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Beach Beat: Who’s on first … outbreak victims not in the lineup

Wednesday, June 13, 2018 21:17
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It’s no laughing matter that children in Tennessee are fighting for their lives. It’s no laughing matter that the majority of them got sick after they were served unpasteurized milk. It’s no laughing matter that public health has one hand tied behind its back while it grasps at straws with the other.

That being said, one of the best known comedy sketches of all time — perfected by Bud Abbot and Lou Costello — applies to the terrible situation unfolding in Knox County, TN. Here’s a little background for context.

At least 14 people, and likely more, have been infected with E. coli O157:H7. “The majority” drank raw, unpasteurized milk bottled under the French Broad Farm brand before becoming ill, according to the Knox County Health Department. Infants and toddlers who all attended the same child care center have also been infected. 

Department officials say all of the outbreak victims are children. A doctor at an area hospital said he has seen 11 children with E. coli O157:H7 infections. It’s the worst outbreak he recalls in 30 years. He said four of the children had to be sent to intensive care units because of kidney failure.

County health officials won’t provide case counts other than to say “more than 10.” They also couldn’t provide the age range of victims or other details because the situation is too “fluid.”

The who, what, why, etc., of it
In their “Who’s on First” bit, Abbott and Costello play their usual personas. Abbott is a bit daffy and more than a bit confused. Costello is a bit intellectual and more than a bit of a fast talker. As they discuss the lineup for a baseball game, both show impeccable timing.

Stick with me on this. 

There are parallels when considering the classic sketch and the tragic situation in Tennessee. Word games and less-than-effective communication sent the laugh meter through the roof for Abbott and Costello. For me, the same concepts apply to the Tennessee outbreak, but no one is laughing.

Compare and contrast
The lineup is a quick read when presented in a simple format. But, batting order banter allowed “Who’s on First” to run the bases endlessly as Abbott and Costello went round and round:

First base — Who
Second base — What
Third base — I Don’t Know
Left field — Why
Center field — Because
Pitcher — Tomorrow
Catcher — Today
Shortstop — I Don’t Give a Darn (or I Don’t Care)
Right field — never identified

Abbott asks “Who’s on first?” Costello answers: “Who’s on first.” Abbott is unable to grasp the difference. Thus begins the repeating loop as the pair reviews the lineup.

My version, as applied to Tennessee’s E. coli outbreak, is a longer read. It’s not about a game, and it’s certainly not a laughing matter. 

First base — Who: The victims, aka the sick, the dead, and their loved ones, are always the “who” in outbreaks. This time around all of the known victims so far are children. It is not unusual for a disproportionate number of victims in raw milk outbreaks to be children. Their immune systems are not mature enough to fight off pathogens and they generally drink more milk than adults, increasing their exposure. Children younger than 5 are at an even higher risk of developing serious complications. 

Second base — What: Pathogens such as E. coli, Salmonella, Listeria and Brucella are not uncommon in milk from cows, goats and other hoofed animals. Pasteurization kills bacteria, viruses and parasites. 

Even if a raw milk dairy does everything perfectly in terms of food safety measures, the bottom line is that there are pathogens in cow poop, said Megin Nichols, a veterinarian and leader of the zoonotic outbreak team at the Centers for Disease Control and Prevention. 

Manure is simply part of a cow’s environment, she said. They are exposed to it in pastures, barns, and other areas of dairy operations. Also, the close proximity of a cow’s anus to its teats — around 24 inches — combines with gravity to provide a direct route for pathogens to follow as they head toward humans. 

It is impossible to see pathogens on the teats or any place else, Nichols said, and virtually impossible to remove all of them from any part of a cow. Infected cows often don’t have any symptoms. Infected teats usually are not swollen and usually remain their normal color. 

Third base — I Don’t Know: On one hand, Knox County officials’ hands are tied. Raw milk dairies in Tennessee do not have to complete any licensing or certification processes. They are not subject to any inspection or testing requirements. That doesn’t provide much information for outbreak investigators.

Tennessee law allows dairies to sell “shares” in a cow or cows. In turn, shareholders receive unpasteurized milk. However, those dairies are not required to maintain or release any records on shareholders, production or distribution. Health officials can’t say anything other than “We don’t know.”

