While I wait with the rest of you hitting refresh on the CDC website waiting on an update on the numbers ill and the cause of the “E. coli Outbreak with Unknown Food Source,” I am reminded by how many times I have been asked why it takes so long to figure these outbreaks out. To borrow from the Beatles, it is a “long and winding road.”

In all CDC announcements of a foodborne outbreak is this caveat: As mentioned above, the true number of sick people in an outbreak is likely higher than the number reported, and the outbreak may not be limited to the states with known illnesses. This is because some of the recent illnesses have not yet be reported to PulseNet as it usually takes 3 to 4 weeks to determine if a sick person is part of an outbreak. In addition, some people recover without medical care and are not tested for E. coli. State and local public health officials are interviewing people about the foods they ate in the week before they got sick.

See below for an illustration. First, you need contaminated food being consumed and then that person being ill enough to seek medical attention from a health care provider. Incubation periods (time between ingestion and symptom onset) can be hours to months depending on the pathogen. You also have to account for the tainted product itself – highly tainted or sporadically? Self-stable, Frozen or perishable? The point being, are you seeing a large quick spike in sick people, or a handful over weeks, months or years? If something does not appear out of the ordinary it can be overlooked.

So, if someone is sick enough to seek medical attention, does that provider take a stool or blood culture (as opposed to a PCR test) to determine the likely pathogen and that test result may take days to return. If the provider does order a test and it comes back positive for a reportable pathogen (some are and some are not reportable – more on that another day), then the provider should report the illnesses to the local and state health authorities and the culture – if available – is sent to the state health department lab for further genetic testing. This process may take days or even weeks.

Assuming that the provider reported the illness and sent the culture to the lab, now comes the “Epi” work. Public health investigators attempt to contact the ill person or the person’s family to determine what the person did and/or consumed during the incubation period for the identified bacteria, virus or other pathogen. Remember, depending on the pathogen, the incubation could be a few hours (like Norovirus) or months (like Listeria). Also, complicating things are how broadly was the offending product sent – locally, across the country or internationally, and, how many people are sick. The unfortunate fact is that the broader the product went and the more people sickened – quickly – the better the chance of determining the tainted product.

Now, assuming that a food product is identified, then the traceback and recall begins.

Like I said, a “long and winding road.”

Although the CDC is still reporting only 29 ill in Ohio and Michigan total. On the ground in the states there are different numbers.

The Ohio Department of Health said cases had been reported in Wood, Lucas, Mahoning, Clermont, Cuyahoga, Franklin, Lorain, and Summit counties. Thus far Wood county has reported 20 illnesses.

The Michigan Department of Health and Human Services (MDHHS), the Michigan Department of Agriculture and Rural Development (MDARD) and three local health departments – Kent, Ottawa and Oakland – are investigating a recent increase in the number of illnesses related to E. coli bacteria.  Thus far MDHHA has reported 98 illnesses.

Although ground beef may still be a possibility for the vector of the outbreak (HUS used to be called “the hamburger disease”), it seems unlikely in 2022 we would be seeing that much undercooking occurring across such a wide geographical area. In addition, although the first decade of my practice was hamburger and E. coli, the last two decades have been leafy greens and E. coli. Also, the epi curve seems a bit tight – July 26 to August 6 – which to me argues for a perishable product. However, with the CDC reporting 38% of the illnesses are women, that argues against leafy greens as most outbreaks involving leafy greens have 60% or more being women.

My bet is leafy greens.

