Depends how you define ‘come into contact’. I think drivers will have to pick up from kitchen crew in some capacity. Kitchen crew can dish up the food into cartons and put into bags but then drivers will have to pick them up whilst still hot ideally. Could leave them in the main bit of the cafe having just been warmed up but there will be some waiting inevitably and they’ll need to put them in cool bags etc and double bag them.
Depends how you define ‘come into contact’.
Be within four metres of them.
drop off
I’ve had a look over different protocols. Which will be linked at the end of this. One form a mutual aid group in London (where I know one of the people involved has a background in healthcare) and one by Queercare. The where both very good and where in broad agreement the London one being easier to follow and the Queercare one being more in depth. I recommend that we use the London based one with Queercare being used as a reference point for further guidance.
The protocol is as follows (with some adaptions) -
• Practice excellent hand hygiene. If you have has hopping shopping and 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.
• Double bag the food and leave only the inner bag outside the door, then ring the doorbell 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.
https://drive.google.com/file/d/13Rqb-nNY_RPNY5UBvnD7jhFoDnhmLsjV/view?usp=sharing
Gloves
The subject of gloves is a difficult one. With people having very strong feelings either. It’s important understand that there are two types nitrile of gloves sterile gloves and non-sterile gloves. In healthcare setting unless the person providing care has a cut or other potential source of infection on their hand the non-sterile gloves only act of to protect the provider not the receiver of care, under normal circumstances that’s done by good hand hygiene or if the person/procedure being done is high risk sterile gloves. We only have accesses to non-sterile gloves.
So what’s the best use of these resources, the Queercare guidelines do suggest the use of gloves if available but they not a substitute for the good hand hygiene we should all be doing anyway. Which they currently are as the kitchen already has some, they will run out fast used this way and there is already a chronic shortage of gloves both sterile and non-sterile in the NHS. Based one the fact they are nonessential for safe drop off and the current shortage I would recommend that this group and other mutual aid groups rather then using any unopened packs of gloves contacts local NHS trust and offer them as a donation first, even if you just a have a few pack. While continuing to make sure everyone is preforming good hand hygiene which plays a larger role in preventing infection. When it’s clear that shortages in healthcare systems have been resolved or when gloves have been offered and rejected by trusts this could be reconsidered.
on the use of gloves in healthcare - https://www.who.int/gpsc/5may/Glove_Use_Information_Leaflet.pdf
on shortages - Unexpected demand fuels glove supply problems for NHS | Nursing Times
NHS doctors beg Boris for equipment to protect them from coronavirus | Metro News
I’ve come around to the use of gloves for delivery because I have doubts about our abilities to do proper handwashing in the field. Perhaps if alcohol based hand rub was available but I don’t know what the current situation is.
The bit about sterile and non-sterile is helpful, and I think people in some other groups don’t really understand this. I think of sterile gloves as a clean hand you can put on and non-sterile gloves as a dirty hand you can take off. So it’s a question of insulating one environment from another.
In our context only the latter case is useful. You can put on gloves for each delivery when out of the car and dispose them before getting back in. This provides a degree of inbound insulation between the risk of a recipient’s house and the rest of the operation. We have a few hundred pairs of non-sterile gloves. Last I knew they were easier to get than ABHR. They’re also less acutely needed in healthcare because in a fixed site operation (kitchen, hospital, shop), this role is better served by handwashing. Sterile gloves are a different matter, no use to us and important in healthcare.
The outbound insulation between the operation and recipients (ie we don’t want an ill but asymptomatic chef or driver to infect a recipient) is provided by a) food safety, b) siloing/distancing of volunteers and c) recipient practice ie. disposing of packaging before reheating. It’s c which is the biggest point of failure IMO so the behaviour needs to be reinforced with an instructional flyer and a reminder on the phone.
We are perfectly justified to be antagonised by and critical of the wasteful magical thinking application of gloves as a sort of health amulet, which only undermines proper safety practice and gives a dangerous false sense of security. It really gets my goat to be honest.
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Very true and while in a ideal world we’d have both sterile and non-sterile gloves to augment or hand washing both are in dire need within healthcare systems where unlike here they are vital. Which is why I think that I think the first port of call should be seeing if any supplies we have could be used by local NHS trusts first and we should work if protocols that although better withing them, work without them. As it’s likely even if we do use our current stock we won’t be able to resupply.
