Norovirus Report Inconclusive
Officials See Correlation Between Food and Illness
While there appeared to be a correlation between consumption of Grab ‘n’ Go items and students’ reported gastrointestinal symptoms early this month, the D.C. Department of Health was not able to determine the origin of norovirus in its recently concluded investigation.
In a report published on its Web site on Friday, the DOH listed its finding for the virus’ etiology, or cause, only as a possible combination of person-to-person contact, contaminated food or contaminated surfaces.
However, the report does note a strong relationship between the afflicted students who were surveyed by DOH and their consumption of Grab ‘n’ Go food.
“We can state with 95 percent certainty that those students who purchased food from the Grab ‘n’ Go station … were 2.9 times more likely to become ill than those who did not purchase food from the Grab ‘n’ Go station,” the report states.
Organic To Go, a Seattle-based food service company and organic food retailer, began supplying several Grab ‘n’ Go items this fall, but university spokesperson Julie Bataille reported last week that the university had terminated its contract with the service for the foreseeable future. Instead, ARAMARK Higher Education, which manages campus dining, will supply its own food for the station.
“When we reopened [O’Donovan Hall], we proactively agreed with the Department of Health to do so preparing our own Grab ‘n’ Go items as there was enough reason to suspect a potential link between those items and the virus on campus,” Bataille said last week.
However, Stephanie Sampiere, vice president of corporate communications at Organic To Go, noted that a number of food options at the Grab ‘n’ Go station, including pre-packaged muffins, cookies and fruit, are provided and stocked by ARAMARK.
Sampiere also said that Organic To Go food is prepared in a central kitchen that serves thousands of customers, which previously supplied O’Donovan Hall as well. The central kitchen, located in the D.C. metro area, passed a routine DOH inspection on Oct. 1 and a Food and Drug Administration inspection last week, she added.
“The company served food prepared at this commissary kitchen to thousands of customers — not only at Georgetown, but through our catering operations and in Organic To Go cafes — and received absolutely no complaints or indication of concern from any of its customers,” Sampiere said.
Students were first treated for symptoms resembling gastrointestinal disorders at Georgetown University Hospital on Sept. 30. In the days that followed, the number of ill students climbed drastically, reaching a high of 212 treated students only one week later, the university reported. The health department was brought in to investigate on Oct. 1 and, the next day, informed the university that tests confirmed it was the highly contagious norovirus.
The report said that 204 Georgetown students reported symptoms consistent with those related to norovirus. The health department interviewed 119 of these individuals in their investigation.
LaShon Beamon, the interim communications director at the DOH, said that the outbreak demonstrates the importance of maintaining high sanitary conditions.
“The big takeaway from this outbreak and for life is proper hand washing. I can’t stress it enough,” she said.
Nov 01 2008 at 9:58 p.m.
Mr. Dwulet: Good article.
The end date of the report period is
not noted explicitly (prior to 10/24
release date, certainly);
there is no email given for the DC Department of Health (or web site);
and the statistics or tables don't note how many of each winnowing were fully tested for the next:
12 confirmed against 57 suspected: all 57 tested?
It is reasonable to only test a subset if the primary or only reason is to confirm norovirus in the population;
to minimize cost. Unless there is another possible vector: multiple sources occur all the time.
57 suspected cases against 119 consistent: same full tests applied on all 119?
I am presuming that 119 to 57 is a winnowing based
on a stricter interview or preliminary lab test;
with the 119 being the initial screening for consistency.
If each tier of numbers does not match exactly and
the article does not state explicitly what the
processes or tests were that were applied
this is not a(n asserted) certainty.
I presume this completeness, but it does not _state_ this is so.
it is easy to miss an external source from a multiple vector during this process:
this is not a criticism of the medical teams: it is a compliment:
the problem is staggeringly difficult. Too many diseases and too many sources.
Rather than the inconclusive nature of the report being a
potential negative indicator (your report makes no such inference)),
I would suggest that the rapid response and elimination of the problem
warrants a thumbs up to the campus authorities and response teams.
