August/September 2020 Issue

Food Insecurity During COVID-19
By Christen Cupples Coopers, EdD, RDN
Today’s Dietitian
Vol. 22, No. 7, P. 36

An Overview of Nutrition’s Importance, the Impact on the US Food Supply, and the Role RDs May Play in the Future

According to the Centers for Disease Control and Prevention, as of this writing, the COVID-19 global pandemic has resulted in nearly 5 million confirmed cases and 160,000 deaths in the United States alone. The health threat of the pandemic and the directives put in place to control it—social distancing, sheltering at home, and limiting business and school activities—have altered food accessibility, safety, and prices worldwide.1

The United States’ complex food system, in which many products are grown or manufactured far from its end consumers, struggled to adopt new ways of doing business with reduced staffing, new safety procedures, and a declining global economy.2

Good nutrition is a pillar of resilience in times of crisis.2 A lack of nutritious food puts individuals at a disadvantage for preventing and fighting the coronavirus. Adequate macronutrient and micronutrient intake, particularly of iron, zinc, and vitamins B6, B12, A, and E, can help prevent and fight infection by boosting immune function.3 These are important for triggering, interaction, differentiation, and functional expression of immune cells.2 In an article published in the European Journal of Clinical Nutrition in April 2020, Muscogiuri and colleagues recommended a Mediterranean-style diet featuring important immune-boosting foods, especially antioxidant-rich fruits and vegetables, to boost immunity against COVID-19.4

Optimal nutrition also supports good mental health and can help individuals cope with the anxiety, uncertainty, and psychological stress posed by COVID-19.5 Nicole Eichinger, RD, LD, owner of Nutrition’s My Life, LLC, in San Diego, reports that the vast majority of her clients have sought help for stress reduction, better sleep, and better gut health during the crisis. She says stress likely led to cases and relapses of numerous conditions among clients. “I’ve had someone who had her [thyroid-stimulating hormone] double since COVID-19. I saw autoimmune disorders and someone who might have had a Lyme disease relapse,” Eichinger says.

Such stories are a reminder that helping clients focus on nutrient-dense foods amid their immensely altered daily routines is crucial.

Since the stresses of the pandemic may lead individuals to revert to less healthful coping behaviors, good nutrition is particularly important for those with alcohol misuse and eating disorders.6 Food quality and quantity also play important roles in overall health during COVID-19. In a time of crisis, a craving for comfort foods, especially high-calorie, nutrient-poor varieties, can lead to health issues that last well beyond the pandemic.4

Some physicians, including Dariush Mozaffarian, MD, DrPH, dean of the Friedman School of Nutrition Science and Policy at Tufts University, emphasize another important connection between diet and COVID-19. Mozaffarian wrote in a March 2020 online report on the 50th anniversary of the White House Conference on Food, Nutrition, and Health that individuals who have obesity as well as diet-related chronic conditions such as diabetes and heart disease are at an elevated risk of serious complications from COVID-19. Obesity can involve hypoventilation and widespread inflammation, both of which lower individuals’ ability to prevent and fight the disease.

Due to COVID-19’s novelty, there are few studies on what Americans have been eating during the pandemic. Market research provides a snapshot of US food habits during the crisis, but it doesn’t offer a breakdown by employment status or food security level. The International Food Information Council published a survey of 1,000 American households in June 2020. One-half of the sample reported doing less in-person shopping and more cooking at home. Four out of 10 respondents reported purchasing more packaged foods.

A Bloomberg article published online on March 19, 2020, notes that Americans are purchasing more comfort foods, including chocolate, ice cream, popcorn, potato chips, and alcoholic beverages.7 The American Frozen Food Institute reported that after a 94% surge of frozen foods in mid-March, overall frozen food sales held at 30% to 35% increases in April 2020 vs a year ago.

Amelia Farquhar Sherry, MS, RDN, a dietitian in private practice in Hastings-on-Hudson, New York, has seen both positive and negative dietary changes in her clients, who are mostly school-aged children. “I have had many parents tell me that their children are eating all meals at home and are more open to trying new foods and recipes than they were before,” she says. “Even parents who feel fatigued by all the extra cooking and meal preparation still comment on the pleasures of having more meals with their children.”

Sherry has noticed a decrease in sugar-sweetened beverage intake, likely because kids weren’t picking up snacks on the way home from school. “I work with children in urban environments where sugar-sweetened beverages would otherwise be widely available,” she says. “On the other hand, many children in urban areas are not getting the physical activity or movement that they usually get.”

The State of Food
According to the USDA, the domestic food supply overall has withstood the pandemic, with supplies of wheat, rice, eggs, meat, and dairy at average or, as in the case of grains, above-average levels. USDA Chief Economist Robert Johansson reports in an online article on April 16, 2020, that the empty shelves and high prices that greeted consumers at the start of the pandemic were due to retailers’ lack of preparation for the sudden surge in demand. Johansson notes retailers have caught up with demand and that shelves will be full and prices closer to normal. He notes that the wholesale price of eggs, for example, reached a record high of $3.07 per dozen at the end of March. Once stores replenished supplies by mid-April, the price fell to $1.97.

