Australia and the world must proceed cautiously with COVID-19
One of these diametrically opposite statements is correct. Which one is it?
A) Freezing is a common method to kill and inactivate viruses, and typically the faster and deeper the freeze the more effective the treatment. OR
B) Freezing is a common method to store and maintain infectivity of viruses, and typically the faster and deeper the freeze the more effective the treatment
To this point I have written a total of 17 posts on the COVID-19 pandemic since 3 February 2020 at MacroEdgo, sent an open letter to PM Morrison, initiated a petition “Je Suis Chinois” to express solidarity with humanity in the pandemic, as well as updated my Coronavirus (COVID-19) Update daily until recently when I shifted to periodical updates.
In my first papers I stated clearly that the coronavirus had certainly escaped the biosecurity net that had been formed around Wuhan, and that the World Health Organisation (WHO) and other officials were engaged in a strategy to slow the spread.
I began referring to the event as a pandemic much earlier than any nation began to do so, and I discussed the political realities that surrounded the management of the pandemic in a modern globalised economy in several posts in mid February.
In these papers I said that I had a great deal of respect for the way that China, and the WHO for that matter, had responded to the pandemic, and with my experience in biosecurity policy development I expected that all nations would struggle with balancing the need to acknowledge the problem to react appropriately to it against the multitude of geopolitical and economic consequences of doing so. That has certainly played out in line with my commentary.
I also spoke about how countries with greater inequality, with large numbers of poor people who do not have resources to go without regular income, and countries where Government has greater influence over citizens and are able to coerce people into returning to work even while the risk of contracting the virus persists, would be impacted more severely even if the data may not be indicative.
The place where my analysis faltered was in the reaction of the Anglophone countries. In my update of 11 February I stated all of the biosecurity measures that have now been enacted would have then been under consideration. I think it is clear that while the medical and scientific experts would have been discussing these, their political masters, the actual decision-makers, were a long way from having come to terms with the challenge that was confronting humanity.
Certainly this is what the WHO is now pointing out in response to criticism by the loudest Anglophone political decision-maker who is seeking to shift blame for his own intransigence towards the COVID-19 threat.
The world should have listened to the WHO then carefully because global emergency, the highest level of emergency, was triggered on January 30 when we only had 82 cases and no deaths, in the rest of the world. And every country could have triggered all of its public health measures possible. I think that suffices the importance of listening to the WHO advice. And we advised the whole world to implement a comprehensive public health approach. And we said find, test, isolate and do contact tracing and so on… countries who followed that are in a better position than others, and this is fact… I assure you that WHO gives the best advice we can based on science and evidence, it is up to the countries to accept or reject [that advice]… each country takes it’s own responsibility [for their decisions based on that advice]
Dr Tedros, Director-General, WHO
As these (especially Anglophone) decision-makers faltered, I increased my urging to take action in posts written in mid-February and in my open letter to PM Scott Morrison.
I have always made it clear that my view is that we in Australia should use our geographical advantage in being an island and with considerable biosecurity human capital and infrastructure to aim at knocking it right back and eradicating COVID-19 if at all possible.
I also have consistently stated that this is a very new pathogen of humans known to mankind for only a handful of months since my friend and former colleague (and co-author) Dr Shi Zhengli isolated the causative coronavirus.
Consequently I have argued that we should be very careful of drawing any presumptions and that we should proceed with an abundance of caution.
For instance, I have continually highlighted that we do not understand the seasonality – if any – for this disease, noting that Australia and other southern hemisphere countries will be the first to experience a full winter with COVID-19 hanging over us.
I have also consistently stated that it would be imprudent to believe that already we understand all of the ways that this pathogen can affect and cause disease in us humans, and in recent days there have been reports of persistent infections in Chinese patients of unknown significance, of uncertain implications of infections in pregnant women, and of an association between COVID-19 and severe complications in children now being recognised globally after early observations suggested that children almost never suffered serious disease.
I have stated that I am flummoxed by the apparent predisposition of many Australian decision-makers and, especially in the early period, some medical or scientific bureaucrats and experts, to show such strong concern for economic considerations above health considerations.
From my earliest writings I acknowledged that it was a difficult balance to strike, but I have been scathing of the balance chosen by Australian decision-makers at times.
Moreover, while it is clear from the reported data that Australia has been far less impacted than many other G20 nations to this point, I have expressed deep concerns that this might produce an unearned sense of achievement when in fact that lower impact thus far may be more due to factors beyond our control which may reverse, for instance, as we head into winter.
