Huh? COVID-19 science and the uncertainty dance

My friend Tim Caufield, professor of law at the University of Alberta, the Research Director of its Health Law Institute, and current Canada Research Chair in Health Law and Policy, writes in an op-ed for the Globe and Mail that COVID public health policies have been with us for a year. So has uncertainty. We’ve all lived through twelve months of “huh”? And this has added to the public’s frustration, fatigue, and stress.

In the early weeks and months of the pandemic, there was uncertainty about masks and asymptomatic spread. There was uncertainty about if and when we’d get a vaccine. There was uncertainty about what type of public health policies worked best and were most needed. We have all had to tolerate a lot of ambiguity. And as the vaccines roll out, we are being asked to tolerate even more. (When will I get a vaccine? Which one will I get? And what about the variants?)

For public health communications to be effective, the public must have confidence in the message. And, unfortunately, for some, that confidence isn’t there. A recent study from the University of Calgary explored pandemic communication and found, not surprisingly, that “participants felt that public health messaging to date has been conflicting and at times unclear.”

This perception is understandable. An atmosphere of seemingly relentless uncertainty and confusion has been created by a combination of scientific realities, media practices, some less-than-ideal communication from policy makers, and the spread of misinformation and conspiracy theories.

The science surrounding COVID was – and, for some topics, continues to be – highly uncertain. While a growing body of evidence has emerged around the most contested issues (such as the value of masks and physical distancing strategies), early in the pandemic there wasn’t much that was unequivocal. The science evolved and, as you would hope with any evidence-informed approach, the resulting science advice and recommendations evolved too. But for some, shifting policies, even if appropriate, just added to a sense, rightly or not, of chaos.

In addition, the media has been reporting on the research as it unfolds, including referencing studies that have not yet been peer reviewed. Often the preliminary or uncertain nature of the relevant research is not reported in the media, thus creating a false impression about the actual state of the science – as exemplified by the “hydroxychloroquine works!” debacle (PS, it doesn’t). Perhaps worse, relatively fringe perspectives – such as those pushing the value of “natural herd immunity” – have been given a relatively high profile in both the conventional press and on social media. This can create a false balance (fringe idea vs. broad scientific consensus) that we know can be detrimental to both public discourse and health behaviours.

Despite the frustration that uncertainty can create, the public has a demonstrated preference for honesty about the limits of our knowledge. A recent study from Germany found that “a majority of respondents indicated a preference for open communication of scientific uncertainty in the context of the COVID-19 pandemic.” This finding agrees with other research that has found that when uncertainty is relevant to their lives, the public wants to know about it.

People may want to hear about uncertainty, but will communicating it do more harm than good? Will it just add to an already confused information environment? The data on this point are actually fairly mixed, but recent research exploring the impact of communicating scientific uncertainty found that it either increased perceptions of trust in science or had almost no impact. This is good news. As the authors of one of the studies notes, “this should allow academics and science communicators to be more transparent about the limits of human knowledge.” Other studies have found that being honest about uncertainties in media reports about research can actually boost the perceived credibility of journalists.

And over the long term, honesty about the uncertainties of the evidence used to inform policy seems essential to the maintenance of public trust. For example, being overly dogmatic about a policy or predictive model could hurt the credibility of decision makers if new evidence requires a revision of a past positions.

When possible, public health authorities (or anyone seeking to communicate science) should start with well-defined and well-supported takeaway messages (e.g., please get vaccinated with whatever vaccine is available to and recommended for you!).But then be honest about what is not known (e.g., while vaccines are our best defense, we aren’t sure how long immunity will last).

Depending on the medium used (a social media post, for example, may not be the best venue for a long discourse on methodological challenges), it may also be wise to explain the limits of the research approach (e.g., observational studies can’t prove causation). If there are areas of scientific disagreement, be honest about that too – but be specific about what is being disputed. Often there is broad agreement about the big stuff (e.g., vaccines work!), but academic debate about some details. Often those trying to sow doubt – like those in the anti-vaccine community – will try to weaponize and over-emphasize small academic disagreements. Don’t give them that room.