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Hi all, I’ve now written some protocols covering all aspects of the solidarity kitchen operation which I would like us to agree before operations restart tomorrow. It’s taken me quite a long time and a lot of research so I would appreciate if people engaged with it and the problems it throws up open mindedly. If Nick/Ben could finish off the sections on gloves and masks I’d appreciate it otherwise I will have a crack at it later on. Just to note in 620 we have two opened boxes of 200 pairs of gloves and I think we have a further opened box at the bike foundry which we could use initially. Further to that we have 3 or 4 unopened boxes there which @nick I would appreciate if you could ask the appropriate department at QE if they would like as a donation.
Please have a read of it here:
https://pad.riseup.net/p/uzNEKQEhBt1mRrG_xAI9
Implications for the project
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need masks for use in preparation and delivery.
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need gloves for deliveries
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we need to write a risk assessment and return to the above document to tweak things on the basis of what we find
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We need to make sure all of the above is clearly represented after it’s agreed: blog, phone instructions, and/or flyer upon delivery
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Thanks so much for working on this! My main point of clarification is that I think we need to specify what we mean by sterilise because I am not clear myself. Does that mean spray with antibacterial and rub down? Or something else?
Also I am not sure of the whole meaning of keeping teams separate. Do you mean always or just during their work? Could someone theoretically be driver one day and kitchen crew next? I think practically this would probably need to be the case. Also we need the food delivered on the day it is cooked and the kitchen needs to be cleaned on the day it’s used.
Going to read this all and do some work on it if possible. I do also have some opened gloves here, somewhere…
- Sterlising can either be done with bleach solution or by washing it with hot soapy water or surface cleaner. Anything with soap is the most effective thing at killing the virus, and most applicable in the kitchen for packaging etc.
- In terms of keeping teams separate what I mean is each volunteer would be working with the same other volunteers each time. We are limited by the number of chefs we have but an ideal situation would be that each volunteer team sticks with one chef to limit the number of shared contacts. Further to that delivery teams would always be the same sets of people so that they didn’t mix. The final bit is that delivery teams and kitchen teams stay separate.
- not sure about the final point. The idea isn’t that the delivery team wait a day to deliver things just that they don’t directly interact with the kitchen team. For instance when the food is packaged it could be placed in the main cafe space in the doorway for the delivery team to pick up allowing a safe distance and fresh air circulation to lower the chance of carrying the infection from the kitchen team to the delivery team or in the other direction should any of them have it.
I have been through the draft guidance; mostly just copyediting but I noticed a few bigger things:
- Is is 14 days from the start of symptoms, or from the end? If you can still be contagious for 14 days after symptoms end then is it is sufficient to only go for 14 days from the start, if our aim is to eliminate outbound infection?
- Considering other guidance I assume you can come back to work sooner than 14 days if discharged or tested negative.
- We need something on how to put masks and gloves on and off, I don’t have time to write that today sorry
- We should reword it to reiterate that volunteers need not just to read and understand the protocols, but to OBEY
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Oh one more thing, I also think it would be helpful - probably for our internal purposes but perhaps for the purpose of education too - to assess and critique processes used by other groups
I found a very good link on the mask issue : https://www.maskssavelives.org
I’ve included it in the links of the pad.
My understanding is WHO have said it can be possible for contagion to last upto 14 days after the symptoms. However I haven’t seen any countries adopting those guidelines - most have gone for 2 weeks. That’s definitely when it drops down if you look at basically all graphs of the viral load. If tested negative then sure I think you can go back - although @canchaflower has heard in spain they are doing two tests for healthcare workers to be sure. No testing here in the U.K though so I think recommending a blanket 14 days for volunteers is prudent.
3) I will maybe chat with @nick about it and see if we can find a clear guide.
4) I agree - perhaps I was being too ‘anti authoritarian’ 
Zine published on Its Going Down about mutual aid safety practices.
Details how to put on and take off masks and gloves and wash hands.
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amazing could you add it as a resource on the blogpost?
I have to say that I have found particularly challenging following the protocol after two days on driver duty.
Double bag the food and leave only the inner bag outside the door, then ring the doorbell and wait at least 2m away while the person picks up the items
I have been using some carrier bags I had in my boot as “dirty bags” but here are the challenges I have found while following the protocol:
- No matter how well you fold the outside bag there is always the chance that the inside bag gets entangled with the outside bag, jeopardising the whole idea, not to say that sometimes the person receiving the delivery picks the outside bag before you have time to explain them.
- Getting 2m away and expecting the person to pick up the delivery is not always an option. Some of the deliveries I have made have been to people with mobility problems and there was not anywhere around that seemed sensible to leave the food for them to pick it up.
