Heroine No. 1 is Sandra Gallegos, 43, a nurse who tracks communicable diseases for the combined city-county health department in Pueblo, Colo. On July 15 Gallegos got a routine report about Lee Harding, a supermarket worker who had been treated at the emergency room at St. Mary Corwin Hospital in Pueblo. Harding went to the ER complaining about three or four days of bloody diarrhea and severe abdominal cramps–a bad case of food poisoning, or possibly the flu. The 22-year-old was given an antibiotic and sent home. Lab analysis of his stool samples then showed the presence of E. coli O157:H7, a bacterium that, because it is usually food-borne and sometimes fatal, always triggers a public-health alert.
GALLEGOS’S JOB WAS TO find out what the victim had been eating before the attack–tedious work, but a necessary first step in tracking any food-borne disease. Harding said he had grilled frozen hamburger patties for dinner on July 9, although his wife, Stacey, had eaten one without getting sick. That’s where he got it, nurse Gallegos thought. Frozen hamburger has a well-documented history as the culprit in E. coli O157 outbreaks; it could easily be the source of infection here. She asked Harding if he remembered the brand name. Hudson Foods, he told her. Better yet, he still had some patties in the original package, which bears the lot number, in his freezer. ““We’ve got to do something,’’ she thought–though at that point, she was only betting on her hunch. Within days, the Pueblo patties were being tested at a U.S. Department of Agriculture lab in Athens, Ga. On July 25 the tests confirmed the presence of E. coli O157, and the nationwide hunt was on.
In Denver, Pam Shillam was worried about contaminated hamburger, too. Shillam, 51, is an epidemiologist who tracks communicable disease, including food-borne pathogens like salmonella, hepatitis A and E. coli O157, for the Colorado health department. She was already concerned about a ““spike’’ in the incidence of O157–by Aug. 12, Colorado had 55 cases, compared with 41 for all of 1996–when she got a report about two cases that seemed to be connected. One was a 12-year-old boy, the other a 26-year-old woman. Both had been treated at Montrose Memorial Hospital, on Colorado’s western slope, and both had attended a July 4 church barbecue at Ridgway State Park. A local doctor theorized that the park’s drinking water was contaminated, but Shillam, back-checking, was able to rule that out. She called the victims and found they both had eaten hamburgers at the picnic. Then the results on Lee Harding’s frozen burgers came in from USDA. To Shillam, that suggested a common source and possible explanation for the statewide increase in E. coli O157 infections. Luck now played a role. The state health lab, using a technique called ““pulsed field gel electrophoresis,’’ had just begun routine DNA screening of O157 samples. Thirteen samples had been screened in June; of these, two would turn out to have the same DNA fingerprint as the Pueblo patties. A second run turned up eight more matches, including the two patients from Montrose. By Aug. 11 the total was 16 cases scattered around the state. Hard science had confirmed Pam Shillam’s intuition–that the surge in O157 cases was connected and that the link, concealed in supermarket frozen-food cases all across Colorado, was Hudson Foods hamburger. ““I made some connections,’’ she said laconically. ““But I’m in a position to see lots of connections and I have years of experience.’’ Then she steered the praise to the Pueblo health department for getting the beef patties to the USDA lab–a vital step that owed everything to Sandra Gallegos.
Last week, just in time to cast a pall over millions of Labor Day cookouts, Colorado’s close encounter with E. coli O157 exploded in nationwide headlines. Hudson Foods’ beef-processing plant in Columbus, Neb., was shut down indefinitely, and the shellshocked company glumly complied with a demand from Agriculture Secretary Dan Glickman that it recall 25 million pounds of ground beef from supermarkets and fast-food outlets all across the country. Burger King, a major customer, ran out of frozen patties at some locations while the chain scrambled to find alternate beef supplies. USDA in fact does not have the legal authority to order such a recall–a point Glickman emphasized in a plaintive press conference where he asked Congress for more power to regulate food. But the publicity barrage forced Hudson’s hand and may have revived the Clinton administration’s safe-foods initiative. This package of regulatory reforms has stalled repeatedly in Congress, but it holds at least some promise for improving protection of the nation’s food supply. The downside, of course, was that Americans were once again left to wonder whether anything was truly safe to eat. A NEWSWEEK Poll shows that 51 percent are taking greater precautions with home-cooked food–a wise decision, according to the experts–and that 62 percent want the government to spend more on food-safety inspections.
But inspections are no panacea. E. coli in fact is everywhere–in the intestines of every cow and human, for example–and it is almost always benign. E. coli O157:H7, on the other hand, is a virulent mutation that has been identified only since the early ’80s. It seems to be on the rise worldwide, and it is very hard to detect. Since infected cattle show no symptoms, it can easily slip into a slaughterhouse. Slaughtering is messy business: even if the animal is properly disemboweled, any shred of intestinal tissue could be enough to pass the infection along. Hamburger production, moreover, is uniquely favorable to E. coli contamination because grinding the meat spreads any bacteria present throughout the meat–unlike, say, a steak. Freezing temperatures don’t kill E. coli O157. But even 15 seconds of 160-degree heat does the trick–which is why no one should eat rare burgers.
