JoNel Aleccia of The Seattle Times writes that food vendors at the Russell Investments Center in Seattle were cleared by inspectors and allowed to reopen Wednesday, days after an outbreak of highly contagious norovirus sickened hundreds who worked in the high-rise building.
Of 600 people who attended a catered event at the building Dec. 1, more than 200 people reported suffering symptoms of norovirus, which causes acute vomiting, diarrhea and gastrointestinal distress, officials with Public Health — Seattle & King County said.
Many more — perhaps hundreds — may actually have fallen ill but were not documented. After health officials had enough evidence to confirm norovirus as the culprit, they stopped tallying survey results, said James Apa, a spokesman for the agency.
“Not collecting more data on magnitude; no indication from building or clients of new outbreak or spread to other locations,” Apa said in an email.
The 42-story building at 1301 Second Ave. was cleaned top to bottom, with special attention to high-touch sites such as doorknobs and elevator buttons, health officials said.
The site houses several high-profile clients, including Zillow, Nordstrom and Marler Clark, the Seattle food-safety law firm.
We’ve got a paper that’s going to come out in the next few months (its been peer-reviewed, edited and approved) about going public, but I don’t want to violate my no-PR-before-publication rule.
However, others are getting on the going public bandwagon.
Seattle & King County in Washington state writes in a release that in a typical week, we receive reports of other enteric (intestinal) illnesses including campylobacteriosis, salmonellosis, shigellosis, and norovirus. At the time of this posting, we’re investigating reports of mumps, pertussis, tularemia, varicella, and suspected rabies exposures. We’re continuing to monitor returning travelers from countries impacted by Ebola and have had several returning healthcare workers evaluated for Ebola infection (none have had it). And we’re in the early phases of our annual ritual tracking the upcoming influenza season.
Why have we publicized some investigations but not others?
As the health department, our top priority is to keep the public safe and healthy, including preventing and responding to disease outbreaks. When we hear about possible outbreaks from individuals, healthcare providers, laboratories or businesses that report cases of illness to us, we investigate but we don’t divulge the ill person’s identity, even if it is a communicable disease. Not only are people’s identities protected by state and federal law, breaking confidentiality could discourage people from reporting diseases – putting us all at risk.
Similarly, if we learn from a food business or from its customers that people got sick from eating at the restaurant, we want that food business to work with us to figure out what happened, confident that we will not prematurely place blame before we have done an investigation to evaluate all possible causes, including (but not limited to) restaurant food safety practices that could have contributed, contamination of a commercial food product the restaurant may have received, and other causes unrelated to the restaurant, business or organization.
But if there’s ongoing risk we’re going to tell you about it. We will always make a public announcement (including names of implicated restaurants and commercial entities) when there is an ongoing outbreak or risk that people need to know about in order to protect their health. We’ll provide information on how to avoid illness and what to do if you’ve been exposed. We may also make a public announcement if it will help us solve an ongoing investigation. In addition, we can inspect and close restaurants immediately if we find food safety violations contributing to an outbreak. We post these closures on our website and publicize with Facebook and Twitter.
Health departments, including ours, typically don’t make public announcements about an outbreak when the outbreak is over, there is no ongoing risk to the public and there are no actions or steps for the public to take to protect their health. In addition, just as we seek to avoid stigmatizing people, we avoid public announcements that implicate businesses, organizations or restaurants when we don’t have good evidence about the source or cause of the problem or we don’t have a confirmed link to the commercial facility and there is no ongoing risk. Our public notification practices are consistent with health departments in our region and around the country.
But … we are learning that people want to know more about our outbreak investigations, above and beyond our public alerts when there’s an immediate heath risk, and we respect that interest. This is part of a larger trend toward greater openness from government, which values the public’s right to know. Conversations with local media that also value public access to information, including the Seattle Times, raised issues that helped our Health Officer, Dr. Jeff Duchin to decide in July 2015 to develop a way to routinely provide public information about outbreaks.
Information about the causes of outbreaks is occasionally straightforward, but more often is unclear and/or inconclusive. In order to provide information about the circumstances and possible causes of outbreaks responsibly, we need to provide important context and background. We don’t want readers to confuse associations, (which are relationships between two or more events or other variables that may or not indicate cause and effect), with actual causes. For example, in many investigations we are not able to identify the cause or source with certainty. This typically happens when there is simply not enough epidemiologic and/or laboratory evidence available to draw reliable conclusions.
We will need to present information in a way that would incorporate at minimum the key facts of an outbreak as well our conclusions regarding potential causes and limitations of the available information. We are going to approach this work thoughtfully and seek input from experts in both public health and communications, and hope to have this ready to roll out in January 2016.
