Elected officials in the U.S. have begun ordering closure of all non-essential businesses to protect public health and slow the spread of COVID-19. So what’s considered “essential” during a crisis of this nature and magnitude?

According to the "Coronavirus Guidelines for Americans" issued on Mar. 16 by the White House and Centers for Disease Control and Prevention (CDC), “If you work in a critical infrastructure industry, as defined by the Department of Homeland Security, such as healthcare services and pharmaceutical and food supply, you have a special responsibility to maintain your normal work schedule."
 
The Cybersecurity and Infrastructure Security Agency (CISA)—which executes the Secretary of Homeland Security’s responsibilities under the Homeland Security Act of 2002—developed an initial list of “Essential Critical Infrastructure Workers” to help state and local officials as they work to protect their communities, and ensure continuity of critical public health and safety functions, as well as economic and national security.
 
The list, which is advisory in nature and not a federal directive or standard, can also inform decision-making to determine the sectors, sub-sectors, segments, or critical functions that should continue normal operations, with modifications based on guidance from CDC to protect workers and customers. 

The DHS list of critical workers in the food and agriculture sector includes: “Workers supporting groceries, pharmacies and other retail that sells food and beverage products,” as well as, “Food manufacturer employees and their supplier employees—to include those employed in food processing (packers, meat processing, cheese plants, milk plants, produce, etc.) facilities; livestock, poultry, seafood slaughter facilities; pet and animal feed processing facilities; human food facilities producing by-products for animal food; beverage production facilities; and the production of food packaging.”
 
State and local officials use their own judgment in issuing directives and guidance. Similarly, critical infrastructure industry partners will use their own judgment, informed by this list, to ensure continued operations of critical infrastructure services and functions. CISA said “all decisions should appropriately balance public safety while ensuring the continued delivery of critical infrastructure services and functions.”
 
Implications for Dietary Supplements
In reviewing several state and local directives, the American Herbal Products Association (AHPA) said it appears that state and local governments’ approaches generally align with or adopt CISA’s guidance.

For example, the Shelter In Place order issued by the City and County of San Francisco, CA on Mar. 16 created several exceptions, including for individuals who “perform work providing essential products and services at an Essential Business.” The order defined “Essential Business” to include: “…[E]stablishments engaged in the retail sale of [food] and any other household consumer products (such as cleaning and personal care products),” including “stores that sell groceries and also sell other non-grocery products, and products necessary to maintaining the safety, sanitation, and essential operation of residences”; “Food cultivation, including farming, livestock, and fishing”; “Businesses that supply other essential businesses with the support or supplies necessary to operate”; “Businesses providing mailing and shipping services, including post office boxes”; and “Businesses that ship or deliver groceries, food, goods or services directly to residences.”
 
A similar emergency order was issued on Mar. 19, by the mayor of Miami-Dade County (Florida) with the exact same definition for an “Essential Business.” AHPA has not reviewed all such recommendations and directives but noted some coordination is occurring among state and local governments throughout the country.

In California, Governor Gavin Newsom issued an order on Mar. 19 for residents to stay at home except as needed to maintain continuity of operations of essential critical infrastructure. In accordance with that order, the State Public Health Officer designated a list of “Essential Critical Infrastructure Workers," which included: “Workers supporting cannabis retail and dietary supplement retail.”

AHPA President Michael McGuffin said that to his knowledge only California has been so explicit to mention dietary supplements in determining essential operations. However, “it’s our understanding that the states are in active communication and value consistency, so we believe other states will be considering this clarification.”

AHPA also strongly recommended companies that determine their status as an essential business and maintain operations also take appropriate measures to protect employees. Relevant guidance is available at the websites of the CDC, the Occupational Safety and Health Administration (OSHA), and the Food and Drug Administration (FDA).

Trade Outreach
In a letter to the nation’s governors, underscoring how dietary supplements qualify as essential, AHPA, the Consumer Healthcare Products Association (CHPA), the Council for Responsible Nutrition (CRN), and the United Natural Products Alliance (UNPA) noted the public health challenges facing the U.S. are serious and warrant decisive action.
 
Acknowledging these unique circumstances require “unprecedented but necessary action” to reduce spread of the virus by limiting non-essential commerce, the associations wrote, “it is critical that key sectors of the economy maintain active operations during this time,” especially food and healthcare product manufacturing.
 
“Dietary supplements qualify as essential because of their unique position as both food and healthcare products,” they wrote. “According to CRN’s Annual Survey, 77 percent of Americans take dietary supplements. They do so for overall health and wellness benefits, to provide energy, to support immune health, to fill nutrient gaps, support healthy aging, and to support heart health, among many other reasons. This $46 billion industry provides billions more in healthcare cost savings as consumers reduce their risk of certain chronic disease through supplement usage.”
 
