Over the last few months, I've become increasingly concerned that supermarkets are our second worst COVID-19 hot spot (behind health-care and nursing-home environments). Since March 20,, I’ve lobbied the Providence City Council,  Mayor Jorge Elorza, federal and  state legislators and  our governor to take more aggressive steps to recognize and stop supermarket spread. The governor took one step to limit capacity and push for social distancing. That was a good first step, but should not be the last.

Given that 29 million to 41 Million Americans visit one of our country’s 38,000 supermarkets every day, and that aerosol and surfaced based COVID-19 virus particles are now known to pose a threat to people of all ages and conditions, there is a good chance that “Supermarket Spread” is our Achilles Heel in this crisis. 

The only way to be sure that cashiers, other supermarket staff and customers are as safe as possible is to keep customers outside. A mandate for curbside ordering and to your car delivery is a solution that may also promote quicker throughput for customer orders and create jobs. Short of such a mandate, every possible way to improve safety should be explored and implemented as soon as possible. 

As COVID-19 rapidly spreads across America, social distancing and maximum group size rules are changing our lives. To keep crowds from forming and to reduce transmission points, governors nationwide are steadily closing down the world around us. 

First were the restaurant closures and work from home (if possible) orders, then it was non-essential retail, and then parks and beaches and nature trails. All of this is done with the goal of enforcing social distance and, therefore, public health. 

BUT, when it comes to supermarkets and pharmacies… with the exception of capacity limits (which limit spot capacity but not the number of customers per day) all bets are off.

THAT, is scary.

Supermarkets are essential and, due to lack of other dining options beyond take-out, supermarkets must be more used than ever before. 

Grocery Shopping Statistics: 23 Fun Size Facts to Know provides a glimpse into the scale of the supermarket situation. Americans spend 41 minutes per trip to the supermarket, 1.5 times per week. Adding it up, 29  million to 41 million shoppers frequent supermarkets every single day. 

Across 38,000 supermarkets, there are 763 to 1,073 visitors per day per market. Assuming 4 check out aisles (assume reduced aisles in many stores for social distancing).. that is 190 to 269 people through each check out aisle per day. That is 19 to 27 per hour… one every 2 to 3 minutes in a 10-hour day. 

One shopper every 2 to 3 minutes per check out aisle seems improbably high except at peak hours… but you get the picture. Supermarkets are a super party every single minute of every single day. That is  not a party I want to attend right now. 

It is not a party in which any low paid, unprotected or lightly protected worker should have to be a part of for an 8 hour shift, or any shift. 

But it’s safe to shop in a supermarket and your food is safe to eat!! 

On March 20, at the time I started contacting my local government representatives, any scan of the news showed stories confirming that food is safe and that grocery stores are safe. The stories relied on six feet of social distancing and good cleaning procedures as being enough to waylay any fears.

Since then, well written stories have emerged that detail customer carelessness and highlight the fears of cashiers, pharmacists and other workers. 

In Grocery Stores are the New Tipping Point, Olga Khazan’s March 24 article in The Atlantic raises concerns that supermarket workers aren’t given masks and highlights the limitations of sanitization in light of shoppers who cough or sneeze. 

Brent Shrotenboer, on March 27, asked Are Grocery Stores and Pharmacies Vectors for the Coronavirus? in USA Today. Among other key points, he reminds us that “Even in the best of times, grocery stores have been hives of invisible germs. A study in 2017 found that shopping carts at regular and budget food stores carry hundreds of times more colony-forming units of bacteria per square inch “than surfaces in your bathroom.” A shopping cart at a budget store had 270 times more colony-forming units than your average toilet handle.” 

Close to home here in Rhode Island, on March 30 The Providence Journal’s  Katie Mulvaney sounds the alarm in For RI Pharmacists, Virus is a Formula for Stress. Mulvaney describes the pressures of drug shortages due to hoarding, sick patients walking in the doors and a lack of PPE. 

Beyond our shores, on April 1, International Business Times’s Alexandria Sage reports In Supermarket Front Lines, Italy's Workers Fear The Worst. She writes “The customers push their carts, touch the food and even lick their fingers while riffling through bills. Any one of them could have the virus, and pass it along. Such are the nagging thoughts of grocery store workers in Italy, exhausted, under protected and, many say, overly exposed to the coronavirus still spreading throughout the country.” She follows with some detail on a 48-year-old cashier and a 33-year-old supermarket security guard who died from COVID-19. Like health-care workers, these people are on the proverbial front lines. 

