Recall fatigue redux: does social media help or hinder?

Posted on June 11, 2012 by Douglas Powell

In July 2007, Robert Brackett, then director of the FDA’s Center for Food Safety and Applied Nutrition said during the Castleberry canned chili sauce botulism outbreak consumers may be suffering "recall fatigue," given the rash of recalls the past year for spinach, carrot juice, lettuce, peanut butter, pet food and other products. "That’s a real phenomenon. If people aren’t getting sick or their family isn’t, they think ‘Oh, it’s not going to happen to me.’"

I said that public communications about such undertakings must be rapid, reliable, repeated and relevant, and that the produce outbreaks of 2006 marked significant changes in how stories were being told on Internet-based networking like YouTube, wikipedia, and blogs. Producers, processors, retailers and regulators of agricultural commodities not only need to be seen — and actually — responding to food safety issues in conventional media, they must now pay particular attention to the myriad of Internet-based social networking sites that allow individuals to act as their own media outlet. Further, proactive producers, regulators and others in the farm-to-fork food safety system will become comfortable with the directness — and especially the speed — of new Internet-based media.

In 2010, the Washington Post reported that government regulators, retailers, manufacturers and consumer experts were concerned that recall notices have become so frequent across a range of goods — foods, consumer products, cars — that the public is suffering from "recall fatigue."

Craig Wilson, assistant vice president for quality assurance and food safety at Costco, was quoted as saying in 2010 that, "The national recall system that’s in place now just doesn’t work. We call it the Chicken Little syndrome. If you keep shouting at the wind — ‘The sky is falling! The sky is falling!’ — people literally become immune to the message."

Today, USA Today has a story about recall fatigue.

Consumers last year were deluged with 2,363 recalls, or about 6.5 recalls each day, covering consumer products, pharmaceuticals, medical devices and food, according to data from the U.S. Food and Drug Administration, the Department of Agriculture and the Consumer Product Safety Commission. The recalls announced mark a nearly 14 percent increase from 2,081 in 2010 and compare with about 1,460 in 2007.

Christopher Doering writes that the increase is the result of a combination of greater oversight by regulators, better testing procedures and the use of social media where consumers can quickly point out and discuss problems with other people.

Increasingly, retailers and government agencies are expanding the methods they use to communicate with the public — from social-media technologies such as Twitter and Facebook to more traditional methods such as phone calls and postings within their stores. But the same methods that prove successful in reaching one customer could just as easily be ignored by another.

"We don’t feel that our members are getting bombarded but certainly the general public is and sooner or later you don’t know what to believe," said Craig Wilson, vice president for quality assurance and food safety at the warehouse giant Costco.

The 602-store warehouse chain uses data supplied from its estimated 60 million members and notifies them within 24 hours if they’ve purchased a recalled item. It then follows up with a letter. The result is that customers return about 90% of recently recalled products and, in the case of major recalls such as when a food product could cause serious health problems or death, Costco gets "the majority of everything that was sold back."

But Wilson says the national recall system "doesn’t work as designed" and that consumers and retailers alike would benefit from a single, uniform network. He says the CPSC, USDA and FDA each have a different recall system with unique requirements, making it more difficult for companies like his to make sure they are complying with the rules.

At Rochester, New York-based Wegmans, the grocery chain has a detailed recall plan that can require hundreds of people to carry out. The 81-store East Coast chain follows a recall protocol increasingly common among retailers: posting recall information on its web page and within stores for customers, notifying its followers using social media tools and, when possible, calling individuals who may have used a store card for the purchase.

Businesses can ease the burden of a recall on their reputation and bottom line by being honest and upfront with their customers and crafting a response plan before any recall occurs that outlines what they will do with the public, media and regulators, industry watchers say.

USDA Secretary Tom Vilsack downplayed the number of recalls that are announced considering the number of products that are produced, items that are sold and meals consumed each day.

"I think people want to know and need to know and have a right to know if there is a problem with a particular product," said Vilsack. "We’re going to look at ways in which we (communicate) and constantly improve how we communicate but we’re not going to stop communicating."