E. coli outbreaks associated with lettuce, specifically the “pre-washed” and “ready-to-eat” varieties, are by no means a new phenomenon. In fact, the frequency with which this country’s fresh produce consuming public has been hit by outbreaks of pathogenic bacteria is astonishing. Here are just a sample of E. coli outbreaks based on information gathered by the Center for Science in the Public Interest, Kansas State University, Barf Blog and the Centers for Disease Control and Prevention:

DateVehicleEtiologyConfirmed
Cases
States/Provinces
July 1995Lettuce (leafy green; red; romaine)E. coli O157:H7741:MT
Sept. 1995Lettuce (romaine)E. coli O157:H7201:ID
Sept. 1995Lettuce (iceberg)E. coli O157:H7301:ME
Oct. 1995Lettuce (iceberg; unconfirmed)E. coli O157:H7111:OH
May-June 1996Lettuce (mesclun; red leaf)E. coli O157:H7613:CT, IL, NY
May 1998SaladE. coli O157:H721:CA
Feb.-Mar. 1999Lettuce (iceberg)E. coli O157:H7721:NE
Oct. 1999SaladE. coli O157:H7923:OR, PA, OH
Oct. 2000LettuceE. coli O157:H761:IN
Nov. 2001LettuceE. coli O157:H7201:TX
July-Aug. 2002Lettuce (romaine)E. coli O157:H7292:WA, ID
Nov. 2002LettuceE. coli O157:H7131:Il
Dec. 2002LettuceE. coli O157:H731:MN
Oct. 2003-May 2004Lettuce (mixed salad)E. coli O157:H7571:CA
Apr. 2004SpinachE. coli O157:H7161:CA
Nov. 2004LettuceE. coli O157:H761:NJ
Sept. 2005Lettuce (romaine)E. coli O157:H7323:MN, WI, OR
Sept. 2006Spinach (baby)E. coli O157:H7 and other serotypes205Multistate and Canada
Nov./Dec. 2006LettuceE. coli O157:H7714:NY, NJ, PA, DE
Nov./Dec. 2006LettuceE. coli O157:H781 3:IA, MN, WI
July 2007LettuceE. coli O157:H7261:AL
May 2008RomaineE. coli O157:H791:WA
Oct. 2008LettuceE. coli O157:H759Multistate and Canada
Nov. 2008LettuceE. coli O157:H7130Canada
Sept. 2009Lettuce: Romaine or IcebergE. coli O157:H729Multistate
Sept. 2009LettuceE. coli O157:H710Multistate
April 2010RomaineE. coli O145335:MI, NY, OH, PA, TN
Oct. 2011RomaineE. coli O157:H760Multistate
April 2012RomaineE. coli O157:H7281:CACanada
June 2012RomaineE. coli O157:H752Multistate
Sept. 2012RomaineE. coli O157:H791:PA
Oct. 2012Spinach and Spring Mix BlendE. coli O157:H733Multistate
Apr. 2013Leafy GreensE. coli O157:H714Multistate
Aug. 2013Leafy GreensE. coli O157:H7151:PA
Oct. 2013Ready-To-Eat SaladsE. coli O157:H733Multistate
Apr. 2014RomaineE. coli O12641:MN
Apr. 2015Leafy GreensE. coli O14573:MD, SC, VA
June 2016Mesclun MixE. coli O157:H7113:IL, MI, WI
Nov. 2017Leafy GreensE. coli O157:H767Multistate and Canada
Mar. 2018RomaineE. coli O157:H7219Multistate and Canada
Oct. 2018RomaineE. coli O157:H762Multistate and Canada
Nov. 2019 RomaineE. coli O157:H7167Multistate
Dec. 2020Leafy GreensE. coli O157:H740Multistate
Jan. 2021Baby SpinachE. coli O157:H715Multistate
Mar. 2022Packaged SaladE. coli O157:H710Multistate

Most current information:

The Ohio Department of Health said that cases had been reported in Wood, Lucas, Mahoning, Clermont, Cuyahoga, Franklin, Lorain and Summit counties. Four people in Ohio have been hospitalized in connection with the outbreak, the department said.  Thus far Wood county has reported 20 illnesses.

The Michigan Department of Health and Human Services (MDHHS), the Michigan Department of Agriculture and Rural Development (MDARD) and three local health departments – Kent, Ottawa and Oakland – are investigating a recent increase in the number of illnesses related to E. coli bacteria.  Thus far MDHHA has reported 98 illnesses.