On the other hand, it was hard to believe the county’s response earlier this week when I asked when test results would be available for samples from patients, the dairy, cows, milk, etc. “We don’t know.” They wouldn’t even ballpark it.

The response was basically the same regarding the age range of the victims and the number of victims’ parents who had provided information. A county spokeswoman said it was not yet known if the victims are infected with the same strain of bacteria. Victims started showing up in doctor offices and hospitals during the last week of May. 

Left field — Why: At this point in the lineup, raw milk advocates usually pull out the baseball card version of their movement’s positions. It is, in short, pasteurization is bad and pathogenic bacteria are not a problem. Today I’m relegating those usual answers to “Because” out there in center field.

Instead, I’m looking at a the economic “why.” Some raw milk dairy farmers say they can’t afford to stay in business if they sell to the pasteurized sector. They turn to raw, unpasteurized milk — in the states where it’s legal — because people are willing to pay $12 to $16 per gallon for it.

There’s another economic “why” that should also be considered. 

The CDC’s Nichols said economic considerations also include the health care expenses of victims, which can easily run into the hundreds of thousands of dollars per person. Also, there is the taxpayers’ cost of paying for public health and agriculture department staff — from local through federal levels — to investigate outbreaks.

Center field — Because: This is where I am willing to take a step back from the batting box and take a breath. The most frequent reason I read/hear from people who drink raw milk and serve it to their families is that they believe it has more health benefits than pasteurized milk.

I can easily believe some are uninformed. Others are likely under-informed and don’t realize the significant differences between reliable online information and basement bloggers’ blather. 

Still other raw milk users are seeking something, anything, to help a loved one who is suffering from any variety of health problems. They’ve heard raw milk can cure everything from asthma to Alzheimer’s. Then there those people who say they drink raw milk and serve it to their children and elderly parents because they simply don’t believe in the science that shows it is a high-risk food. Very high. Sigh. I have no words. 

Pitcher Tomorrow: I’ll be on the mound again tomorrow, and the next day and the next day, on and on, pitching for science and against parental negligence.

Catcher Today: I’ll be catching flak today for this op-ed column, no doubt. But that’s better than “catching” an infection or a virus. OK, I know you don’t technically “catch” an infection, but I’m on past third and headed for home in this analogy, so forgive me.

Shortstop I Don’t Give a Darn (or I Don’t Care): I’d like to tell every parent or guardian out there that “I don’t care” what they eat or drink. They can guzzle unpasteurized milk and mainline lighter fluid while riding a motorcycle without a helmet for all I care. I just don’t give a darn. But I do give a darn about the children in their care.

We have laws prohibiting parents and others from giving alcohol to children. Tobacco products are similarly regulated. Child restraint systems must be used in motor vehicles. Kids deserve the same protection where unpasteurized products are concerned. 

 Right field — never identified: I don’t know if it was an oversight or intentional, but the “Who’s on First” sketch did not identify a right fielder. You know that position has to be covered though. There has to be a person there. You just don’t know their name.

That’s what it’s like in a foodborne illness outbreak. There are always more sick people out there. Depending on the specific bacteria involved, and several other factors, public health scientists estimate dozens of illnesses go unreported for every person who has a laboratory-confirmed foodborne illness.

Some parents who serve raw milk are less likely to seek medical attention for their children. They simply don’t believe any illness can be caused by unpasteurized milk. Others seek medical attention for their children if they become ill after consuming unpasteurized milk, but they decline to talk to public health staff about it.

E. coli infections are referred to as “reportable” because health care providers must inform public health departments when they are diagnosed. This protects all of us from widespread outbreaks. The reports trigger epidemiological investigations, which include interviews with patients, or in the cases of children, their parents.

“Some people decline the interviews,” said Nichols. “We see this more often with raw milk outbreaks. And, it can be written into cow-share contracts that the members cannot disclose information.” 

Until further notice
‘Who’ knows when
The Knox County Health Department continues to repeat a public warning first posted June 5.

“KCHD advises the public not to consume raw milk or any other unpasteurized products from French Broad Farm in Knoxville, Tenn. at this time. Officials also recommend consumers dispose of all raw milk and unpasteurized products they may have from this farm,” the health department advises.

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Source: http://www.foodsafetynews.com/2018/06/beach-beat-whos-on-first-outbreak-victims-not-in-the-lineup/

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