It's Just Food Poisoning
When I think of food poisoning, I often think back to President Josiah Bartlet calling the Butterball Hotline after Toby Ziegler warned him that cooking the stuffing in his Thanksgiving turkey would make his guests ill (and possibly kill them). President Bartlet is surprised by this and has a series of ridiculous interactions with his staffers trying to track down the truth of the matter before finally receiving some excellent advice from the Butterball Hotline. If you'd like to relive the late 90s joy of The West Wing, you can find the video to the right.
““How can I help you?”
”Stuffing should be stuffed inside the turkey. Am I correct?”
”It can also be baked in a casserole dish.”
”Well, then we’d have to call it something else, wouldn’t we?”
”I suppose.”
”If I cook it inside the turkey, is there a chance I could kill my guests? I’m not saying that’s necessarily a deal breaker.”
”Well, there are some concerns. Two main bacterial problems are salmonella and campylobacter jejuni..”
”Alright, well, first of all, I think you made the second bacteria up and, second of all, how do I avoid it?”
”Make sure all the ingredients are cooked first. Sauté any vegetables, fry sausages, oysters, etc.”
”Excellent. Let’s talk temperature.”
”165 degrees.”
”No, see, I was testing you. The USDA calls for turkeys to be cooked to an internal temperature of 180-185 degrees.”
”Yes, sir, I was talking about the stuffing, which you want to cook to 165 degrees to avoid the health risks.”
”Okay. Good testing.””
The big food holidays are (mostly) over for a bit, but outbreaks of foodborne illness never stop giving. In the Salish Sea area this month, just two Mexican restaurants have been linked to a nororvirus outbreak that includes as many as 400-500 cases (sick people). Thankfully, outbreaks on this scale are relatively rare, but foodborne illnesses make up a substantial burden of disease in both rich and poor countries. The CDC estimates that every year in the United States, 48 million people are sickened by foodborne illness, 128,000 are hospitalised, and 3,000 die.
Most people understand how influenza spreads, but there’s often more mystery surrounding foodborne illnesses. With that in mind, I’m going to talk a bit about the different types of common diseases that come from food, their incubation periods (how long it takes to start feeling sick), and their transmission (how we can spread them). (Spoiler alert: food poisoning can and often does spread person-to-person.)
It must have been the chicken I ordered last night!
Some of the most common pathogens (germs) people encounter in their food probably sound familiar to you (E. coli, salmonella, norovirus, listeria), but others may be less familiar (campylobacter, clostridium, vibrio). Below is a table I adapted from a 2004 (I know, it's old) CDC Morbidity and Mortality Weekly Report (MMWR) on the management of foodborne illnesses. It is very abbreviated and should not be used in place of seeing a physician for diagnosis or treatment, but will hopefully give you a sense of some of the more common causes of foodborne illnesses.
I tried to keep the terminology simple in the table, but below are a couple of brief explanations for some of the terms. If something in the table doesn't make sense (or is wrong!) please do let me know. I'm happy to explain and/or correct it.
Pathogen: the infectious agent ("germ") that either directly makes you sick or creates a toxin which makes you ill.
Incubation period: the time between when the pathogen enters your body and when you start to experience signs or symptoms of illness (i.e., when you start to feel sick)
Symptoms: the poopy (sometimes literally) things that happen to you which make you feel sick.
Duration: the period between when you first start to feel sick and when you feel better.
A very abridged overview of some foodborne illnesses
So, now that we've covered the food invaders that make us feel awful, what do we notice about them? I see a lot of overlapping "problem foods" like undercooked proteins (meat, eggs) and unpasturised dairy products. I also see a lot of long incubation periods, which makes identifying the source of the illness challenging. Think back to last Wednesday. Can you name everything you ate, all the ingredients in it, what their brand names were, and where you bought them?* If you're anything like me, you probably can't. I'm pretty cautious about what I eat (no sprouts, no pre-cut melons, no undercooked proteins), but I definitely can't remember what I ate for breakfast this morning.
Gobble gobble!
It's convenient to blame the restaurant you ate at last night for your belly ache today, but it's more likely that (if it's not norovirus or vibrio) your own home was the site of infection. Inadequate sanitation of surfaces, cross-contamination of cutting boards or dishes, and improper preparation/storage are all common places where a delicious meal can become future suffering.
