Coronavirus communication and trust

The global coronavirus disease (COVID-19) pandemic has already had an enormous impact and will surely have profound consequences for many years to come.

The authors reflect on three risk communication themes related to the pandemic: trust, tradeoffs, and preparedness. Trust is critically important during such a rapidly evolving event characterized by scientific uncertainty. Reflections focus on uncertainty communication, transparency, and long-term implications for trust in government and science. On tradeoffs, the positive and unintended negative effects of three key risk communication messages are considered (1) stay at home, (2) some groups are at higher risk, and (3) daily infections and deaths.

The authors argue that greater attention to message ‘tradeoffs’ over ‘effectiveness’ and ‘evaluation’ over ‘intuition’ would help guide risk communicators under pressure. On preparedness, past infectious disease outbreak recommendations are examined. Although COVID-19 was inevitably ‘unexpected’, important preparedness actions were largely overlooked such as building key risk communication capacities.

COVID-19: Reflections on trust, tradeoffs, and preparedness, April 2020

Journal of Risk Research

Dominic HP Balog-Way and Katherine A McComas

https://www.researchgate.net/publication/340958173_COVID-19_Reflections_on_trust_tradeoffs_and_preparedness/references?utm_medium=email&utm_source=researchgate&utm_campaign=re413&loginT=iZBjE6QqKQDtgm9mIth3elm18k_fuz-NWD_VJXbuMq0_VSlbSUu0QyWSAb06_bTWyEX92MLG8X_6SgQ&pli=1&utm_term=re413_p_pb&utm_content=re413_p_pb_p4&cp=re413_p_pb_p4&uid=nL3zUTnj0PdkgYxg8hJW1mCbrq7iJZlhMSga&ch=reg

When our eldest daughter was about six-weeks-old in 1987, my ex and I took her to a Grateful Dead concert at an outdoor amphitheater north of Toronto. We sat at the back. The dead did this Buddy Holly song as part of their encore and it was fabulous.

Rates of FBI going nowhere

Is unconditional love a real thing? Is it possible to maximize an individual’s goals and relationships at the same time? Is microbial foodborne illness still a thing?

Unconditional is a subjective word that means different things to different people.

Rather than going for the safe middle in conflict resolution, I have a therapist who says, go for the jugular: have a great relationship and go after great goals (note: it helps if you tell your partner what you want in terms of the relationship and goals).

Microbial foodborne illness rates in the U.S. have been stagnant for 15 years. It’s a thing, but it’s not clear who cares.

The Washington Post stated back in the day, “Between 1998 and 2004, illnesses reported by CDC that were caused by E. Coli, listeria, campylobacter and a few other bacteria decreased by 25 to 30 percent, perhaps because of improvements in the handling of meat and eggs. Since about 2004, however, the rate of these illnesses has basically remained steady.”

There’s lots of new media toys out there, but it’s the high-tech version of signs that say, “Employees Must Wash Hands.” Reposting press releases – especially in the absence of critical analysis — is a waste of bandwidth and resources. And there is no evidence it results in fewer sick people.

Last week, the U.S. Centers for Disease Control reiterated the incidence of most infections transmitted commonly through food has not declined for many years.

Incidence of infections caused by Listeria, Salmonella, and Shigella remained unchanged, and those caused by all other pathogens reported to FoodNet increased during 2019. Infections caused by Salmonella serotype Enteritidis, did not decline; however, serotype Typhimurium infections continued to decline.

New strategies that target particular serotypes and more widespread implementation of known prevention measures are needed to reduce Salmonella illnesses. Reductions in Salmonella serotype Typhimurium suggest that targeted interventions (e.g., vaccinating chickens and other food animals) might decrease human infections. Isolates are needed to subtype bacteria so that sources of illnesses can be determined.

I’ve been harping about the need for new messages and new media for 15 years – even did a road trip in 2009 with a number of talks stressing this point – with apparently little effect.

So maybe I’ll focus on relationships and being the best partner, father and person I can be.

