On July 24, the CDC issued a report about a growing outbreak of Salmonella poisoning in nearly two dozen states. The report read, in part, “[A Salmonella outbreak] is rapidly growing in size. A specific food item, grocery store, or restaurant chain has not been identified as the source of infections. If you have symptoms of a Salmonella infection, report your illness to your local health department and talk to a healthcare provider. If you receive a call from your health department, please answer their questions about your illness and the foods you ate before you got sick. This information is vital for public health officials to identify the source of this outbreak and to take steps to prevent additional illnesses. In all, it has been reported that 212 cases of Salmonella in 23 different states, including 31 hospitalizations. The current case count includes a spike of 87 additional cases that were reported between July 21, 2020, and July 24, 2020. No deaths have been reported."
To date, the CDC has not made any recommendations nor can they trace the source of this outbreak (note: outbreak has been identified, see below), but this reminds us of something that needs to be discussed, and before we go any further, this is not meant to panic any seniors, but to bring information to them about avoiding salmonella from a common source that many of us, not just older adults, may not be aware of. But this information is especially important for our elder population.
And why, you may ask? Because as the CDC points out, it is seniors and children under 5 who are most vulnerable to the deadly effects of salmonella. We are going to go back to an incident that we become aware of a few years ago involving a recently retired couple who took a summer trip seeking peace and solitude while contemplating their next step in the journey of retirement.
Joann and her husband, Stan, had just returned from the local supermarket and began unloading their groceries in anticipation of a wonderful weekend vacation at a rental summer cottage along Narragansett Bay. For the couple, this was their first time away from the family home since they both retired the previous fall.
Joann emptied her reusable bags, which she stored in her car for her shopping trips to the local market. As she pulled out the lettuce and tomatoes, Stan popped on his chef’s apron and put together a quick salad to go along with the burgers he was readying to put on the grill.
As daylight waned and the moon rose over the water, they sat outside enjoying their meal and voiced just how wonderful it was to get away without the pressure of needing to return to work as a new week came around. Retirement wasn't so bad after all, they thought.
“We worked a long time just for this”, Stan said to Joann as both sat quietly on the porch, relaxing with a wine cooler and music playing in the background. In just a few hours, however, things would take a turn for the worse.
As they prepared for bed, both began to experience serious stomach cramps along with diarrhea and vomiting, and it didn't seem to stop. The ride home seemed like a cross-country drive. After two days of being ill, Stan, who suffered from heart disease, began to feel chest pains. The vomiting and lack of appetite along with his inability to keep liquids down turned what they thought was a stomach bug into a life and death struggle as he developed a severe case of dehydration. He was rushed to the hospital where he spent several days. Although he did fully recover, the couple’s first post-retirement getaway was far from the idyllic time they had hoped for.
So, just what was the cause of this weekend from hell that Joann and Stan experienced?
Joann speculated that perhaps the lettuce had carried salmonella while Stan felt that the ground beef had stayed in the hot car a bit too long. But, the answer did not lie in the mishandling of the meat or even in the fresh lettuce. Instead, the culprit was bacteria growing in the reusable bags in which she carried the groceries, a problem that was brewing for some time.
In the couple’s hometown, the city council had decided months before that in order to be environmentally friendly, they would ban the local merchants from using plastic bags forcing many residents to turn to reusable bags. Although reusable bags have many advantages, there is a very real, and perhaps deadly, disadvantage if they are not cared for properly. This is especially true during the summer months – and the summer of 2020 has been especially hot and humid.
With COVID-19 spreading through the country, many stores have stopped using plastic bags and advise the use of reusable bags, but medical researchers report that if reusable bags are not washed thoroughly on a regular basis (just like our hands with the coronavirus), there will be a buildup of bacteria, yeast, mold, and coliforms that could result in a health hazard.
In a study done a few years ago by Canadian researcher Dr. Richard Summerbell in Toronto, he collected 49 “used” reusable bags to test for any potential viral health hazards they may have contained and if they could be a source of disease transmission.
What he found was startling.
64% had levels of bacteria
30% had elevated bacteria counts
24% indicated a presence of mold
20% were positive for the presence of yeast
12% had dangerous levels of coliform
The study concluded that reusable bags are an “active microbial habitat and a breeding ground for bacteria, yeast, and coliforms”. The study also concluded that the presence of yeast and mold was a major concern for those with compromised immune systems, such as the elderly or those with HIV or undergoing cancer treatments. In this study, it was also concluded that even washing these bags may not be effective the more they are used and that they should be replaced on a regular basis.
Most of us are aware of the fact that foodborne illnesses sicken many people throughout the year and especially during the summer, but the sheer numbers are indeed surprising. The Centers for Disease Control (CDC) estimates that each year, 1 out of 6 Americans (48 million people) get sick from these foodborne illnesses. Of this group, 128,000 ends up in the hospital, and some 3000 will die with the elder population appearing to be at most risk for hospitalization and death.
Now, you may be asking, just how do these researchers know that reusable bags are responsible for this? After all, it could be poor hygiene habits or improper storage of food that could be the problem. And that is a perfectly reasonable question, however, there is also research to back up these claims.
San Francisco was the first major jurisdiction to enact a ban on plastic bags about a decade and a half ago. After medical professionals reported an increase in the number of individuals with bacterial illnesses related to food showing up in emergency rooms, a study was done and a report was issued entitled “Grocery Bag Bans and Foodborne Illness”.