In addition, we are currently in the process of expanding how restaurant inspection information is made available to the public – via storefront signs and improved online access. This will be an update to our current practice of posting inspections online – we were one of the very first health departments to do this way back in 2001!
Save the exclamation marks for the truly exclamatory.
Elizabeth Buder was among 13 people sickened in August and September after eating food from the Los Chilangos food truck operated by Menendez Brothers, LLC of Bellevue. The firm, which operates two food trucks that serve seven farmers markets in King and Snohomish counties, was shuttered temporarily in late August by officials at Public Health — Seattle & King County — after an investigation into the outbreak.
A complaint filed this month in King County Superior Court states that the child, known as “Scout,” shared food with her parents from a Los Chilangos truck on Aug. 8 at the Issaquah Farmer’s Market. She fell ill days later and was eventually admitted to Seattle Children’s, where doctors confirmed an E. coli O157: H7 infection according to the complaint prepared by Marler Clark, a Seattle firm that specializes in food-safety cases.
The girl developed hemolytic uremic syndrome, or HUS, a life-threatening complication of E. coli poisoning, and kidney failure. She was hospitalized for three weeks and will require ongoing monitoring and care. She was only recently cleared to return to school, her father said.
King County officials identified no specific source of the E. coli outbreak. The bacteria are often linked to undercooked ground beef, but can be spread through produce such as spinach and sprouts or through foods such as unpasteurized juice and raw milk.
Los Chilangos was allowed to reopen on Sept. 2 after an inspection. King County officials also shuttered Eastside Commercial Kitchen, a commissary where Los Chilangos and other vendors prepared food, but allowed that site to reopen on Sept. 8. Health officials said it’s possible the source of the outbreak may never be determined.
Elizabeth has been complaining about her tummy non stop. “She’s constantly ‘My tummy. My tummy,'” said her mom, Deanna Buder. “And then she says ‘I want to see my friends. I want to see kids,’ because no kids are allowed in there. She just misses home.”
The Buder family shared a plate of carnitas at a Los Chilangos food truck last August 8. Although the mom and dad were fine, Elizabeth or Scout as people would call her, started complaining of stomach ache days later. “Normal things that a kid might get, a tummy ache, she was a little tired, she wasn’t hungry,” said Buder. However, Scout’s conditions became worse as her body released some bloody diarrhea. A trip to the emergency room confirmed the parents’ worst nightmare, as Scout’s kidney deteriorates and she has to stay in the Intensive Care Unit.
Scout is just one of the six — now 10 — confirmed positive of a dangerous strain of E.coli O157, all linked to Los Chilangos. Los Chilangos’ Bellevue and other locations were closed last Wednesday by the Public Health department. Los Chilangos serves food at seven farmers markets in King and Snohomish Counties, operates two food trucks, and also caters events. However, they were able to secure an approval to reopen on Thursday. None of the employees were positive of the disease and investigators still have not found the source of the infection.
The Buder family would like to seek more justice beyond the shutting down of the kitchen and the food truck. “”There should be consequences beyond shutting down the kitchen for a few days,” said Buder. “People need to be aware of what to look for, and then after that be aware that you shouldn’t go to this business,” she said.
All little Elizabeth Buder knows is that she’s in the hospital with a painful tummy ache, but the 4-year-old’s parents know the strain of E. coli she has can be deadly.
“There’s not just IV tubes in her arms, but in her neck,” said Elizabeth’s dad, James Buder. “How do you explain that to a 4-year old?”
Health officials believe Scout, as she likes to be called, contracted E. coli after eating steak tacos with pico de gallo at the Issaquah Farmers Market on August 8th. She ate at a food stand run by Los Chilangos food truck catering.
The owner, Noemi Mendez, is cooperating with the investigation.
“I feel horrible,” she said. “And I apologize. I feel like, you know, it’s my responsibility, but also I don’t feel like I’m to blame here.”
Mendez said the Heath Department told her E. coli may have come from cilantro, which she uses in all her food and gets from several different suppliers.
“They can’t be certain, because now they have to go through every suppler that I get the cilantro from and find out what happened there,” Mendez said.
“Through a few initial interviews with ill people, we determined that everyone who became sick had something in common – they ate food prepared by, a local food vendor called Los Chilangos,” Public Health staff said in a statement.
The department required the food truck to stop selling food.
A 4-year-old girl is one of those affected, and her mother said her daughter became sick after eating at Los Chilangos around August 8.
The food truck visited the Issaquah and Sammamish farmers markets.
Deanna Buder said her 4-year-old daughter started experiencing pain and swelling in her abdomen, and stopped eating. Tuesday is her seventh day at Seattle Children’s Hospital.
