Meatpacking plants should, whenever possible, install physical barriers on the production lines that are pumping out cuts of meat, conduct daily health screenings for workers, provide more hand sanitizer stations, require universal mask use and work on better air flow in buildings.

Those are among the recommendations in a playbook and checklist developed by University of Nebraska Medical Center disease and public health specialists to help meat plants in Nebraska and nationwide prevent and decrease the spread of the coronavirus.

“It is our top priority to protect the health of workers and their families who are braving the COVID-19 pandemic to put food on everyone’s tables,” said John Lowe, assistant vice chancellor for health security training and education at UNMC, in a Thursday press release.

Outbreaks at food and meat processing facilities have sickened workers and forced plants, including a massive Tyson beef plant in Dakota City, Nebraska, to temporarily shut down, threatening disruption to the food chain that sends chicken breasts, bacon and ground beef to the grocery store.

The recommendations, from the Global Center for Health Security and Center for Agricultural Safety and Health at UNMC, came after infectious disease specialists toured 10 meatpacking plants over the past two weeks across Nebraska to observe working conditions and give pointers on infection control.

“These efforts should be made an urgent public health priority because infection among worker populations could also lead to community infection, eventually affecting further spread in entire population’s health,” reads the “Meat Processing Facility COVID-19 Playbook.”

Indeed, Hall, Dawson and Dakota Counties in Nebraska — all areas with large meatpacking or manufacturing workforces — have emerged in recent weeks as major coronavirus hot spots.

Inside the plants, the playbook recommends installing dividers or plastic sheeting to separate workers on the production line and in hallways, cafeterias and crowded locker rooms where workers change clothes. Flexible absence and sick leave policies should be adopted and communicated widely so workers know they can stay home — without being penalized or fired — if they’re feeling ill.

“Unemployment and disability compensation are not adequate sick leave policies for COVID-19 for workers,” according to the guidelines.

Multilingual signs should clearly explain COVID-19 symptoms and hand-washing techniques. Many workers are immigrants or refugees, and multiple languages are spoken in many of the plants, including English, Spanish, Somali, Arabic, Karen and Nepali.

Air flow should be adjusted to circulate clean air in one direction; recirculating air may require the use of filters or ultraviolet-light sterilization. Turbulent air flow may stir up and redistribute virus particles that have landed on plant surfaces, the report said.

Bloomberg News reported that a new study out of Wuhan, China, suggests that the coronavirus may hang in the air in spaces that are crowded or lack ventilation.

While UNMC’s guidelines say masks and other personal protective equipment are a lower priority compared to other safety measures, the report still recommends that plants hand out masks, preferably surgical-style, and require that they be worn on the premises at all times. Workers must be taught how to safely remove soiled masks.

“It is highly recommended, as available, to provide employees in meat processing plants with procedure (surgical) masks due to the close contact they have with other employees and the liquid contact frequency in the work environment,” it states. “Cloth face-coverings may not provide the needed protection for these workers. Hair and beard covers provide no protection; they should not be used as an alternative for a face mask.”

The daughter of a worker at a Smithfield Foods pork plant in Crete said workers were originally given hairnet-like masks to cover their face before that idea was scrapped the next day.

Large meat processors such as Tyson Foods and Smithfield Foods have said they already have implemented some of these measures, like regular temperature checks and urging sick workers to stay home. Other advocacy groups have said stronger protections are needed.

The playbook says procedures must be developed for how to deal with sick workers and inform any co-workers with whom they had contact. All employees and visitors should have their temperatures checked and answer simple screening questions before entering the plant: Do you have any flu-like symptoms? Have you lost your sense of taste or smell?

The health director overseeing Hall County, home to Grand Island and a large JBS USA beef plant, has said it’s not totally clear whether workers at the plant are catching the virus from their close-quarters work or out in the community and then bringing it to work.

Nebraska Gov. Pete Ricketts has said the outbreaks may be a “community issue” that has less to do with working conditions and more to do with workers’ lives outside the plants.

But the playbook contains clear strategies and recommendations for decreasing the spread of the virus inside the plants, where hundreds, sometimes thousands, of workers clock in for shifts, along with suggestions for how plant operators can work with community leaders and local health departments on virus outreach and education outside the workplace.