Cyclospora Outbreak Associated with Bagged Salads in Midwest US, 76 Cases to Date

The FDA, along with CDC and state and local partners are investigating a multistate outbreak of Cyclospora infections potentially linked to ALDI, Hy-Vee, and Jewel-Osco grocery store brand “garden salads” containing iceberg lettuce, red cabbage, and carrots.  As of June 19th, there have been 76 cases with 16 hospitalizations, with onset date ranging from May 11th through June 14th.

"FDA and CDC are recommending that consumers should not eat, and restaurants and retailers should not sell or serve all ALDI Little Salad Bar Brand Garden Salad sold in Iowa, Illinois, Minnesota, and Missouri, all Hy-Vee Brand Garden Salad sold in Iowa, Illinois, Kansas, Minnesota, Missouri, and Nebraska, and Jewel-Osco Signature Farms Brand Garden Salad sold in Illinois."

https://www.fda.gov/food/outbreaks-foodborne-illness/outbreak-investigation-cyclospora-bagged-salads-june-2020
Outbreak Investigation of Cyclospora: Bagged Salads (June 2020)
Don’t eat ALDI, Hy-Vee, or Jewel-Osco store brand bagged salads labeled as ‘garden salads’ and sold in six mid-western states.
Case Counts
Total Illnesses: 76
Hospitalizations: 16
Deaths: 0
Illness Onset Date Range: 5/11/2020 - 6/14/2020
States with Cases: IA (28), IL (23), KS (1), MN (10), MO (7), NE (7)

NJ Company Recalls 43,000 Pounds of Ground Meat for Potential E. coli Contamination

Lakeside Refrigerated Services, a Swedesboro, N.J. establishment, is recalling approximately 42,922 pounds of ground beef products that may be contaminated with E. coli O157:H7.  The problem was discovered during routine FSIS testing. There have been no confirmed reports of adverse reactions due to consumption of these products.

https://www.fsis.usda.gov/wps/portal/fsis/topics/recalls-and-public-health-alerts/recall-case-archive/archive/2020/recall-012-2020-release
Lakeside Refrigerated Services Recalls Beef Products due to Possible E.coli O157:H7 Contamination
Class I Recall
012-2020
Health Risk: High
Jun 13, 2020

Raw Macadamia Nuts Recalled After Lot Tests Positive for Salmonella

An Illinois company, NOW Health Group, Inc. (NOW), is recalling its NOW Real Food® Raw Macadamia Nuts because this lot has the potential to be contaminated with Salmonella. NOW became aware of the potential contamination after routine sampling in a later lot of finished product (which contained the same lot of raw material as used in the recalled lot) found the bacteria. This later finished product lot was not released and remains in a quarantined state.

https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/now-health-group-inc-voluntarily-recalls-now-real-food-rraw-macadamia-nuts-because-possible-health
NOW Health Group Inc. Voluntarily Recalls NOW Real Food ®Raw Macadamia Nuts Because of Possible Health Risk
Summary
Company Announcement Date: June 12, 2020
FDA Publish Date: June 12, 2020
Product Type: Food & Beverages Nuts & Nut Products
Reason for Announcement: Potential Salmonella contamination
Company Name: NOW Health Group, Inc.
Brand Name: Now Real Food
Product Description: Raw Macadamia Nuts

COVID Times - June 9, 2020

People with Blood Type O May Have Reduced Risk of COVID Infection and Hospitalization - A study conducted by the 23andMe, the genetic testing company, has found preliminary evidence that people with blood type O may have reduced risk of infection as well as lower rate of hospitalization if infected.

Study of Sailors Exposed to Virus Aboard Ship - CDC published a study that looked at an COVID-19 outbreak on a US Naval Ship.  In the sampling of sailors, "healthy U.S. service members experiencing close contact aboard an aircraft carrier, those with previous or current SARS-CoV-2 infection experienced mild illness overall, and nearly 20% were asymptomatic. Approximately one third of participants reported fever, myalgia, and chills and had higher odds of SARS-CoV-2 infection than did persons who reported cough and shortness of breath. Participants reporting anosmia (loss of sense of smell) or ageusia (loss of sense of taste) had 10 times the odds of having infection, compared with those who did not."

