The ghost of Heston: Norovirus outbreak in England

After battling the Covid-19 pandemic for almost two years, a new virus outbreak has been reported in the UK, which is spreading like wildfire. Referred to as the vomiting bug, Norovirus is highly infectious and causes vomiting and diarrhoea.

Arushi Bidhuri of The Health Site writes Public Health England issued a warning about this nasty virus after routine surveillance reported that there has been a massive jump in cases of norovirus. According to reports, 154 outbreaks have been recorded in England since May. This is roughly three times the previous five-year average of 53 outbreaks over the same time period. According to PHE, while small children have been affected, there has also been an increase in infection across all age categories.

As we continue to take precautionary measures against Covid-19, here are some precautions you should take to avoid the contraction of the highly infectious, norovirus. Again, the most important thing is to pay close attention to hygiene.

Quarantine yourself in case you experience any symptoms of norovirus.

Wash your hands frequently and thoroughly, using soap and water. Unlike COVID-19, alcohol sanitisers do not kill norovirus, therefore soap and water are the best options.

To disinfect contaminated household surfaces, use a bleach-based household cleaner or a mixture of bleach and hot water.

Avoid cooking or eating with others at least 48 hours after recovering from the infection.

Any contaminated clothes or bedding should be washed with detergent and at 60 C, and contaminated objects should be handled with disposable gloves if feasible.

People infected with the virus should take rest and stay hydrated.

Seek medical attention if symptoms persist for more than 24 hours.

Since young children and the elderly are more prone to rapid dehydration, take extra care and be cautious.

Food safety lessons of the COVID-19 pandemic

While it is, perhaps, premature to look at the COVID-19 pandemic through the rearview mirror only, there is, according to Max Teplitski of The Packer, enough data to extract some useful lessons. 

There has been an 80-95% drop-off in the cases of norovirus infections in the U.S. (and a similar trend in England and Wales) during the COVID-19 pandemic, and another study focusing on a decline in foodborne bacterial infections. 

Similarly, studies in Israel and Spain report a 30-80% decline in reported cases of salmonella, shigella and campylobacter infections. Even though the healthcare system was stressed, authors point out that under-reporting of cases could be ruled out.  

While it is beyond doubt that SARS-CoV2 is not a foodborne pathogen, what can we learn from the measures that were put in place to control COVID-19 that also had a positive impact on food safety?

Even though we cannot eliminate the possibility that lockdowns minimized interpersonal interactions and that limited the spread of some foodborne illnesses, other factors were also likely at play. 

From the first days of the pandemic we were all reminded of the importance of hygiene: washing hands, using alcohol-based sanitizers and doing so often. While hand hygiene is something that is commonplace in the produce and, more broadly, food industry, it was the first time that consumers went to great lengths to sanitize hands before coming into public places and after leaving them.  

The authors of the Israeli study, in fact, make a direct link between an increase in handwashing and a reduction in shigella infections. I firmly believe that continuing handwashing and hand sanitizing habits learned over the past 18 months is the single most effective intervention that the food industry and consumers can implement to reduce the burden of foodborne illness. 

Disinfecting shopping carts was a new practice implemented during the pandemic. While it was put in place to sanitize high-touch surfaces (such as cart handlebars), I have no doubt that this was the second most effective practice in reducing transmission of foodborne pathogens. 

Restaurant worker training effectiveness during covid-19

The restaurant business has turned into a dynamic and ever-growing industry. So, food safety must be a priority for these establishments, especially during the COVID-19 pandemic. The aim of this study was to determine the effect of training intervention on the health and food safety knowledge, attitude, and self-reported practice (KAP) of restaurant food handlers during the COVID-19 pandemic.

