Archive for February 2016
By: Amy Kullas, Ph.D.
Chipotle boasts that they exclusively use non-genetically modified organism (non-GMO) foods to ensure safe, healthy ingredients, great taste and care for the environment. However, starting in August of 2015, a series of food-poisoning outbreaks were linked to the restaurant chain. In total: 64 customers in Minnesota were diagnosed with Salmonella, 100 customers in California were diagnosed with norovirus, 53 people contracted Shiga-toxin producing Escherichia coli (STEC) that spanned nine states, 140 students were infected with norovirus and another outbreak of Escherichia coli infected five people in three states. Over 25 people were hospitalized and luckily no one developed hemolytic uremic syndrome (HUS) nor were any deaths reported from any of the outbreaks. HUS is a disease characterized by hemolytic anemia, acute kidney failure, and a low platelet count; most cases of HUS are preceded by an infection with E. coli, Shigella, or Campylobacter. At the beginning of February 2016, the Centers for Disease Control and Prevention (CDC) announced that the “outbreaks appear to be over.” However, it is troubling that the CDC’s investigation failed to “identify a specific food or ingredient” linked to STEC contamination; the Salmonella outbreak was attributed to contaminated tomatoes and the norovirus outbreaks were blamed on sick employees. Chipotle’s director of public relations, Chris Arnold, said: “If there’s a silver lining in this, it is that by not knowing for sure what the cause is, it’s prompted us to look at every ingredient we use with an eye to improving our practices.”
Chipotle has been proactive about taking action to address these series of food-borne pathogen outbreaks. On February 8, 2016, the company shut all of its stores for four hours to hold mandatory food-safety meetings with employees. Chipotle revealed a “comprehensive food safety plan” while also blaming its own employees for the norovirus outbreak. Steve Ells, the founder, chairman, and co-CEO of Chipotle, released a letter stating that while Chipotle’s food safety programs had met or exceeded the industry’s standards, the company is applying additional steps “to be sure all of the food we serve is as safe as it can be,” including:
- Implementation of high-resolution sampling and testing of many of the ingredients to prevent contaminants,
- Working with their suppliers to further enhance their food safety programs,
- Introduction of additional microbiological kill steps to eliminate microbial risk (new sanitation procedures and additional food safety training for employees),
- Preparation of some of the ingredients at ‘central kitchens’,
- Marinate meat only at night to reduce raw meats coming into contact with other ingredients,
- Blanch produce (flash-boiling for 5-10 seconds to kill microbes on the outer surface).
Chipotle’s food safety plan also includes increasing the number of paid sick days for employees (previously employees had only gotten two days of paid sick leave, which is two days more than most of the food industry). The fact that the food industry in general does not provide sufficient sick leave for employees can directly impact the health of the consumer and general public. If an employee returns to work or does not even take time off from work for being sick because he or she needs the money, and prepares food for customers, it is only a matter of time before an outbreak, such as the norovirus outbreaks, occurs.
As Chipotle’s previous food safety plan had at least met, if not exceeded, the food industry standards, it is important for the entire industry to raise the accepted standards in order to prevent future food-borne pathogen outbreaks in restaurants. Unfortunately, it is unlikely that the food industry will be as proactive as Chipotle for fear of hurting their bottom line. Many restaurants rely on purveyors who use antibiotics or pesticides to increase food production and keep food costs low. Antibiotics and antimicrobials are routinely used in agriculture and are given to livestock (cattle, pigs, poultry, etc.) in their feed or drinking water as well as being sprayed on crops. In fact, it has been estimated that over 50% (other estimates are as high as 70%) of the antibiotics in the United States are used in food production. They are given for a variety of reasons: to help them gain weight faster, use less food to gain weight, and the treatment, control, or prevention of diseases. Many scientists feel that this is contributing to the rapid increase in antibiotic-resistant bacteria. The correlation between antimicrobial use in food production and the dramatic increase in bacterial resistance has triggered a reassessment of agricultural practices in numerous countries, including the U.S. The CDC stated, “up to half of antibiotic use in humans and much of the antibiotic use in animals is unnecessary and inappropriate and makes everyone less safe.”
As part of the investigation of the norovirus outbreak, the U.S. Food and Drug Administration (FDA)’s Office of Criminal Investigations served a subpoena to Chipotle in December 2015. Chipotle states that they will fully cooperate with the investigation, insisting that these series of outbreaks were isolated incidents. This series of food-borne outbreaks has significantly impacted Chipotle’s bottom line. Chipotle released that it anticipates spending between $14 and $16 million in response to the outbreaks. Furthermore, since the outbreaks began in August, Chipotle’s cost per share has plunged by more than 40%! Some of the customers affected in the outbreaks have announced that they plan to sue the enterprise.
Regrettably, the Chipotle was not the first food-borne outbreak linked to a major restaurant chain. In the 1990’s the restaurant chain, Jack in the Box, suffered a large E. coli outbreak that involved 73 restaurants and over 730 people (four children died and 178 were left with permanent damage). Additionally, there was an E. coli linked to undercooked hamburgers sold by the restaurant giant, McDonalds, in which consumers also died. However before Chipotle’s troubles began, the restaurant had a loyal fan base with its non-GMO practices and other health conscious programs. However, after a restaurant, such as Chipotle, has had its reputation tarnished, how can it begin to woo back consumers? One of Chipotle’s solutions was free burritos. This will help to retain Chipotle’s teen and young adult consumer-base, which represents ~35% of its total consumers. Importantly, this population has not stopped eating at Chipotle despite the outbreaks. Bonnie Riggs, a restaurant industry analyst said, “Their willingness to overlook any food safety concerns to eat Chipotle could be a result of unabashed loyalty.”