Did you leave the turkey to thaw on the counter overnight or rinse it in the sink (spraying tiny droplets of raw turkey around the kitchen)? Did you wipe your hands on a dishtowel or your apron while cooking? How long did the food sit on the table before being cleared away and stored in the refrigerator? When you bought your meat at the market, did you wrap it in a plastic bag before sitting it next to your apples in the cart?
It's easy to absentmindedly contaminate food; I know for a fact that I've itched my cheek while stuffing lamb pasties. Fortunately, it's always possible to learn more and develop new habits while cooking. I have vivid memories of my stepfather putting cooked chicken on the same plate that he'd used to carry it out to the grill, but, after my mother explained why that was dangerous, I never saw him do it again. I realise how patronising that is to say, but I have absolute faith that we could dramatically reduce the burden of foodborne illnesses in our communities with by making a few habit changes. January is usually the time we associate with making changes, but it's always a good time to improve our handwashing technique and frequency.
"It's just food poisoning, right?"
It's not listed on our Foodborne Illnesses chart, but there's another characteristic those germs all (except listeria beyond the prenatal period and botulism) share: they can and are passed directly from one person to another. Sometimes this looks like drinking water that is contaminated with human waste (poop), but in countries with good sanitation systems (like the US, most of Europe, and Singapore) transmission is more likely to happen because of poor handwashing. When people go to work while they're sick—even if it's "just food poisoning"—they risk infecting others around them. When I was a child, I often heard that "sharing is caring," but that's not really the case with infectious diseases. I can't think of a worse present from a friend or coworker than whatever it is that's kicked their immune system into overdrive.
Please don't perpetuate this attitude. It's not very Public Healthy.
In the United States, there is no federally guaranteed sick leave (either paid or unpaid) and that means a lot of food service and lower-paid healthcare workers (like nursing assistants) cannot afford to stay home. There's a lot of pressure among higher wage workers to not use the sick time they do have and "tough it out." We have a toxic mindset in a lot of high income countries that demands we push through illness as though 1. taking care of ourselves is somehow a sign of weakness and 2. our presence won't spread whatever we have to the potentially immunologically vulnerable people around us.
These are social failings that need to be addressed through policy, but, if you have sick leave available, you should be able to use it to protect yourself and your community. Cultural shifts can take a long time, but there's good progress being made at the state and local levels in lots of communities. My program manager is a total Public Health Boss and makes a point to tell us all that he's taking a sick day because he feels unwell (or notices that he's mentally exhausted) and actively encourages us to follow his example when we need to. I freely admit that awful at this, but being in a work environment which encourages me to take care of myself (this is absolutely an economic privilege) has encouraged me to take better care of myself. I recently took some time off because I was struggling with a loss in my family and it was much easier for me to stay focused on my work when I had processed my grief.
Okay, so what can I do?
We can't control the social forces acting around us (unless you're a legislator, in which case, yes, you absolutely can), but we can take control of some transmission risks when we're sick:
Good handwashing goes a long way to reducing the spread of communicable disease. You should wash your hands periodically while cooking and after using the toilet, changing a baby, or interacting with animals. (Petting zoos are full of diseases.)
Avoid preparing food for others (I know this is particularly hard if you have children or work in food service).
Disinfect your workspace, kitchen, and bathroom areas as often as you can. Toilet handles, washroom door handles, and sink taps especially should be wiped down at least once a day while you're symptomatic (still feeling ill). The CDC has easy-to-follow guidelines to sanitise surfaces here. It's intended for schools trying to control the flu, but they're still good guidelines.
Contact your legislators and tell them to invest in public health measures like paid sick leave. You can find a listing of the people who represent you in Congress (if you’re in the US) here. There are equally convenient links if you’re in the UK, Ireland, or Canada.
If you're a supervisor, make it clear to your team that you want them to keep themselves and each other healthy. Be the change you want to see in your workplace!
With that, I'll leave you with what is undoubtably the catchiest public health jingle ever. It even references Washingtonians' love of high-fives, which is worth an automatic bonus point.
*Epidemiologists use a lot of awesome detective work like your shopper cards, receipts, and pictures to investigate, but the job is still really tough. I'm constantly in awe of the foodborne epidemiologists in my office.