And the bug is genuinely dangerous. Although it is basically similar to other forms of E. coli that produce nothing more than watery diarrhea, O157 produces two toxins that appear to kill human cells–which is probably what causes the bloody diarrhea typical of the illness. These toxins may also be the reason O157 can be fatal to young children, geriatric patients and adults whose immune systems are compromised. This medical catastrophe is known as ““hemolytic uremic syndrome,’’ or HUS, and it can lead to kidney failure and death. For reasons no one yet understands, HUS causes anemia and breaks down the body’s blood-clotting capability. About 75 percent of HUS victims need at least one blood transfusion, and half require kidney dialysis. Five percent die. E. coli O157 may be responsible for as many as 20,000 diarrhea cases–and 100 or more deaths–in the United States each year. A major outbreak in 1993, which led to the deaths of four children on the West Coast, forced the entire fast-food industry to start cooking burgers medium well.
Now for the bad news: E. coli O157 is by no means limited to hamburger–or even to meat. It can and does hide out on vegetables, fruit and nuts, and it has been carried in unpasteurized juice. It is the same pathogen that forced the massive recall of Odwalla brand apple juice last year, an episode that caused the death of a Colorado child and left the manufacturer saddled with massive damage claims. Nobody knows how the germ got into the juice: it may have come from bits of deer feces on the apples. The bacterium is also responsible for the worst case of food poisoning in Japanese history–and apparently entered the food supply aboard radish sprouts. From May to December last year, according to Japanese officials, 9,451 people were treated for diarrhea and other symptoms, and 12 died. It is a rough disease even for healthy adults. ““I thought I was dying,’’ Harding says. ““I’m a 200-pound guy and the cramps knocked me straight to the ground.''
The best defense against this bug is eternal vigilance–and lots of soap (graphic). Food-safety oversight at the federal level is strangely split between the USDA, which regulates the meat and dairy industries, and the Food and Drug Administration, which regulates fruits and vegetables. What’s more, the global economy makes it harder to stop harmful bacteria. The United States imports much more food than it used to, raising questions about safety standards overseas, while the domestic food-processing industry is increasingly centralized. This trend toward bigness–in beef and chicken, for example–has both an upside and a downside. The upside is that it is much easier for the Feds to monitor food safety because the number of processors is low. The downside is that when something goes wrong, as it did at Hudson Foods, the resulting contamination spreads much more widely through the food chain. Still, no one really disputes that sanitation standards within the meat industry are dramatically better than they were a century ago, when Upton Sinclair shocked the nation with his exposes of filthy conditions in packing plants and slaughterhouses. The real question is whether food safety is deteriorating now, and it is a tough question to answer.
The Hudson Foods beef-processing plant in Columbus, Neb., is a good place to start. Only two years old, it is a state-of-the-art facility that produces about 500,000 pounds of frozen hamburger patties a day. The raw beef, trucked to the plant from slaughterhouses, is inspected, ground, frozen and packaged in a continuous assembly line that is stripped down and sterilized every working day. USDA inspectors are present at the beginning of every shift, spot-checking the plant’s compliance with a randomized list of federal guidelines. Nevertheless, E. coli O157 was present in the plant on June 5, when Lee Harding’s hamburger patties were processed. The company believes, and the USDA agrees, that the bug came from outside the plant–probably in a load of beef processed on that day. That implicates a slaughterhouse: at the weekend, USDA sources would say only that any one of 10 slaughterhouses could have been the source of the contamination.
ALL HELL BROKE LOOSE AT Hudson Foods on Tuesday, Aug. 12, the day the USDA notified the company about Colorado’s E. coli outbreak. As company officials tell it, the Feds wanted to announce a recall immediately and demanded to know how many pounds would be involved. Hudson didn’t know: 20,000 pounds sounded about right. Three days later USDA raised the ante to 1.2 million pounds, but even that wasn’t enough: the monster recall Glickman announced equaled the plant’s total production since June 5. With USDA officials hinting that the investigation could lead to criminal penalties, Glickman also dispatched a ““SWAT team’’ of investigators to the plant and another contingent to Hudson’s corporate headquarters in Arkansas. The violations they found, so far, reportedly consist of recordkeeping discrepancies that make it difficult to tell which incoming shipment may have been contaminated. The Feds also charged that Hudson routinely mixed leftover batches of ground beef with newer shipments–but if that violated federal rules, why did the USDA inspectors who toured the plant every day allow it? For the time being, at least, there is no answer to that question–though Glickman promised that his ““SWAT team’’ would scrutinize the USDA’s performance as well Hudson Foods'.
The irony of last week’s hamburger crisis is that the meat industry may be one of the safer parts of national food supply–and it is about to get safer. Come January, large-scale meat and poultry producers must meet new USDA requirements for food safety and sanitation. The new rules require producers to police themselves–under federal supervision–and sample their own products for common bacterial contaminants like salmonella. Slaughterhouses are already required to perform so-called ““generic’’ E. coli testing as a measure of overall cleanliness. Although such tests do not identify E. coli O157 itself, USDA investigators hope slaughterhouse records will provide new leads to the Hudson Foods case. The Clinton administration, meanwhile, is pushing for more seafood inspections under the FDA, better egg inspections under the USDA and plans to establish a nationwide early-warning system to detect food-borne disease outbreaks through physician surveys.
