I have been following the outbreak in Germany rather intensively for sustainable agriculture groups and local organic farmers, because of my past work on E. coli O157:H7 and spinach for CAFF (the Community Alliance with Family Farmers).
This is the moment when there may be a breakthrough in the epidemiology and investigation of the origins of the outbreak.
So far the outbreak, awful though it is, has been more like a very tightly woven cloth in northwest Germany, centered in Hamburg, and not like a chain reaction, exploding into an epidemic. Because the “cloth” is so tightly woven, it has been very difficult for the public health officials to pull on a single thread and carefully follow it back to the origin of the outbreak.
They have made mistakes, or misstatements, over the course of the outbreak.
Spanish produce exports have basically been destroyed. There have been multiple bans on produce imports from Germany, the Netherlands, Spain and other countries. Russia and the U.S. Air Force have banned the purchase of any EU fresh produce.
There finally are a few loose threads to follow. One thread was picked up in Lübeck, not far from Hamburg. This is one of the few cases where a specific location, a restaurant called The Potato Cellar can be associated with multiple disease cases from a few days in May. One group of 37 women who ate there had 8 women fall severely ill and one died. The patients have, or had since one died, the virulent, unusual, outbreak strain. None of the produce or other foods at the restaurant now, almost three weeks later, tested positive. Employees are being tested with the lab results due Monday.
But the investigators now have a thread, a supply chain to follow, from the Potato Cellar to a supplier in Molln, and from Molln to a supplier at the Hamburg Wholesale Market. There are several other threads like this. They may of course, pull loose and not lead to a definitive source. But even then they still could identify where to focus further investigation.
Most German officials, but not U.S. newspapers, are now being very careful to say explicitly “contamination could have occurred anywhere along the supply chain” and not blaming farmers in particular without evidence. The pattern of the epidemic suggests, to the German investigators, that somewhere intermediate — between farms and, say, the Potato Cellar — was the point of contamination. If it’s found, then the German health authorities will have a chance to understand the origin of the contamination and the reason for it.
The restaurant owner has documented handling and cold chain records, and the health authorities are being careful not to blame him. This is fair but may seem ironic to Spanish farmers, who were blamed for the outbreak initially, when no illnesses or deaths were attributed to them. But a different non-outbreak E. coli strain that was suspicious was found in German tests of Spanish cucumbers, at first, so the warnings were the best available information at the time. The question is should the investigators have waited for confirmation? The answer isn’t easy to give, ever.
Cucumbers are now being given away free by gay community groups in Spain. Spanish cucumbers may now be the most tested fresh produce in the world. Spain and Germany are cooperating to try and get EU compensation for Spanish farmers.
If human to human transmission turns out to be easy, then the outbreak could become an epidemic, and will spread in a chain reaction.
Four passengers returning from Germany to the United States are reported, by the CDC and the press, to have the outbreak strain. This isn’t quite accurate. Four returning passengers from Germany (as well as two U.S. military personnel in Germany) have come down with the most serious consequences of infection and been hospitalized and then diagnosed. Neither the CDC nor anyone else has done surveys to find out how many people returning from Germany had mild cases or may have remained healthy and can still be carriers. The UK, in a similar situation, is being much more cautious about this.
So there is another moment of truth approaching. Until now, the outbreak centered in Germany has been very large but is not growing exponentially, like a chain reaction. On the other hand, there is a longer lag time between contact and disease symptoms than usual; and then the symptoms progress more rapidly and more often to the worst outcomes than anyone has seen in the past. So one does not know yet what will happen, because not enough time has gone by in the epicenter of the outbreak in northwest Germany around Hamburg.
In the meantime, in cosmopolitan cities of travelers and restaurants like San Francisco, where one could eat three meals a day at a new place every day all year — or maybe forever, due to turnover — it might be wise to take extra care with the sanitary and health precautions that should be standard in ordinary times.
Daniel Cohen is the owner of Maccabee Seed Company, an agricultural research, development and consulting company in Davis, CA.
Photo from Hamburg by Gretchen Goetz© Food Safety News