This quasi-experimental study was conducted on 159 restaurant food handlers in Tehran, Iran. The training intervention was developed based on the latest global guidelines. The KAP of the subjects was measured before and after the training. Fisher’s exact test, paired t test, and repeated measures ANOVA were used for statistical analysis. Data analysis was done using the IBM_SPSS software. The total knowledge scores of participants were low (17.6%), moderate (35.2%), and good (47.2%) before training, which were changed to 5% (low), 23.9% (moderate), and 71.1% (good) after training. The total pretraining attitude scores were 0.6, 77.4, 18.2, and 3.8% that were changed to 0% (strongly negative), 49.1% (negative), 33.3% (positive), and 17.6% (strongly positive), respectively. Also, the self-reported practice scores of the participants before training were 1.3, 56, and 42.7 that were changed to 0% (weak), 26.4% (acceptable), and 73.6% (desirable) after the intervention, respectively. Paired t test results showed a statistically significant increase in all scores. The interaction of training with age and education was statistically significant in increasing the knowledge and attitude scores of the participants by the repeated measures ANOVA.

Improving the KAP of food handlers by health and food safety training can improve the status of restaurants and minimize the outbreak of pandemic diseases, including COVID-19, which is an effective step in community health. Thus, it is an urgent need for policymakers to design an online system of continuous food safety training for food handlers.

A quasi-experimental study on the effect of health and food safety training intervention on restaurant food handlers during the COVID-19 pandemic, 25 April 2021

Food Science & Nutrition

Fatemeh Mohammadi-Nasrabadi, Yeganeh Salmani, and Fatemeh Esfarjani

DOI: 10.1002/fsn3.2326

Food Safety Talk 209: Joe Exotic Stimulus Check

The show starts with some French Canadian references, cousin talk and Belgium TV shows (at least one). The guys talk a bit about code switching, and Ben’s rewatching of the Marvel Cinematic Universe (even the bad ones). They then talk about how COVID-19 is affecting essential employees, and what that means for the food industry and supply. Ben and Don talk about what they think about pausing inspections and go into a deep dive about a blip in recalls. The discussion shifts to chicken liver pate and forcemeats. The show ends with the guys talking about Adam Schlesinger and John Prine.

Download the episode here or at a podcast place.

Show notes so you can follow along at home:

What We Know – And Don’t Know – About Food Safety And COVID-19

The always awesome, and all around great dude, Matt Shipman pitched a bunch of questions to Lee-Ann Jaykus and I about COVID-19 and food safety. Here’s what we said: (from The Abstract)

Photo by Louis Reed on Unsplash

As the world grapples with COVID-19, people have a lot of questions about how to best protect themselves. Many of those questions have to do with food, and NC State experts are sharing the best available information on food safety, and what risks are associated with eating takeout and going to the grocery store.

Sharing this information is part of our mission as a land-grant university: we want to help people make informed choices about how to protect their health. We also want to help people get a better understanding of what we know and what we don’t know about the COVID-19 virus. And there is a lot we don’t know.

There are quite a few resources available online that can help readers better understand what we do know about COVID-19, such as this Q&A page from the World Health Organization. So we thought we’d talk to some folks at NC State about the basics of COVID-19 and (importantly) what we don’t know in the context of food safety, as well as what’s being done to fill those gaps in our understanding.

With that in mind, we took some time to pick the brains of Lee-Ann Jaykus and Ben Chapman. Both are trained microbiologists and are internationally recognized experts on various aspects of food safety. Jaykus, in particular, is a leading authority on food virology.

The Abstract: Okay, first question: what is “food virology”?

Ben Chapman: Food virology is the field of studying the biology, infectivity, transmission, epidemiology and control of human pathogenic viruses that are associated with the food we eat. Common foodborne viruses include norovirus and hepatitis A, but there are some lesser known ones like hepatitis E and astroviruses (a particular favorite name of mine) that we are learning more about and their impacts on the food system. This area of study is closely related to animal virology, as we look at public health as a combination of animal and human health – known in our world as “one health.”

Lee-Ann Jaykus: Foodborne viruses are diverse but have many features in common: non-enveloped structure; human-only transmission; fecal-oral exposure routes; a high degree of environmental persistence; resistance to commonly used food processing techniques and disinfectants, etc. SARS CoV-2, the virus that causes COVID-19, is structurally very different from these viruses and is not considered “foodborne” per se. Nonetheless, SARS CoV-2 has been particularly challenging because it is less fragile than most common respiratory viruses and there is still much that we don’t know about how to control it.