Social media helps investigation of sapovirus gastroenteritis at 2011 Las Vegas Marathon

Posted on March 19, 2012 by Douglas Powell

The annual Rock ‘n’ Roll Las Vegas Marathon and ½ Marathon was attended by about 44,000 runners on Sunday Dec. 4, 2011. By Tuesday, complaints of illness were trickling in to the Southern Nevada Health District. By Thursday, traditional media reported on increasing complaints of barfing on the event’s Facebook page. An investigation was launched.

Within a week, health-types were able to say it wasn’t the water distributed during the race that made runners sick, quelling a rumor that had already taken on a life of its own.

Below are excerpts from the final report, issued last week, identifying the first outbreak of sapovirus in Nevada and the emerging role of social media in epidemiological investigations.

Links to an epidemiology online survey were shared on the marathon’s Facebook page (with 25,732 followers) by members of the running community on four consecutive days starting on the day of release of the survey, and a total of 42 times within one week as part of a number of discussions among ill runners. Twenty-two people shared the survey link on Twitter, potentially reaching 17,982 followers. A total of 362 responses had been submitted within 12 hours of the release of the survey. After the survey had been posted for 4 days, a total of 1,146 surveys had been submitted. Of the 1,082 completed surveys, 578 (53.4%) were from persons who reported developing diarrhea or vomiting. Of these, 528 (91.3%) met the case definition.

Seventeen ill local runners were requested to provide stool specimens; specimens were provided by nine marathon runners and two symptomatic children of a symptomatic marathon runner. Specimens were collected between December 9, 2011 and December 11, 2011 (5-7 days after symptom onset), and all specimens submitted were formed stools. Two were positive by rRT-PCR for sapovirus and negative for all other tested pathogens at CDC and the SNPHL

The findings of this investigation point to the source of the sapovirus outbreak among marathon runners as a common exposure on the morning before the race, most likely at the health and fitness expo. It was not possible to determine which common exposure was responsible for the outbreak. The timing of the exposure and the incubation period of sapovirus resulted in the majority of cases becoming ill during the race or in the hours shortly after; however, exposure during the race was not the cause of the outbreak.

Sapoviruses (genus Sapovirus, family Caliciviridae) are a group of viruses that cause acute gastroenteritis in humans. Sapovirus is not as well-characterized as norovirus, but is thought to be similar to norovirus in that it has a short incubation period (1-2 days), low infectious dose, causes a self-limiting illness that is rarely serious with a significant percentage of asymptomatic infections, and is easily spread from person to person through fecal-oral transmission. Both infections cause diarrhea, although a lesser percentage of sapovirus patients develop vomiting as compared to norovirus patients.

Outbreaks of sapovirus have been reported in the literature, but reports of foodborne outbreaks and outbreaks among adults outside long-term care are rare and the majority of cases occur in children under 5 years of age. This outbreak represents the first outbreak of sapovirus in Southern Nevada and the first time the virus has been identified in the local population. However, sapovirus testing is not available locally and has not been previously ordered during an outbreak. Rather than representing a newly-introduced disease, the identification of the virus likely indicates that sapovirus circulates at low levels in the population but goes unidentified.

This investigation was also the health district’s foray into using social media as an investigative tool, rather than just as a method of disseminating information to the public. Using the active community of runners on Facebook and Twitter allowed for the rapid dissemination of the survey directly to the exposed population without a delay in requesting participant information from the race organizers. Comments posted to social media sites provided ongoing, real-time insight into the needs and concerns of the ill population, and provided a feel for the efficacy of health district investigation efforts. Comments about SNHD were overwhelmingly positive, and indicated a level of trust and willingness to cooperate from the community.

Ill and non-ill runners quickly responded to the survey, which allowed SNHD staff to rapidly identify ill persons for laboratory testing. It also allowed for a preliminary data analysis to be quickly completed, which allowed the water provided by race organizers, an early focus of complaints by runners, to be ruled out as a source of the outbreak. The water provided in the race was the same potable water that is distributed throughout Southern Nevada, and it was important to quickly determine if the general population was at risk of disease.

The ill persons identified by SNHD staff complied very quickly with the request to submit specimens for laboratory testing. The submission of stool samples for testing is often a difficult task due to the type of sample requested and the handling requirements. The ill persons were highly motivated to provide samples that could be used to identify the causative agent of the outbreak.

