Lending Microbiology Expertise Outside of the Lab

June 22, 2020

When I retired as the Director of the Clinical Microbiology-Immunology Laboratories at University of North Carolina (UNC) Health Care in February 2019 after 40 years working in clinical microbiology, I was looking forward to well-earned rest. The folks who worked with me knew that my 4 favorite words in our workplace were, "The meeting is canceled." In my new life, those 4 words transitioned to "There is no meeting." People asked me early in the current pandemic if I missed being in the lab. My answer was always the same, "No, I like sleeping at night." However, a more honest answer was that we trained exceptional people in our CPEP postdoctoral training program, including Rick Hodinka, Melissa Miller, Sue Whittier, Tony Tran and Karissa Culbreath. They and other graduates of the UNC CPEP program and the 19 other CPEP programs throughout the United States, are up to solving these challenges and answering those questions. The discipline is in excellent hands.

However, little did I know that my community would call on me in a way I could not have imagined: to provide credible, science-based information to protect the economic livelihood of 50-60 families. Additionally, I assisted in the development of a novel, restaurant-based food hub which protected dozens of additional jobs.

One of the ways I was engaged with my community while working 50-60 hours a week began in 1985 with my weekly visits to the Carrboro, N.C. Farmers’ Market. Each week for many years, I would sit with Dan Graham, one of the farmers, talking for an hour or 2 about the community and the issues of the day while his son Louie and daughter-in-law Trisha minded their stand.

Carrboro Farmers’ Market started in 1977 and has steadily grown over the past 40 years to become a year-round market with local produce, meat, dairy products, flour and artisan food, bakery goods and crafts. Depending on the season, 50-70 vendors, who derive 40-100% of their income from sales at the market, sell their products, with weekly total sales estimated to be $50,000-80,000. One of its pioneers, Alex Hitt, has been a national leader of the "farm to fork" (now "farm to table") movement. Local and nationally-renowned celebrity chefs can often be seen shopping for the best of the season. It has also been a model for the development of farmers’ markets in surrounding communities, including both Chapel Hill and Durham, N.C. Clearly, the market is important to the social and commercial fabric of the town of Carrboro, and central to the livelihood of farmers in the surrounding 50-mile region.

On the evening of March 13, I got a frantic call from Trisha Graham, Chair of the Board of Directors of the market. She related that a Carrboro town official was threatening to shut down the market in response to the COVID-19 pandemic. We learned that this was not an idle threat, as the Durham Farmers’ Market had been closed that day and would remain closed for the next 8 Saturdays. She asked if I could come and talk to the farmers at 6:30 the next morning as they were setting up the market. It was, by far, the most unusual request I have received to give a "talk" on microbiology and perhaps one of the most high impact ones, with the livelihoods of 50-60 families on the line. And I had 10 hours to prepare. But I was not worried, because social distancing was something I had been teaching medical and graduate students about for years.

I had 3 basic points to share with the farmers and the town official:

  1. The farmers had products to sell on which their livelihood depended.
  2. Given the large open space, and if we had only vendors handle the products, shopping in the market was safer than shopping in a supermarket.
  3. The market would provide a sense of normalcy for the customers who were about to embark on potentially many weeks of staying at home.

When we gathered the next morning, it quickly became apparent that the town official was mainly worried about the safety of the vendors and customers coming to the market. As I spoke to the vendors, I saw looks of fear, defiance and everything in between. But everyone was paying attention. We agreed on some basic ideas.

  1. No vendor who had symptoms of COVID-19 (described to them as flu-like symptoms) should sell at the market.
  2. Only vendors could handle products. If possible, the vendors should sanitize their hands often.
  3. We would try to maintain social distancing with assistance from the local fire department, which was next to the market. A firefighter was deployed at each of the market’s 4 entrances to provide information about social distancing.
  4. We would round up or down purchase prices so no coins would be involved.
  5. We would encourage customers to grab and go.
  6. The onsite playground would be closed to discourage families with young children from turning a visit to the market into play time.
  7. The market would open the next week 2 hours earlier to spread out the customers.

