By: Heather Williams

Two countries, 58 sick, 22 hospitalized, 2 with serious complications, and 2 deaths.  This information was last updated December 28, 2017.  No additional information is available at this time from either government’s sources.  This E. coli outbreak (or outbreak[s] depending on who is doing the talking) allegedly linked to romaine lettuce.  Consumers are stuck between conflicting information from reputable sources.  Some say it’s two separate outbreaks.  Others say they are linked.  Some say it’s definitely romaine and we should be eating different types of lettuces.  Others say there is nothing wrong with lettuce and we don’t have enough information to make any food choice decisions as a result.  While everyone is fighting on all sides, the consumer stands by waiting for a solid answer.  But will that answer come?  What are we to think in the mean time?

The Details

We have two countries experiencing an E. coli outbreak.  The United States and Canada.

Canadian cases started a short time before people in the United States began falling ill.  So far 41 individuals across 5 provinces (New Brunswick, Newfoundland and Labrador, Nova Scotia, Ontario, and Quebec) in Canada have fallen victim to the same strain of E. coli, linking them together in outbreak status.  So far 17 have been hospitalized and 1 has died.  Enough information has been gathered to link the outbreak to romaine lettuce, but not enough information has been uncovered to trace it back to a specific supplier so no recall has been issued.

The United States cases were reported in a Center for Disease Control and Prevention (CDC) Media Statement on December 28, 2017 (at the same time as the last update from the Public Health Agency of Canada.  Stateside we have 17 cases linked to an E. coli outbreak across 13 states (California, Connecticut, Illinois, Indian, Michigan, Nebraska, New Hampshire, New York, Ohio, Pennsylvania, Virginia, Vermont, and Washington).  So far 5 patients required hospitalization, 2 of which have developed a serious form of kidney failure caused by E. coli infection known as hemolytic uremic syndrome or HUS.  One American has died.

What the Public Health Agency of Canada is Saying

Based on interviews, the Public Health Agency of Canada has identified romaine lettuce as the source of the E. coli outbreak.  While no official recall has been issued, the Canadian government has issued a warning in a Public Health Notice issued by the Public Health Agency of Canada.  Their warning is for people living in affected provinces to take a proactive approach in their food selection.

“It is difficult to know whether a product is contaminated with E. coli because you can’t see, smell or taste it. Romaine lettuce can have a shelf life of up to five weeks; therefore it is possible that contaminated romaine lettuce purchased over the past few weeks may still be in your home. Individuals in Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador should consider consuming other types of lettuce, instead of romaine lettuce, until more is known about the outbreak and the cause of contamination.”

What the CDC is Saying

The CDC is being more conservative on the American side of the investigation.  While there are genetic similarities of the E. coli strain infecting American patients and the Canadian E. coli outbreak strain linked to romaine lettuce, the food source has not been indicated.  At this time, “CDC is unable to recommend whether U.S. residents should avoid a particular food.  This investigation is ongoing, and more information will be released as it becomes available.  The problem is, this was over a week ago.  No additional details have become available.

Some within the CDC, such as Matthew Wise, an epidemiologist and CDC response team leader, indicated that Canada has had a head start.  “Canada has many more illnesses in their outbreak investigation.  They have linked that to Romaine.  We are working really hard to … confirm whether or not that’s the case also in the U.S.”

Others within the CDC indicate that there is not enough evidence to link to a source, so no convincing information is available to take a stance on.  According to Brittany Behm, MPH who is a CDC spokesperson, “There is not enough epidemiologic evidence at this time to indicate a specific source of the illness in the United States.”  She explains that, “although some sick people reported eating romaine lettuce, preliminary data available at this time shows they were not more likely than healthy people to have eaten romaine, based on a CDC food consumption survey.”  She indicated that health officials will only take action with evidence linking to contaminated food is “clear and convincing”

Consumer Reports is Taking a Stronger Stand

Consumer Reports is an independent and not-for-profit organization that advocates for consumer needs.  Their reports provide consumers with unbiased research “unconstrained by advertising and other commercial influences” to “create a fairer, safer, and healthier world” according to their own mission.  It is not surprising that they have decided to take a stance on this debated issue.