In this study, the authors found that foodborne related illnesses that resulted in death increased by a whopping 46 percent after the plastic bag ban was put into place. In addition, the numbers from emergency rooms in the area showed an increase of 34% where E. Coli was identified as being responsible for the illness.
The authors further stated that the true correlation between the banning of plastic bags and foodborne illness cannot be fully known because many people suffer these illnesses without seeking medical treatment. They also wrote that similar increases in these illnesses have been seen in other areas where the plastic bag ban is in effect.
Although death among the elderly from foodborne illness is not a regular occurrence, fatalities do occur at higher rates than among these groups in this country and there can be other lasting effects of such diseases.
In a published article entitled, “The Long-Term Health Outcomes of Selected Foodborne Pathogens”, the author discussed the potential lifelong complications of some foodborne illnesses, especially in the senior population. These complications included kidney failure, paralysis, seizures, hearing/visual impairments, and brain damage.
Before we dismiss foodborne illnesses as a major problem in our population, there is a number that we must keep in mind – nearly 20 percent of our citizens are at a higher risk for contracting these diseases and as our nation ages, so do the risks and the numbers of those who could potentially be affected. We are seeing this, unfortunately, with the current pandemic numbers.
So could the most recent cases of salmonella be linked to reusable bags being stored after use without cleaning? That would just be speculation, but this outbreak does give us a reason to highlight the importance of taking care of these bags so to avoid any illnesses. Just like we are being reminded to wash our hands, similar reminders must also be made about washing reusable bags. And like the face masks, we are using and need to replace on a regular basis, we need to also remember that reusable bags have a life expectancy as well. And, the steps to stay safe are mostly common sense and easy to accomplish. Here they are:
Use separate, leak-proof, easily washable bags for meat/poultry/seafood and for fruit and vegetables - retailers can still provide small plastic bags for these higher-risk products which are recyclable at major supermarkets;
Regularly check your reusable bags and replace if soiled or can't be cleaned;
When purchasing your reusable bags, make sure you get a cooler bag to keep your refrigerated and frozen food at a safe temperature on the way home and, you may need to add ice bricks on warmer days;
Choose a clean handbasket or cart for your shopping (because of coronavirus, most supermarkets have disinfectant towels available at the entrance of the store);
Never put fresh fruit and vegetables that won't be peeled or cooked before eating directly into the cart; put them in a clean bag;
Plan to do your food shopping last and take it straight home so perishable food doesn't warm to temperatures in the danger zone where bacteria can grow (41 to 140 degrees);
Don't leave your groceries in a hot car (recent studies say that during a hot summer day and in direct sunlight, the inside of a car can reach temperatures of 130 to 170 degrees);
When home, pack chilled and frozen products into your refrigerator or freezer immediately;
It's best not to store your reusable shopping bags in your car where they can get hot or can come into contact with pets or dirty items such as sporting equipment and shoes. If you do keep them in the car, zip them into a cooler bag to keep them clean.
Attorney Connelly points out that as more seniors are becoming more environmentally conscious and staying home with the help of home health aides they should be educated about the use of these bags.
"It's important that we think about our environment and factually, salmonella poisoning is a rare occurrence. But as our current battle with COVID-19 shows, some very simple things like washing our hands and social distancing can provide a level of safety for those most vulnerable to the virus. So there are some simple things we can do to prevent foodborne illnesses from occurring," stated Connelly.
“One thing we know," Connelly continued, "seniors are extraordinarily susceptible to a multitude of illnesses due to the deterioration of the immune system as we age. The best way to deal with the problem of foodborne illnesses among the elderly is to educate them on a regular basis about proper food handling to prevent such an illness from occurring rather than trying to treat it after the fact."
“Home healthcare providers should provide training for their clients on the subject of food safety as part of their overall service plan. This should include the proper handling and cleaning of reusable bags”.
Seniors who choose to use reusable shopping bags should wash and/or sanitize their bags on a regular basis to preclude bacteria buildup and possible illness from foodborne pathogens and to prevent viral disease transmission. In the event that reusable bags cannot be sanitized, sanitary plastic or paper bags should be used instead. If these bags are not available free of charge, the senior should supply their own sanitary plastic or paper bags.
Finally, there is a new generation of reusable bags that are resistant to bacteria and viral infections and can provide an added level of safety. If buying reusable bags, check and see if these materials are available. They do not cost much more and the peace of mind it can provide is worth the extra pennies.
Update: (July 31, 2020) The CDC has linked that current Salmonella outbreak to red onions. Do not eat, serve, or sell any onions from Thomson International Inc. or products made with these onions. Onion types include red, white, yellow, and sweet varieties. They have made the following recommendations:
Check your refrigerator and kitchen for any of these onions or fresh foods made with them;
Check the package or look for a sticker on an onion to see if it is from Thomson International, Inc. If it is, don’t eat it. Throw it away;
If you can’t tell where your onions are from, don’t eat them. Throw them away;
If you made any foods with onions and you don’t know where they are from, do not eat them. Throw them away, even if no one got sick;
Wash and sanitize any surfaces that may have come in contact with onions or their packagings, such as countertops, refrigerator drawers, reusable bags, knives, and cutting boards.