San Luis Obispo County Public Health confirmed on Tuesday evening, November 10, that one person tied to the E. coli O157 outbreak linked to Brookshire Farms has died. Department spokesman Tom Cuddy told The Tribune that “one individual associated with the E. coli outbreak has died,” and that the county was sharing the news with the family’s permission. KSBY carried the same confirmation. The county offered its condolences and gave no age and no other detail about the person.

That is the family’s decision to make, and it should be respected. I have sat with families in this position for more than thirty years. Nothing I write tonight will be of any use to them. My thoughts are with them, and with the families whose children are still recovering.

I also want to recognize Kaytlyn Leslie and Hannah Poukish of The Tribune, who reported the death Tuesday night. It is an article no one wishes to write, about a loss in their own community, and they and their paper wrote it with care and restraint. Local reporters have carried this story since the first day, and the public knows what it knows because of them.

What the county has said, and what it has not

The official count has not changed since Friday. The county’s November 6 closing release lists five people with laboratory-confirmed Shiga toxin-producing E. coli O157, all of whom visited Brookshire Farms on October 17 or 18, and ten more who visited between October 16 and 26, became ill and are counted as suspect cases. That is fifteen. Some reports tonight use eight unconfirmed cases, which was the county’s October 30 figure; the closing release says ten.

The October 30 release also reported that three children had developed hemolytic uremic syndrome (HUS), the kidney failure that is the most feared complication of an O157 infection.

The county has not said whether the person who died was one of the five confirmed cases or one of the ten suspect cases. It has not said whether the person was one of the three children with HUS. 

As of tonight, the confirmation exists only as a statement to reporters. The newest item on the county’s public health news page is still the November 6 release.

The investigation closed on Friday without naming a source

The county announced it was wrapping up at 4:27 p.m. on November 6, about five and a half hours after the farm reopened. Its findings, in its own release:

The bacteria from three of the five confirmed patients matched each other by genetic testing and did not closely match anything in national databases, which the county said strongly suggests “a common and unique source.” A fourth test was pending. A fifth could not be done.

Water, food and other environmental samples from the farm did not find E. coli O157. Other strains of E. coliwere found in some samples.

Sampling was limited by the number of possible sources, the absence of testable items and the delay between exposure and sampling. No further environmental testing is planned.

Edible corn cups, pumpkins, hay and non-potable water sources were common to the people who became ill. None was identified as the source.

No farm animals or petting zoo were open to the public.

Health Officer Dr. Christy Mulkerin said in that release that a negative environmental result is not unexpected, because contamination is often temporary and hard to detect, and that the clinical and epidemiological evidence still points to a short-lived shared exposure. She is right about that. A negative swab taken days later does not clear a location. It means the bacteria were gone, or missed, by the time anyone looked.

I wrote that night that closed is not the same as answered. That was true on Friday. It carries more weight now.

What E. coli O157 does every year

The CDC estimates that E. coli O157 causes about 97,000 illnesses, 3,270 hospitalizations and 30 deaths in the United States each year.

CDC does not publish a national yearly count of HUS. Its FoodNet surveillance found that 6.3 percent of people with a confirmed O157 infection developed HUS, and 15.3 percent of children under five did. Applied to CDC’s illness estimate, that is roughly 6,000 HUS cases a year. That figure is my arithmetic, not CDC’s, and it is a rough one, because CDC’s estimate includes milder illnesses that are never diagnosed. In the same data, 4.6 percent of the people who developed HUS died.

Thirty deaths a year is a small number until one of them is in your town.

What a death should change

A death does not change the epidemiology. It does change what the public is owed. Four things would help, and none requires reopening a fight with anyone.

First, the county should publish the fourth sequencing result when it arrives and say whether the person who died is counted among the confirmed or the suspect cases, to the extent the family permits.

Second, the county should write and publish a final outbreak report: what was sampled, where and on what dates; what could not be tested and why; and what the interviews showed about the corn cups, the hay, the pumpkins and the non-potable water. A strain the county calls unique came from somewhere.

Third, the California Department of Public Health should review the file. A fatal O157 outbreak with three children in kidney failure and no identified vehicle is a reasonable thing for a state to look at twice.

Fourth, the county should say what it will ask of seasonal farm attractions before next October, including potable water, handwashing stations, and how food is served to as many as a thousand visitors a day.

About the farm

Co-owner Shawn Callaway told The Tribune last week that he and his wife are devastated, that safety has always been the farm’s priority, and that the only link he knows of among the confirmed cases is that they visited Brookshire Farms. I take him at his word on all three. No one opens a pumpkin patch expecting this. The last of those statements is also the county’s finding, and it is the reason the remaining questions deserve answers.

For families who visited

Anyone who visited between October 16 and 26 and became ill should tell their doctor and the county health department, even now. The California Department of Public Health describes the symptoms: stomach cramps and diarrhea, often bloody. In a child who has had diarrhea, decreased urination, unusual paleness or extreme tiredness are warning signs of HUS and call for emergency care. E. coli O157 can also spread within a household, so careful handwashing matters when someone at home is sick.

Marler Clark represents two families sickened in this outbreak.