While this particular outbreak has received a lot of media attention, it remains up to the food industry as a whole to make food safe again for its consumers or for the federal government to step in to pass laws requiring additional food safety measures. The CDC estimates that each year, “1 in 6 Americans get sick from eating contaminated food.” Since the 1950’s, there have been dramatic changes in the country’s food production and supply (i.e. local environmental changes, decrease in family farms, more imported food, more food additives used, etc.). During this same time frame, there has been an increase in multi-state foodborne outbreaks colliding with new and emerging antibiotic resistant bacteria. Recently, there has been a series of announcements from prominent players to reduce the abuse from industrial farming. These include: McDonald’s stating that it will “phase out eggs from hens kept in cages” and Perdue using no antibiotics in over half of its chicken production. As awareness of the repercussions of industrial farming continues to grow, hopefully there will be more positive solutions from the food production and restaurant industries to increase the overall food safety in agriculture.
By: Rachel Zamoiski, Ph.D., MPH
Zika virus has been all over the news lately, but it hasn’t been that long since a different virus was making headlines all over the world: Ebola. The Ebola epidemic of Western Africa, which began in 2014 and ended in January 2016, has resulted in over 28,000 Ebola diagnoses and over 11,000 deaths. While the seemingly near-constant news updates on Zika may remind us of the media coverage of Ebola, the two diseases are very different from each other. However, there are still lessons to be learned from the Ebola outbreak that can be applied to how we deal with this potential Zika epidemic.
The illnesses caused by Ebola and Zika are very different from each other. With Ebola, the main concern is the disease itself. Ebola is often fatal, especially in settings without good infrastructure or advanced medicine. The symptoms of Ebola are severe and can involve severe vomiting and diarrhea, as well as uncontrolled bleeding. Ebola is transmitted by contact with the body fluids of an infected person, even after the patient has died. In contrast, the symptoms of Zika are mild. It’s uncertain exactly how Zika is spread, but the primary route of transmission of Zika appears to be via mosquitoes and not direct contact with infected individuals, although other routes of transmission may be possible, as limited reports have emerged of sexual transmission. In addition, recent reports state that scientists have found active virus in saliva and urine, although it is not known if those fluids could transmit the virus. The actual symptoms caused by Zika virus is not particularly concerning when compared to Ebola. While the symptoms of the disease caused by Ebola and its high case-fatality rate were the main concerns of the Ebola outbreak, the greatest concern with Zika is the possible effect on fetuses when pregnant women are infected.
An article in Morbidity and Mortality Weekly Report from January 29, 2016 describes a “possible association” between Zika and microcephaly in babies born to mothers infected during pregnancy. The authors report an increase in cases of microcephaly, defined as a head circumference greater than two standard deviations below the mean, adjusted for gestational age and sex. The babies with microcephaly were born to mothers who either lived in or had visited areas with current Zika outbreaks. The article states that pregnant women should try to avoid contact with mosquitoes, while also noting that “further studies are needed to confirm the association of microcephaly with Zika virus infection.” While the link between Zika and microcephaly is still not well understood, it still seems prudent to advise pregnant women to avoid contact with the virus, out of an abundance of caution.
While it is important to be cautious and not expose people to unnecessary risk, even when the risk is uncertain, it’s also true that an overabundance of caution is not always a good idea. With Ebola, there were efforts to quarantine health workers returning from West Africa even when they posed no threat to public health. These efforts were made largely by politicians, and not by people with medical or scientific expertise, who instead recommended routine monitoring but not quarantine in asymptomatic individuals, as patients needed to be symptomatic in order to transmit the virus to others. This is in contrast with the well-known case of Typhoid Mary, a woman working as a cook who was forcibly quarantined because she was infecting people with typhoid even though she was not sick herself, and was unwilling to stop working as a cook. In situations like that of Ebola, not only does forced quarantine punish people for performing work that should be celebrated and honored, but it also potentially discourages healthcare workers from traveling to disease-ridden areas by stigmatizing them and treating them like prisoners unwelcome in their own country.
Less is known about Zika than about Ebola. With Zika, we don’t really know how infectious it is, or exactly how it’s transmitted. But what lessons are there to be learned from Ebola, to guide our response to Zika?
It’s important to take emerging infectious diseases seriously. One of the downsides of having such effective vaccines against formerly-common illnesses like measles and mumps is that we can forget how powerful and widespread viruses can be. The Ebola outbreak reminded us that viruses still have the potential to infect and kill many thousands of people, both far away and close to home.
Included in the threat of infectious diseases is the widespread fear caused by the perception of a seemingly unstoppable deadly virus. This understandably scared many people and undoubtedly contributed to the unscientific overreaction by many politicians. This underscores the need for good communication in the management and control of infectious diseases. If a politician announced plans to forcibly quarantine cancer patients, there would be widespread outcry and ridicule, because the general public understands cancer well enough to know that quarantine is not an effective method of preventing cancer. The same should be true for new public health concerns as well.
Finally, good data are paramount in understanding and implementing effective methods to prevent and disrupt transmission. Our efforts should focus on collecting good data, clarifying the risks of Zika, and better understanding how it is transmitted, as well as how it’s not transmitted.
With Zika, we should be cautious, and take precautions to avoid the virus even when we don’t fully understand its effects. At the same time, our response to this public health crisis, as well as others in the future, should be based on good data, and not politics or scare tactics.