The associations argued that consumers need access to dietary supplements to assure they receive proper nutrition, maintain their immune health, get proper sleep, promote bone and heart health, and proactively reduce their risk of certain chronic diseases “without burdening an already overstretched healthcare system. Dietary supplements help consumers achieve all these ends.”
 
Alongside conventional foods, subcategories like dietary supplements, infant formulas, medical foods, and spices and flavors should all be deemed essential, they suggested. And in addition to product manufacturers, the associations noted the critical importance of upstream links in the supply chain, including “suppliers of ingredients, excipients and other manufacturing materials, transportation and warehousing, and necessary service providers, such as analytical labs used to verify ingredient identity and prevent contamination.”
 
“Our industry is ready to do our part in serving Americans during this pandemic,” they concluded.

Steve Mister, president & CEO of CRN, noted that on an ordinary day supplements play an important role for the health and well-being of consumers, “and it is critical that we ensure continued consumer access to these products during this public health pandemic.”
 
Recent sales data and reported outages in stores suggest consumers rely on these products, Mister suggested. “This is not the time to jeopardize consumer access to these products. Simply put, they matter more than ever right now.”
 
CRN said it is advocating aggressively for the continued functioning of the entire dietary supplement industry during the pandemic by reaching out to the U.S. Department of Homeland Security (DHS), the U.S. Food and Drug Administration (FDA), Coronavirus Task Force, members of Congress, governors, mayors, and local officials. The association also joined other groups in the healthcare industry, and the food industry in issuing letters to these leaders.

“CRN supports the recent actions by federal, state and local officials in the effort to reduce the spread of COVID-19 and understands the role of limiting non-essential commerce to protect the health and safety of the public,” said Mister. “We believe it is vital for key industries like food and healthcare product manufacturing, including dietary supplement facilities, to be considered essential as these sectors produce products that promote better health and provide consumers with critical nutrients they need every day.”

More than three-quarters of Americans take dietary supplements. “We recognize there is well-established research demonstrating how dietary supplements can play an important role in supporting health and wellness, and now is not the time to deny consumers access to these beneficial products,” said Luke Huber ND, vice president, scientific & regulatory affairs, CRN. “At the same time, we encourage the public to remain vigilant for fraudulent products. No supplement may claim to cure, treat or prevent COVID-19, and any product that says it does should be avoided.”

NPA Action & Interpretation
In a letter dated Mar. 18 addressed to President Trump, Daniel Fabricant, PhD, president and CEO of the Natural Products Association (NPA) also expressed his concern about potential closures of manufacturing operations that would limit the public’s access to health products.
 
“A reliable and functioning supply chain is imperative for essential businesses—including natural products retailers—to continue operating and providing nutritional supplements and other health and wellness products during this public health emergency. Local businesses are an essential resource for Americans in times like these, especially people at risk, who need access to nutritional supplements.”
 
In addition, “Three in every four Americans use at least one natural product and the natural products industry is responsible for over 380,000 direct jobs, $16 billion in direct wages and almost $15 billion in taxes each and every year,” Fabricant wrote. “Many of the men and women who make up the natural products industry are the neighborhood small businesses that are vital to all local economies.”
 
NPA said that based on guidance from DHS, and the White House’s Mar. 18 declaration, its members would remain open "at the discretion of business operators" in order to provide essential services during the COVID-19 public health crisis. 
 
“We have a responsibility to stay open and provide essential services, and that is exactly what we are going to do. Health food stores that provide nutritional supplements and other health and wellness products will remain open at the discretion of business owners,” said Fabricant. “Local businesses are an essential resource for Americans in times like these, especially people at risk, who need access to neighborhood stores. Communities need these stores open and we are asking lawmakers to lift any order as it relates to health food stores.”
 
DHS guidance relevant to health food stores and the nutritional supplement supply chain includes:
 
Food & Agriculture

• Workers supporting groceries, pharmacies and other retail that sells food and beverage products
• Food manufacturer employees and their supplier employees—to include those employed in food processing (packers, meat processing, cheese plants, milk plants, produce, etc.) facilities; livestock, poultry, seafood slaughter facilities; pet and animal feed processing facilities; human food facilities producing by-products for animal food; beverage production facilities; and the production of food packaging
• Employees and firms supporting food, feed, and beverage distribution, including warehouse workers, vendor-managed inventory controllers and blockchain managers
• Workers in food testing labs in private industries and in institutions of higher education
• Employees of companies engaged in the production of chemicals, medicines, vaccines, and other substances used by the food and agriculture industry, including pesticides, herbicides, fertilizers, minerals, enrichments, and other agricultural production aids

 
Critical Manufacturing 

• Workers necessary for the manufacturing of materials and products needed for medical supply chains, transportation, energy, communications, food and agriculture, chemical manufacturing, nuclear facilities, the operation of dams, water and wastewater treatment, emergency services, and the defense industrial base.