Peace and love.

Preliminary incidence and trends of infections with pathogens transmitted commonly through food—foodborne diseases active surveillance network, 10 US sites, 2016-2019, 01 May 2020

Morbidity and Mortality Weekly Report pp.509-514

Danielle M. Tack, DVM1; Logan Ray, MPH1; Patricia M. Griffin, MD1; Paul R. Cieslak, MD2; John Dunn, DVM3; Tamara Rissman, MPH4; Rachel Jervis, MPH5; Sarah Lathrop, PhD6; Alison Muse, MPH7; Monique Duwell, MD8; Kirk Smith, DVM9; Melissa Tobin-D’Angelo, MD10; Duc J. Vugia, MD11; Joanna Zablotsky Kufel, PhD12; Beverly J. Wolpert, PhD13; Robert Tauxe, MD1; Daniel C. Payne, PhD1

https://www.cdc.gov/mmw/volumes/69/wr/mm6917a1.htm?s_cid=mm6917a1_w&deliveryName=USCDC_921-DM26943

Raw is risky: Study finds raw-type dog foods as a major source of multidrug-resistant bacteria that could potentially colonize humans

I’m nervous this is not peer-reviewed, has a small sample size, but thought I’d share anyway.

I’ve never fed any of my pets a raw-food diet.

New research due to be presented at this year’s European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) reveals that raw-type dog foods contain high levels of multidrug-resistant bacteria, including those resistant to last-line antibiotics. The potential transfer of such bacteria between dogs and humans is an international public health risk, conclude the authors who include Dr. Ana Raquel Freitas and colleagues from the Faculty of Pharmacy, UCIBIO/REQUIMTE, University of Porto, Portugal.

Enterococci are opportunistic pathogens—so they are part of our normal internal microbiota but can cause infections (for example in patients who are immunosuppressed or hospitalised).

Raw-food-based diets for dogs have grown popularity recently as a healthier choice. Increasing controversy regarding their safety is emerging, with some scientific evidence showing their role as vehicles for transmission of antibiotic-resistant bacteria. In addition, dogs have been described as reservoirs of clinically-relevant ampicillin-resistant (AmpR) Enterococcus faecium, but the source remains unknown.

In this study, the authors analysed enterococci obtained from processed (both dry and wet types) and non-processed (raw-frozen) foods of the main brands commercialised in Portugal. The study included 46 samples (22 wet, 15 dry, 9 raw-frozen) from 24 international brands, sourced from 8 supermarkets and one veterinary clinic. Samples were obtained during September to November, 2019.

Raw-frozen samples were mainly constituted of salmon, chicken, turkey, calf, deer or duck, being a mixture of different meat types, fruits and vegetables.

Samples were cultured and then tested with a range of antibiotics. Enterococci (n=163) were identified in 19/46 (41%) of the samples: 8 of 15 (53%) in the dry foods; 2 of 22 (9%) of the wet samples, and 9 of 9 (100%) in the raw-frozen samples, and identified as the Enterococcus species E. faecium (91 isolates), E. faecalis (59 isolates) or other species (13 isolates).

Across the 9 raw-frozen meat samples, there were 30 E. faecium and 30 E. faecalis recovered. All nine carried multidrug-resistant (MDR) enterococci (20 E. faecium and 22 E. faecalis), including those resistant to a wide range of antibiotics, while only one MDR- E. faecium (resistant to erythromycin/tetracycline/gentamicin) was detected in one of the wet food samples and none in the dry food samples.

Resistance was found to the antibiotics ampicillin, ciprofloxacin, erythromycin, tetracycline, streptomycin and chloramphenicol in all 9 raw-type samples; seven of nine contained enterococci resistant to the last line antibiotic linezolid (78%), and six of nine contained enterococci resistant to gentamicin or quinupristin-dalfopristin. Resistance to clinically-relevant antibiotics such as linezolid, ampicillin or ciprofloxacin was only detected in raw-frozen samples.

