There are few in the business of combating diarrhea that I respect more that Frank Yiannis and Rob Tauxe.
I am sure that it is not reciprocated, because I am one of those “damn ambulance chasers.” But, guys, it is past time to stop hiding foodborne illness outbreaks – regardless of the thin legal justification.
Failing to be transparent gives a false sense of security to both the leafy green industry and the public. And, when the outbreak is outed, there is no doubt that many consider that you are being toadies to the industry – that is not good and it is not accurate. You and the agencies you lead are far, far too valuable to squander your good names.
If the two of you want to debate the pros and cons of transparency, please name the time and place.
This week from the good people at Food Safety News:
January 24, 2020: Federal officials today confirmed another E. coli outbreak that they had previously not revealed to the public. Specific details were not available from the CDC or the FDA, but at least four states have been reported with confirmed patients.
The most likely source of the E. coli O157:H7, reported by 9 of 11 sick people who ate at fast food locations, was lettuce on Subway sandwiches, according to a source close to the investigation. Neither the FDA nor the CDC would confirm that Subway products are involved.
“This is an ongoing investigation into an outbreak that was identified in December,” Food Safety News learned from Peter Cassell, a press officer for the Food and Drug Administration.
“Upon detection, the outbreak had already ended. In an abundance of caution and to try to inform future prevention, we are working to see if we can identify the source. Per CDC and FDA policy, since there were no specific, clear and actionable steps for consumers to take to protect themselves from contaminated food associated with this outbreak, there was and is no current public health advisory.
“Should our investigation conclusively identify a source and/or contributing factors that could inform future prevention, we are committed to publicly communicating these insights.”
The CDC also provided Food Safety News with confirmation of the previously undisclosed outbreak. An official comment from the agency did not include any specific details except that patients were confirmed in four states.
“In early December 2019, CDC, along with the U.S. Food and Drug Administration and four states, began investigating a multistate outbreak of E. Coli O157 infections,” according to a press officer from the Centers for Disease Control and Prevention.
“No new illnesses have been reported since CDC initially identified this cluster, and the outbreak is over. CDC is continuing to work with FDA to identify the source of the outbreak.”
The four states are Nevada, Maine, Vermont and New Hampshire, according to a source close to the investigation.
January 28, 2020: Officials in two states have confirmed they are working with federal officials on an investigation into E. coli illnesses linked to lettuce served by a national restaurant chain.
Spokespeople with the Nevada and Vermont state health departments say the agencies are working with the federal agencies on the investigation. Both the CDC and the FDA confirmed for Food Safety News on Friday that they have an open investigation into the outbreak, which had not previously been made public. A source close to the investigation says the implicated restaurant chain is Subway.
Health department officials in the other two outbreak states, Maine and New Hampshire, did not respond to requests for information about the outbreak and investigation. Vermont had five confirmed patients, Maine had four and New Hampshire and Nevada each had one.
The Vermont spokeswoman echoed what federal officials said Friday in regard to why the public had not been informed about the outbreak when it was discovered. She said there wasn’t any actionable information for the public and that public risk has now passed.
However, as with the FDA’s statement, the Vermont spokeswoman said officials became aware of outbreak illnesses in November but then said that by the time the outbreak was discovered in December the illnesses had stopped.
The FDA and CDC are being notably silent on the outbreak and ongoing investigation.
The outbreak marks the second time in the recent months when the FDA and CDC did not go public with information about an outbreak.
On Halloween, Food Safety News learned of an E. coli O157:H7 outbreak that the two federal agencies had not revealed to the public. It ended in September and involved romaine lettuce. [A total of 23 people infected with the outbreak strain of E. coli O157:H7 were reported from 12 states: Arizona (3), California (8), Florida (1), Georgia (1), Illinois (2), Maryland (1), North Carolina (1), Nevada (1), New York (1), Oregon (1), Pennsylvania (2) and South Carolina (1). Eleven people were hospitalized and no deaths were reported. Illnesses started on dates ranging from July 12, 2019 to Sept. 8, 2019. No illnesses were reported after CDC began investigating the outbreak on Sept. 17, 2019.]
Spokespeople from FDA and CDC said at the time that because they believed all of the implicated romaine had passed expiration dates by the time the outbreak was discovered, agency officials did not think the public needed to know.