The World Health Organization Still Trying to Get It Right - WHO had to clarify a statement by one of their experts who said that spread from asymptomatic carriers was very rare, this of course is not the case.  This comes as they also backtracked on the use of masks.

Have the Lock Downs Helped? - Many may complain, but studies indicate that the lock downs have helped in saving lives.  Not to say that lock downs need to continue, but they provided an opportunity for learning how to better function through the use of preventive measures at the same time, allowing for the medical community to improve on treatments.  This is not to say we are out of the woods as areas in the country still struggle with cases spiking.

CDC Report - Survey Indicates Some People Using Unsafe Disinfection Practices Including Using Bleach on Food

CDC published a report indicating that a good number of people feel that using bleach on food products to remove potential COVID-19 virus was okay.  It isn't okay to use disinfectants on food

In April, CDC reported that there as an increase in chemical-related health issues caused by the misuse of disinfectants by people trying to reduce the risk of COVID-19.

A survey was conducted, and while a good portion of people had the basic understanding for use of chemicals, "Thirty-nine percent reported intentionally engaging in at least one high-risk practice not recommended by CDC for prevention of SARS-CoV-2 transmission (2), including application of bleach to food items (e.g., fruits and vegetables) (19%); use of household cleaning and disinfectant products on hands or skin (18%); misting the body with a cleaning or disinfectant spray (10%); inhalation of vapors from household cleaners or disinfectants (6%); and drinking or gargling diluted bleach solutions, soapy water, and other cleaning and disinfectant solutions (4% each)."

"These practices pose a risk of severe tissue damage and corrosive injury (8,9) and should be strictly avoided. Although adverse health effects reported by respondents could not be attributed to their engaging in high-risk practices, the association between these high-risk practices and reported adverse health effects indicates a need for public messaging regarding safe and effective cleaning and disinfection practices aimed at preventing SARS-CoV-2 transmission in households."

https://www.cdc.gov/mmwr/volumes/69/wr/mm6923e2.htm?s_cid=mm6923e2_w
Knowledge and Practices Regarding Safe Household Cleaning and Disinfection for COVID-19 Prevention — United States, May 2020
Early Release / June 5, 2020 / 69
Radhika Gharpure, DVM1,2; Candis M. Hunter, PhD1; Amy H. Schnall, MPH3; Catherine E. Barrett, PhD1; Amy E. Kirby, PhD1; Jasen Kunz, MPH1; Kirsten Berling, MPH1; Jeffrey W. Mercante, PhD1; Jennifer L. Murphy, PhD1; Amanda G. Garcia-Williams, PhD1 (View author affiliations)

FDA Warning Letter - Michigan Food Company for RTE Sandwiches, Salads and Bakery Products

FDA issued a Warning Letter to a Michigan Food company, Quality Dairy Company of Lansing, MI.  The company produces ready-to-eat (RTE) sandwiches, salads, and bakery items.  There were issues with the Preventive Control plan as well as with GMPs.

Preventive Controls

• "sanitation control procedures did not ensure cleanliness of food-contact surfaces and prevention of cross-contamination,"
• "sanitation controls monitoring records as part of the Sanitation Preventive Controls were not reviewed within 7 working days after the records were created"
• "did not implement your written sanitation control verification procedures for environmental monitoring - did not do environmental monitoring as they had written in their plan"

GMPs

• "observed five apparent dead German cockroaches and "our investigators observed one apparent live German cockroach nymph crawling on the MDARD Inspector’s white inspection coat"observed flying insects in your facility which were most concentrated along the donut lines."
• "an employee used a pressurized hose to rinse/spray cleaned production equipment and floors. We observed overspray from spraying the floors being deposited on exposed cleaned and sanitized production equipment and utensils."
• "a sanitation employee scrubbed the donut cooling conveyor, a food contact surface, with a brush that was stored in a yellow bucket with water. This bucket is the same shape, color, and style with the same markings as the yellow buckets used to mop the floors around the facility."

