Substitute workers for sick staff spreads disease, study finds

Vanesa Martinez of The Irish Times reports that the common policy of replacing a teacher or a health worker with a substitute when they are sick could help to increase the spread of disease, a new study found.

THE_SUBSTITUTE_LOCKUP_ALPHA_400x400This result may be counterintuitive but the authors back up their analysis of mathematical models of the spread of disease with actual recorded data from past outbreaks.

Infectious diseases would spread faster due to placing a healthy person in a situation where he or she could become infected as well.

“Findings show that a common-sense response during outbreaks could in fact be adding to the problem,” says Prof Lina Zgaga, Associate Professor of Epidemiology at Trinity College Dublin Centre for Health Sciences.

The results could help develop better public health policies during outbreaks, the authors say. For example, vaccinating key workers could significantly decrease the danger of faster disease spreading.

Yes, vaccines work.

The results are published this week in the scientific journal Nature Physics.

Does your state suck at food safety? CDC releases prevention status reports

CDC has just released the latest Prevention Status Reports (PSRs), which highlight the status of state-level policies and practices to prevent or reduce problems affecting public health. The PSRs cover 10 public health topics—including food safety—and rate states on their implementation of recommended policies and practices. 


skippy.burger skippy.burgerThe reports include a new measure on state adoption of selected provisions in the 2013 Food and Drug Administration (FDA) Food Code. The Food Code is a science-based model code that states can use to develop or update their food safety rules to better prevent foodborne illness and outbreaks.

CDC identified four Food Code provisions especially important in reducing outbreaks in restaurants and other retail food establishments:

  • exclude ill food service staff from working until at least 24 hours after symptoms, such as vomiting and diarrhea, have ended;
  • prohibit bare hand contact with ready-to-eat food;
  • require at least one employee in a food service establishment to be a certified food protection manager; and,
  • require food service employees to wash their hands.

The other two measures continue from the 2013 Prevention Status Reports. High scores for these two measures enable efficient detection and investigation of outbreaks:

  • speed of DNA fingerprinting using pulsed-field gel electrophoresis (PFGE) testing for all reported cases of Shiga toxin-producing E. coli O157; and,
  • completeness of PFGE testing of Salmonella.

The PSR website has been enhanced to include an interactive map that leads directly to topic reports for each state. The website also includes State Summary tables that outline the full set of policy and practice ratings for each state; a National Summary that gives aggregate ratings across states and rating comparisons for 2013 and 2015; the PSR Quick Start Guide; a fact sheet; answers to frequently asked questions; and a link to the 2013 PSRs. 

20 sickened at Subway: Colorado norovirus outbreak in BV serves as warning

Local health officials said they hope a norovirus outbreak in Buena Vista that left approximately 20 people ill in mid-November will serve as a reminder to area restaurants and food providers to be extra cautious.

norovirusThe Mountain Mail reports Chaffee County Public Health received complaints from five people saying they were ill after eating food from the Subway in Buena Vista, according to a restaurant inspection report.

Lab tests on samples from the five individuals all tested positive for norovirus.

Public Health estimates roughly 20 people, mostly students at Buena Vista High School, might have fallen ill in the outbreak.

An investigation by Chaffee County Environmental Health Manager Victor Crocco, who declined to name the restaurant, found that one employee reported feeling ill the day after the illness was originally reported.

Subway manager Brandon Alexander said he did not recall any of the employees being sick around the time of the outbreak.

Crocco’s investigation led him to conclude a sick employee, and not a larger food contamination, most likely caused the contamination.

Alexander said he doesn’t remember anything like this happening in his 8 years at the restaurant.

It was the waitress; 23 sick with Norovirus at Minn. Lion’s Club

A recently ill waitress was the likely source that caused about two dozen people to get sick after eating at a Nisswa Lion’s Club meeting, the Minnesota Department of Health (MDH) found.

brainerdThe March 24 Lion’s club meeting was held at the Nisswa Community Center, but was catered by Red, White and Blue Catering, which operates from the Nisswa American Legion.

An investigation by MDH showed that 23 people became ill with vomiting and diarrhea after the dinner meeting.

The symptoms of the illness lasted between seven to 115 hours for those affected, the department of health found. Other symptoms included cramps, fever and bloody stools.

Two people sought medical attention at a clinic and one was seen at an emergency room. No one was hospitalized.

Dan Bridge, owner of Red, White and Blue Catering, the waitress’ employer, said the incident is the first in the three decades he’s been operating the business.

“We try to do all we can to keep it from happening,” he said. “And it never does, except for this. It’s unfortunate. It just happened.”

Disappointed by the incident, Bridge says something like this “takes fun out of cooking.”

In MDH’s investigation, health officials determined that 23 people were sick, not the original six that first reported symptoms.