In the future, several steps should be implemented to improve the investigative process and to prevent disease at similar events. First, although the survey was developed quickly, a standard template should be developed to allow the rapid deployment of standardized surveys for illness. In addition, corresponding standard analytic tools should be developed to allow for the rapid analysis of survey data.

Next, SNHD should consider using social media more frequently to administer surveys given the appropriate audience; in this case, the use of Facebook was effective because there was an active community of marathon frequently posting and reading the marathon’s page. During a large event, it might be appropriate to set up a social media site for the event response. This would provide an additional avenue for SNHD to share information from the public, and following discussions would allow for real-time feedback on the needs and concerns of the public. However, the decision to launch a social media site should be thoroughly discussed prior to launch, as it would place SNHD in the role of moderating the discussion on the topic (for example, removing libelous comments or threats against employees). It would also necessitate the development of policies on the participation in such discussion by staff members on work time or personal time.

The complete report is available at: http://www.southernnevadahealthdistrict.org/download/stats-reports/rocknroll-marathon-sapovirus-outbreak-final-report.pdf.

Webidemiology: disease sleuths surf for outbreaks online

Posted on February 25, 2012 by Douglas Powell

Most folks who wake up feeling crummy will sit down with a computer or smartphone before they sit down with a doctor.

They might search the Web for remedies or tweet about their symptoms. And that’s why scientists who track disease are turning to the Internet for early warning signs of epidemics.

Philip Polgreen, an epidemiologist at the University of Iowa, told NPR’s Adam Cole, "Surveillance is one of the cornerstones of public health. It all depends on having not only accurate data, but timely data."

The current system requires the Centers for Disease Control and Prevention to compile reports about from physicians and labs all over the country — and that can take a while. There’s typically a week-long delay between an outbreak and the release of an official report.

To get an early read on things, epidemiologists look for the first clues of illness — a rise in thermometer sales or increased chatter on hospital phone lines. Now, they’re tapping into the Internet.

A team of researchers at Johns Hopkins wanted to see if Google’s estimates would prove accurate and useful in the everyday operation of a hospital.

They compared Google searches originating in Baltimore to the number of patients who showed up with flu-like symptoms at a local emergency room.

"It seems like a stretch, but what we found — amazingly — is that there’s a really high correlation between these searches in the community and what we’re seeing in hospitals," says Richard Rothman, the study’s co-author.

Online disease surveillance — or "Webidemiology" — is a cool new tool, and researchers are eagerly testing it out and double-checking the data they collect. But it won’t be used by itself to make important public health decisions anytime soon.

"The Internet is just one additional stream of information," Polgreen says. "It’s certainly not going to replace traditional forms of surveillance."

While the Internet may not be a perfect predictive tool, researchers and public health officials agree that it is great for one thing: communication.

Social networking allows officials to easily reach the public and enter into a conversation. Tweets, searches and Facebook posts can give officials a sense of public reaction to vaccines, or their attitude towards an epidemic.

"It’s a quick and easy barometer for public anxiety," Polgreen says.
And in a public health emergency, that can be just as useful as cold, hard numbers about cases.

Social media role in tracking norovirus outbreak at journalism gathering

Posted on January 22, 2012 by Douglas Powell

This sounds like norovirus. And some investigators discovering that youngsters use different ways to communicate.

Michelle Ferguson tried to avoid it, but the rapid onslaught of nausea took its toll on her body when she suddenly vomited in the back seat of a school bus last weekend.

She and her fellow delegates, attending a journalism conference in downtown Victoria, were on their way to the Vertigo nightclub for the final gala when dozens of formally dressed students started vomiting on the buses, in their hotel and at the club.

Almost instantly, messages on Twitter told the stories of people suffering from extreme stomach pain, vomiting and diarrhea. Staff at Canadian University Press, who organize the conference every year, contacted health officials as the numbers increased. Within minutes, delegates were asked to return to the Harbour Towers Hotel and Suites.

The well-documented outbreak is considered a successful example of the effectiveness of communicating through social media. The conference’s Twitter hashtag, #nash74, led news agencies to the story, became a slick crisis-control tool and has inspired health officials to consider using similar methods to monitor outbreaks.

"It would be fascinating to learn how to use social media to control and manage outbreaks like they did," said Dr. Murray Fyfe, chief medical health officer for the Vancouver Island Health Authority. "I’m sure some were able to limit their exposure because of it."