https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/quality-dairy-company-604285-05132020
WARNING LETTER
Quality Dairy Company
MARCS-CMS 604285 — May 13, 2020

COVID-19 Prevention Plan for Food Establishments

A HACCP based approach for conducting a risk assessment for COVID-19.  While done for foodservice establishments, it can be used for any type of operation.

https://extension.psu.edu/covid-19-prevention-plan-for-food-establishments
COVID-19 Prevention Plan for Food Establishments

As restaurants and food operations reopen during the COVID-19 pandemic, owners and managers must put controls in place to limit the risk of infection for both employees and customers.

Establishments are encouraged to follow state and federal guidelines, including those published by OSHA, the Occupational Safety and Health Administration. OSHA developed a COVID-19 planning guidance based on traditional infection prevention and industrial hygiene practices. OSHA is tasked with investigating workplaces where there is the potential for SARS-Cov-2 infection.

As part of the OSHA guidance for food retail establishments, titled "Retail Workers and Employers in Critical and High Customer-Volume Environments", employers have been asked to assess their operation and implement controls to reduce the risk of infection. While there is no requirement for a written assessment, there are many advantages to having a documented assessment.

Click here for the Form - COVID-19 Risk Assessment Form for OSHA Guidelines (2020-05)

One advantage is that it allows the manager or owner to visualize what procedures need to be in place. This is especially beneficial for operations with multiple operating units where it may be easier to miss some element within a given operation. Conducting an assessment will show due diligence regarding liability in the event of an infection outbreak centered at the establishment.

It is important to remember that each operation is different, thus the types of controls used will vary depending on the specifics of a given operation. There are physical controls, or what OSHA calls Engineered Controls, that are physical elements such as plexiglass shields between the customer and the person taking the order. Another category of controls is termed Administrative and these are procedural in nature, for example, limiting the number of people in a food establishment. Finally, there are personal protective equipment, or PPE controls, which includes the use of face coverings and gloves.

It is best to have written procedures that provide more consistent application of the procedure over time and allow for more standardized training of employees. All employees should be trained, and this training should be documented.

OSHA appears to be getting more involved in workplace related COVID-19 cases. The agency has recently announced that operations should determine whether employee COVID-19 illnesses are work-related and thus recordable when employees come down with infection. Having a solid plan for preventing infection and then implementing that plan with documentation will go a long way to making a safer workplace without the need for OSHA enforcement.

Reference

FDA. Best Practices for Retail Food Stores, Restaurants, and Food Pick-Up/Delivery Services During the COVID-19 Pandemic.

OSHA. Retail Workers and Employers in Critical and High Customer-Volume Environments.

This Week In Mislabeled Products for Week Ending May 30. 2020

Chicken in the Box, but Not on the Label - Nestle Prepared Foods Company, a Jonesboro, Ark. establishment, is recalling approximately 29,002 pounds of chicken product labeled as Lean Cuisine Fettuccini Alfredo because the product contains undeclared soy.  The Lean Cuisine Fettuccini Alfredo is not supposed to contain chicken and chicken does not appear in the ingredients statement or on the label.  The problem was discovered when the firm received multiple consumer complaints that the product labeled as Lean Cuisine Fettuccini Alfredo contained chicken that is not referenced on the label or ingredients.

Someone Grabbed the Out-Dated Labels - Johnson Sea Products of Coden, AL, is recalling its 12oz package of frozen “Home Style Crab cakes” because they contain undeclared ingredients of wheat and soy.   The recall was initiated after it was discovered that the wheat and soy containing product was distributed in packaging that did not reveal the presence of wheat or soy. Subsequent investigation indicates the problem occurred when an out-dated sample label was used on the Home Style Crab Cakes that contain wheat and soy.