When communicating about uncertainty it is also important to highlight what is being done to reduce it, such as forthcoming research or new data analysis. This provides a road map forward and invites the public to follow the science as it unfolds. It is also a way to stress that uncertainty is a natural part of the scientific process.

For the public, try not to let the uncertainty kerfuffle distract you from the big picture. Remember that there are many clear knowns. Vaccines, physical distancing, hand washing, masks, and being responsible when symptoms emerge will get us through this pandemic.

Finally, it is also important to take a break from all the uncertainty noise. Studies have shown that the constant consumption of conflicting COVID news can (no surprise here) add to our stress. Put down the phone, back away from the screen, and take ten from “huh?”

Petting zoos in Switzerland as public health problem

Animal petting zoos and farm fairs provide the opportunity for children and adults to interact with animals, but contact with animals carries a risk of exposure to zoonotic pathogens and antimicrobial‐resistant bacteria.

The aim of this study was to assess the occurrence of Shiga toxin‐producing Escherichia coli (STEC), Salmonella, extended‐spectrum β‐lactamase (ESBL)‐producing Enterobacteriaceae and methicillin‐resistant Staphylococcus aureus (MRSA) in animal faeces from six animal petting zoos and one farm fair in Switzerland. Furthermore, hygiene facilities on the venues were evaluated.

Of 163 faecal samples, 75 contained stx1, stx2 or stx1/stx2 genes, indicating the presence of STEC. Samples included faeces from sika deer (100%), sheep (92%), goats (88%), mouflons (80%), camels (62%), llamas (50%), yaks (50%), pigs (29%) and donkeys (6%), whereas no stx genes were isolated from faeces of calves, guinea pigs, hens, ostriches, ponies, zebras or zebus. Salmonella enterica subsp. enterica serovar Stourbridge (S. Stourbridge) was detected in faecal samples from camels. A total of four ESBL‐producing E. coli strains were isolated from faeces of goats, camels and pigs. PCR and sequencing identified the presence of blaCTXM15 in three and blaCTXM65 in one E. coli. Antimicrobial resistance profiling using the disk diffusion method revealed two multidrug‐resistant (MDR) E. coli with resistance to ciprofloxacin, gentamicin and azithromycin, all of which are critically important drugs for human medicine. Multilocus sequence typing identified E. coli ST162, E. coli ST2179, extraintestinal high‐risk E. coli ST410 and E. coli ST4553, which belongs to the emerging extraintestinal clonal complex (CC) 648. No MRSA was detected.

On all animal petting venues, there were inadequacies with regard to access to hygiene information and handwashing hygiene facilities. This study provides data that underscore the importance of hygiene measures to minimize the risk of transmission of zoonotic pathogens and MDR, ESBL‐producing E. coli to visitors of animal petting venues.

Animal petting zoos as sources of shiga toxin-producing Escherichia coli, salmonella and extended-spectrum Beta-lactamase (EXBL)-producing Enterobacteriaceae

Zoonosis and Public Health

Meret Isler, Ramona Wissmann, Marina Morach, Katrin Zurfluh, Roger Stephan, Magdalena Nüesch‐Inderbinen

https://doi.org/10.1111/zph.12798

https://onlinelibrary.wiley.com/doi/abs/10.1111/zph.12798

US to miss foodborne disease reduction goals

I’ve said this for years.

Need new messages, new strategy.

The American Veterinary Medical Association newsletter reports numbers of confirmed illnesses in humans resulting from common foodborne pathogens have risen or remained level for several years, putting the U.S. on track to miss 2020 reduction targets.