TA: Because COVID-19 is caused by a virus, not by bacteria, that means it cannot be treated with antibiotics, right?

Chapman: Yes. COVID-19 is caused by SARS-CoV-2, which appears to be closely related to another coronavirus that was the cause of illnesses classified as Severe Acute Respiratory Syndrome almost 20 years ago. As antibiotics or antibacterial soaps are created to disrupt certain biological functions of bacteria, they don’t have the same impacts on viruses.

Jaykus: That’s right. Viruses are obligate intracellular parasites; in other words, they require a live host cell in order to multiply. In fact, once they infect the host cell, they take over its functions, producing many new viruses, infecting surrounding cells and causing the symptoms of the disease. In general, the antibiotics we normally use are designed to kill or prevent the growth of certain bacteria and hence do not commonly work on viruses.

Chapman: There are antiviral drugs however, and applying these compounds as treatment for COVID-19 is something that medical researchers are investigating.

TA: So, the available resources addressing food safety and COVID-19 are based on the best available science. Given that COVID-19 has only been around for a matter of months, how much science is available right now?

Jaykus: Not much, although I think it is very safe to say that this is not a foodborne virus in the traditional sense of the term. And if the virus were present in a food, it would still not be likely to infect the person eating that food – although it’s probably not impossible. However, for such an infection to occur, all the right factors would need to be in place. It is so much easier for the virus to jump from one person to another by close personal contact and respiratory secretions. I believe putting our attention on foods takes attention away from what we already know works, which is social distancing and isolation.

Chapman: There are researchers around the world investigating the virus daily, helping us determine some of the very basic characteristics of SARS-CoV-2.

We also have a body of literature on SARS-CoV-1 that is giving us some indication on environmental stability, infection, shedding, symptoms, transmission, inactivation and other control measures that may apply to SARS-CoV-2.

The other big data set we’re all watching in real time is from the epidemiological studies that are coming out of some of the earlier clusters of outbreak. Work out of Wuhan, Washington State and cruise ships are all adding to what we know. But yeah, being only months into this, there’s not a rich body of work to make decisions on. Comparatively, we have decades of data on norovirus outbreaks to make decisions on – but even with that virus, it took many years to figure out how to grow it in a laboratory. So what we know about SARS-CoV-2 is really still in its infancy.

TA: How has our scientific understanding of COVID-19 and food safety evolved in recent months, or even in recent weeks?

Chapman: We’re relying on the data we do have in hand – that epidemiology is pointing largely to person-to-person transmission from symptomatic and asymptomatic individuals. We’re also drawing on the library of literature on SARS-CoV-1 and other respiratory viruses. As of right now, CDC and FDA have been fairly clear that they don’t have any data (epidemiological or otherwise) that is showing that food or food packaging is a primary risk factor for illness. It’s not to say that transmission isn’t possible (we don’t use a lot of absolutes in the scientific world), but the evidence currently isn’t pointing to food as something we need to manage differently than we normally do for other foodborne illnesses. But every day I think we are actively looking to make sure we haven’t missed anything.

Jaykus: Quite frankly, and rightly so, we are not looking at SARS-CoV-2 as a foodborne pathogen, so we haven’t really studied it in the food system. Food companies are focused largely on preventing aerosol or tactile (hands or surfaces)-based contamination of foods and trying to protect their workforce from infection, which in turn protects the food they come into contact with. Using the controls currently in place and mandated by federal, state, and local food safety and public health authorities remain the best approaches: adequate and frequent handwashing; prevention of bare hand contact with ready-to-eat foods; surface cleaning and disinfection; and (uniquely), liberal use of hand sanitizers. Add to that social distancing and exclusion of ill or infected food workers.

TA: How have we been able to learn even this much in such a short period of time?

Jaykus: It’s a pandemic. Scientists are racing against the clock. It is a different world when everyone is in it together and we’re saving lives.