Johansson also predicted that prices would be further driven down by the drastic decline in demand for food from restaurants and hotels, which will leave a larger volume for households. National data on food spending show that restaurant sales were 50% lower in April 2020 than in April 2019 and 68% lower in March 2020 than in March 2019. Grocery store sales were up 99% in March 2020 compared with March 2019 and up 25% in April 2020 compared with April 2019.

Nevertheless, these top line data don’t reveal the multiple problems occurring in the food system, costing dollars and lives. As Forbes reported on April 28, dairy farmers are trying to decide between dumping their milk and selling their dairy cows for beef. Some contract chicken growers have been asked to “depopulate” their animals. Hog farmers in Iowa and Minnesota are starting to euthanize their pigs. USA Today reported on May 22 that officials have publicly linked at least 15,300 COVID-19 infections and 63 deaths to 192 US meatpacking plants, according to tracking by the Midwest Center for Investigative Reporting.

Hunger Amid the Pandemic
However, even with an abundance of food in reserve, COVID-19 has added many more Americans to the ranks of the food insecure due to job losses and increases in factors that existed long before the pandemic—poverty, lack of access to healthful food, and the high cost of living.

Before the pandemic, about 37 million (11.5%) Americans were food insecure.8 Feeding America, the largest domestic hunger relief organization, projects that if unemployment and poverty increase to the levels the nation saw during the Great Recession, anywhere from 10 million to 17 million more people may join this group. The organization also projects that $1.4 billion in additional resources will be needed over the next six months to provide enough food for hungry Americans—a 30% increase to the baseline six-month operating costs of 200 of its member food banks nationwide.

Feeding America predicts that “rising unemployment and rising poverty due to quarantine and stay-at-home orders will disproportionately impact people already at risk of hunger.” In addition, donations to Feeding America’s network are decreasing as consumer demand rises, the food system faces new challenges, and regular donors such as manufacturers and grocery retailers donate fewer items. The organization also has faced a 60% reduction in its number of volunteers across its network.

Other organizations, some led by RDs, are seeing disheartening numbers of people in nutritional need. Clancy Cash Harrison, MS, RDN, FAND, founder of the Food Dignity Project and president of the Al Beech/West Side Food Pantry in Kingston, Pennsylvania, says her pantry increased food distribution by 1,700% since the COVID-19 pandemic. In March and April 2019, the food pantry served an average of 35 households at each two-hour distribution. Contrast those numbers with March and April 2020, when the food pantry served an average of 700 households at each two-hour distribution, with those figures projected to increase substantially. The food pantry is now distributing more than 30,000 lbs of nonperishables, milk, bread, and produce at each distribution time, often with a two-mile drive-up waiting line.

Lisa Andrews, MEd, RD, LD, owner of Sound Bites Nutrition in Cincinnati and president of the Ohio Academy of Nutrition and Dietetics, started a single food pantry years ago, which led to the creation of 25 to 30 additional pantries in the region. “It’s especially useful during COVID-19 when people are either out of work or cannot get to the store for food,” she says.

Andrews has seen donations increase and a particular uptick in demand for peanut butter and canned beans. She has donated 10% of the profits from her themed T-shirt company, Lettuce Beet Hunger, to
provide food for people in her community.

During the pandemic, Sherry, who has shifted to telehealth visits during COVID-19, screens all of her patients for food insecurity at initial visits and follows up with each client. Although she hasn’t had a patient screen positive for food insecurity, Sherry suspects that “perhaps this is because my patients live in the New York City area and are connected to schools and food pantries. Then again, it might be because the patients who are under physical, mental, and financial stress due to the outbreak aren’t showing up for nutrition appointments.”

Competing priorities of work, child care, elder care, and illness may be larger priorities for some families during the pandemic.

Government Response
An April 17, 2020, press release from the USDA announced the launch of the USDA Coronavirus Food Assistance Program, a $19 billion relief initiative to assist farmers, ranchers, and consumers in response to the COVID-19 national emergency. The plan’s purpose was to maintain the integrity of the nation’s food supply chain and ensure every American can access and receive food they need. On May 15, 2020, the House of Representatives passed another bill, the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act, which would boost government-sponsored food assistance programs. The bill hasn’t yet been voted on in the Senate.

HEROES would provide $10 billion in additional funding for Supplemental Nutrition Assistance Program (SNAP) benefits until September 30, 2021. It also would increase the minimum monthly SNAP benefit from $16 to $30. The law also would exclude pandemic unemployment compensation as income in calculating SNAP eligibility and benefit levels for 10 months. It would allow participants to purchase hot foods and hot foods ready for immediate consumption, and provide flexibility in SNAP Education.

However, the HEROES Act didn’t authorize SNAP use at approved retailers nationwide. It also didn’t include a model for online delivery of food from small- and mid-size farmers who accept SNAP benefits.

HEROES would offer $1.1 billion to boost the WIC program to meet increased demand. Participants in the program can increase the value of the WIC Cash Value Voucher from $9 for children and $11 for women per month to $35 per month for women and children through the end of fiscal year 2020. The Older Americans Act Nutrition Programs received an additional $19 million in funding for senior nutrition services and $1 million for nutrition programs for Native Americans.