Messages about the widespread vomiting were sent out on #nash74. CUP staff saw the numbers climbing and shut down the gala.

CUP staff went door-to-door as well, but nothing worked more efficiently than Twitter, according to students.

"I feel a lot more people would have gotten sick without Twitter," Mattern said. "This whole thing would have played out a lot differently."

Methods for tracking and managing outbreaks could change because of the role Twitter played in this incident.

Fyfe and his staff have analyzed the Twitter feed from the conference and could follow how the outbreak spread.

"A traditional investigation would have trouble getting those details," he said. "We’re interested in partnering with people who have expertise in social media to use it as a tool to investigate outbreaks and as a communication tool to control outbreaks."

Can you cope? On-line reviews

Posted on January 22, 2012 by Douglas Powell

Last May, it was reported that 195 of the 580 people served Easter Brunch at Luciano’s Cotton Club in Worcester, Mass. were struck by norovirus contracted from a sick employee, and the incident was chronicled on Yelp and a food safety site called barfblog.com.

“I would really drive home the point that they had a problem, investigated to determine what it is, and outlined a plan for what we’re going to do from now on,” said Gregory Charland, founder and chief executive officer of Charland Technology, a Hubbardston-based company offering a wide range of technology services. “Organizations should use problems like that to really do some soul searching and figure out how and why this happened. The overriding concept to underline is that they are never going to have their name in the news about this again.”

(Hint, and it’s in the blog post: don’t let sick employees work, even at an Easter buffet).

Alex Barbosa, the restaurant’s manager, declined comment.

That’s one anecdote in a story about on-line reviewing, which some love and some hate.

Alec Lopez dislikes consumer-driven review websites like Yelp, TripAdvisor and UrbanSpoon.

The owner of Armsby Abey in Worcester, Mass. said, “I don’t read reviews often,” Mr. Lopez said. “I hate Yelp because it’s an unanswered forum for people to bitch. I feel like it’s a green light to voice your opinion without consequences.”

Worcester native Andrew Chandler, a 29-year-old medical student at the University of Massachusetts Medical School, had an unpleasant dining experience at Armsby Abbey, and chronicled it on Yelp.

“I was really sad to have done it, but I think that when a place isn’t responsive or accommodating, people should know about it. I was hoping Armsby Abbey would read it and respond. I think it goes a long way if a manager explains what the circumstances were, and how they’ll prevent the problem from happening again. Today, online reviews can make or break a customer’s decision.”

In September, Harvard Business School professor Michael Luca released research that found a one-star rating increase on Yelp directly led to a 5 percent to 9 percent boost in revenue for independent restaurants, with comparable projections for independents in other industries. Despite the growing influence of Yelp and similar websites, business owners like Mr. Lopez continue to ignore — or worse, incorrectly address — negative feedback when it comes in the form of an online review.

With 61 million monthly visitors and 22 million reviews online by the end of the third quarter last year, Yelp is the most popular online review destination for everything from dentists to dieticians. Yelp’s popularity is proof that consumers trust reviews written by the average Joe, and enjoy contributing their own 2 cents.

Wilson Wang, chef and owner of Baba Sushi in Worcester, said he checks online reviews of his restaurant “all the time,” monitoring what diners like — and don’t like.

Mr. Wang, whose customers’ reviews currently rank Baba Sushi 4.5 out of 5 stars on Yelp.com, said he doesn’t respond personally to people’s comments but rather sees such reviews “as a mirror” to reveal what could be done better. “We are on the high level and we are really proud,” he said last week.

Yelp and websites like it open the door for independent businesses with limited marketing budgets, giving them an opportunity to advertise through old-fashioned word of mouth in a high-tech world. They offer a safety net to consumers who, with a few keystrokes, can be reassured that trying something new — rather than falling back on the reliability of a chain — won’t be a waste of their money.

“Every time I’ve given a negative review and gotten some sort of constructive, non-judgmental response, I’ve made it a point to go back to whatever business it was and give them a clean slate,” said Amy Jamieson, a 42-year-old Yelp user and homemaker from Worcester. “If they’re willing to try again, so am I.”