All these new practices should make the nation’s food supply marginally safer–and, not coincidentally, let the Clinton administration stake its claim to a popular reform. It is simply absurd, as Secretary Glickman noted last week, that the USDA still doesn’t have the power to order a food recall, and it is offensive that many previous recalls have been concealed from the public. And one of the more effective tools for fighting bacteria, say health experts, is irradiation; but it still faces a phalanx of opposition from environmentalists who are wary of treating food with low levels of irradiation (following story). Still, no one predicts a day in which all food will be perfectly free of disease or that humankind will ever conquer its bacterial and viral adversaries. The bugs, properly understood, are too smart for that: they outflank our defense measures all the time. ““Ten years ago I would never have predicted we’d have [the E. coli O157:H7] problem,’’ says Dr. Mitchell Cohen, a bacteriologist at the Centers for Disease Control in Atlanta. ““The more we look, the more we find–and the more we find it, the harder it is to control.''
You can help protect yourself from the dangers of food-borne disease at home by using common sense and some extra precautions when handling food. Some tips:
Wash the dishes, air-dry; It is best to wash dishes and utensils relatively quickly, within two hours, and let them air to avoid recontamination from hands.
Wash your hands; Before and after handling food, especially raw meat, you should wash them for 20 seconds. If you have an infection or a cut, wear rubber gloves.
Clean the sponges; Dish rags and sponges are breeding grounds for bacteria. Sanitize them regularly in a solution that is one teaspoon bleach and one quart water.
Clean the Counter; Bleach and commercial cleaning agents are best for getting rid of bacteria. Hot water and detergent do a good job but may not kill all bacteria.
Clean the cutting board; Experts argue over whether plastic is much better than wood, but washing it after each use will definitely reduce the risk of disease.
Pop it in the fridge; As soon as possible and within two hours put cooked perishables in the refrigerator. Date leftovers so they can be used in three to five days.
Keep the fridge cold; It should be at 40 degrees F or less. That temperature slows the growth of most bacteria, and fewer bacteria means less disease.
Defrost in the fridge; Meat and poultry and fish should be defrosted in the refrigerator, the microwave or cold water that is changed every 30 minutes
Don’t eat the batter; As tempting as cookie batter is, don’t eat it until it comes out of the oven. Uncooked batter and other food made with raw eggs carry a salmonella risk.
Cook the red out; Cooking food until it is 160 degrees F in the center usually protects against food-borne illness.
E. coli 0157:H7 is not the only danger to your food. Other potential miseries:
Cyclospora: A parasite spread by eating food or drinking water tainted with feces. It can cause diarrhea and vomiting and is treated with antibiotics.
Hepatitis A: A virus spread in shellfish, water and contaminated feces. It causes muscle and joint aches and nausea. Usually clears up without treatment.
Listeria monocytogenes: A bacterium spread through fecal food contamination. It starts with nausea, but can lead to meningitis. Treated with antibiotics.
Salmonella: A common food bacterium, it can be transmitted through meat, eggs, baked goods and fruits. It cause nausea and fever and can last for days.
Last week’s recall of 25 million pounds of hamburger may have been unprecedented in size, but food-borne illness has become all too common in the 1990s. Bacteria, parasites and disease have been making regular appearances in our food in recent years. A look at some recent outbreaks:
Cantaloupe, 1991 - After eating cantaloupe, 400 people in 23 states were made ill with salmonella. Investigations found a link between the illness and fruit from salad bars.
Hamburger, 1993 - Two people died and more than 600 in Washington and Nevada got sick after eating E. coli-contaminated hamburger from a fast-food restaurant.
Ice Cream, 1994 - Ice cream that had been transported to a plant in an inadequately cleaned truck let to a salmonella outbreak that affected 600 people in 41 states.
Alfalfa sprouts, 1995 - In June a bad batch of alfalfa sprouts created a salmonella outbreak that hit 242 people in 17 states. Some of the sprouts were tracked to seeds that had been imported from Europe.
Raspberries, 1996 - Last summer almost 1,000 people in 20 states suffered extreme diarrhea, cramps and fever after eating raspberries infected with Cyclospora, a single-celled parasite. The culprit was a small crop of berries that came from Guatemala la.
Eggs, 1996 - After eating homemade mayonnaise from a sandwich shop I Greenville, S.C. 250 patrons contracted salmonella. An investigation traced the disease to bad eggs.
Apple juice, 1996 - More than 70 people, many of them children in Washington and Colorado, were made ill by unpasteurized apple juice that was infected with E. coli.
School lunches in Japan, 1996 - Between May and December of last year, 12 people were killed and more than 9,000 made ill by school lunches tainted with E. coli bacteria.
Oysters, 1997 - More than 400 people in five Southern states fell ill in January after eating oysters from Louisiana that were infected with the Norwalk virus.
Strawberries, 1997 - Mexican strawberries were responsible for a hepatitis A outbreak that affected 230 people, including 100 Michigan schoolchildren, earlier this year.