Better tests and more testing may help explain why the numbers have not fallen, but to reach its goals, the U.S. needs more work to reduce food contamination, according to authors of an article published this spring in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report. Among the findings, the authors wrote that preliminary 2019 data show confirmed illness counts for Listeria, Salmonella, and Shigella have remained unchanged over several years, and confirmed illness counts for the other five pathogens tracked by the CDC’s Foodborne Diseases Active Surveillance Network increased.
“FoodNet surveillance data indicate that progress in controlling major foodborne pathogens in the United States has stalled,” the article states. “To better protect the public and achieve forthcoming Healthy People 2030 foodborne disease reduction goals, more widespread implementation of known prevention measures and new strategies that target particular pathogens and serotypes are needed.”

I saw the Hip at a bar in Waterloo, Ontario, Canada on this tour with my 6-month pregnant ex-wife.

Great show.

Food safety management: the UK version

My 28-year-old music therapist came over for her one hour session this morning which is the highlight of my week. I sing and play guitar like no one is watching. And I introduce her to 50-year-old songs, like those on Workingman’s Dead, which we played this morning in its entirety (Oh, and Chapman, she likes Jimmy Buffett, so suck it).

This paper forms part of an ongoing project studying various approaches to the management of hazards and risk in the food industry with implications for other areas of risk management where cooperation and collaboration between organisations are of a potential benefit. In this paper we give particular focus to the Food Standard Agency’s proposed Regulating Our Future that requires closer cooperation and collaboration between the public enforcement authorities and the industry organisations that police food hygiene and food safety management. The forming of a Primary Authority between Cornwall Council and Safe and Local Supplier Approval (SALSA) emerged as a potential means of contributing to this by improving trust between all parties involved, sharing of information, assessing risk, reducing inspection times and frequency of inspections from Primary Authority. Attention is given to the current relationship between the various organisations involved from the perspectives and viewpoints of Local Authority Enforcement Officers from Preston City Council, Cornwall Council and SALSA and other experienced food safety professionals. The research is qualitative and grounded, including a review of the extant literature and interviews with food safety and food standards professionals from the private and public enforcement sectors.

Approaches to the management and policing of food safety: The food standard agency’s regulating our future, 2019

International Journal of Management and Applied Research vol. 7 no. 2

Richard Bradford-Knox, Kevin Kane, Simon Neighbour

http://ijmar.org/v7n2/20-012.pdf

Tick the boxes is not enough: Leadership in food safety management in Australia

My friend Andrew Thomson writes in this piece for Hospital Health here in Australia:

COVID-19 has sharpened our focus on safety, with lockdown providing an opportunity to reflect on current approaches and where improvements to compliance policies and practices could be achieved.

Food safety management systems in Australia have largely not changed on the safety front. A one-size-fits-all approach to food safety management systems is widespread across the foodservice sector — a certain recipe for failure. All too familiar food safety problems persist at unacceptably high rates.

Leaders (at all levels) do not fully understand their food safety obligations — they are wanting a quick fix so they can tick the regulatory box.

Characteristically, a leader within an organisation will copy and paste another organisation’s food safety management system and make minimal changes; or they will download a template to assist them develop what they believe is a compliant system. This leader fills out a few text boxes here and there throughout the document, which is done in isolation of operational employee consultation and involvement. The newly created food safety management system completely lacks operational detail and bears no resemblance to site-specific operational and food law requirements.

Validating the system and developing robust verification mechanisms are poorly understood, and in many cases does not occur.

Production processes impacting on food safety are not fully understood by operational leaders and employees, or there is inconsistent understanding of the processes. If leaders and employees do not know how the food safety system works (or is supposed to work), how can they improve it?

There are significant shortcomings around resource allocation, including sub-par training — there is no genuine commitment to training, nor are there any accountability processes in place — this is just another example of ticking the box.

Food handling employees need to know:

what to do,

how to do it,

why it’s important, and

what corrective actions to take when required.

Corrective action is a critical food safety step that helps prevent a food safety incident from occurring.

The dated ‘compliance-based training’ and ‘mandatory online modules’ approach and refresher training has failed. New training and learning habits and practices will need to be created.

Implementation and meaningful review of food safety management systems rarely occur. An organisation must be able to demonstrate that it is complying with its food safety management system and conduct a regular review — a requirement of Australian food law.

