Episode 27 – COVID-19: Impacts on Commercial Laundries

Welcome to the TRSA podcast. Providing interviews and insights from the linen, uniform, and facility services industry. Most Americans might not realize it, but they benefit at least once per week from the cleanliness and safety of laundered, reusable linens, uniforms, towels, mats and other products provided by various businesses and organizations. TRSA represents the companies that supply, launder, and maintain linens and uniforms. And in this podcast, we will bring the thought leaders of the industry to you.

 

This is Jason Risley, the senior editor of digital and new media at TRSA. And we’re back with another episode of the Linen and Facility Services Podcast sponsored by 6 Disciplines Consulting Services. In last week’s episode, we discussed hygienically clean consulting with Audrey Carmichael, a client coach with 6 disciplines. If you haven’t heard it yet, go back and listen. This week, we’ll tackle another health care topic and one that has been in the news and on a lot of T RSA members’ minds lately, the COVID 19 coronavirus outbreak.

 

Joining us today is doctor Murray Cohen, a retired US Centers For Disease Control and World Health Organization epidemiologist who specializes in occupationally transmitted infectious diseases. Doctor Cohen currently serves as the Chairman of the Frontline Healthcare Worker Safety Foundation. Additionally, Joseph Ricci, the president and CEO of TRSA, joins us to discuss TRSA’s development of materials for its members to communicate to their customers, employees, and leadership teams about COVID 19. 1st, I wanna get us grounded in where we are, and hopefully not in a panic in this pandemic. We still are in the midst of this year’s seasonal influenza epidemic in the United States.

 

Influenza types a and b are actively circulating, and CDC just reported that so far this flu season, there have been 34 1,000,000 cases and 20,000 deaths from flu in the US. So this is the reality compared to all of the news every day about these cases of of COVID 19, which I don’t wanna minimize. I just wanna put in a context. The influenza is a huge mortality, morbidity and mortality burden, and it’s seasonal. And over the next 10 minutes or so, I’ll be explaining why I think COVID 19 also is going to become seasonal.

 

I liken the sense of of risk that people are not necessarily stopping and thinking about with influenza compared to COVID 19 to fatalities from auto wrecks. Every year in this country, we have about 50,000 of those, and people don’t pay much attention unless you’re personally involved or it’s on a local newspaper for one day. But if a commercial airliner goes down and 300 people are killed, it’s in worldwide press for 3 weeks. So it’s just kind of a difference of what is an acceptable risk to the population until you really stop and think about what the risk really means. As of yesterday, there were a 116,000 cases worldwide of COVID 19, and there are a 100 different countries that have laboratory confirmed cases.

 

There’s a 1,000 laboratory confirmed cases so far in the United States. Now there’s a lot of news, particularly from the director general of the World Health Organization about whether or not this is a pandemic. I find that kind of a silly conversation. When you’ve got a new disease, it’s been around for less than 3 months, and it’s in a 100 countries By any definition, that is a pandemic. So that’s what we’re dealing with right now.

 

I wanna talk about how these new pathogens emerge. This particular one is an existing benign animal pathogen that has jumped to humans. We call this zoonoses. It’s the most common way these kind of pathogens emerge. Jump means that they they mutate or they commingle with human animal interactions, particularly human, animal interactions among people who might be immunocompromised, and the virus becomes able to infect human and then is able to be passed from human to human.

 

Other routes of transmission or these, are emergence for these pathogens, these existing benign animal pathogens will commingle and mutate with human pathogens. This is what happened with, swine flu back in 2,009. It’s what happens with, highly pathogenic avian influenza, such as, h one m one. Think of this kind of as a hybridization biology, where the virus is is simply growing together, exchanging genetic material, and forming a new strain or a new virus. This is a normal process of mutation, keeping in mind that viruses undergo about a half a 1000000 generations in the span of 1 human generation.

 

So that’s an awful lot of biological interactions for these changes to occur, and it’s quite normal. Finally, in the normal human biome, we have opportunistic infections, particularly those that have become antibiotic resistant organisms, And they then move from simply being benign organisms living in humans to pathogenic organisms living and spreading human to human. Specifically, in the next slide, we look at what is a coronavirus. And by the way, some of the silliness going on, issue watch stocks. The, sales of corona beer in the United States have plummeted.

 

And, of course, there’s no relationship whatsoever, but that’s a measurement, I think, of the degree of, panic or unreasonableness that, that the public shows. Coronaviruses, when you look at them under an electron microscope, rather than a smooth surface, have spike like proteins. And it looks kinda like a crown, that’s why they’re called coronaviruses. And that family has been around forever, and it’s actually the cause of, quite a few of what we’d call in any given season a common cold, which is very, very common viruses of both the respiratory and gastrointestinal tracts. However, some have, emerged, in this millennium, that have been very, very much more severe.