- Gloves are not very practical when you rely heavily on your phone (as you do when you are driving because of GPS and phone calls).
- Using hand sanitiser all the time is terrible for the hands, I am using plenty of cream when I get home but still they sting terribly.
As you can see I do not have alternatives or solutions, maybe there are not any and this protocol is the best we can do in terms of health and safety. I just wanted to raise the challenges I have personally found (I am open to suggestions).
I have been thinking on the above and I think we are missing an important trick regarding health and safety: time.
We know two things related to time about the COVID-19 illness:
- that the virus is stable on some surfaces up to three days [https://www.nih.gov/news-events/news-releases/new-coronavirus-stable-hours-surfaces]
- that the virus has an average incubation period of 5.1 days [https://annals.org/aim/fullarticle/2762808/incubation-period-coronavirus-disease-2019-covid-19-from-publicly-reported]
If we assume that a level of exposure of the drivers is almost unavoidable no matter how much we try to minimise it (because of what I explained in my previous reply) we should not be allowing drivers to do more than two runs a week (as space das possible), an ideally just one run per week.
That way:
- even if the car or any surface is not completely disinfected or some area is missed during cleaning, the virus will die on those surfaces (assuming the car is not shared and is being used only for deliveries, as it is my case);
- if a driver gets sick will display symptoms before their next run.
I have personally done two runs in two consequent days, but I am going to write to the email to ask for my rota to be changed in order to further protect the health of the people I deliver to.
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Staggering the shifts would be a good idea - we would need to get more drivers on the books but not that many more than we have currently (off the top of my head I feel like we have a lot of drivers currently doing 1 shift a week or so, plus a half dozen very keen ones who probably do 3+ shifts per week).
As for the bags, meals should come double bagged from the kitchen. If the purpose of the bags is to prevent the driver infecting the recipient, which seems the only thing they’d really help with, then possibly you could place the inner bag only on the doorstep, only touching the outer bag (which you then take with you) yourself. I don’t see any particular disadvantages doing it this way as opposed to the Queercare routine of leaving the outer bag rolled down so the recipient can grab the inner bag out.
As for the glove question, my opinion is that all they’re good for is providing a disposable surface to avoid the recipient infecting you in turn. So you’d get out the car, put on gloves before you take the meal out of the boot, make the delivery, return to the car and discard the gloves in your boot before returning to the driving seat. With discipline / care you could do this with one glove per drop (keeping your bare hand in your pocket perhaps, so you don’t inadvertently touch something with it).
Hand sanitiser is a much better solution but I also have skin that reacts badly to it. I like O’Keefe’s Working Hands, Weleda Skin Food and Body Shop help hand protector.
The thing with the bags protocol is that it is impossible to keep 2m distance in many cases as you have to hand the bag directly to some people (usually because there is not a proper place to drop the delivery or because the recipient is not going to be able to get it if you leave it on by the doorstep because they are elderly or disabled).
Of course on those situations I do it in a way that they just grab the inner bag (or I try to, sometimes they just grab both bags from my hands) to avoid contact, but still I get closer than 2m quite often.
In any case, the bottom line is that no matter how hard you try (and believe me, I try really hard 
) protocols are going to be compromised, so better to add the extra factor of time as a safety measure.
Ok but be careful @Carlos. This is a life and death situation. If we can implement this time measure that would be a good thing I think.
I know this sound a bit out there but is there anything we could use like a hooked stick or something? I’ll ask my housemate who is good at this sort of stuff.
I am not sure the stick idea would be practical to implement for all drivers. (I am not thinking here about myself but about all drivers).
As I have said, believe me I am as careful as you can imagine (I am very conscious about the virus, to the point that I am a bit paranoid), and from what I have seen when picking up deliveries I am more prepared than many drivers.
But the reality is that we make drop offs in very varied and unpredictable conditions (eg. on Friday in a block of flats with narrow corridors a kid turned a corner and almost run into me; in another drop off a guy approached me as I was leaving my vehicle to ask me for change and I felt terrible asking him to stay back quite expeditively), so drivers are going to be exposed sooner or later.
The only way I can think to minimise risks that is easy to apply to every driver is to space up shifts in order to make symptoms evident if a driver is compromised and to facilitate “time desinfection”.
We have to remember drivers are the airlock of the operation and as much as we can do to make sure drivers are healthy through their shifts would be positive (to the point that I am tempted to say that drivers should take their temperature before the shift, I do it but I am aware not everyone has a thermometer at home).
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