food.
Guidance for Volunteers
Our safety protocols span from food arriving into the building, right through to the delivery of the meal to the recipient. Here’s how it works.
[N.B. If you struggle with long text, please let us know and someone can go through it with you.]
Volunteers
We require all of our volunteers to adhere to the general guidance for members of the public, as well as having a full understanding of the procedures for the Solidarity Kitchen.
1) Drivers
All drivers must thoroughly sterilise bikes, cars and vans before every shift.
How do you sterilise a car/van? Make a solution of one cup of bleach to every two litres of water. Putting this solution into a spray bottle makes application easy. Make sure to sterilise the driver area, delivery storage area, doors and doors handles.
How do you sterilise a bike? Make a solution of one cup of bleach to every two litres of water. Spray the parts of the frame that are touched and the saddle, but avoid the brakes if possible.
If using wipes, use 1 wipe per 30cm (roughly the size of a ruler) and make sure it is wet enough for the surface to be visible dampened for 4 minutes.
2) Backroom protocol
In terms of health & safety there are a few rules to keep in mind.
- Always ask if the recipient has any allergies, dietary requirements or needs around food and eating (e.g. difficulty swallowing, pre-cut) . Make sure this is always the first question you ask.
- Always explain the receiving delivery guidelines to the recipients.
3) Kitchen protocols.
Anyone volunteering in the kitchen must read and understand these protocols before a shift. This applies to delivery drivers who might need to come into the kitchen or within close proximity to food prep areas. There must be a professional chef with at least a Level 2 food hygiene certificate present at all times in the kitchen and during all food preparation. Please report back if this is not happening.
In addition to this, all volunteers and chefs working in the kitchen will be following additional separate kitchen health & safety guidelines, available in the notes.
Some basic rules to remember include:
- During cooking and transferring food into storage boxes (known as plating the food) masks will be worn to prevent any transmission from coughs, sneezes, or breathing from volunteers who may be asymptomatic carriers of the virus or whose symptoms have not yet begun. N.B. Asymptomatic means someone who is carrying the virus without knowing as they do not suffer from any symptoms. See this summary for estimates on what proportion are asymptomatic.
- The most effective way to reduce transmission of the virus during food prep is thorough and rigorous hand washing and not through the use of gloves. Gloves can be used, but shouldn’t be considered a safety measure.
- Volunteers should bring a clean change of clothes to wear in the kitchen. Long hair should be tied back and hand jewellery removed.
It is worth noting that the main risk in the kitchen is virus transmission via packaging not through food handling as high heats and cooking are ways of killing the virus. This means the main risk is when packaging the meals both before they are packed when the food storage boxes are prepared, while packing and bagging.
4) Having breaks and meals
Kitchen volunteers will be using the Warehouse Cafe cafe space during the day when on a shift to make cups of tea, go to the toilet and have lunch. Delivery drivers also use this space in the evening in addition to other staff who work in the building. This means that we need certain guidelines to minimise the risk of transmission in this space.
- Door handles and light switches must be sanitised every 4 hours during a shift as well as at the start and end of the day.
- Please sanitise and clean the coffee machine after use, if making a hot drink as well as any other equipment that is used. Please don’t make hot drinks for other volunteers, only yourself.
- Practice social distancing in the café space, staying 2 metres away from other volunteers/ building users.
- Volunteers eating at the cafe. Please eat at a safe distance from other volunteers. Please get your own cutlery and don’t share utensils.
- Wash your hands for 20 seconds when entering or leaving the cafe space, before a delivery begins, before entering the kitchen and after meals and brakes.
5) Keeping teams separate.
We’ve devised a way to minimise risk of cross infection across volunteers in the case of a suspected Covid-19 infection in one of our volunteers. It works a bit like an affinity group, if you know what that is. It’s mainly relevant for kitchen volunteers but also delivery drivers. Here’s how it works.
Each volunteer will be assigned to a team (kitchen or delivery) and the teams work separately to each other. Each kitchen team will operate on different days, meaning you will only ever work in the kitchen with your team i.e. the same other volunteers and chef. This is to avoid meeting and coming into contact with more people than necessary.
The idea is to ‘airgap’ the process. If one member of a team becomes infected or becomes symptomatic of Covid-19 the other members of the team will have to self-isolate. However the other kitchen teams won’t have had any contact with the infected team so after deep cleaning they can continue working. Delivery teams will operate independently. The bagged meals will then be picked up by a delivery team, without them making contact with people in the kitchen.
6) Delivery protocols.
Below is an outline for our guidelines on how to mitigate risk and maintain hygiene when delivering meals. All volunteers who are involved with any part of the delivery process must familiarise themselves with these steps.
The reason for this is to minimise any transmissions between the delivery team ‘A’ and people in the house ‘B’ and also cross transmissions between house ‘B’ and house ‘C’ where our delivery team ‘A’ acts as the transmitter.
-The most important part of preventing transmission is regular hand washing.
– If gloves are available fresh pair of gloves should only be used while folding down the outer bag, not while handling your phone or the general environment. Sanitise hand both pre and post using gloves.
– Delivery drivers will wear DIY masks (as explained above) when conducting deliveries to limit transmissions.
Summarised guidelines
• All deliveries in two bags outer dirty bag and inner clean bag
• Practice excellent hand hygiene. If you have hand sanitiser, use it regularly.
• Wear a cloth mask or a scarf over your face if you can. It won’t protect you completely from the virus (although it will give some protection) but it will stop you from breathing out water droplets onto the items – depending on availability of mask, they should be prioritised for healthcare workers if there is shortage.
• Fold down the outer bag and leave outside the door, call and wait at least 2m away while the person picks up the items.
• Tell the dispatcher as soon as you’ve completed the delivery.
• Re-perform hand hygiene before next drop off.
Note that these guidelines will be updated as our operations continue. We will post details of those updates or corrections below.
Start the discussion at forum.cooperationbirmingham.org.uk