 

The first was SARS in, 2003, MERS in 2009, and then COVID 19, of course, coming up last year in December. I wanna emphasize, and probably the most important thing I will be saying today is that COVID 19 is the real deal. This is not an overreaction. It is a very real virus, a very real threat. It is, very dangerous.

 

And just to look at some of the case fatality rates by comparison, we’ve talked about influenza and the huge morbidity and mortality burden it has. It has a 0.2% case fatality rate. So it’s pretty much regarded as a minor infection. COVID 19, we don’t have an exact figure yet, but we know that it’s at least 2% or tenfold more fatal than influenza, meaning that that many more people who get infected will die from it. Now compared to these other seriously emerged coronaviruses, SARS had an 11% case fatality rate and up to 50% in some older age groups, and MERS has a 30 to 40% case fatality rate.

 

Very, very, very nasty, nasty viruses. Let’s look at the course of infection with COVID nineteen and why I say it’s it’s, it’s a really nasty virus and the real deal. The first phase is viral replication, maybe asymptomatic. Typically, we have a slightly elevated temperature or what might be called a low grade fever as a leading indicator. Other symptoms are a dry cough, no runny nose.

 

If you have a productive cough and a runny nose and you’ve got a cold, COVID 19 is dry and no runny nose. It’s almost always a sore throat because the infection first takes hold in the throat. Very important for those who have been exposed to hydrate very well, particularly warm liquids, sipping hot liquids. And if throat sore, saltwater gargle pretty routinely, and you can, fight it off. The more serious phases are, an autoimmune response, an immune system hyperreactivity.

 

This is where the immune system is so reactive that it’s not only going after the viruses, but also attacking normal cells, particularly in the lungs, which causes, pulmonary destruction often called the honeycomb effect because of how it looks on an x-ray. And then finally, respiratory failure. Very, very, very unpleasant, disease. Next slide is gonna be very helpful in understanding most of the control strategies that we need for COVID 19. The first one that the droplet spread is the only way that we absolutely know that this virus is transmitted.

 

That means when an infected person coughs or sneezes, the droplets that are produced, contain a lot of virus. That’s how the virus gets out and can be available to infect another person. On metal and on hard surfaces, these droplets, can survive for more than 12 hours. On porous surfaces such as textiles, they survive up to 6 hours. It’s important to realize that in, although it’s a nasty bug in a in a patient, outside of a patient, it’s a it’s a pussycat.

 

This is a very, very fragile virus. It dries out very quickly. That’s how it dies on surfaces or even dies out in the air. Just about anything will kill it. Soap and water, sunlight, any of the kinds of sanitation products that you use, you don’t need to go get anything in particular to be cleaning up after this virus.

 

The second route of transmission is aerosol, and this is how influenza is transmitted. This is the droplets that are sneezed or coughed out are so tiny that they float in the air for hours and can disperse throughout a room before they land on surfaces and, in fact, can be inhaled, get past the normal human body immune systems, you know, in the nose and the throat and go right into the lung. Although there have been some confirmed cases of aerosol transmission and a lot of research on that with COVID 19, it’s it’s not as common as the droplet. I wanna point out that the other two routes of exposure typical for viruses are fecal oral routes, such as what happens with, norovirus and, blood borne routes, such as happens with hepatitis and HIV. What’s interesting to me is that we have been able to confirm in laboratory samples of patients both presence of COVID 19 in stool samples and in blood samples.

 

I am not aware of any confirmation of transmission by these routes. But the fact that the virus is present indicates that it very well may be transmitted that way. And I think that the fact that it might be transmitted by every possible pathway and that it has a pretty long latency period of 14 days may explain why there’s such a high communicability for COVID 19, why there’s so many people, who are getting it. We see an awful lot of silliness about wearing masks. What’s important for all of you in your workplaces, you are the same as a hospital as far as protection of your workers against the virus is concerned.

 

You need to use an m 95 mask on those who might be exposed. That’s the only thing that will protect the workers themselves. Use of surgical masks is what goes on a patient who’s infected so that as they sneeze or cough, the droplets don’t escape very much past, you know, the face. By the way, I neglected to mention when I was talking about the droplet transmission. Theoretically, these droplets can travel about 2 meters before they, you know, either dry out or fall to a surface.

 

Practical reality is they really only go about 3 meters or 3 feet excuse me, 1 meter. It’s it’s kinda like wet soggy raisins compared to all of the other particulate floating around in the air. So they they cough out, and then just fall to a surface. This is what’s going to be a real concern to your customers. And that’s what we’ve learned from the other major outbreaks of coronavirus.