At the Lion’s club meeting, 35 people ate the buffet-style meal, which included pork chops, lettuce salad, potato salad, calico beans, rolls, butter and brownies.

But “no food item was significantly associated with illness,” the MDH said.

The waitress reported being sick with vomiting and diarrhea on March 19 and recovered on March 20.

She returned to work on March 21, where she plated salads and specials for the restaurant. On March 24, she prepared the salad for the Lion’s Club event.

The waitress tested positive for norovirus GII, the MHD said.

Noma and food pornographers struggle with notion sick people shouldn’t serve food

The best restaurant in the world, Denmark’s Noma, continues to struggle with some food safety basics.

In response to the sickening of at least 67 people who dined at the restaurant and the release of a report by Danish food types Fødevarestyrelsen, Noma came out with its own statement, offering to reimburse diners for the meal they upchucked and blaming the outbreak on Norochicka worker sick with norovirus, who magically didn’t have any symptoms.
And they’re really, really sorry.

Inspectors from the Danish food ministry criticized the restaurant for not alerting authorities quickly enough and for failing to take adequate action after the worker fell ill.

Noma blamed a delay in disinfecting the restaurant’s kitchen on internal communication problems.

Even when members of two separate dining parties complained by email, and one employee reported being ill after handling food, no measures were taken the next day.

Three immediate and obvious problems with the response from Noma.

“We received the first e-mail Thursday Feb 14.  We have staff and guests from all over the world and unfortunately there was a slight delay as the email was picked up initially by a non-Danish speaking member of the team and wasn’t responded to until Monday after the weekend service.”

For a virus with an incubation of a few hours, a delay in notification by some 90 hours is inexcusable.

Noma charges about  $275 for a meal – drinks extra – and they can’t find someone to check e-mail every waking minute? That’s what the best food service folks require, and me, and I’m just a professor who couldn’t begin to afford the food porn at Noma (nor would I want to).

“Noma is required to have at least one sink for washing hands in the kitchen. Noma has kitchens on two floors. On both floors noma has two sinks for washing hands. On the day it was tested, Wednesday Feb 20, three sinks worked to full satisfaction with very hot water, and the last one in the prep-kitchen was only lukewarm when tested. Noma’s reaction was to call a plumber immediately to fix the problem, and it was.”

Water temperature is irrelevant for the microbiological goals of handwashing. My guess is, handwashing has been lax.

“Noma has always had a strict policy for members of staff showing signs of sickness, and that is to send them home immediately and ask them to stay home for 48 hours even after they feel well.”

Heston-what’s-his-name who sickened 535 diners with norovirus in his fancy-pants restaurant tried the same we-have-a-manual argument. So did the folks at the Haaarvvaarrrrd Club. Is there any evidence that anyone follows the manual? Can Noma provide evidence that sick employees have stayed away from work? Or is it just a soundbite?

There have been hundreds of norovirus outbreaks involving sick workers and food over the past 20 years. Maple Leaf was really, really sorry after it nomakilled 23 people with Listeria in its deli-meats in 2008 in Canada. In so many of these cases, people forget to pay attention to the basics, but then want some sort of acknowledgement because they said sorry.

Not good enough.

And despite basic failings, Noma continued to receive adulations from Frank Bruni of  the New York Times today, who wrote a long-winded and thesaurus-aided column about food fraud.

“At the restaurant Noma in Copenhagen, the trailblazing and lavishly celebrated chef René Redzepi has been known to serve live ants. When I ate there nearly three years ago, he served me live shrimp. I managed to get down only one of them, and only after persuading myself that doing so was an act of honesty and proper responsibility: instead of having someone else kill my dinner out of view.”

These people have no concept of microbiology. Maybe Frank got lucky and the server didn’t have noro.

Keeping tabs on Denver’s restaurant-inspection policy

The frictions between the Denver health types and the city’s restaurants are thoroughly covered in a feature by Lori Midson of Denver Westword News. Brief excerpts below:

On Wednesday, March 28, 2012, the first complaint came in. The Colorado Department of Public Health and Environment received a call from a diner who had recently eaten at Osteria Marco and claimed to have fallen ill because of that meal. The CDPHE reported the call to the Denver OsteriaDepartment of Environment and Health, the city agency that ensures Denver food-service establishments are in compliance with state and federal laws, as well as all city regulations.

The DEH sent investigator Thuy Vu and a rep of Denver Public Health to Osteria Marco; she initially noted that an “unknown pathogen” was the suspected culprit. But she would soon report that “based on interviews conducted by DPH, [the] suspected pathogen is norovirus or noro-like virus.”

Owner Frank Bonanno, one of Denver’s most successful restaurateurs, was out of town when the trouble started. Denver health officials were “demanding all of our OpenTable guest information, including phone numbers,” he says, and also requesting anal swabs from several Osteria employees. “DPH conducted interviews of two ill employees, both of whom refused the request from DEH and DPH to submit specimen samples from rectal swabs and bulk stool samples,” Vu noted.