The CDC posted this today:

A food has not yet been identified as the source of this fast-moving outbreak. So far, illnesses have only been reported from Michigan and Ohio.

The CDC, public health and regulatory officials in several states (in addition to Ohio and Michigan?), the U.S. Food and Drug Administration (FDA), and the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS) – I do not recall a CDC post recently that included working with both the FSIS (regulates, Beef, Pork, Poultry and Catfish) and the FDA (regulates everything else).

Here are some details:

29 Illnesses- 14 in Ohio (Wood County Health Department reports 20) and 15 in Michigan (Michigan Department of Health reports 98).

Illnesses onset dates: July 26, 2022, to August 6, 2022.

Age: 6 to 91 years, median age of 21 years, and 38% are female (hmm, what do 62% of men eat?).

17 people with information available, 9 have been hospitalized.

A food has not yet been identified as the source and this investigation is ongoing. So, meat, leafy greens or something else? As you will see from the below, the genetics are tight – this clearly is is a one bug outbreak from one source.

Present Outbreak – Ill people range in age from 6 to 91 years, with a median age of 21 years, and 38% are female.

Produce: 862 cases, ~67% female

Packaged salads, 2021, 10 cases, 100% female

Baby spinach, 2021, 15 cases, 80% female

Leafy greens, 2020, 40 cases, 60% female

Chopped salad kits, 2019, 10 cases, 60% female

Romaine, 2019, 167 cases, 64% female

Romaine, 2018, 62 cases, 66% female

Romaine, 2018, 210 cases, 67% female

Leafy greens, 2017, 25 cases, 67% female

RTE Salads, 2013, 33 cases, 60% female

Spinach and spring mix, 2012, 33 cases, 63% female

Romaine, 2011, 58 cases, 59% female

Spinach, 2006, 199 cases, 71% female

Beef/Meat: 442 cases, ~49% female

Bison, 2019, 33 cases, 52% female

Ground beef, 2019, 209 cases, 51% female

Ground beef, 2018, 18 cases, 33% female

Beef products, 2016, 11 cases, 45% female

Ground beef, 2014, 12 cases, 42% female

Beef, 2010, 21 cases, 43% female

Beef, 2009, 26 cases, 50% female

Beef, 2009, 23 cases, 36% female

Ground beef, 2008, 49 cases, 57% female

Ground beef, 2007, 40 cases, 45% female

Looking at the NCBI database, these are the most likely WGS fingerprints (in red) are in this subcluster

30 Isolates Selected

Distance between selected isolates: minimum = 0 SNPs, maximum = 2 SNPs, average = 0 SNPs

Target creation date range: 2022-08-09 to 2022-08-15 

Well, more tomorrow.

New or fairy new outbreaks should remind us all how much the FDA does with the limited resources it has. Here is most of the latest:

An outbreak of E. coli O157:H7 (ref# 1081) in an unidentified product was added to the table and FDA has initiated a traceback investigation. CDC has issued an Investigation Notice.  

An outbreak of Salmonella Senftenberg (ref# 1087) in an unidentified product was added to the table.

An outbreak of Salmonella Typhimurium (ref# 1095) in an unidentified product was added to the table and traceback has been initiated.

For the outbreak of Salmonella Braenderup (ref# 1075) in an unidentified product, the outbreak has ended.

For the outbreak of Cyclospora in an unidentified product (ref# 1084), the case count has increased from 77 to 98.

And, of course Daily Harvest:

Total Adverse Illness Events: 329*
Hospitalizations: 113*
Deaths: 0
Last illness onset: July 16, 2022*
States with Adverse Illness Events: AZ, CA, CO, CT, DE, FL, GA, IL, IN, IA, MD, MA, MN, MS, MI, MO, MT, NV, NH, NJ, NY, NC, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WI

Here is a link to the FDA.

Cases of E. coli in Wood County appear to be related, according to a Tuesday update by the Wood County Health Department.