In a recent release, Consumer Reports is suggesting that Americans follow the Canadian suggestion to avoid romaine lettuce until a source for the outbreak can be identified.  “Even though we can’t say with 100 percent certainty that romaine lettuce is the cause of the E. coli outbreak in the U.S., a greater degree of caution is appropriate given that lettuce is almost always consumed raw,” says James Rogers, Ph.D., director of Food Safety Research at Consumer Reports.  While anyone becoming sick from the outbreak is unfortunate, some groups of the population are at a higher risk for severe complications.  Young children, frail and elderly people, and those with a compromised immune system such as people with cancer or diabetes) are a higher risk group.  “People in these groups should be particularly vigilant about avoiding romaine lettuce,” says Rogers.

Jean Halloran, director of Food Policy Initiatives at Consumer Union (which is the policy and mobilization division at Consumer Reports) echoes the sentiment.  Why is the United States not as conservative and proactive as Canada?  “The FDA should follow the lead of the Canadian government and immediately warn the public about this risk,” she says.  She indicates that if people are not warned of the dangers, more can become sick.  The problem also lies with the type of food indicated.  Romaine is not an easy produce item to fully disinfect.  “Leafy greens tend to have little nooks and crannies where it’s hard to wash off the bacteria,” Halloran explains.  “FDA needs to act promptly to protect consumers’ health.  People could eat a lot of potentially contaminated romaine while waiting for a company recall or for the CDC and FDA to identify the specific source of the outbreak and order a mandatory recall of the affected products,” Halloran indicates.  At that point, more damage than necessary has been done and too many people have fallen ill that could have been diverted.

 Avoiding Romaine May Not Be Enough

Some believe that avoiding romaine lettuce may not be enough to prevent illness.  “[To] say ‘avoid romaine for now,’ I don’t know if I have enough information to agree with that statement,” says Benjamin Chapman, an associate professor and food safety specialist at North Carolina State University.  His skepticism lies in that even the Canadians have not pinpointed the exact source of the romaine lettuce allegedly linked to the E. coli outbreak on the Canadian side.  He ponders the possibility that the contamination could be from a single source, such as a contaminated water supply, that could have an affect on other foods.  Not just romaine.  “Avoiding just romaine may or may not be enough,” he explains.  “It could be that there’s a different [food] source of this exact same pathogen.”  Chapman is on the side that believes the possibility that the United States E. coli outbreak and the Canadian E. coli outbreak are two separate outbreaks that happen to involve a similar bacterial strain.  He goes on to say that it is possible that the outbreaks could be linked, though more evidence is needed to draw that conclusion.

What’s Taking So Long?  It’s a Traceability Issue.

Many experts, including Sylvain Charlebois, a researcher in food distribution and policy at Dalhousie University in Canada, is surprised at how long it is taking each country to issue a recall.  On the Canadian side, one death and dozens of illnesses linked to romaine lettuce indicates half the story has already been put together.  He explains that it is unusual for an outbreak to go on for more than a week without a recall being issued. Charlebois indicates that better traceability systems are clearly needed for produce in order to narrow down the source.

Charleboois is a support of blockchain systems for grocers where distributors can share digital data to track the supply chain system, essentially allowing a retailer to trace the origin and distribution of each product.  Without this technology, a product that changes hands many times takes time to sort through supply chain data.  That same information could be at an investigator’s fingertips in the time it takes to generate a search query.  “So when you have a situation like this, if you are using a new technology, you can trace problems very quickly,” he adds.  “But now we have a case where traceability is probably an issue … I would say the weakest aspect of our food safety system is traceability.”

Romaine E. coli Lawyer filed Romaine E. coli Lawsuit

Where Do You Stand?

Where do you stand on this issue?  Do you opt for spinach instead of romaine?  Or do you take a chance and enjoy your Caesar salad?  Do you consider it a risk or just a basic meal decision? As for us, we are avoiding romaine for now and keeping a close eye on the CDC and FDA for new alerts.  UnsafeFoods will continue to monitor these cases and update as more information becomes available.