Seeing the confirmed cases spread from roughly 0 to well over 100,000 cases in the USA in one month should be ample evidence to raise suspicion that assumptions were wrong about simply sanitizing hands and surfaces but falling short of recommending face masks in indoor spaces. “Anecdotally,” a Los Angeles Times story by Richard Read on the Skagit Valley Choir tells us that 45 of 60 people got sick and 2 died within 19 days of their March 10th rehearsal. This story should also be enough to confirm that airborne virus droplets and aerosols, at least indoors, are a threat to address quickly and squarely. 

New Research Challenges Prior Assumptions

The research has caught up with front-line worker fears and anecdotal evidence.

MIT’s Lydia Bourouiba, Ph.D., published new research in JAMA on March 26 showing that droplets can travel up to 27 feet and can remain suspended in stagnant air for hours before settling onto a surface. 

Couple that with a letter to the editor in the New England Journal of Medicine on March 17th which warns that the virus remains viable in aerosol form for more than 3 hours and can remain viable on surfaces for more than 72 hours. 

Finally, people are starting to understand that the virus *is* in the air and, at least when indoors, it is harder to dodge than we think. Per Elizabeth Cohen’s April 4 story on CNN, Even experts advising the White House are saying coronavirus can spread through talking or even just breathing. 

Despite so many precautions, even health care workers are getting sick in high numbers. Ann Goulard’s March 31 article in The Telegraph asks “What is viral load and why are so many health workers getting sick?” Along with a lot of other convincing facts, she states that “Studies in mice have also shown that repeated exposure to low doses may be just as infectious as a single high dose.” 

Implications for Supermarkets

A small amount of exposure *might* be OK, but supermarket (and health-care) environments which are indoors and exposed to 100s or 1000s of people throughout the day, possibly leaving their workers exposed to high viral loads, or low viral loads that add up over time.

People enter the supermarket, exhale (and possibly cough or sneeze) throughout the store, while they also touch and handle products as well as open and close freezer doors. They pass each other well within a six-foot radius as they work their way through the aisles. Then they stack up at the checkout aisle. Since you can only have one person at the check out aisle, a line inevitably piles up into the main thoroughfare leading to the checkout aisle. Shoppers working through their lists have to navigate around these lines as they gather. 

Searching for Solutions

Supermarkets are likely to be a COVID-19 Achilles Heel, and every weapon in our arsenal should be used to combat that possibility. Pharmacies see less foot traffic, but are also enclosed and are a popular place for people who are ill and need to pick up medication and other remedies. 

We know that people are now using online shopping more and more. That’s great, but as of a year ago, only 3 percent of shoppers buy groceries over the internet. There has been a big increase in online orders for home delivery, but that has brought problems. If you go to PeaPod, you may have to schedule deliveries up to one to two weeks out. My own experience: We waited 2 weeks for a delivery, and, upon arrival, it was missing the eggs and a few other key items. 

How do we fix this in a way that lets people get their groceries today? in a way that is safe? in a way that actually improves shopping time? in a way that improves personal safety for shoppers and workers?

Easy. 

Look no further than veterinarians in Rhode Island for a good idea. The Providence Journal’s Donita Taylor’s March 26th story Veterinarians can see animal patients, but humans have to stay out says it all.

If a veterinarian doesn’t allow a few healthy dog owners a day into their office out of fear for their staff’s health, why should a supermarket allow 1,000+ customers into their place of business? 

Curbside ordering and to your car delivery works for veterinarians, and it should work for supermarkets too. 

Retailers like Camping World have a Curbside program. Whole Foods also announced “In response to COVID-19, we're quickly expanding our list of stores that offer grocery pickup.” If Whole Foods sees any need for pickup, why then don’t they also see a need to expel customers entirely? These two thoughts are hard to reconcile in combination. 

There are challenges 

Kelly Tyko’s March 31st USA Today story, Curbside pickup is growing due to coronavirus, lists 20 stores offering a curbside program. She puts a finger on one key problem with this quote:

“Many grocers are offering curbside pickup but the issue is that websites can’t put the highest volume (items) online because they sell out so quickly, so that limits the appeal of online grocery shopping… People need to go to the store to get the products they want.”

The answer is the people need to go to the store, without going into the store

Curbside (or online) ordering and to your car delivery can work. 

It can also increase throughput, decrease the time it takes to “shop,” reduce hoarding, reduce the number of hours a market must stay open, and protect public health. 

In order for it to work in a way that solves the public health problem and the supermarket staff problem, it has to be mandatory and it has to work for everyone. 

This wants to be done as a no-tech, simple approach that doesn’t require an App and doesn’t require you to wait days or weeks for grocery delivery, only to discover that they couldn’t include your eggs or dish soap. 