A review is of critical importance as food production activities within the operation will change over time, such as when new equipment is purchased or changes are made to cooking methods.

The involvement of senior leadership is required in the review process, to provide an opportunity to examine business activity from a different perspective. Soft or inconsistent regulatory audits are simply not helpful and place the organisation and other stakeholders at risk, including the regulator. In many situations food safety management is not a priority and is not taken seriously, with a ‘she’ll be right’ approach, until there is a food safety incident or regulatory intervention. This can often lead to unwanted and negative (social) media attention.

Food safety colleague Dr Doug Powell explained that when there is an outbreak of foodborne illness many food operations will rely on a go-to soundbite, “Food safety is our top priority”.

For Dr Powell, a former professor of food safety for 17 years at the universities of Guelph and Kansas State, this sets up a mental incongruity: if food safety is your top priority, shouldn’t you show me?

The other common soundbite is, “We meet all government standards”.

With a changing regulatory landscape, advances in technology, and food products and ingredients travelling great distances, it is time for senior leadership and boards of directors to elevate the food safety conversation within their organisation.

Far too many foodservice operations are leaving brand protection to government inspectors or auditors — this is a bad idea.

Organisational leaders should commit themselves to achieving optimal industry standards in food safety management instead of aiming to meet minimum requirements. Leaders must be actively involved in celebrating team success and equally the reporting and development of risk-reduction strategies when a food safety issue arises. Leaders must hold every employee accountable for consistent adherence to recognised food law requirements and safety practices. Failing to respond to these matters leaves many organisations (and employees) vulnerable to a myriad of risks.

Chinese primary school hit by food poisoning with more than 100 children hooked to drips

Abigail O’Leary of the Mirror writes that a primary school hit by a wave of food poisoning caused scenes of chaos as more than 100 children were struck down. 

The school, in the central Chinese province of Henan, saw pupils suffering from vomiting, stomach pain and diarrhoea.

Officials are now investigating a so-called ‘central kitchen project’ in Yucheng County, where four government-contracted catering companies are supplying school meals to 4,500 kids.

Distressing images from rural hospitals in the county show young children hooked up to intravenous drips while others are slumped on chairs in waiting areas with their parents.

More than 100 youngsters have been admitted to hospital since Wednesday (10th June). County officials said most have been discharged, but some are still receiving treatment.

Home-based food businesses in Alberta with “low-risk” products no longer require handling permits

This is why I avoid potlucks (not that anyone would invite Dr. food safety).

I have no idea of the kitchen prep area, nor the personal hygiene of the providerer.

According to David Opinko of Lethbridge News Now, the Government of Alberta (that’s in Canada) has made it easier for individuals to start or continue operating businesses out of their home that sell food.

Health Minister Tyler Shandro says this will also help to increase the public’s access to locally grown or processed foods.

“This regulatory change maintains our standards for food safety, supports Alberta entrepreneurs, adds new jobs, and benefits the economy by giving Albertans new opportunities to buy locally produced foods. It also makes it easier than ever to turn your passion into a home business.”

Specifically, those who sell low-risk items, or ones that have a lower ability to create food-borne illnesses, will not require food-handling permits or be subject to inspections.

Uh-huh.

C. diff rates decline

Efforts to prevent Clostridioides difficile infection continue to expand across the health care spectrum in the United States. Whether these efforts are reducing the national burden of C. difficile infection is unclear.

The Emerging Infections Program identified cases of C. difficile infection (stool specimens positive for C. difficile in a person ≥1 year of age with no positive test in the previous 8 weeks) in 10 U.S. sites. We used case and census sampling weights to estimate the national burden of C. difficile infection, first recurrences, hospitalizations, and in-hospital deaths from 2011 through 2017. Health care–associated infections were defined as those with onset in a health care facility or associated with recent admission to a health care facility; all others were classified as community-associated infections. For trend analyses, we used weighted random-intercept models with negative binomial distribution and logistic-regression models to adjust for the higher sensitivity of nucleic acid amplification tests (NAATs) as compared with other test types.

