As the tomato Salmonella outbreak heads past the 800 case level, it’s time to ask some questions about why we don’t know the source of what is the largest produce associated disease outbreak on record. CDC has its own explanation, namely, that figuring out where tomatoes come from and where they go is much harder than they thought. Said another way, the experts in foodborne disease outbreaks at CDC and FDA didn’t know much about the industry. Since tomatoes have been a frequent cause of Salmonella outbreaks, that seems odd, except that my experience with CDC in recent years is that it is full of inexperienced people who don’t know what they are doing being managed by incompetent managers who spend too much time brown nosing the boss who spends too much of her time sucking up to the Bush administration. Because of bad management the professional expertise at what was once the jewel in the crown of federal public health headed for the exits as soon as their twenty years were up. There are still some terrific, dedicated scientists at CDC, but they are being submerged by mediocrity and bureaucracy. But back to tomatoes:
Frustrated federal officials today reported they were still hunting for a major break in their investigation of a nationwide Salmonella outbreak thought to be caused by tomatoes, and for the first time they hinted that another type of produce might be responsible for the illnesses, which have now risen to 810 confirmed cases.
David Acheson, MD, associate commissioner for foods at the US Food and Drug Administration (FDA), at a press briefing today said teams of investigators have spent the past week taking hundreds of samples from farms, packing houses, and distributors in Florida and Mexico.
Of about 1,700 samples collected so far–mostly of tomatoes–none have yielded the relatively rare Salmonella enterica Saintpaul strain found in the sick patients, he said. (Lisa Schnirring and Robert Roos, CIDRAP News)
They’ve spent the past week taking samples? Let’s hope this doesn’t mean they didn’t take any samples until last week. Since they haven’t found any tomatoes with Salmonella yet, how sure are they tomatoes are the vehicle. The evidence for this is based on old fashioned “shoe leather epidemiology,” in this case by taking histories from the cases to see if there is a food item consumed by cases not consumed by people like them who didn’t get sick. That’s called a case – control study. Once raw tomatoes, some of it in fresh salsa or guacamole, were implicated the task was to find out where the tomatoes came from. The best way to do that is to compare the sources of tomatoes eaten by cases with those eaten by controls. Not only do you expect meals of cases to have tomatoes more often but you expect them to come from different sources. Unfortunately the FDA did not do this. They have only been trying to trace back the tomatoes from the cases, not the health controls.
Dr. Michael Osterholm, director of the University of Minnesota Center for Infectious Disease Research and Policy, also thinks that FDA and CDC have done a poor job of using independent food industry experts to help. That’s one reason why they didn’t know that tomatoes from Florida could be packed and distributed from Mexico and vice versa. The investigation field personnel are too often inexperienced, so it’s taken them weeks to figure this out, weeks during which the epidemiological trail is growing cold. That trail can be very difficult to follow even under the best of circumstances, but we are far from having the best of circumstances:
Public health authority rests with state and local departments, Osterholm said, and he acknowledged that federal officials often don’t have the authority to assign outbreak response a higher priority. He said communication between state and local health departments and federal public health officials is often poor and that states vary widely in their ability to conduct and quickly report laboratory tests. “We have a very fragmented system with major delays. For time-sensitive outbreaks, you can’t have that happen,” he said.
“The overall system is broken,” Osterholm said. “It looks like we’re doing a lot, but I want to know how many cases we’ve prevented–a very small percentage, I would argue.” (CIDRAP News)
So we’ve got broken agencies working in a broken system. That’s what you get when you cut taxes, divert money to pay for a foreign policy debacle, and run the government like a patronage shop. There’s always been some patronage and politics in federal public health (although not very much), but the last seven years are qualitatively different than any Democratic or Republican administration in recent memory. As of today there are 202 more days left in the Bush administration. You can do a lot more damage in 202 days, and the amount of damage already done is prodigious. We are so much less safe, in almost every way, after seven years of these clowns. Throw the bums out.