Chapman: It’s such a global focus, like nothing we’ve ever experienced before. Everyone is generating and analyzing data as quickly as possible. Keep in mind that in many places people don’t have access to their labs, so that is definitely slowing the progress down. Still, there’s a ton of COVID-19 research coming out on a daily basis.

But there are lots of caveats to everything that has been done. For example, we are just beginning to really know what this virus is all about and still need to confirm that it acts like other coronaviruses. And we don’t have all that data in hand yet.

TA: What are some of the outstanding questions that we’re working to understand? Who’s taking the lead on addressing those questions?

Jaykus: From a food-safety perspective, characterizing the efficacy of various disinfectants is critical. For instance, we just don’t know if there is a “best,” or even a recommended, cleaning and sanitation regimen for food processing. I think that is a critical question right now. The facemask debate is a problem; I can see arguments both ways, but we have to be careful not to use face coverings only to find that they are a way to spread the virus.

It appears that the fecal matter of some infected people contains evidence of the virus, but we don’t know if that virus is actually infectious. Answering this question would allow us to better understand transmission in general.

Development of an inexpensive and very rapid test method that can be used to screen pre-symptomatic individuals or those shedding virus after recovery would be good for all, and especially helpful for critical infrastructure, including food manufacturing. Having such a test will be really important as we move toward lifting social isolation restrictions.

Chapman: Another big one is how long the virus remains viable on different surfaces (including food and packaging). There are a few studies out there that address this, but there are still a lot of unanswered questions. We need to know how long the virus remains viable not only on different materials, but under various temperature and humidity combinations. Another line of questioning involves the extent to which heat, disinfectants, UV light and pressure can inactivate the virus. And, of course, questions surrounding transmission, such as why there are seemingly so many asymptomatic individuals who are shedding virus.

TA: Why are those things important?

Jaykus: Because understanding these issues will provide scientific evidence upon which we can make better recommendations for controlling the spread of the virus.

TA: Where can people go to keep track of new information as it becomes available?

Chapman: The CDC is a go-to source, because they are proactive about posting new information daily. And NC State also has a bunch of resources available online.

Jaykus: There are good resources for tracking the pandemic here and here. People may also want to visit the Association of Food and Drug Officials Coronavirus website.

TA: What advice do you have for people who are trying to figure out, for lack of a better term, how to eat during a pandemic?

Chapman: Remember that the biggest risk factor is being around other people, so reduce those interactions as much as possible. Limit contact by using delivery or curbside pickup of food. Handwashing and sanitizer are excellent secondary control steps.

Jaykus: We all have to eat and food is low risk for transmitting this virus. Use of surface disinfectants and particularly, frequent handwashing and sanitizing is a useful protection. But really, your best protection is to put your efforts into the controls recommended by public health officials: i.e., limit your contact with other people and, when that is not possible, maintain social distance.


Human-to-cat COVID-19 virus transmission: Belgium

My Guelph (that’s in Canada) friend, hockey buddy and veterinarian, Scott Weese, has done an admirable job of updating the world on pets and coronavirus through his Worms and Germs Blog.

He notes that a cat in Belgium, owned by a person with COVID-19, has tested positive for the virus. The cat developed diarrhea, vomiting and respiratory difficulty about 1 week after the owner got sick, and SARS-CoV-2 was found in the cat’s feces. It’s not clear whether the test used was PCR (which can detected live or dead virus) or virus isolation (which only detects live virus), or if other samples were also tested. It’s also not clear whether the cat was sick because of the infection with SARS-CoV-2 or whether it had some other co-incidental problem (or whether the cat is still alive or not).  They were clear that this is another suspected case of human-to-animal transmission, and not the other way around.

Is this surprising?

Not really. We’ve been saying there’s likely going to be some human-to-pet transmission, and cats have been a concern because they are theoretically a susceptible species based on analysis of the virus and cell receptors.

Is this concerning?

I don’t have any more concern today than I did before this report, since it was likely that this was going to happen, and animals (still) presumably pose very limited risk. An infected cat isn’t a big concern in the household since the person who exposed the cat in the first place is the main risk. This virus is being transmitted very effectively person-person, so animals likely play little role, if any in the grand scheme of things.  But we still want to take basic steps to keep the risk as low as possible.