The authors conclude: “Our study demonstrates that raw-frozen-foods for dogs carry MDR enterococci including to last-line antibiotics (linezolid) for the treatment of human infections. The close contact of pets with humans and the commercialisation of the studied brands in different EU countries pose an international public health risk if transmission of such strains occurs between dogs and humans. There is strong past and recent evidence that dogs and humans share common multidrug-resistant strains of E. faecium, and thus the potential for these strains to be transmitted to humans from dogs.”

Dr. Freitas adds: “These raw-frozen foods are supposed to be consumed after being thawed and could at least be cooked, to kill these drug-resistant and other bacteria. Although these foods seem to be regulated regarding their microbiological safety by EU authorities, risk assessment of biological hazards should also include antibiotic-resistant bacteria and/or genes besides only establishing the presence of bacterial pathogens, such as Salmonella.”

Practical ways to help vets during COVID-19

Maureen Anderson writes in the Worms & Germs Blog, “the COVID-19 pandemic has put a lot of strain on a lot of people, and those in the veterinary profession are no exception.  Thank you, Captain Obvious. 

Self-care and mental health support at times like these are critical, but can be hard to come by for many still working on the front lines in clinics, both human and veterinary.  It’s important to recognize that everyone is stressed, even our clients, but giving others that extra little bit of leeway and understanding can be tough when you’re already at the end of your own rope. (Right, that’s Kate the Vet of Kansas State University and my research partner on a couple of handwashing projects and papers back in the day.)

A little bit of kindness can go a long way, and that’s as important now as it was a month ago when the world changed overnight, maybe even more so.  Dr. Christopher Byers, a fellow veterinary internist in the US, wrote a blog post about how pet owners can help veterinarians during this crisis, and it also speaks to how we can all help each other.  Our mental and physical health go hand-in-hand, and are also closely associated with the health and welfare and care we are able to provide our animals.  Consider it a non-infectious consequence of a highly infectious disease, so I thought it was appropriate to share here.

You can read Dr. Byers full post on CriticalCareDVM.com, but here are his three very simple and practical points for pet owners:

  1. Be flexible
  2. Be kind
  3. Stay home if your pet isn’t sick

Zoonoses in Minnesota

Prospective, population-based surveillance to systematically ascertain exposures to food production animals or their environments among Minnesota residents with sporadic, domestically acquired, laboratory-confirmed enteric zoonotic pathogen infections was conducted from 2012 through 2016.

Twenty-three percent (n = 1708) of the 7560 enteric disease cases in the study reported an animal agriculture exposure in their incubation period, including 60% (344/571) of Cryptosporidium parvum cases, 28% (934/3391) of Campylobacter cases, 22% (85/383) of Shiga toxin-producing Escherichia coli (STEC) O157 cases, 16% (83/521) of non-O157 STEC cases, 10% (253/2575) of non-typhoidal Salmonella enterica cases and 8% (9/119) of Yersinia enterocolitica cases. Living and/or working on a farm accounted for 61% of cases with an agricultural exposure, followed by visiting a private farm (29% of cases) and visiting a public animal agriculture venue (10% of cases). Cattle were the most common animal type in agricultural exposures, reported by 72% of cases.

The estimated cumulative incidence of zoonotic enteric infections for people who live and/or work on farms with food production animals in Minnesota during 2012–2016 was 147 per 10 000 population, vs. 18.5 per 10 000 for other Minnesotans. The burden of enteric zoonoses among people with animal agriculture exposures appears to be far greater than previously appreciated.

Animal agriculture exposures among Minnesota residents with zoonotic enteric infections, 2012-2016, 17 December 2019

Epidemiology and Infection

CA Klumb, JM Scheftel and KE Smith

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/2F76B12833C41C4F63153CC4315C22F0/S0950268819002309a.pdf/animal_agriculture_exposures_among_minnesota_residents_with_zoonotic_enteric_infections_20122016.pdf

Australian rockmelon growers get best practice guide to help food safety

Really?