These outbreaks are hard to contain and difficult to trace:
I had (knee cartilage) damage as a result of the bird/swine flu virus on UNC Chapel Hill campus
back in 1999-2000: 2-3 years in advance of normal expectations,
the US authorities did not have the vaccines on the east coast to contain
that specific variant that year.
End result: students form North China flew back from Christmas holiday and brought it directly in.
And our medical authorities eventually did trace it, but by then it had already resolved.
Sometimes, it is not the actual food source:
It can be a single package that despoils or falls open, resulting in exposure
and breeding conditions of a small latent source that does not become operative
elsewhere, or a multiple hop vector that is carried in to a specific location for a
specific period for a limited time.
it can also be hidden by claimed compliance with health regulations:
Another hard to trace sequence is a single employee who had the virus
from a different source, and brought it in with a small breeding field
(a food smear, a wet source sneezed into, whatever;
or a natural immune infected that displayed no symptoms who wiped their nose and
then touched a surface
or a trucking employee who brought it in, that finally got wiped off a surface.
Same comments form watching employees in the local McDonalds and other fast food chains:
same problems and worse. They just do not catch/admit of the "flu" outbreak that occurs afterwards.
If there is interest in following this up further:
You might detail a student mathematics/statistics/analysis class and a medical center
epidemiological class to run a second level study on the other traceable sources
within the resulting data stream of the medical services report.
It would make an excellent exercise, and releive the financial on the medical services.
Otherwise, unless a return occurs:
An international community such as GU that has _so_few_ occurrences
is due for a thumbs up for it's effectiveness:
the job is abysmally difficult to do. And getting worse with cross over vectors.
----
We had a study called "SENIC" at UNC Hospital in the 70s that traced
Iatrogenic diseases: those caused by medical care, in that case hospital born.
The simple conclusion then (and to a lesser extent to this day):
75% of in-hospital infections were completely eliminatable by:
a) MDs and nurses cleaning their hands (80%)
b) Staff buttoning their protective whites or outer garments
(MDs do not always do so) (15%)
c) Surface cleaning daily with simple disinfectants.
The first "a)" was not done largely because for staff to do so
EVERY time some 50-100 ties per day with betadine based
disinfectant (the only one regarded as effective at that time,
at cost effective levels) would result in dry chapped bleeding skin.
...it was not until a 1-2 decades later that effective products
with _skin_emollients_ became available:
literally, they did not have or realize the solution of
hand cleaning stations (such as those in use at GU now).
(You CANNOT use a hand cleaner followed by a bottle of emollient:
the emollient bottle becomes the primary contamination source;
because even medical staff makes mistakes and uses the emollient bottle
either without washing hands, or touching the bottle surface after it becomes
contaminated another way.)
(We also did not have the infrared trigger solution: a physical touch trigger
had to be used: a contaminant source)
Result: you had to wash your hands,
use a sterile dry cloth from a packet, not touch anything else,
and turn off the water with the back of your hand or elbow.
And irritate your skin
by overdoing it.
Result#2: Medical staff quit doing it,
to protect from literally destroying their hand skin,
and disease vectoring occurred.
And still does. Same problem, but reduced, ongoing.
=====
Similar case:
My mother suffered 10+ months from an infection in a broken ankle,
repaired brilliantly (10 pieces plated in an area the size of your palm),
and then the surgeon opens the cast to inspect the wound healing and
...his tie flops out of the open whitecoat into the opened cast.
4 months with silver cream to knock down the infection;
with three months of hydrotherapy at the start
6 months for the wound to close fully.
Similarly, once again, when the ankle shifted and was reset by rebreaking:
infection and necrosis set in because:
the second hospital recommended home outpatient care after the
second brilliant surgery
and insufficient oxygen flow resulted in another infection
.... 10 major procedures and 2 years later: the wound had still not closed.
Small differences at times result in big differences.
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