In that same March 29 report, Vu detailed other critical violations she’d observed at Osteria Marco, including “bare hand contact on ready-to-eat foods, hands not washed as required, hand sinks used to dump customer water, use of unpasteurized raw shell eggs in cocktails, improper cold holding temperatures of potentially hazardous foods, and evidence of pests (fruit flies/phorid flies).” Moreover, she noted, the “general manager also reported that nine employees (kitchen and waitstaff) called in sick within five days,” in addition to “another large party” that “called the facility directly to complain about a separate, unrelated incident of foodborne illness.”

A follow-up inspection of Osteria Marco on March 30 resulted in a cease-and-desist order for bare-hand contact on ready-to-eat foods, as well as a request for the name of every other Bonanno employee who worked not just at Osteria Marco, but Mizuna, Bones, Luca d’Italia, Lou’s Food Bar, Russell’s Smokehouse and Green Russell. “During the course of the March 29 visit to Osteria Marco to investigate the illness complaint, the investigator learned that there were a number of employees who worked at Osteria restaurant.inspectionMarco and other Bonanno Concepts facilities who had recently been ill,” explains Danica Lee, food program manager at DEH and an official with whom the outspoken Bonanno already had a rocky relationship. (“Yes, Danica, I’m mean” was the start of one of Bonanno’s blog posts in May.)

Bob McDonald, the city’s director of public-health inspections and a twenty-year veteran of the DEH, says his inspectors had every reason to look into Bonanno’s other establishments. “When Osteria’s outbreak came to my attention,” he adds, “I instructed inspectors to check out Frank’s other restaurants. With chains like that, it’s common that there are cross-employees.” …

In 2008, there were 9,003 food-service inspections conducted in the City and County of Denver, and the total fines collected amounted to $122,335; in 2009, the department inspected 7,811 food-service establishments, collecting $157,690. In 2010, the health department conducted 8,211 inspections, generating $118,995 in fines. But in 2011, when the Denver health department conducted 8,090 inspections, it managed to collect $731,900 in fines. And 677 restaurants were fined in 2011, compared to 315 in 2008. …

But as the fines increased, so did complaints from restaurants — particularly restaurants owned by Frank Bonanno. “Frank has a challenging personality,” McDonald says. “I would encourage him to spend as much energy focusing on correcting violations and keeping them corrected and less time on arguing and fighting with health inspectors, whose job it is to make food-service safety a priority.”…

While Bonanno, who regularly cooks at all of his restaurants, still gets cranky about some of the department’s policies, he and his staffs are doing everything they “possibly can to comply with the health department,” he says. “We have a checklist for every restaurant, and every day, the chef or the sous chef goes through the checklist and basically does an inspection of things that we used to get dinged for — making sure the hand sink is clean, making sure that gloves are available everywhere in the kitchen.

“If you stay on top of things, and if the health department is more understanding about what really makes people sick — none of us want to do that — then I think we can have a good relationship,” he adds. “I hope that 2013 is a better year for all of us.”

67 sick with noro; fancy food ain’t safe food, world’s greatest restaurant edition

At least 67 dinners were barfing after dining at the world’s so-called greatest restaurant, Noma, in Denmark.

Danish food types Fødevarestyrelsen criticised Noma for not disinfecting the kitchen in time in order to prevent the contagion from spreading and also norovirus-2said there was no hot water in the taps that staff used to wash their hands.

Water temp doesn’t matter when it comes to hand washing, but my guess is there was little handwashing to begin with.

From February 12-16, 2013, out of 78 guests served over the period, a total of 63 fell ill, which prompted Fødevarestyrelsen to make an inspection in which it found hygiene problems.

“There has been illness among staff who have handled the food products”, Fødevarestyrelsen wrote in its report. “The inspection visit was due to guests nomocomplaining of vomiting and diarrhea.”

The restaurant is aware of four additional people who have taken ill, which brings the total number of ill diners up to 67.

I like Danes; worked with two carpenters for five years, my sister lived there with her family for a couple of years; our daughter is named Sorenne. But just like Heston-what’s-his-name and his Fat Duck restaurant, where 535 people were sickened with norovirus in 2010, and like the Haaaaarrrrr-vard Club, food porn and profit trumps food safety. In all three outbreaks involving food for the fancy-pants set, the celebrity chefs were too damn dumb about norovirus to know how incredibly infectious it is. Worse, people get sick, but they keep going back, underwriting more porn and more idiocracy.

And in the lamest public excuse offered for some time, someone from Noma said, “We acknowledge that the internal procedures haven’t been good enough and because of busyness, employees didn’t check e- mails.”