Here’s how it could work, as a simple analog to how people shop already: 

The solution relies on paper, an outdoor squad, and an indoor squad. 

Customers print and fill out an order sheet at home, or get one from the “Outdoor Squad" when they arrive at a store. 

Order sheets are organized into zones in the market such as Produce, Deli / Butcher, Center Aisles, Cold Area.

Each item on the sheet has a check box to indicate if a “substitute item” is OK. 

Each sheet has box to indicate your parking spot, car description, plate number and cell phone. 

A shopper hands the sheet to someone in an outdoor squad - possibly dropping it straight into a plastic sleeve. A credit card could be included with the order. The order is assigned an order number and a corresponding number card is placed in the shopper’s windshield (or hand). 

The outdoor squad takes the order sheet (and a few others) to the indoor squad. 

The indoor squad shops for two customers at at time, using one or two carts. 

By shopping for two a time, the indoor squad improves throughput and reduces the number of people that ever have to be in the premise by at least half. 

Indoor squad members are knowledgeable of the store, as well as what is in stock, and will move through the aisles quickly and in a one-way pattern that reduces the number of times the indoor squad members are near each other. 

When the indoor squad shopper finishes two orders, they unload onto the end of a check out counter’s belt. The order sheet and customer credit card is included. 

Now, the indoor squad member goes to get another sheet. The checkout person/cashier moves the order along and bags it. 

An outdoor squad member picks up the bags from the end of the checkout counter, rolls them out to the waiting customer’s car and puts them in the customer’s trunk. 

Notice that no one ever goes through the check-out aisle. As such, there *could* be more cashiers without compromising social distance. However, minimizing cashiers (and number of indoor staff overall) is still advisable. 

All the regular supermarket employees, as well as indoor and outdoor squad members, are temp checked and surveyed in the morning to determine that they are feeling healthy and so are the people with whom they have come in contact. They all wear masks, and possibly gloves.

A given store might need 5 to 10 outdoor squad members and 10 to 30 indoor squad members. That is a lot of people, but is nothing compared to the 800 to 1,200 shoppers that might come through a store in a given day. By reducing the total population going through the store and confining it to trusted employees, there’s a logical chance that potential for COVID-19 exposure to staff drops by orders of magnitude and potential to expose customers drops to a point that is close to zero. Less is more. 

You might wonder where all the squad members come from and how they are paid? 

I do too! 

Fortunately, there is no lack of idle workforce in the USA right now. 

With the closure of so many restaurants, the first logical source of workforce for the squads is the ample supply of well trained waiters and food service professionals who are presently out of work. Many of these workers have food safety training and certification. Besides being available and aware of how to safely handle food, this segment of our labor market knows their food products very well and are customer service driven. I imagine there are ample people from other walks of life, and who do not need to take care of children or others at home, who could be well suited to this kind of employment.

Financially speaking, it may be worthwhile for supermarkets to hire indoor and outdoor squads because it would allow the markets to service more customers with less risk to their own staff, and to their own customers. Furthermore, supermarkets and pharmacies (and Netflix, perhaps) are some of the few businesses that are *not* negatively affected by the COVID-19 crisis. In light of that, they can likely afford to adapt to this model. 

If markets can’t make it work financially, states and/or federal government could cooperate, by allowing squad members to remain on unemployment plus a possible bonus from the market. 

Moving to a curb-side ordering and to your parked car delivery model is a national and international priority. It could save millions of lives by solving for one of our biggest addressable Achilles Heel in the midst of the COVID-19 crisis. 

I think the only way to move in this direction is a local, state or federal government mandate with a very limited time horizon to achieve it. If a given supermarket chain does it voluntarily, though, I’d gamble that others would follow suit. 

Some Other Ideas

While curb-side ordering and to your parked car delivery is one good idea, there are others. Just a few other ideas include: 

• find ways to move more people to online shopping and home delivery, while improving responsiveness to 2 hours to 2 days maximum wait time

• provide high quality - possibly N95 - masks to supermarket staff - to reduce their viral load and their potential to infect customers

• require shoppers to wear surgical or, at least, multi-layer cotton masks

• further reduction of the number of shoppers allowed in each store at any time

• increase social distancing in-store from 6 feet to 10 or more feet higher number

• create one-way traffic patterns in-store

• require customers to drop products on the checkout belt, then circulate around to the other side of the check-out counter without going through the check-out aisle itself

• increase air circulation in-store (if that helps, not hurts) 

• put high-touch foods like produce behind a counter that is serviced by an employee

• staff the freezer aisle with a person who opens the doors for shoppers

Many a good thinker out there could think of a lot more ideas. 

Jordan Frank is a Providence-based entrepreneur and civic leader.