So, what do we do?

The same thing we’ve been saying all along. If you’re sick, stay away from animals just like you would other people. If you have COVID-19 and have been around your pets, keep your pets inside and away from other people. While the risk of transmission to or from a pet is low, we don’t want an exposed pet tracking this virus out of the household (just like we don’t want an infected person doing that).

This is completely unsurprising. It doesn’t mean things are changing or that we have more risk today than yesterday. It just emphasizes again the importance of paying attention to basic infection control measures.

If you’re worried about getting COVID-19, worry about your human contacts, not your pets. Keep pets away from high risk people, but otherwise, your risk is from exposure to people, not your pet.

Managing food safety in the time of COVID-19

I collaborated with a team of food safety professionals on the below article. Byline is:

Eric Moore, Director of Food Safety and Industry Relations, Testo

Ben Chapman, Professor, Food Safety Specialist, NCSU

Don Schaffner, Professor, Extension Specialist, Rutgers

Steven Mandernach, Executive Director, AFDO

Hal King, CEO Active Food Safety

March 2020 was a month unlike any of us have experienced before. Beyond the transition to working remotely and the seemingly endless video meetings and webinars, we’ve collectively learned a lot about coronaviruses, environmental stability, inactivation, transmission routes, how to perform wellness checks of employees,  and have fielded dozens of questions from food industry stakeholders and the media. This tragic pandemic has led to partnerships and collaborations towards many common public health, food safety and risk goals.

The current challenges to ensuring the health and safety of employees and customers has never been more difficult. There are likely unintended positive food safety impacts that are being seen across the food system. We guess that employee handwashing practices are likely at an all time high with all the added focus. Extra attention to proper chemical use to clean, sanitize and disinfect both food and non-food contact surfaces, especially high-touch surfaces, is almost certainly happening. 

Although much of what we know about COVID-19 is emerging, many media outlets are sharing consistent (and evidence-based) messages that food safety professionals have been teaching and preaching for years. On a more personal level, hearing our kids belt out new handwashing songs, watching Tik-Toks on social distancing, and now all know a little something about epidemiology – flattening the curve — is heartening. There is even a slick new website, Wash Your Lyrics, that you can use to generate your own song and handwashing poster with everything from Styx to Post Malone to the Grateful Dead. It’s been truly amazing to see how in the face of adversity some amazing advancements in enabling and supporting behavior change can happen. Of course we would have preferred there be no pandemic, but this is now the new normal. 

Since food manufacturing, foodservice, food retail, agriculture and transportation are all classified as essential critical infrastructure, the collective food industry has a responsibility to respond. It is with great thanks and admiration to these organizations and the numerous individuals that run them who are helping the rest of us get through daily life by ensuring we have safe food which is essential for our survival. We are also trying to find any positives that may result such as better reporting, and creative approaches to food manufacturing and sales.

After conversations over the last few weeks at GFSI in Seattle, then AFFI-Con in Las Vegas we thought it might be time to take a minute to share some of the ideas and recommendations  because it’s never too late to start planning for what comes next and being ready for the next challenge including the potential for seasonal reemergence (and don’t forget a pandemic flu is likely in our future as well). How can food safety professionals learn from our current situation to establish sustainable practices? Here is what we have so far. The list is not all inclusive but includes  ideas we feel merit further consideration, action and diligence: 

Management Team:

  • Implement an employee health and wellness program that supports pro-active restriction and or exclusion.  
  • Have a pandemic response plan incorporated into your organization’s Business Continuity Plans which should include key aspects of service limitations, increased cleaning/sanitizing and disinfection, etc.
  • Designate roles within your organization that will connect to global, national, regional and local regulatory authorities to monitor the situation and to deploy adequate control measures to continue operations. 
  • Identify backups for each job position and if possible alternate production sites to offset production delays.
  • Promote remote work for non production or essential roles. Digital food safety management systems (FSMS) are a great tool to facilitate and maintain adequate processes and controls are being met even from a remote location.  
  • Consider providing transportation for employees that use public transportation.