HEROES proposed $3 billion in additional funding for child nutrition programs, including emergency funding for school meal programs and the Child and Adult Care Food Program, which provides meals for child care centers, home care centers, and after-school programs. The bill would allow states to include children who wouldn’t otherwise have received meals through child care and require states to offer access to families who have been economically disadvantaged by COVID-19.

HEROES also would allow schools wider authority to serve foods provided by the Fresh Fruits and Vegetable Program. However, the bill doesn’t appear to devote any funding to streamline services while schools adapt to the logistical challenges of providing more food to more children, which requires different methods of service and using more safety measures than usual.

Many school districts have had to creatively solve myriad problems in getting food to children in a completely new way. Ryan Cengel, MS, MA, RD, LDN, CPT, SNS, head of nutrition at the Austin Independent School District in Austin, Texas, has been continuing to offer healthful and tasty meals via curbside delivery at 18 schools and more than 60 bus stop locations since the schools closed due to COVID-19 on March 23.

“We are serving a package of breakfast and lunch Monday through Thursday and a package of six meals for the weekend every Friday,” Cengel says. “Since the schools closed, we have served over 600,000 meals to our students. Sixty-five percent of our students qualify for free and reduced-price lunch during normal times, and with the impacts of COVID-19 that need has increased exponentially, even among families that have never needed food assistance in the past.”

Cengel and his staff recently created a partnership with the City of Austin and local restaurants to provide meals to caregivers who are picking up meals for their children. “This allows us to support our local restaurants and provide meals to our caregivers made by some of the best chefs in the city,” Cengel says.

Farm-to-School grant recipient schools across the nation are working with local farms to turn after school programs into salad and snack programs, bussing fresh, local produce to students. Other programs are sending free home gardening kits to children so they can learn about and experience food while sheltering at home.

As is the case with many RDs working in nationally funded food assistance programs during COVID-19, Cengel’s role has been multifarious: keeping current with ever-changing state and federal regulations, creating plans to keep food safe for consumption, making newly revamped operations efficient, promoting his team’s operations to the community, and working in cooperation with many others to get food to those who need it.

Cengel seeks to advocate for food assistance programs like his locally and nationally. “Food insecurity is a serious issue right now in our community,” he says, “and we are happy to be able to help our students and families get the nutrition they need in any way that we can.”

What will the future hold for resolving food insecurity during this and potential future pandemics? Kate Gardner Burt, PhD, RDN, an assistant professor of dietetics at Lehman College in New York City and a researcher on nutrition during COVID-19, believes RDs will continue to play a role in developing different methods of food distribution via food pantries and other organizations, such as providing boxed meals and offering drive-through pickup options. She predicts that RDs may help redefine the future of restaurants, which may become more focused on takeout rather than inhouse dining if physical distance between individuals remains critical.

Brennan Rhodes-Bratton, MPH, a doctoral candidate in sociomedical sciencesat Columbia University in New York City and a COVID-19 researcher, suggests that Americans likely will realize the value, security, and safety that local food systems provide. Rhodes-Bratton concurs with others such as Cengel that “thinking local and community” may be the best path for safely and reliably providing food for people during this and possible future pandemics, while also supporting local agriculture, families, and economies.

— Christen Cupples Cooper, EdD, RDN, is founding director and an assistant professor of nutrition and dietetics in Pace University’s College of Health Professions in Pleasantville, New York. You can find her at pace.edu/nutrition.

References
1. The COVID-19 pandemic is disrupting people’s food environments: a resource list on Food Systems and Nutrition responses. United Nations System Standing Committee on Nutrition website. https://www.unscn.org/en/news-events/recent-news?idnews=2039. Retrieved May 13, 2020.

2. Naja F, Hamadeh R. Nutrition amid the COVID-19 pandemic: a multi-level framework for action [published online April 20, 2020]. Nature. doi: 10.1038/s41430-020-0634-3.

3. Gleeson M, Nieman DC, Pedersen BK. Exercise, nutrition and immune function. J Sports Sci. 2004;22(1):115-125.

4. Muscogiuri G, Barrea L, Savastano S, Colao A. Nutritional recommendations for CoVID-19 quarantine. Eur J Clin Nutr. 2020;74(6):850-851.

5. Shah K, Kamrai D, Mekala H, Mann B, Desai K, Patel RS. Focus on mental health during the coronavirus (COVID-19) pandemic: applying learnings from the past outbreaks. Cureus. 2020;12(3):e7405.

6. Clay JM, Parker MO. Alcohol use and misuse during the COVID-19 pandemic: a potential public health crisis? Lancet Public Health. 2020;5(5):e529.

7. Patton L. Americans are flocking to the safety of comfort foods. Bloomberg. March 19, 2020. https://www.bloomberg.com/news/articles/2020-03-19/with-virus-lurking-americans-flock-to-safety-of-comfort-foods

8. The impact of coronavirus on food insecurity. Feeding America website. https://www.feedingamerica.org/research/coronavirus-hunger-research. Updated April 22, 2020.