It began slowly, with a trickle of sick patients starting with one case on Sept. 24. By the end of October, 24 people ill. Then by Nov. 10, 40 people in 16 states had been sickened with E. coli, and 28 of them were hospitalized. Five developed kidney failure. (None have died.)
As the number of illnesses grew, public health officials searched for the culprit, and on Nov. 21—11 days after the last reported illness—the U.S. Department of Agriculture's Food Safety and Inspection Service announced they had their answer: lettuce.
Officials at the Maryland Department of Public Health had tested an unopened Ready Pac Bistro Chicken Caesar Salad in an ill person’s home in Maryland. They tested the different components of the salad, and the lettuce tested positive for the strain E. coli O157:H7; using whole genome sequencing, they determined that was the likely source of illness in two other Maryland cases, and the multi-state outbreak.
From there, health officials acted swiftly. On Nov. 21, the company Missa Bay LLC, based in New Jersey, recalled 75,233 pounds of pre-packaged salads because the lettuce may be contaminated with E. coli. USDA officials flagged the health risk as "high," and are urging consumers in 22 states on the East Coast and in the Midwest to discard or return the salads if they are still in their refrigerators. (California is not included in the potentially contaminated shipment of salads.)
The recalled product list released by the USDA includes salad brands Ready Pac, Safeway's Signature Cafe and Walmart's Marketside.
The next day, Friday, Nov. 22, the U.S. Centers for Disease Control and U.S. Food and Drug Administration had traced the lettuce back from the packaged salad products to their source: "Epidemiologic, laboratory and traceback evidence indicates that romaine lettuce from the Salinas, California growing region is a likely source of this outbreak," according to a statement from the FDA.
The FDA followed up with a warning to consumers that goes beyond the scope of yesterday's recall: "Consumers should not eat romaine lettuce harvested from Salinas, California…Consumers ordering salad containing romaine at a restaurant or at a salad bar should ask the staff whether the romaine came from Salinas. If it did, or they do not know, do not eat it."
Similar advisories for distributors and restaurants and retailers follower: If the romaine you have was harvested in Salinas, toss it.
The CDC's message was similar: "Based on new information, CDC is advising that consumers not eat and retailers not sell any romaine lettuce harvested from the Salinas, California growing region."
The FDA is sending inspectors to Salinas Valley fields.
For growers in the Salinas Valley, the advisory by the CDC and FDA might be reminiscent of a 2006 outbreak of E. coli traced to spinach grown and washed and packaged in Salinas Valley, when federal health officials urged people to stop eating fresh spinach.
But even smaller scale outbreaks and warnings can have an impact.
At $733 million in value last year, lettuce is Monterey County's number-one crop in its number-one industry, although leaf lettuce fell in value from 2017 to 2018 by 11 percent due to previous romaine recalls associated with E. coli, according to the Monterey County Agricultural Commissioner's annual crop report.
"Outbreaks of E. Coli infections resulting in food safety alerts from the Centers for Disease Control and Prevention negatively impacted romaine lettuce production," Ag Commissioner Henry Gonzales wrote in his introduction to the annual crop report.
In a statement released Friday afternoon, U.S. Rep. Jimmy Panetta, D-Carmel Valley, spoke out to both the agriculture industry and to consumers.
"Today, I spoke with FDA [Deputy Commissioner for Food Policy and Response Frank Yiannas] about the bacterial contamination outbreak linked to romaine. As the representative of the Salinas Valley, food safety is of the utmost importance to me and my constituents," Panetta said. "I urged Yiannas to work collaboratively and communicatively with industry partners to minimize any health risks to consumers and reduce the loss of safe and healthy crops that are not connected to this outbreak.
"He promised to provide my office with daily updates throughout the investigation. I will continue to work with the FDA, CDC and our producers to ensure that the investigation is completed in a timely manner so that our consumers are safe and our industry is secure in its production of romaine."
The Grower-Shipper Association of Central California, the trade group that represents a number of local lettuce growers, also issued a statement, noting they've retained Dr. David Acheson, a former associate commissioner of food for the FDA and now the leader of food safety consulting firm The Acheson Group, to help prioritize next steps and to work with government health agencies.
"To those who are suffering with this illness and their families and loved ones, we know our apologies aren't enough, as heartfelt as they are," the Association's statement reads. "GSA is committed to keeping you informed about how we advance continuous improvement in food safety for romaine products because that is truly what this is about: making both the big and small changes throughout the supply chain, from farm to fork, each and every day. And, most importantly, keeping the health of consumers in our hearts and minds with every decision we make."