Perishable Food:

  • Reduce food waste by lowering par inventory levels.
  • Identify if/what products in your inventory that can be frozen without quality compromises, and used at a future date. Think about consolidating inventory in preparation for staff reductions 
  • When closing a facility, divert safe food to local food banks or shelters – donate as much product to them as possible as long as it has not passed its expiration date.
  • To assist locations in returning to normal operations (post pandemic) discard perishable products near the end of useful life. 

Refrigeration Recommendations:

  • Reorganize inventory and condense products into fewer refrigeration units. 
  • Empty refrigerators should be turned off, as empty refrigeration space places more stress on the cooling system that could lead to unnecessary wear and tear. This also conserves energy and allows for deep cleaning to take place as well as preventative maintenance to ensure optimal functionality once placed back into service.


  • Adopt Digital Food Safety Management systems (DFSMS) based on HACCP guidelines that enable real time refrigeration temperature monitoring and alert based operational compliance reporting. These systems have the ability to consolidate multiple important critical food safety reporting activities by providing visibility and awareness across an entire organization 
  • Implement the use of infrared handheld thermometers as a pre-screening tool  to measure temperatures of individual employees at the start/end of their shift. Screening methods and results should be based on CDC guidance and confirmed by a medical professional.   
  • Investigate the use of advanced thermal imaging instruments to assess elevated body temperatures and in consultation with local health professionals and legal advisors, make decisions to protect employee health.

Communication Practices:

  • Leverage technology to maintain internal communication (teleconference, video conference and webinar). 
  • Keep handwashing and hand sanitizing and employee health top of mind for employees and family members via job aids and training 
  • Encourage  customers to use order ahead options and delivery services.
  • Promote the use of cashless payment at operating locations. 

Operations Planning:

  • Incorporate the use of a daily set of health assessment questions as part of temperature monitoring  (are you sick, have you been around anyone sick, do you live with anyone that  is sick) based on the CDC guidance for employee wellness.
  • Decide when to close dining rooms, restrooms and seating areas and reassessment plans for reopening. 
  • Protect cashiers by providing physical barriers between them and customers
  • Clean and disinfect credit card pin pads and touch screens between each customer at indoor self-checkout locations.
  • Clean and disinfect outdoor touch screens/credit card pin pads at routine intervals.
  • Eliminate self-serve items, buffets, and areas that encourage high touch surfaces and when possible package foods that are sold individually. 
  • Designate continuous cleaning and disinfection of high touch surfaces in the entire facility (door knobs/handles, handrails, phones, light switches, hand sinks, paper towel dispensers, restrooms, credit card pin pads and touch screens, etc.) to one or more employees
  • Have liquid hand sanitizer stations as well as sanitizer wipe stations in operating locations so employees can sanitize hands when hand washing is not feasible 
  • Designate employees to monitor customers entrances to ensure that all consumers are prompted to use sanitizer prior to entering.
  • Set up que line placements (e.g., X every 6 feet) and signage  to ensure customers are able to stand 6 feet apart IF a line is likely for pick-up service. 
  • Place signage encouraging anyone who feels ill to not enter and provide alternatives as to how to help them with food essentials (delivery, curbside pickup).
  • Consider transition from traditional paper and laminated menus to a digital format, when re-opening. Further consider systems that allow the customer to use their own device to access menus.

Production Planning:

  • Review your operations production and operating hours, should they be shorter or different from normal operating hours. 
  • Reduce or rethink your menu to take advantage of alternate labor models or product availability. 
  • Consider simplifying your menu items to less complex products, this would support a more sustainable labor pool that may have less formal culinary training as well as reducing the amount inventory which should help control food waste during such an unpredictable event.     
  • Divide employees into small function-based teams and stagger production times or production areas to promote adequate social distancing.

We have all had people ask us where to get information and stay up to speed with the newest and emerging information about COVID-19. Here are links to the most accurate resources that we are using daily to answer our food safety questions.