After that recap, which readers can verify by reading my earlier reports, I would hope that it can be agreed that I have earned the right to not just express an opinion, but have it heard, on where Australia should head into the future with the COVID-19 pandemic.
First an outline of the significance of the persistence and viability of SARS-CoV-2, the virus that causes COVID-19, in certain environmental conditions.
While the lay person, who often confuses virus for bacteria, and infectious for non-infectious disease, might have been inclined to believe that the correct answer to my introductory question was A, the correct answer is B. Moreover, while ideal storage of viruses is achieved in facilities only available in laboratories – under liquid nitrogen or in ultra-deep freezers (set at -70 Celsius) – infectivity is preserved in tissue frozen in a domestic freezer and I have certainly done transmission trials with viruses held under such conditions for many months. What is more, viruses can remain infective in material held in domestic refrigerators for a prolonged period.
What is the significance of this you might ask.
Well as I have been pointing out there is a lot unknown about SARS-CoV-2 and COVID-19, and while it might be easy to sideline certain comments with blanket statements that “there is no evidence of” in relation to multitude of issues, the reality is that a general knowledge of viruses points to certain risks that need to be heeded.
While there is some emerging data on the persistence of SARS-CoV-2 when subjected to different environmental conditions of temperature, humidity and UV light, with the main aim of determining what is the likely impact of seasonal change on the ease with which the virus spreads, we already know from a general knowledge of viruses, and indeed other human coronaviruses, that it is likely to remain infective longer under cooler conditions and in the absence of UV light.
In the appendix below I have summarised the relevant data on similar viruses and what has been determined thus far for SARS-CoV-2 together with sources. Here I do not want to bog down on technical detail.
The significance, however, for me is for more widespread than seasonality and critically relates to what has been observed in the meat processing industry in North America.
As at writing, 13 major meat processing plants in the US have been closed due to COVID-19 outbreaks amongst staff, including 10% of beef processing and 25% of pork processing capacity, and Canadian plants are similarly affected. In a full page advertisement in several newspapers including The New York Times and The Washing Post on Sunday 26 April Tyson Foods Chairman John Tyson alerted Americans that “The food supply chain is breaking”.
These processing plants are closing due to deaths of workers with COVID-19 and high infection rates amongst employees. Moreover, over 100 meat inspectors, of a US total of 6,500, have been infected with the virus and their movement between different processing plants is a major concern for the industry as potential spreaders of the disease.
The issue being discussed publicly relates to the inability to process meat because of the difficulty of providing a safe environment for those working in the industry when conditions favour the spread of the virus between workers as they work very closely together in processing lines and because they are a tight-knit community often carpooling and socialising outside of work. In most countries over recent years the workforce of meat workers has become heavily dependent on temporary resident workers on visas.
This quote from an article in USA Today highlights the concerns thoroughly:
More than 150 of America’s largest meat processing plants operate in counties where the rate of coronavirus infection is already among the nation’s highest, based on the media outlets’ analysis of slaughterhouse locations and county-level COVID-19 infection rates.
These facilities represent more than 1 in 3 of the nation’s biggest beef, pork and poultry processing plants. Rates of infection around these plants are higher than those of 75% of other U.S. counties, the analysis found.
And while experts say the industry has thus far maintained sufficient production despite infections in at least 2,200 workers at 48 plants, there are fears that the number of cases could continue to rise and that meatpacking plants will become the next disaster zones.
Initially our concern was long-term care facilities,” said Gary Anthone, Nebraska’s chief medical officer, in a Facebook Live video Sunday. “If there’s one thing that might keep me up at night, it’s the meat processing plants and the manufacturing plants.”
Less discussed, for reasons that will become clear below, is that the meat processing plant environment is ideal for the survival of the virus on surfaces because it is cool and moist, and there is obviously little to no sunlight with natural UV radiation.
Relevant unions are heavily involved to safeguard the health of the workers. The CDC together with Occupational Safety and Health Administration (OSHA) has produced interim guidelines to help meat and poultry workers and employers reduce the spread of COVID-19 amongst the workforce.
While I absolutely share those concerns for the workers, there is an even more significant and widespread issue at play here that some readers may have begun to realise.
The significance of food-borne viruses in causing disease in humans has been increasingly understood in recent decades. The relevance of microbial assessments in determining the risks associated with imported animal and plant products has thus grown in significance, and has highlighted the need for research analyses.
Viruses have proven to be some of the most important pathogens to manage due to their infective persistence in food processing environments and because of their potential to cause severe disease.