RESULTS

The number of cases of C. difficile infection in the 10 U.S. sites was 15,461 in 2011 (10,177 health care–associated and 5284 community-associated cases) and 15,512 in 2017 (7973 health care–associated and 7539 community-associated cases). The estimated national burden of C. difficile infection was 476,400 cases (95% confidence interval [CI], 419,900 to 532,900) in 2011 and 462,100 cases (95% CI, 428,600 to 495,600) in 2017. With accounting for NAAT use, the adjusted estimate of the total burden of C. difficile infection decreased by 24% (95% CI, 6 to 36) from 2011 through 2017; the adjusted estimate of the national burden of health care–associated C. difficileinfection decreased by 36% (95% CI, 24 to 54), whereas the adjusted estimate of the national burden of community-associated C. difficile infection was unchanged. The adjusted estimate of the burden of hospitalizations for C. difficile infection decreased by 24% (95% CI, 0 to 48), whereas the adjusted estimates of the burden of first recurrences and in-hospital deaths did not change significantly.

CONCLUSIONS

The estimated national burden of C. difficile infection and associated hospitalizations decreased from 2011 through 2017, owing to a decline in health care–associated infections. (Funded by the Centers for Disease Control and Prevention.)

Trends in US burden of clostridioides difficile infection and outcomes, 02 April 2020

New England Journal of Medicine

Alice Y. Guh, M.D., M.P.H., Yi Mu, Ph.D., Lisa G. Winston, M.D., Helen Johnston, M.P.H., Danyel Olson, M.S., M.P.H., Monica M. Farley, M.D., Lucy E. Wilson, M.D., Stacy M. Holzbauer, D.V.M., M.P.H., Erin C. Phipps, D.V.M., M.P.H., Ghinwa K. Dumyati, M.D., Zintars G. Beldavs, M.S., Marion A. Kainer, M.B., B.S., M.P.H., Maria Karlsson, Ph.D., Dale N. Gerding, M.D., and L. Clifford McDonald, M.D.

DOI: 10.1056/NEJMoa1910215

https://www.nejm.org/doi/10.1056/NEJMoa1910215

Irony can be pretty ironic sometimes

And there will be no Alanis videos here.

Almost 10 years ago, I, full professor who had been tenured since 2000, was fired by Kansas State University for bad attendance because I did want to be the spouse who crushed his partner’s dreams and not move to Australia (she has lots of other ways to be disappointed in me, join the line).

I said, why not run a distance course.

That didn’t work out so well.

Now all the unis are trying to develop distance courses as they face shutdowns in response to Coronavirus.

Just saying.

Everyone’ got a camera Red Rooster Australia edition

Nick Hall of Franchise Business reports fast food chain Red Rooster has made the drastic decision to shut two Perth outlets after leaked photos raised concerns over food safety.

Images posted on Facebook appear to show cooked chickens piled into the back of a Red Rooster delivery vehicle; unwrapped, unrefrigerated and in seemingly unsanitary condition.

Furthermore, reports suggest the chickens were being transported on day when the Perth sun was at its deadliest.

Social media users slammed the outlet for its unsanitary practices, with many questioning why the chickens were placed in the back of the car in the first place.

“To me this looks like a store has ran out of chicken and someone has transferred these from one store to another,” one user speculated.

In response to the alleged food safety breaches, Red Rooster quickly moved to close Forrestfield store, along with another in Waypoint also under the same franchisee’s direction.

In a statement, Red Rooster confirmed that the stores would remained closed until investigations were finalised.

“These stores will remain closed while detailed investigations are conducted, required actions are taken and we are satisfied that the operating standards of these locations meet the high expectations of our strict brand standards,” the brand said.

“We have alerted the relevant authorities and are working with them closely while our local staff on the ground undertake the investigation and actions required to meet our brand standards.”