Los Chilangos serves food at seven farmers markets in King and Snohomish counties, operates two food trucks, and also caters events. Los Chilangos uses Eastside Commercial Kitchen, where they share space and equipment with about a dozen other food businesses.
The kitchen was told to stop producing food, as were the food trucks that used it.
“We are still investigating the source of the E. coli,” the Public Health statement said. “If we determine that a food contained the E. coli bacteria, we will try to trace it back to stores, suppliers, and even farms to address the root of the problem with corrective actions, if possible.”
King County Public Health released the key steps of their investigation:
We [King Co. Public Health] interviewed people who got sick.
“At this time [Tuesday afternoon], six people have been infected with the same strain of E. coli (three have been hospitalized). When Public Health determines that anyone is sick from a serious foodborne illness like E. coli, we [King Co. Public Health] interview them to determine what may have caused their illness. We [King Co. Public Health] do this to find the source of the outbreak and prevent others from getting infected. In this instance, through a few initial interviews with ill people, we [King Co. Public Health] determined that everyone who became sick had something in common – they ate food prepared by a local food vendor called Los Chilangos. Public Health took swift action and required Los Chilangos to cease operations.”
We [King Co. Public Health] investigated a food business that was associated with the people who got sick.
“But we [King Co. Public Health] didn’t stop there. Los Chilangos serves food at seven farmers markets in King and Snohomish Counties, operates two food trucks, and also caters events. Los Chilangos utilizes a shared kitchen space, called a commissary kitchen. The kitchen that they use is Eastside Commercial Kitchen, where they share space and equipment with about a dozen other food businesses.”
We [King Co. Public Health] intervened at the specific site and operation.
“The condition of the commissary and the potential for cross contamination were deemed an imminent health hazard, and the health officer issued a cease and desist order to the commissary on Thursday, August 27. Additionally, all of the food vendors permitted by Public Health that use this kitchen were also told to cease operations. Recognizing that this lapse in operation hurts business, our team has worked diligently with these vendors to find new places for them to resume their work and remind them about important food safety measures.”
Next steps: tracing the source
“As of today, the investigation isn’t over. We [King Co. Public Health] are still investigating the source of the E. coli. If we determine that a food contained the E. coli bacteria, we will try to trace it back to stores, suppliers, and even farms to address the root of the problem with corrective actions, if possible.
But, it’s possible that the source of E. coli may never be determined. E coli is often linked to beef, but it can also be linked to produce, such as spinach and sprouts, along with a variety of other foods such as unpasteurized juices, raw milk, game meats, and other common foods.
For outbreaks such as this one, we [King Co. Public Health] continue to monitor the situation and look for other common factors among ill people. While we know Los Chilangos is linked, they may not be the only ones involved. For instance, the source of E. coli could be served by other vendors.
We [King Co. Public Health] are currently working with all of the businesses connected to this outbreak to make sure that they are not using any products that may have become contaminated and that they have food safety measures in place. This includes having the businesses address needed repairs to their equipment, providing education to their staff, and ensuring their operations are safe to open.
Though Los Chilangos has been linked to this outbreak, they deserve credit for their dutiful cooperation during our investigation. No food vendor wants to make people sick, and we know everyone is very concerned about the people who have become ill. We will be updating this blog as the picture becomes clearer.”
JoNel Aleccia of The Seattle Times reports that at least 56 people in eight Washington state counties have been sickened by a rare strain of salmonella food poisoning apparently linked to eating pork, health officials said Thursday. Most of the cases, 44, have occurred in King County.
The individual cases and small clusters have occurred in several foods and at several events across the region as of Wednesday. Other meat sources could be to blame as well, health officials said. Five people have been hospitalized.
“Why we’re sending out this message now before the investigation is complete is because we’re saying: ‘You’ve got to be really careful with raw meat,’ ” said Dr. Scott Lindquist, state epidemiologist.
Some of the cases appear to be tied to whole-pig roasts, he added.
The outbreak strain is Salmonella I, 4, 5, 12:i: -, a germ that has been emerging nationally during the past five years, but never before seen in Washington state, Lindquist said.
Because of the unique nature of the outbreak, the Centers for Disease Control and Prevention (CDC) and the U.S. Department of Agriculture are assisting with the investigation, Lindquist said.
No cases have been reported in states bordering Washington, so officials are investigating whether pork or other meat processed and distributed in the state might be involved in the outbreak.
JoNel Aleccia of The Seattle Times reports that as many as 16 people were likely sickened with salmonella poisoning from raw eggs used in Father’s Day weekend brunch dishes served at Tallulah’s restaurant in Seattle’s Capitol Hill neighborhood, health officials said Wednesday.