In my post “Investment Theme: Product and Food Miles” I highlighted how the food production industry had changed significantly since the time of my Grandparents, who survived the 1918 Spanish flu pandemic as late teenagers. Not only is perishable food distributed regionally, unlike then when the lack of refrigeration necessitated its consumption immediately and thus locally, perishable food under refrigeration is traded both nationally and internationally.
This opens up the possibility of transmission of pathogens that remain viable in cool conditions, and viruses are chief amongst these, over wide geographies and wide temporal ranges given that viruses present in frozen material may remain a risk for a very prolonged period.
The WHO was quick to recognise this potential with COVID-19 and in its Situation Report No 32 published on 22 February included a section entitled “SUBJECT IN FOCUS: Food related considerations” which contained the following statement:
Currently, there are investigations conducted to evaluate the viability and survival time of SARS-CoV-2. In general, coronaviruses are very stable in a frozen state according to studies of other coronaviruses, which have shown survival for up to two years at -20°C.
Below in the appendix I provide an up to date review of the relevant data.
To cut to the chase, unless I was extremely confident in risk mitigation strategies to prevent workers infected by COVID-19 from coming into contact with product in the processing chain, I personally would be very reluctant to purchase packaged meat in Australia if COVID-19 became widespread.
While it is absolutely true that cooking for even a brief period is highly likely to totally inactivate the virus, as the domestic cook for my family, I realise that it is difficult to limit the spread of blood and general fluids from meat and its packaging during food preparation, and the potential for contamination is significant.
My family biosecurity strategy for COVID-19 aims to physically prevent the introduction of the viable (infective) virus into our home and at the point that COVID-19 became widely prevalent in sources of perishable food products which I source for my family would be the point at which I would cease to purchase those products. (I am fortunate to have a fruit and vegetable garden, and I have planted a community garden on the verge and would encourage all Australians to do likewise.)
I would hope that right now there will be research being conducted on nucleic acid and infectivity detection for SARS-CoV-2 in meat from plants where there have been confirmed COVID-19 cases. However, given the extreme sensitivity around the issue of the public’s perception of food safety, this issue will be treated with the utmost of discretion.
All of this just makes the case for why I have been pushing so hard to minimise the number of infections by SARS-CoV-2 within Australia with a strong preference to eradication.
Given all of the uncertainties around this new human pathogen, and given we in Australia have experienced a relatively low expression of COVID-19 thus far which suggests that eradication might be a real possibility, loosening of biosecurity measures at this point in mid-Autumn seems to me to be highly imprudent and suggestive of at least a hint of political hubris.
A far more prudent approach would be to continue with very strict biosecurity measures and increased testing, firstly of all those with symptoms of respiratory infections and then as and if capacity allows, all people (prioritising those who have been, through work requirements, more active in the community), to detect any and all cases so that eradication can be achieved.
This will allow us by the depths of winter to have a very good understanding on whether we really have gotten on top of the virus.
On the other hand, a loosening of measures invites the virus to get away from us just as we enter the most critical period for the southern hemisphere. That would be an enormous error, one that the electorate is unlikely to forgive decision-makers for given that there remains reasonably strong support for the social distancing measures currently in place.
Allowing COVID-19 to surge in winter would entail loss and impacts on Australian families that have been experinced in the United Kingdom, United States and elsewhere which to this point has not been the common experience, and that would produce deep psychological scarring which would persist far longer than a few more months with these social distancing measures.
In my earliest writing on COVID-19 I continued to develop my views on the theme of global inequality, that I had been discussing in relation to climate change, in the context of the emerging pandemic. It is already noticeable in this pandemic that it is the most vulnerable amongst humanity where the virus is spreading most prolifically. Rapid spread amongst lower paid migrant workers who live in low quality, cramped quarters is a theme that has played out around the world from China to Singapore to North America.
Moreover, wealth inequality between continents and nations, and within societies, has been exposed as a major differentiator and factor in COVID-19 spread and impact.
Again, and to borrow the words of FDR, we have learned that we can not live alone in good health if we are not equally concerned about the good health of all people in all societies including those of nations far away. We must not live as dogs in a manger, but as members of the human community.
Not only must Australia meet the challenge that COVID-19 presents within our own borders, we must act as a member of the global community and join with humanity to earn our luminous future (the theme of my next post in draft).
I also note the following statement in an article published in The Guardian entitled “Trump to order meat-processing plants to continue operating amid pandemic“:
“We only wish that this administration cared as much about the lives of working people as it does about meat, pork and poultry products,”
Stuart Appelbaum, president of the Retail, Wholesale and Department Store Union, told Bloomberg.