Of the samples sent to Ohio Department of Health for testing, five have come back and all of those have been the same serotype, said Beth Peery, public health information and education manager.

“That tells us that there may be a link between cases. Approximately 30% of Shiga Toxin E. coli (STEC) cases are this serotype, so it’s not definitive but does help us identify next steps to pursue in the investigation,” Peery said.

“At this stage, we are working with state and federal partners to explore what those links could be and understand next steps. As we explore possible links, various partners at the state and federal level can help us better understand the value of individual lines of inquiry.”

No new cases or hospitalizations have been identified since yesterday. The last reported illness had an onset date of Aug. 9, Peery said.

As of Monday, there had been 18 cases, including six hospitalizations, reported.

Health Commissioner Ben Robison briefed the board of health about the outbreak at Thursday’s meeting. At that time there were 15 cases.

The age range of cases is 13-60 years.

Ohio: According to Wood County Department of Health, sixteen people in Wood County, Bowling Green, Ohio area have come down with E. coli in the past week, prompting the health department to begin investigating. From 2016 to 2020 the county only saw twenty-seven cases altogether. Those who have fallen ill range from ages 13 to 60 years old and those who contract the virus can experience different levels of sickness and gastrointestinal symptoms. Out of the 16 people who have contracted the virus in Wood County, five are currently in the hospital.  One woman who I spoke to tonight was just released and indicated that the health department seems to be focusing on a local restaurant. The Wood County Health Department has sent lab samples to the Ohio Department of Health to learn whether the illnesses are connected. Results, and more information, are expected early next week.

Michigan: The Ottawa County Department of Public Health in Holland, Michigan is alerting the public to The Ottawa County Department of Public Health in Holland, Michigan is alerting the public to increasing cases of Shiga-toxin producing E. coli infections in the community. The Department is currently monitoring twelve cases of STEC, which is significantly higher than the typical number of cases reported at this time of the year. The Department is working with the Michigan Department of Agriculture and Rural Development (MDARD) and the Michigan Department of Health and Human Services (MDHHS) to investigate possible links between the cases. Five of the twelve cases (two children) have been hospitalized for their symptoms.

E. coli: Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of E. coli outbreaks and hemolytic uremic syndrome (HUS). The E. coli lawyers of Marler Clark have represented thousands of victims of E. coli and other foodborne illness infections and have recovered over $800 million for clients. Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation. Our E. coli lawyers have litigated E. coli and HUS cases stemming from outbreaks traced to ground beef, raw milk, lettuce, spinach, sprouts, and other food products.  The law firm has brought E. coli lawsuits against such companies as Jack in the Box, Dole, ConAgra, Cargill, Wendy’s, and Jimmy John’s.  We have proudly represented such victims as Brianne KinerStephanie Smith and Linda Rivera.

Additional Resources: If you or a family member became ill with an E. coli infection or HUS after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark E. coli attorneys for a free case evaluation.

Nearly a month ago I urged the FDA to follow Frank Sinatra’s advice to “float down to Peru.” I do not know if the FDA has, but they long ago should have.

As you know, I have sued Daily Harvest, and after asking who manufactured the French Lentil + Leek Crumbles, and being rebuffed, I was able to determine that the manufacturer was Stone Gate, and they were brought into the litigation. I then asked both Daily Harvest and Stone Gate who was the Tara supplier, and was also rebuffed.

Well, I got a tip who the supplier was and I heard from the supplier’s lawyer today. As a courtesy I will wait until next week to add them into the litigation as well. My guess is the I will be “float[ing] down to Peru,” to determine other entities in the manufacturing, exporting and importing supply chain.

I will also be asking Courts next week to order Daily Harvest and Stone Gate to supply the victims with Tara samples so that we can independently test the product to try and determine what is sickening their customers – that only seems right?

By the way, I assume that the FDA is not only testing Daily Harvest and Revive products, but also the Tara used by both companies?