 

Although hospitals are where they these these epidemics have been amplified. For SARS and MERS, in fact, it was hospital exposures that were the were essentially the outbreak. They really didn’t get out into communities. We already know we’ve missed that chance of containment with COVID 19, and so it is out in communities. But your customers are gonna be very concerned about keeping the virus out of their facility period.

 

And as I mentioned on your textiles, you’ve got to look at what textiles that might be exposed in the hospital versus how they might be exposed in transit from your facilities to the hospitals. This is actually a pretty important slide, and to try to say in English. Those circles represent 5 super spreaders. This is data from the SARS epidemic in, 2003. Pretty much every one of the cases worldwide was caused by spread from 5 index cases.

 

So we call them super spreaders. And each one of these dots is another patient who was found through contract contact tracing to be exposed directly to someone who had the virus from laboratory exposures or hospital exposures. So the first the first circle there was what happened in Singapore. The next 2 were in Hong Kong, and the 2 after that were in Canada. And for a variety of reasons, we contained SARS just in in those countries.

 

We had a few cases in the US, but it was pretty minor. And then the next slide is an important concept. These, again, are data from the SARS 2003 outbreak. We know that people with subacute fever can shed virus. It’s a big controversy.

 

I know that, we’ve seen a lot of the public health experts on national TV sort of giving different stories about this. But but we know that people who do not have overt signs of infection can indeed be spreading the virus. Usually, they have a subacute fever, not a fever that’s making them feel sick, or otherwise impede their, their daily life. But their immune system is starting to fight off the virus, and they are shedding. This is probably the most important factor over the next 4 to 6 weeks of how the epidemic is likely to spread in the United States.

 

It will be people who, besides those who are infected, not quarantining, but many of those don’t even know they’re infected and are just going to be out exposing lots and lots of of people. Now for a brief message I’m here today with Audrey Carmichael from 6 Disciplines Consulting Services. Audrey, can you give us a little bit of background about yourself? Sure, Jason. Thanks.

 

So I work with 6 Disciplines Consulting Services, and I’ve been involved in the laundry industry for about 2 years. Prior to joining 6 disciplines, I was the director of quality assurance and a continuous improvement manager for a large energy company. So I bring to HC Consulting my experience and and my background from doing auditing and in a quality control perspective. Other work that I do with 6 disciplines includes our strategic planning and execution process and lean and 6 Sigma training. And let’s dive into your hygienically clean consulting services.

 

Where can TRSA members go to learn more about this and sign up? As you know, more and more textile customers want hygienically clean certification from their laundries. The process for getting certified is very straightforward. You go to the t r s a web site and download an application. After you submit the application and the fee and you’re ready for an inspection, you contact TRSA to schedule 1.

 

But how do you know if you’re ready for an inspection? 1st, you have to have a deep understanding of the requirements. TRSA has 4 hygienically clean certifications, food safety, food service, health care, and hospitality. Each of these has its own standard, which lays out the requirements for obtaining certification. Those are on the TRSA website too.

 

You download those and make sure your program complies to the appropriate standard. At the inspection, the inspector will visit your site, conduct a thorough walk through, a review of your QA manual, and your records. Then they collect a sample of your product for bacteriological testing. If your QA manual and walk through show you’re in compliance with the standard and your back bacteriological test is good, you qualify for certification. How does hygienically clean consulting fit into the process?

 

What we do at 6 disciplines is give laundry operators a third party objective assessment of their facility and their readiness to apply for certification. It’s a low risk way to see if you’re ready to schedule an inspection and understand if you have more work to do. We’ve designed our 6 disciplines, HC consulting and coaching service to work with the facilities from the early stages of their planning through to their application and inspection. Our commitment is to meet your organization where you are and help navigate It’s a It’s a multistep process. 1st, we’ll take the standard and verify that the operation has a policy and a procedure to address each of the requirements exactly.

 

These all need to be up to date and all compiled directly in a quality assurance manual. That’s the first step. Then we’ll look for evidence that the procedures are being followed. This can be through reviewing records that have been kept or by verifying compliance physically, sometimes both. I’ll give you an example.

 

This standard will require a pest control plan. I’ll look in the QA manual to be sure there’s a policy around pest control, and I’ll look for a procedure for how they go about it. For example, how did they choose their pest control contractor? How often do they treat for pests? How do they handle the situation if a rodent is seen in the plant and so on?

 

Then I’ll look for evidence they’re complying with their own procedure. I’ll check for a contract with the pest control company and invoices to prove they’ve done the work as often as the procedure calls for. Out on the plant, I’ll look for traps or strips that show they’re following their own procedure in their pest control company’s program. During the review, I’ll make notes of any gaps in the program. Are they missing a procedure?