That is a very clear-cut echo of my writing from 28 February in this post entitled “Australian Politicians Care More About the Health of Our Prawns and Bananas Than About People” and I thank Mr Appelbaum for the sincere compliment.
Any objective reader of my posts and work knows that I have been extremely accurate and prescient with my views on the progression of the COVID-19 pandemic and its economic and societal implications.
I do not profess for a moment that my published views captured the full spectrum of consequences and implications. However, I do feel that is not immodest to suggest that I have been one of the most accurate of those who have made public their views on the pandemic since very early in its progression.
My arguments for Australia to move early to close the borders and then eradicate COVID-19 were purely from a humanitarian position of wanting to minimise the pain of loss that humanity would experience. However, as time has progressed, as the world has gone into shutdown and the economic consequences which I foresaw have come to pass, it has also become clear that it would have been better economically for Australia if decision-makers had enacted my recommendations when I was calling for them.
Instead of dithering for an extra few weeks, if these measures were implemented immediately we would have a much more functional domestic economy by now which would remain the case for as long as we were able to prevent the re-introduction of the disease.
In this new report I have highlighted newly recognised threats that have surfaced because of the spread of the disease in countries that failed to heed the advice provided by the WHO.
What should also be clear now to the objective observer is that when all efforts are focused on the humanitarian side – that our aim is to minimise the pain of loss to human beings – then the cohesion that that creates places us all in the best possible position to fight against this scourge which we all want to defeat as soon as is humanly possible. The outcomes that result from that patience and compassion also brings economic benefits.
APPENDIX – Scientific data on viability to assess the risk associated with SARS-CoV-2 presence in chilled and frozen foods
While there have been no confirmed reports of transmission of SARS-CoV-2 from food preparation, and the commercial sensitivity around food safety means that many reports on the subject will go to lengths to suggest that it is unlikely, this can not be discounted if viable virus is present.
In this case, “the lack of evidence” line is weak. Virtually every pathogen/microbial risk analysis that has ever been conducted could contain just this one line.
Vast numbers of pathogen and phytopathogen risk analyses use the issue of viable pathogen present and a potential pathway for exposure to recommend strong risk mitigation strategies, eg. cooking of all imported prawns into Australia unless from an area proven by credible surveys to be free from significant pathogens or PCR analysis conducted on each shipment to prove freedom from significant pathogens.
That might seem a ridiculous segue, but that is the ridiculous disparity that we confront as I have pointed to previously and which the union representing meat workers in the US has picked up on themselves.
I have no intention here to carry out a full risk analysis, but what follows is in effect a very brief one. To prove that there is significant concern I need to satisfy to a reasonable degree three points:
1) there needs to be a likelihood that viable pathogen may be present in product;
2) there needs to be a pathway for exposure to that pathogen; and
3) there needs to be a significant impact from that disease.
I think that we can agree that the third condition has been amply satisfied to this point on 1 May 2020 with over 3,000,000 cases confirmed globally and over 200,000 deaths.
While some would suggest that being a respiratory virus that lessens the chance of exposure. But not really. Anybody who has been involved with food preparation knows well that cleaning up after food processing involves lots of splashing (opportunity for aerosol production). Moreover, many respiratory viruses have a high involvement of touch and self-inoculation via membrane surfaces in the mouth, nose and eyes, and there is no doubt that there is ample opportunity for this to occur with those involved with food preparation and those that co-inhabit using those preparatory areas and wash facilities.
Furthermore, while cooking is likely to destroy most viruses, there is variability amongst viruses in sensitivity to heat, and in modern times there are significant dishes that utilise minimal or no heat and some with minimal addition of acids or other ingredients that might otherwise be likely to inactivate viruses.
I would suggest that this represents about as strong a case for a viable pathway for exposure to a pathogen that is present in a product as in virtually any product risk analysis. So I would suggest that condition 2 has been met.
So we are left with pathogen viability. As I have continually stated we are dealing with a pathogen known to mankind for all of 4 months, so understandably there is a paucity of research data on many aspects. However, given the important issue of potential seasonality there is some information on viability of SARS-CoV-2 in different environments, some of which are relevant to food production, storage and usage. Moreover, given the prior outbreaks of significant disease in humans by other coronaviruses, there is some information on other similar viruses which will be highly indicative for SARS-CoV-2.
Whether a pathogen will be viable in a product is dependent on whether it is likely that viable pathogen will be present at the completion of processing and then whether it will survive the storage period before it is prepared for consumption.