It still does seems like this is the perfect time for the FDA to “float down to Peru” and see what is up with Tara? It does not seem that far:

I leave you with the rest of the lyrics:

The Ottawa County Department of Public Health is alerting the public to increasing cases of shiga-toxin producing E. coli (STEC) infections in the community. The Department is currently monitoring 9 cases of STEC, which is significantly higher than the typical number of cases reported at this time of the year. The Department is working with the Michigan Department of Agriculture and Rural Development (MDARD) and the Michigan Department of Health and Human Services (MDHHS) to investigate possible links between the cases. Four of the 9 cases have been hospitalized for their symptoms.

Jan Larson McLaughlin of the BG Independent News reports that the Wood County Health Department has recorded three years’ worth of E. coli cases in the past week.

Health Commissioner Ben Robison reported to the Wood County Board of Health Thursday evening that 15 known cases of E. coli have been identified in the last week. That compares to 27 cases in the last five and a half years in the county, he said.

“We are in the very front stages of an investigation,” Robison said.

Tests are being conducted by the Ohio Department of Health to see if there is a link between the cases. The results are expected back next Tuesday.

Robison cautioned that the 15 known cases are likely just the beginning.

“This number we expect will grow,” he said.

Of the 15 cases reported so far, five people were hospitalized, ranging in age from 21 to 60, Robison said. 

The Wood County Health Department is partnering with other agencies to try and solve the puzzle of the origin of the E. coli. Those partners include the Ohio Department of Health and other county health departments. It could be expanded to the Ohio Department of Agriculture if a link is identified to food products in the early stages of growing or processing.

Understandably, my nearly 350 clients sickened by Daily Harvest French Lentil + Leek Crumbles (and possibly additional products) are frightened and angered by the lack of information about the contaminant in the tara, that according the the FDA, has hospitalized over 100 with symptoms consistent with acute liver failure. Dozens of people have had their gall bladders removed, as well as several with liver biopsies. Hundreds have suffered through over two months of illness with unbearable pain, jaundice, multiple procedures, including extensive blood draws, MRI’s, CT scans – and the list goes on. Because they do not know what has sickened them, they fear the future complications that may or may not appear. Medical bills are now pouring in that risk credit score damage and bankruptcy for some.

And, what did they do – they thought they were eating something healthy.

The below is the last official update from Daily Harvest ( nearly 1 month ago) as they now go about their way on other social media sites touting their food safety protocols and marketing additional products. I think customers deserve more.

We have asked privately that Daily Harvest and its manufacturer, Stone Gate, to consider three things – 1) to provide us samples of tara to independently test, 2) to name the tara supply chain so that can be brought into the pending litigation so all responsible parties are in the same Courtroom, and 3) to consider helping victims financially now to avoid making their suffering even worse.

So far – silence. They can delay the above, but eventually the Court will force compliance with each of the three.

In an effort to get to the root cause of the contamination, I have shared with Daily Harvest, Stone Gate AND THE FDA, redacted information about hundreds of peoples’ symptoms and test results. We have also provided all three with product test results in real time.

The goal of all should be to find out what happened and what is causing the suffering and to stop it – isn’t it?

And, Stone Gate has said nothing.

Watch this space and court filings.

At some point in the not too distant future through the process of litigation, Daily Harvest, Stone Gate and Revive will be forced to both tell me the source of the Tara (and why they used it) and to provide samples to test. It does beg the question as to why they will not willingly provide the information and the samples now?

Through a private lab, we have been testing dozens of French Lentil + Leek Crumbles and Pineapple and Mango Smoothie samples – as has the FDA and presumably Daily Harvest and Revive. To date, we have not determined what in the Tara is causing all the illnesses. The hunt continues.

For those who have been following my blog the last two months, there is little surprise that Tara is the link to some or all the illnesses from Daily Harvest French Lentil + Leek Crumbles (and possibly other Daily Harvest products) and Revive smoothies – specifically, the Pineapple and Mango (which is not longer for sale).