The Importance of Masks in Reducing the Risk of COVID-19

An article in the journal Science details the importance of masks in reducing transmission of the SARS-CoV-2 virus.  Social distancing may not be sufficient by itself, especially in indoor conditions., so masks help to reduce aerosols, the leading method of spread, especially from asymptomatic or pre-symptomatic individuals.  Even the act of speaking can emit aerosols.  And any properly fitting mask will help reduce the risk.   (Of course, wearing a mask down around your chin, with mouth and nose exposed, does nothing).

Science
https://science.sciencemag.org/content/early/2020/05/27/science.abc6197
Reducing transmission of SARS-CoV-2

Kimberly A. Prather1, Chia C. Wang,2,3 Robert T. Schooley4 1Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA 92037, USA. 2Department of Chemistry, National Sun Yat-sen University, Kaohsiung, Taiwan 804, Republic of China. 3Aerosol Science Research Center, National Sun Yat-Sen University, Kaohsiung, Taiwan 804, Republic of China. 4Department of Medicine, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, CA 92093, USA. Email: kprather@ucsd.edu 

Masks and testing are necessary to combat asymptomatic spread in aerosols and droplets

Excerpts:

"Recent studies have shown that in addition to droplets, SARS-CoV-2 may also be transmitted through aerosols. A study in hospitals in Wuhan, China, found SARS-CoV-2 in aerosols further than 6 ft from patients with higher concentrations detected in more crowded areas (8). Estimates using an average sputum viral load for SARS-CoV-2 indicate that 1 min of loud speaking could generate >1000 virion-containing aerosols (9). Assuming viral titers for infected super-emitters (with 100fold higher viral load than average) yields an increase to more than 100,000 virions in emitted droplets per minute of speaking."

"The World Health Organization (WHO) recommendations for social distancing of 6 ft and hand washing to reduce the spread of SARS-CoV-2 are based on studies of respiratory droplets carried out in the 1930s. These studies showed that large, ~100 μm droplets produced in coughs and sneezes quickly underwent gravitational settling (1). However, when these studies were conducted, the technology did not exist for detecting submicron aerosols. As a comparison, calculations predict that in still air, a 100-μm droplet will settle to the ground from 8 ft in 4.6 s whereas a 1-μm aerosol particle will take 12.4 hours (4). Measurements now show that intense coughs and sneezes that propel larger droplets more than 20 ft can also create thousands of aerosols that can travel even further (1). Increasing evidence for SARS-CoV-2 suggests the 6 ft WHO recommendation is likely not enough under many indoor conditions where aerosols can remain airborne for hours, accumulate over time, and follow air flows over distances further than 6 ft (5, 10)."

"Overall, the probability of becoming infected indoors will depend on the total amount of SARS-CoV-2 inhaled. Ultimately, the amount of ventilation, number of people, how long one visits an indoor facility, and activities that affect air flow will all modulate viral transmission pathways and exposure (10). For these reasons, it is important to wear properly fitted masks indoors even when 6 ft apart. Airborne transmission could account, in part, for the high secondary transmission rates to medical staff, as well as major outbreaks in nursing facilities."

"After evidence revealed that airborne transmission by asymptomatic individuals might be a key driver in the global spread of COVID-19, the WHO recommended universal use of face masks. Masks provide a critical barrier, reducing the number of infectious viruses in exhaled breath, especially of asymptomatic people and those with mild symptoms (12) (see the figure). Surgical mask material reduces the likelihood and severity of COVID-19 by substantially reducing airborne viral concentrations (13). Masks also protect uninfected individuals from SARS-CoV-2 aerosols (12, 13). Thus, it is particularly important to wear masks in locations with conditions that can accumulate high concentrations of viruses, such as health care settings, airplanes, restaurants, and other crowded places with reduced ventilation. The aerosol filtering efficiency of different materials, thicknesses, and layers used in properly fitted homemade masks was recently found to be similar to that of the medical masks that were tested (14). Thus, the option of universal masking is no longer held back by shortages."

"From epidemiological data, countries that have been most effective in reducing the spread of COVID-19 have implemented universal masking, including Taiwan, Hong Kong, Singapore, and South Korea."