Are these guidelines actually going to make fewer people barf and die?

It’s all about the implementation and verification, but that’s expensive and rarely undertaken beyond soundbites.

When Listeria killed seven people in Australia last year, linked to rockmelon (cantaloupe for you North American types) growers acted like it never happened before and just wanted to get product back on shelves.

They should never be cut in half, although all retailers do it, and it’s just greed over public health.

In the fall of 2011, 33 people were killed and 147 sickened from Listeria linked to cantaloupe in the U.S.

And it keeps happening.

The NSW Department of Primary Industries has released a best practice guide for rockmelons and speciality melons prompted by the 2018 listeria detection on a NSW farm which severely impacted the entire Australian rockmelon industry.

Domestic and export sales ceased for around six weeks. It has taken the following two years to regain market share.

To support rockmelon growers and combat foodborne illness risks, Hort Innovation launched a review of all industry food safety practices to strengthen food safety measures and provide training support for the industry.

Delivered by the NSW Department of Primary Industries (NSW DPI), the project involved working individually with all Australian rockmelon growers to review and audit current practice and critical control points.

One-on-one food safety consultations with growers, managers and key farm staff also took place.

The project also developed a Melon Food Safety Best-Practice Guide and a “toolbox” for grower use including risk assessment templates, training guides, food safety posters and record sheets to support food safety programs.

Women

In honor of International Women’s Day (yesterday in Canada) and the first all female crew calling an NHL game (which I am watching), here’s to my girls who play hockey (digital cameras and iPhones didn’t exist when my older two were playing so I apologize for the lack of pics).

Back in the BC time frame (before children) Amy and I went to a game in Chicago versus St. Louis where I was giving some sort of talk (it may have been the melamine in pet food one, where I offended everyone by saying, pets are not humans).

But that doesn’t mean they should be fed shit.

That’s the game on tonight with the all female crew, and all I can think of is various people chanting, Missouri sucks

Same as it ever was: David Byrne explains food safety failures on SNL last week

It was probably 2009 that me and Amy and the 6-month old kid went on a southern U.S. road trip, featuring many stops to breastfeed, and many talks.

Sure, it wasn’t the same as me and the ex taking our now 33-year old to see the Grateful Dead north of Toronto when she was 6-weeks old, but it was cool (the Dead went back to Americana roots in 1970 and 71, producing two albums that had nothing to do with psychedelia and everything to do with, we are America, this is our music).  The theme of the 2009 road trip was, how did food safety get so shitty (see future posts). I found resonance in The Talking Heads, and David Byrne resurrected the iconic song which was the soundtrack of my 2009 tour last week on Saturday Night Live.

I have great memories of that trip, but now, all I have is memories, and they are fading fast.

Enjoy.

 

So sorry: Texas woman who pooped in cop car to hide drugs in her feces gets prison time

Chacour Koop of the Star Telegram reports a woman who pooped in cop car to create a hiding spot for her drugs is going to prison, officials say.

Two years ago, Shannen Martin, 34, was arrested during a theft investigation at an H-E-B grocery store in Corsicana, Texas, police said. She was handcuffed and put in the patrol vehicle after resisting the cops, police said.

On her way to jail, Martin “intentionally defecated” in the car and hid 2.3 grams of crack cocaine, a crack pipe and a Valentine’s Day card in the poop, police said.

An officer had to dig through the poop to find the evidence, police said.

Martin pleaded guilty to possession of a controlled substance and tampering with evidence. She also pleaded guilty to injury to a disabled person for macing a relative during an argument, according to the Navarro County District Attorney’s Office.

Last year, Martin was sentenced to probation instead of prison.

As part of her sentencing, she also was required to write a letter of apology to the officer who had to dig through her poop, court records show.

However, Martin’s probation was revoked in September after she violated terms of her agreement multiple times, prosecutors said. Last week, she was sentenced to three years in prison.