 

Do they have records that are required, and are they located where they can be easily shown to an inspector? This way, by the time they schedule their inspection, they have everything complete and in order, ready to go. But if they have gaps in their program and need some help, 6 disciplines can work with them to prepare for their certification too. We offer multiple levels of service to help guide and coach. And what are the level of services that you provide?

 

This is where I think we clearly differentiate ourselves. We’re there every step of the way if you want us to be. 6 Disciplines has worked with TRSA to lay out three levels of service for hygienically clean consulting and coaching. The first level is a pre audit consultation and report. We conduct this as a mock interview at your site.

 

We review your QA manual, perform a walk through of the facility, and review your records. We provide a report with actions we recommend you take prior to scheduling your inspection. This is to give you some peace of mind that you’re ready or that you need to look more closely at some areas. The second level is a higher level of service. We review your existing SOPs and help develop additional ones so that your QA manual complies with the standard.

 

This level also includes a mock audit and report. The 3rd level could be described as a turnkey service. We work with your team and create your QA program and manual, including forms, records, checklists, pretty much everything you need to have in place. This service also includes a final mock audit and walk through of your facility. We’re there to help because the reality is your team’s probably focused on running the business.

 

Bringing us in short term can help you achieve the goal of getting certified sooner rather than later. Also, if you need more help, we can work with you on activities like training your staff, project managing your tasks, and so on. We’re committed to helping you however you need. Can’t TRSA member organizations do this on their own? Sure.

 

Some organizations can and have gotten certified on their own, but others would like to have some guidance along the way in help putting the program together. 6 disciplines offers our service as a low risk way to check on the readiness for inspection or even as a turnkey solution. It all depends on where they’re starting from, but it does take time and resources, and it can be a big endeavor on their own. I say everyone comes to this differently, so we’ll meet you where you are, and we’ll help navigate it together. The truth is all organizations have competing priorities and are managing different things.

 

So while certification may be very important to your strategic plan, your available resources may not allow you to complete it in the time frame you want. Our consulting for HC can provide focus and momentum and even some of the heavy lifting. Now back to the episode. TRC put out, an email last week with a series of resources that we put together. We put those resources together in conjunction with the European Textile Services Association, ETSA, whose members represent about 10 countries in Europe.

 

We participated in teleconference and sharing of information with those countries to gather what they were doing and compare it to what we’re hearing here in the United States from the standpoint of, you know, hearing from the CDC and the and the World Health Organization, etcetera. So we, developed 3 different sets of resources. The first resource, is for internal operations. So it highlights issues that deal with operational aspects of your business, dealing with managers, supervisors, making sure you’re protected, giving you updates from the w h o and other organizations. And I think it’s very useful for you to distribute to your management team supervisors, your senior management team within your organization.

 

This is information for your employees. We have this in English and in Spanish. These are things that we developed, also things that were developed by the CDC. There are printable posters and handouts and again they’re in both English and Spanish. I would encourage you to download those and hand those out to your staff to help with the educational process.

 

We will keep those updated if things change. They’re pretty standard straightforward documents, focusing again on hand washing and spread of germs and how they spread and, those types of, that type of information, which you’ve seen and heard a lot about, from Catalina and from Murray and from Todd. So, we developed these resources so that if you don’t have your own, you can just simply use ours, to communicate with your employees. We also developed resources that you can share with your customers. This information talks about the education and training and information sharing we do from a TRC standpoint and, you can this is information you could print out and share with your customers or give you use as talking points within your customer service or management team when they’re talking to customers.

 

I encourage you again to to go and download these. These, you will need, your TRSA username and password, in order to, access these materials. It’s really easy to do. Just go to the website, myTRSA, and it will walk you through the process of making sure you’ve got your username and password. You can access the materials that TRSA president and CEO Joseph Ricci mentioned by visiting www.

 

Trsa.org/covid19. Again, that’s www.trsa.org/ covid19. Today’s episode of the podcast featured excerpts from a recent webinar titled coronavirus /covid 19, Communication Tools for Your Customers, Employees, and Leadership Teams. If you want to hear the full broadcast, which also featured information from Catalina Dongo, the director of human resources at UniFirst Corporation, and Todd Logsdon, a partner in the Louisville office at Fisher and Phillips LLP, visit TRSA’s on demand learning center at www.trsa.org/ondemand.TRSA will also rebroadcast the webinar several times over the next couple of weeks. Visit www.trsa.org/calendar to view the exact dates and times.

 

Finally, if you’d like a copy of the slides from the recent webinar, email podcast attrsa.org, and we’ll send you a copy. Thanks again to our sponsor, 6 Disciplines Consulting Services. And as always, make sure you subscribe, rate, and review our show on iTunes, Google Play, and Stitcher. Additionally, follow TRSA on Facebook attrsaorg, on Twitter attrsa, on LinkedIn at Textile Rental Services Association of America, and on Instagram at trsaorg.