Victims in the June 21 outbreak ranged in ages from 4 to 71, officials with Public Health — Seattle & King County said. There were nine confirmed cases and seven probable cases of infection, including one person who was hospitalized.
The infections were traced to crab and ham eggs Benedict dishes, which typically include a sauce made from raw eggs. Managers at the restaurant at 550 19th Ave. E reported the problem to health officials after receiving complaints from customers. Restaurant staff have been cooperative with the environmental health and epidemiologic investigation, officials said.
An investigation of the egg supplier and distributor conducted by the Washington State Department of Agriculture revealed no violation of regulations regarding temperature control, storage or handling, officials said. The producer reported no recent positive tests for salmonella bacteria, although they don’t routinely test raw shell eggs.
The restaurant menu was appropriately labeled to note that dishes made with raw or undercooked foods could result in foodborne illness.
It’s deeply weird or deeply hypocritical that Seattle, self-proclaimed home to many things food, doesn’t have a decent restaurant inspection disclosure system.
“We’ve tried to make as much information available as possible,” says Becky Elias, Manager of Food Protection for Public Health – Seattle & King County. “As a consumer, you could look up an individual restaurant and see the entirety of all of their inspections, and see how they’ve done. We did that because we wanted it to be as transparent as possible.”
But two-time E. coli victim Sarah Schacht says the system is antiquated and overly complicated, making it difficult to quickly determine how a restaurant is actually doing.
She launched a petition on Change.org earlier this year calling for the county to mandate publicly posted restaurant inspection scores. She says other cities such as Los Angeles, San Francisco and New York have seen significant reductions in food-related illnesses since restaurants began posting A, B, C, or F grades in their front window.
“We saw, in Toronto, a 30 percent reduction of total foodborne illnesses when they started a public scoring system for restaurants,” Schaht says.
“We have heard that message loud and clear that that’s something people are wanting,” Elias responds. “So we’re now actively engaging in the process.”
The health department has formed several committees made up of restaurants, health officials and others to come up with new policies for presenting food inspection results.
Elias says they’ll look at findings from other cities, and while they might not adopt a letter grade, they are committed to some public display that quickly informs customers how a restaurant fared.
“I think that we’re really excited about working towards something that meets the need of improving food safety, making something that is easier for people to understand, and also designing something that is equitable for the incredibly diverse array of food businesses that we have here in King County,” says Elias.
I’m glad you’re excited, with your public service salary, but you haven’t done anything. Toronto did it 12 years ago.
Here’s some researxh to get you more excited.
Can I have your salary and benefits?
Filion, K. and Powell, D.A. 2009.
The use of restaurant inspection disclosure systems as a means of communicating food safety information.
Journal of Foodservice 20: 287-297.
The World Health Organization estimates that up to 30% of individuals in developed countries become ill from food or water each year. Up to 70% of these illnesses are estimated to be linked to food prepared at foodservice establishments. Consumer confidence in the safety of food prepared in restaurants is fragile, varying significantly from year to year, with many consumers attributing foodborne illness to foodservice. One of the key drivers of restaurant choice is consumer perception of the hygiene of a restaurant. Restaurant hygiene information is something consumers desire, and when available, may use to make dining decisions.
The World Health Organization estimates that up to 30% of individuals in developed countries become ill from contaminated food or water each year, and up to 70% of these illnesses are estimated to be linked to food service facilities. The aim of restaurant inspections is to reduce foodborne outbreaks and enhance consumer confidence in food service. Inspection disclosure systems have been developed as tools for consumers and incentives for food service operators. Disclosure systems are common in developed countries but are inconsistently used, possibly because previous research has not determined the best format for disclosing inspection results. This study was conducted to develop a consistent, compelling, and trusted inspection disclosure system for New Zealand. Existing international and national disclosure systems were evaluated. Two cards, a letter grade (A, B, C, or F) and a gauge (speedometer style), were designed to represent a restaurant’s inspection result and were provided to 371 premises in six districts for 3 months. Operators (n = 269) and consumers (n = 991) were interviewed to determine which card design best communicated inspection results. Less than half of the consumers noticed cards before entering the premises; these data indicated that the letter attracted more initial attention (78%) than the gauge (45%). Fifty-eight percent (38) of the operators with the gauge preferred the letter; and 79% (47) of the operators with letter preferred the letter. Eighty-eight percent (133) of the consumers in gauge districts preferred the letter, and 72% (161) of those in letter districts preferring the letter. Based on these data, the letter method was recommended for a national disclosure system for New Zealand.