Storytelling is vital, so is content: Doctors on TikTok try to go viral

For decades, sex education in the classroom could be pretty cringey. For some adolescents, it meant a pitch for abstinence; others watched their teachers put condoms on bananas and attempt sketches of fallopian tubes that looked more like modern art.

Me and my veterinarian first wife had no qualms about explaining biological reality to our young daughters– no stork, no parthenogenesis, no saviour prince.

Emma Goldberg of New York Times writes that on TikTok – which my children are still trying to explain to me — sex ed is being flipped on its head. Teenagers who load the app might find guidance set to the pulsing beat of “Sex Talk” by Megan Thee Stallion.

A doctor, sporting scrubs and grinning into her camera, instructs them on how to respond if a condom breaks during sex: The pill Plan B can be 95 percent effective, the video explains.

The video is the work of Dr. Danielle Jones, a gynecologist in College Station, Tex., and so far has racked up over 11 million views. Comments range from effusive (“this slaps”) to eye-rolling (“thanks for the advice mom” and “ma’am, I’m 14 years old”).

 “My TikTok presence is like if you had a friend who just happens to be an OB/GYN,” Dr. Jones said. “It’s a good way to give information to people who need it and meet them where they are.”

Dr. Jones is one of many medical professionals working their way through the rapidly expanding territory of TikTok, the Chinese-owned short-form video app, to counter medical misinformation to a surging audience. The app has been downloaded 1.5 billion times as of November, according to SensorTower, with an audience that skews young; 40 percent of its users are ages 16 to 24.

That would be the food service audience. Guess I better get hip.

I’ve learned to text more. Seems like an entire generation missed e-mail.

Although medical professionals have long taken to social media to share healthy messages or promote their work, TikTok poses a new set of challenges, even for the internet adept. Popular posts on the app tend to be short, musical and humorous, complicating the task of physicians hoping to share nuanced lessons on health issues like vapingcoronavirusnutrition and things you shouldn’t dip in soy sauce. And some physicians who are using the platform to spread credible information have found themselves the targets of harassment.

Dr. Rose Marie Leslie, a family medicine resident physician at the University of Minnesota Medical School, said TikTok provided an enormous platform for medical public service announcements.

“It has this incredible viewership potential that goes beyond just your own following,” she said.

Dr. Leslie’s TikToks on vaping-associated lung diseases drew over 3 million views, and posts on the flu and HPV vaccines also reached broad audiences beyond her hospital.

Striking a chord on TikTok, Dr. Leslie said, means tailoring medical messaging to the app’s often goofy form. In one post, she advised viewers to burn calories by practicing a viral TikTok dance. She takes her cues from teen users, who often use the app to offer irreverent, even slapstick commentary on public health conversations. She noted one trend in which young TikTokers brainstormed creative ways to destroy your e-cigarette, like running it over with a car.

TikTok’s executives have welcomed the platform’s uses for medical professionals. “It’s been inspiring to see doctors and nurses take to TikTok in their scrubs to demystify the medical profession,” said Gregory Justice, TikTok’s head of content programming.

Earlier this month, Dr. Nicole Baldwin, a pediatrician in Cincinnati, posted a TikTok listing the diseases that are preventable with vaccines and countering the notion that vaccines cause autism.

Her accounts on TikTok, Twitter, Facebook and Yelp were flooded with threatening comments, including one that labeled her “Public Enemy #1” and another that read, “Dead doctors don’t lie.”

A team of volunteers that is helping Dr. Baldwin monitor her social media has banned more than 5,200 users from her Facebook in recent weeks.

Dr. Baldwin said she started out feeling enthusiastic about the opportunity TikTok provides to educate adolescents, but her experience with harassment gave her some pause.

 “There’s a fine line physicians are walking between trying to get a message out that will appeal to this younger generation without being inappropriate or unprofessional,” Dr. Baldwin said. “Because of the short content and musical aspect of TikTok, what adolescents are latching onto is not the professional persona we typically put out there.”