Does moral education make food safer? China says yes; food is worse than twitter weiners

Posted on June 17, 2011 by Douglas Powell

Maybe I’m losing something in translation, but Xinhua reports that experts in China have called for strengthening moral education to ensure food safety following a string of scandals in recent months.

Zhao Chenggen, an expert at the School of Government at Peking University, said on Wednesday that to promote moral education is conducive to urging food producers to place a higher value on public health.

Under the influence of moral cultivation, food producers could enhance their subjective consciousness to resist ill-gotten gains through adding toxic materials into food, he said.

"Moral decline in the food industry is more terrible than that in social communications," said another expert, Xu Yaotong, a professor of political science at the National School of Administration.

Premier Wen Jiabao said, "A country without the improved quality of its people and the power of morality will never grow into a mighty and respected power.”

Wen said that advancing the moral and cultural construction would help safeguard normal production, life and social order, as well as to eradicate the stain of swindling, corruption and other illegal conduct.

Ill diners use Facebook to close popular restaurant in Costa Rica

Posted on April 16, 2011 by Douglas Powell

Keep using those fancy cell phones and social media to hold people accountable.

According to The Tico Times, Nelly Campos joined three of her friends for a meal at Café Mundo on March 22. After having some appetizers at a cocktail reception, she ordered a light meal of bruschetta topped with tomato, cheese and basil. She finished her meal with a portion of sugary pecan pie.

The following night Campos and her friends all experienced symptoms of food poisoning: vomiting, diarrhea, body aches and dehydration. One of the women, Francella Conejo, ended up in the hospital.

Two weeks later, the Health Ministry shuttered Café Mundo, citing unsanitary conditions. A health report released by the ministry remarked on various health code violations found on the morning of April 5.

Inspectors observed surfaces that were neither washed nor disinfected, cleaning solutions were placed near the liquors, uncooked meat settled next to vegetables in the kitchen. The restaurant was undergoing remodeling but no separation existed between the construction area and the kitchen. Dust coated the walls, floors and tables in the kitchen.

“The food was tasty,” Conejo said. “There’s no way we could’ve imagined the level of problems that existed [in the kitchen].”

The reports of food poisoning at Café Mundo seemed to occur over a three-week period beginning in mid-March. But the decision to close the popular San José restaurant in Barrio Otoya didn’t occur until early April. Instead Campos and others, with the help of social network Facebook, gathered the names of food poisoning victims at Café Mundo and encouraged them to create an uproar.

In the end, the Health Ministry received 25 to 35 “denuncias,” or complaints.

Each complaint represented one member of a family or a dinner with friends or business gathering that had been affected by the restaurant’s food.

On March 31, Cristy Valdés had a friend post her criticism about Café Mundo on the Facebook page of Health Minister María Avila. Valdés began her message by saying, “I don’t know whether to laugh or cry or whether to denounce Café Mundo or the Health Ministry.” She went on to explain that after the incident occurred, Valdés spent three days calling the Health Ministry trying to file a complaint. Once she explained what happened, Valdés said she was told that four denuncias weren’t enough to lead to an inspection. On Facebook though, the complaints found an audience.

Valdés learned from one commenter that another woman named Nelly Campos was putting together a list of those afflicted by a meal at Café Mundo. They worked together to find people who alleged food poisoning from an unsanitary meal. Valdés also continued to call Café Mundo, only to have the people working the phone deny that customers had called about any grievances with the food.

As Valdés built up her list, a member of the Health Ministry started noticing the outcry on Facebook over Café Mundo.

On April 6, 2011 health inspectors dropped by Café Mundo, saw numerous violations and shut down the prominent tourist dining spot.

The networking done by Valdés, Campos and others had compelled the government to take action.

Reached by phone Thursday, Café Mundo’s owner Diego Meléndez said the restaurant plans to reopen during the first week of May. He contradicted some of the claims made in the Health Ministry’s report, saying there was a plastic barrier separating the parts of the kitchen under construction. Although concerned, Meléndez said he decided to keep the restaurant open since only 0.04 percent of his customers were reporting an illness. And when Café Mundo finally did close, Meléndez said it was his decision after he invited a health administrator to investigate the problems.

The owner also cast doubt that his clients were actually sickened by food poisoning, adding that doctors told him there’s been a stomach flu epidemic in the country.