Here are a few important quotes from the WHO/FAO “Viruses in Food” report:
This report draws attention to the threat of viruses as a risk to public health when they are present in food. Viruses require special attention because they behave differently from bacteria, and because currently used control measures typically either have not been validated and there is not a good understanding of their efficacy towards viruses, or are not effective in controlling virus contamination. Data from recent studies have shown that foodborne viral infections are very common in many parts of the world despite the measures already in place to reduce bacterial contamination.
Member states of the WHO were quick to note their concern for the risk of spreading COVID-19 with food and WHO Situation Report 32 on 22 February stated:
WHO continues to collaborate with experts, Member States and other partners to identify gaps and research priorities for the control of COVID-19, and provide advice to countries and individuals on prevention measures. National food safety authorities have been following this event with the International Food Safety Authorities Network (INFOSAN) Secretariat to seek more information on the potential for persistence of the virus on foods traded internationally and the potential role of food in the transmission of the virus. Experiences from previous outbreaks of related coronaviruses, such as the Severe Acute Respiratory Syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV) show that transmission through food consumption did not occur. To date, there have not been any reports of transmission of SARS-CoV-2 virus through food. However, concerns were expressed about the potential for these viruses to persist on raw foods of animal origin.
Currently, there are investigations conducted to evaluate the viability and survival time of SARS-CoV-2. In general, coronaviruses are very stable in a frozen state according to studies of other coronaviruses, which have shown survival for up to two years at -20°C. Studies conducted on SARS-CoV ad MERS-CoV indicate that these viruses can persist on different surfaces for up to a few days depending on a combination of parameters such as temperature, humidity and light. For example, at refrigeration temperature (4°C), MERS-CoV can remain viable for up to 72 hours. Current evidence on other coronavirus strains shows that while coronaviruses appear to be stable at low and freezing temperatures for a certain period, food hygiene and good food safety practices can prevent their transmission through food. Specifically, coronaviruses are thermolabile, which means that they are susceptible to normal cooking temperatures (70°C). Therefore, as a general rule, the consumption of raw or undercooked animal products should be avoided. Raw meat, raw milk or raw animal organs should be handled with care to avoid cross-contamination with uncooked foods.
Most additional research results released since this time have concentrated on ambient – i.e. normal human living conditions – to assess seasonality.
Importantly, in their experimental conditions Chin et al. 2020 found that SARS-CoV-2 infectivity was largely preserved when exposed to +4 Celsius for 14 days.
Given that COVID-19 has been shown to be highly prevalent in meat processing workers, and the data on coronavirus and specifically SARS-CoV-2 survival in conditions present in meat processing and storage facilities, the potential for a pathway for exposure to infective virus is clear.
Clearly this warrants urgent scientific research to fully determine the risks of the foodborne route for transmission.
Sources
Casanova LM, Jeon S, Rutala WA, Weber DJ and MD Sobsey. 2010. Effect of air temperature and relative humidity on coronavirus survival on surfaces. Appl Environ Microbiol. 76(9): 2712–2717. doi: 10.1128/AEM.02291-09
Chan KH, Malik Peiris JS, Lam Y, Poon LLM, Yuen KY and WH Seto. 2011. The effects of temperature and relative humidity on the viability of the SARS coronavirus. Advances in Virology. Article ID 734690. 7 pages. https://doi.org/10.1155/2011/734690
Chin AWH, Chu JTS, Perera MRA, Hui KPY, Yen H-L, Chan MCW, Peiris M and LLM Poon. 2020. Stability of SARS-CoV-2 in different environmental conditions. Lancet Microbe 2020. https://doi.org/10.1016/ S2666-5247(20)30003-3
van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BM et al. 2020. Aerosol and surface stability of SARSCoV-2 as compared with SARS-CoV-1. N Engl J Med 2020; published online March 17. DOI:10·1056/NEJMc2004973.
FAO/WHO [Food and Agriculture Organization of the United Nations/World Health Organization]. 2008. Viruses in food: Scientific Advice to Support Risk Management Activities: Meeting Report. Microbiological Risk Assessment Series No. 13. Rome. 79 pp.
National Academies of Sciences, Engineering, and Medicine 2020. Rapid Expert Consultation on SARS-CoV-2 Survival in Relation to Temperature and Humidity and Potential for Seasonality for the COVID-19 Pandemic (April 7, 2020). Washington, DC: The National Academies Press. https://doi.org/10.17226/25771.
WHO. 2020. Coronavirus disease 2019 (COVID-19) Situation Report – 32. February 22, 2020.
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