I wrote this several years ago when I was complaining about the same lack of transparency in another case:
It is therefore with mixed emotions, and the knowledge that I likely make my relationship with public health – both federal and state – even more tenuous, that I question his quotes in today’s MSNBC dust-up over the disclosure or non-disclosure of “Mexican-style fast food restaurant chain, Restaurant Chain A” that is a source of a Salmonella outbreak that sickened 68 people in 10 states. Here is what he had to say to MSNBC:
Dr. Robert Tauxe, a top CDC official, defended the agency’s practice of withholding company identities, which he said aims to protect not only public health, but also the bottom line of businesses that could be hurt by bad publicity. The CDC, the Food and Drug Administration and state health departments often identify companies responsible for outbreaks, but sometimes do not.
“The longstanding policy is we publicly identify a company only when people can use that information to take specific action to protect their health,” said Tauxe, the CDC’s deputy director of the Division of Foodborne, Waterborne and Environmental Diseases.
“On the other hand, if there’s not an important public health reason to use the name publicly, CDC doesn’t use the name publicly.”
Because companies supply vital information about outbreaks voluntarily, CDC seeks to preserve cordial relationships.
“We don’t want to compromise that cooperation we’ll need,” Tauxe said. …
Tauxe acknowledged there’s no written policy or checklist that governs that decision, only decades of precedent.
“It’s a case-by-case thing and all the way back, as far as people can remember, there’s discussions of ‘hotel X’ or ‘cruise ship Y,” he said.
I too was quoted in the article above and was repeatedly asked if I thought that the CDC was bending to company pressure to keep the restaurant name quiet. I said emphatically no! But that did not make it into the article. So, not to put words in Dr. Tauxe’s mouth (and granted he may have had more to say), but as best as I can tell, these are his arguments for disclosure and non-disclosure and my thoughts in italics:
A. Although there is no written policy, it is the way we have done things for years;
Why do I hear my mom saying, “just because so and so does that does not mean you should too.” Like all government policies (and neckwear) – change is good.
B. Since the outbreak has concluded, there is not an immediate public health threat;
Frankly, that is true in most foodborne illness outbreaks. In nearly every single outbreak investigated by the CDC the outbreak is figured out far after the peak of the illnesses happened. However, disclosure gives the public information on which companies have a strong or weak food safety record.
C. Disclosing the name of the company jeopardizes cooperation from the company in this and future outbreaks; and
If a company will only cooperate if they are placed in a witness protection program and with promises of non-disclosure, it does not say much for our government’s and the company’s commitment to safe food.
D. Bad publicity may cause economic hardship on the restaurant.
True, but not poisoning your customers is a better business practice.
I would also add a couple more reasons that I have received via email (mostly anonymously):
1. The source was an unknown supplier, so naming the restaurant might place unfair blame on the restaurant;
This one does make some sense. However, is this the unnamed restaurants first problem with a faulty supplier, or is this a pattern? And, even if it is the first time, perhaps some of the unnamed product is still in the market?
2. Since the outbreak involves a perishable item, by the time the CDC announces the outbreak, the tainted product has long been consumed;
This one I have heard a “bunch” of times – especially in leafy green outbreaks. However, why should the public be left in the dark about the type of product that sickens as well as the likely grower and shipper so they can make future decision who to buy from?
3. Going public with the name of the restaurant compromises the epidemiologic investigation by suggesting the source of the outbreak before the investigation is complete;
I completely agree with this one. This is a tough call, and one that must create the most angst for public health officials – they decide the balance between having enough data to go forward to protect the public health or wait for more data. The point is do not go forward until the investigation is complete.
4. Public health is concerned of making an investigation mistake like, it’s the tomatoes, err, I mean peppers; and
See my answer to 3 above. This is why under the law; public health officials are immune for liability for the decisions that they make in good faith to protect the public.
5. Public health – especially surveillance – is under budgetary pressures and there is simply not the resources to complete investigations; and
There is no question that this is true. I have seen it in dropped investigations over the last few years. Labs are not doing genetic fingerprinting to help reveal links between ill people. And, many tracebacks are stopped by the lack of peoplepower to do the research necessary to find the “root cause” of an outbreak.
For me it is easy – the public has a right to know and to use the information as it sees fit, and people – especially government employees – have no right to decide what we should and should not know.
Perhaps when Congress gets back to governing, we can do a hearing or two on the above. Its been a decade since Energy and Commerce grappled with food safety issues. It is past time to do it again.