To date we have been retained by over 350 acute liver failure survivors (some 30 left without a gallbladder) of Daily Harvest Crumbles (containing Tara), and we are investigating nearly another 30 Daily Harvest illnesses linked to other products. We have also been retained by nearly 30 people sickened by Revive Pineapple and Mango smoothies that also contained Tara.

Much more to be uncovered. I feel a field trip to Peru?

Early morning in wonderful Machu Picchu

Last week we filed two lawsuits against Revive (a Canadian company) in New York Federal Court. We have filed three lawsuits against Daily Harvest – one on behalf of a woman who lost her gallbladder and on behalf of two minor children – one an infant and one an 11-year-old.

Three lawsuits (two in New York Federal Court and one in New York State Court) have been filed against Daily Harvest and the company that manufactured the French Lentil + Leek Crumbles, Second Bite Foods d.b.a, Stone Gate Foods, that have been linked to nearly 300 cases of acute liver failure.

The first lawsuit filed by a Tulsa woman that purchased the Daily Harvest product on May 3 and consumed it on May 7. Later the same day, she began experiencing abdominal pain and gastrointestinal discomfort. She also suffered from right shoulder pain. The next day, she experienced more significant pain accompanied by nausea and headache. On May 9 her husband took her to the emergency room at St. John’s Ascension Medical Center.

At the Medical Center, she received pain medicine and had blood and urine tests along with ultrasound and CT scans. She was discharged with advice to pursue a bland diet. She again purchased the “French Lentil + Leek Crumbles.” from Defendant on May 17 and had them for lunch on May 28. By 7 a.m. the next day, she was again experiencing abdominal and shoulder pain. The pain was so severe by the next that she again required hospitalization.

Her hospitalization lasted four days, and it found that she was experiencing liver and gallbladder dysfunction. After consulting with her primary care doctor, she underwent surgery to have her gallbladder removed on June 24, 2022.

We did voluntarily dismiss this lawsuit to avoid – for now – an unnecessary fight over Daily Harvest’s “Terms of Service” where it is trying to force its customers to arbitrate vs litigate. More on this in the coming weeks.

The second lawsuit was filed on behalf of a 4-month-old baby and her mother became ill and were hospitalized after the mother ate the lentil-based product at the end of May and beginning of June, according to a lawsuit filed in the Supreme Court of the State of New York, County of New York. Beginning May 25, the infant experienced vomiting, diarrhea, screaming and dark urine after her mother consumed the product and breastfed her, the lawsuit said. 

After consuming the product again in June, the baby’s mother was hospitalized with extreme abdominal pain and gastrointestinal distress from June 8 to 15, the suit said. At the time, the infant also began having symptoms including fever, vomiting and gastrointestinal distress, the suit said, adding the mother continued to breastfeed during her hospitalization on the advice of her doctors, who did not know the cause of her illness.

The infant was seen by a physician on June 24, where tests showed high liver enzymes and she was hospitalized on June 25 before being released the next day with ongoing testing and monitoring from experts, the lawsuit said. 

In a third lawsuit filed this week on behalf of a child, a father alleges his daughter became ill with symptoms including abdominal pain and elevated thyroid and liver enzyme levels. The lawsuit said a gastrointestinal and liver specialist told the girl the elevated liver enzymes could indicate a “potential lifelong, life-threatening illness” and that she could no longer participate in her soccer, the girl’s passion, because “an inflamed liver could lacerate while playing and be fatal.” The child’s liver function is being monitored, according to the lawsuit, which was filed in federal court for the Southern District of New York.

Complaints:

https://www.foodpoisonjournal.com/files/2022/07/155840_2022_John_Looby_v_Daily_Harvest_Inc_et_al_COMPLAINT__AMENDED__2.pdf

https://www.foodpoisonjournal.com/files/2022/07/First-Amended-Complaint-filed-07152022-2.pdf

https://www.foodpoisonjournal.com/files/2022/07/Ltr-motion-to-file-2nd-Am-Comp-07152022.pdf