One of the attendees at that morning briefing was a local business man, Tom Raynor. By March 14, most restaurants in Carrboro and Chapel Hill were closed because their sales were down as much as 90%. A subsequent state order closed all in-restaurant service. Many individuals were laid off. Raynor’s idea was to start a food hub where restaurants could sell prepared meals, which could be picked up at a central location. This would provide or preserve jobs for dozens of individuals. For people who wanted to avoid frequent trips to the grocery store, there would be perishables like eggs and produce. However, Tom needed someone to help him understand how to do this safely, especially at the site of the food hub. He wanted to start the hub in 7 days. I spent many hours that week and the next discussing strategies with him and his colleagues, including a critique of operations on the initial day of the hub, with a follow up visit to see if the suggested changes were in place. The hub did open the following Saturday, providing 300 meals. Today, it provides an estimated 1,200 meals a week. As of this writing, the hub has been in place for 11 weeks, with estimated sales of $60,000/week.

On Monday March 16, I had a debrief with the Board of the market to try to determine what steps we could take to further enhance safe operation of the market. I cautioned that while there were many steps they could take to make the market safer, the County Health Department did have the authority to shut the market down if they chose to do so.

Enhancements made for the market for March 21 included signage explaining the new social distancing and safety policies. Farmers with websites, email lists and other social media outlets encouraged pre-paid orders. Spacing was increased to 10-20 feet between vendors. Vendors were encouraged to have separate individuals handle produce and payment. Only 1 family was served at a time by vendors.

The final enhancements to the social distancing safety policies were made for the market the week of March 28 after consultation with the Orange County Health Department. The Health Official required that there be unidirectional flow of customers with a single, separate entrance and exit, that vendors wear face coverings and that customers be encouraged to do so as well, that there be a handwashing station at the entrance, and that a limited number of individuals be allowed into the vendor’s area, with marking on the walkways to assure social distancing among customers waiting to be served by a vendor. All of these practices were to be monitored by the town, which currently supplies 4 individuals to do so. One thing that was not adopted by the market was early shopping for seniors, because the Board recognized that seniors already make up between 60-80% of the customers between 7 and 8 a.m.

On May 16, the Board of the Market met again to talk about "returning to normal." We discussed that they had done a great deal to address the safety of the community, but any changes going forward should only be done if they felt safe. Compliance with the County’s requirements for wearing masks has been excellent: on June 13, >95% of over 2,000 customers and close to 100% of vendors were doing so.

On June 10, the Orange County Board of Commissioners extended the State of Emergency until August 31, due in part to a troubling rise over the past 2 weeks in COVID-19 cases within the state to their highest level since the beginning of the pandemic. One of the specific requirements of the Board is that face coverings are to be worn when social distancing cannot be maintained. With temperatures likely to be in the 80s and 90s during the markets, the requirement to wear face coverings will be challenging, especially for the vendors, and may meet with resistance from customers.

Lessons learned:

  1. Any conversation with non-scientists should begin by asking questions of them to determine what they want to know.
  2. The general population wants science-based advice on how they can safely conduct economic activity. They will ask things for which there is no good answer and they should be told that.
  3. Our understanding of the risk of COVID-19 transmission associated with different activities will be greatly enhanced by robust testing and contact tracing.
  4. Scientists need to learn to explain the risk of different activities and to describe what is dangerous and what is not. Scientific organizations, such as ASM and the Association of Public Health Laboratories (APHL), should consider working in a bipartisan way to fill gaps in that public knowledge.
  5. A simple idea is that people have safe zones (home, car), exposure zones (open air activities; areas where social distancing can be easily accomplished) and danger zones (crowded, indoor activities where social distancing is not possible; masks should be worn by everyone).

For many years, I have acted globally, but now that I have the time, I find "thinking globally but acting locally" is very much appreciated by and important to my community.

Author: Peter Gilligan, Ph.D., D(ABMM), F(AAM)

Peter Gilligan, Ph.D., D(ABMM), F(AAM)
Peter Gilligan, Ph.D., D(ABMM), F(AAM) is the former Director of the Clinical Microbiology-Immunology Laboratories at the University of North Carolina Hospitals.