Live on Channel 10 news tonight: Effect of media attention on outbreak investigations

1
Live on Channel 10 news tonight Effect of media
attention on outbreak investigations
Media Coverage
On May 7, 2005, a local newspaper published an
article entitled Virus shuts down Mesa
restaurant. The article included the name and
location of the restaurant, that one patron had
died and 26 reported illness, the fact that the
restaurant was closed voluntarily, and the
diagnosis of norovirus for the deceased patron.
The article was picked up by the Associated
Press. Additionally, the MCDPH Public
Information Officer conducted interviews for
Channel 3 and 10 local newscasts to run on the
same evening.
Introduction
When large outbreaks attract media attention,
the impact on outbreak investigators can be
great. This media attention can help in
identifying cases, yet can also increase the
complexity of an investigation. Press releases,
increased case reports, the involvement of the
director and public information officer, and when
chain restaurants are involved, frequent demands
from restaurant corporate headquarters are added
elements.
Statistics
Impact of Media Exposure
Summary of Events
Timeline

• Increased concern among the public about the food
  safety at the implicated restaurant. Increased
  need for public information. Investigators were
  giving information to PIO daily.
• Publicity greatly increased case finding.
• Additional resources had to be devoted to public
  relations as well as to traditional epidemiologic
  activities (i.e. many additional interviews).
• Increased communication between Epi staff and the
  risk management staff for the restaurant.
• Establishing good relationships with corporate RM
  provided many benefits including access to
  information from corporate complaint line and
  data collected during the corporations internal
  investigation.
• Relationship with RM also ensured cooperation of
  local restaurant management, although long term
  effects are uncertain. A follow-up inspection
  less than a month after the investigation
  revealed several violations.
• Requests to complete the investigation report in
  a short time period occurred, particularly
  requested by RM and attorneys working on
  potential law suits by patrons.

On April 21, 2005, the Maricopa County
Department of Public Health (MCDPH) Office of
Epidemiology (Epi) initiated an epidemiologic
investigation at a chain restaurant following two
separate complaints from patrons. Following an
initial site visit by the Maricopa County
Department of Environmental Services (ES), Epi
and ES returned for a follow-up site inspection
and conducted interviews with employees at that
time. On May 7, an article appeared in a local
newspaper stating that the restaurant was closed
and an "older" patron who reported illness after
eating at the restaurant died (exact cause of
death unknown). This article prompted additional
illness complaints to the restaurant's corporate
offices and to MCDPH. When the AP wire and the
local television news picked up the story, the
restaurant's corporate risk management (RM)
department increased its involvement in the
investigation and response. Epidemiologists
worked closely with the facility and RM to
implement an exclusion rule for ill employees and
to deal with frequent requests for information
from the corporate offices throughout the
investigation. The media exposure also required
epidemiologists to work closely with the MCDPH
Public Information Officer (PIO) as well as the
MCDPH Director. At this point, the number of
complainants increased greatly. The total number
of individuals reporting disease tripled (from 33
to 92) within 14 days after the media reports.
Most of these persons had onset dates several
weeks before the news stories appeared, but did
not call the MCDPH until after hearing the
news. Involvement of the media in an outbreak
investigation could potentially cause an increase
in the number of spurious calls. In this
investigation, six reports (6.5) were unrelated
to the current investigation, as determined by
onset dates incompatible with the outbreak.
(However, the percent of spurious calls in
outbreaks not receiving media attention is
unknown.)
Date Action
4/15/05 First exposure and onset of illness related to investigation
4/19/05 First complaint received by ES
4/21-4/26/05 Four additional complaints received by ES
4/21/05 Epi notified of outbreak investigation initiated
4/22/05 First site visit by ES
4/24/05 Death of patron
4/27/05 During interviews, earlier fatality of a restaurant patron discovered. Site visit by Epi and ES. Initial contact by corporate risk management (RM) to ES
4/28/05 Autopsy of decedent prelim results positive for norovirus
4/29/05 Restaurant closes voluntarily for cleaning
5/2/05 Restaurant reopens. Additional Epi staff added for short follow-up interviews with employees
5/3/05 RM sends spreadsheet of ill employees to Epi. Epi identifies point person to communicate with RM
5/4/05 RM calls Epi for update. Last onset of illness related to investigation
5/5/05 Epi calls RM for information and in the process RM requests more information
5/7/05 Article in local newspaper. AP wire picks up story. MCDPH PIO completes interviews with TV stations for later newscasts
5/9/05 RM calls Epi to report influx of calls to 1-800 line after media exposure. Additional Epi staff added to complete interviews, etc.
5/27/05 Data entry complete
6/1/05 Investigation closed
6/22/05 ES follow-up inspection reveals restaurant still in violation of food code
6/23/05 ES follow-up inspection, all violations corrected


Prior to the media exposure on Saturday, May 7,
2005, interviews for all those registering
complaints with Environmental Services and
employees of the restaurant were completed
(n33). Within 14 days after the media reports,
which provided a 1-800 number to submit
complaints, 59 additional interviews were
completed for a total of 92.
Future Recommendations

• Essential to plan for media attention as early as
  possible in an outbreak investigation
• Recognize when investigating an outbreak in a
  chain restaurant that corporate RM will be
  involved and establish a point person early. (Of
  course, this is the case with any corporate chain
  restaurant, regardless of media involvement, but
  involvement may be more intense with media
  exposure.)
• Assigning one point person to communicate with
  the PIO helps both Epi and the PIO and ensures a
  single voice.
• Assume increased case finding and need for
  additional resources.

Although most onsets occurred between April 16
and April 28, most reports were received after
the media exposure.
Jeanette Gibbon, MPH1, Jennifer Stewart, MS1, and
Mare Schumacher, MPH1. (1) Office of Epidemiology
and Data Services, Division of Disease Control,
Maricopa County Department of Public Health, 4041
N Central Ave, Suite 600, Phoenix, AZ 85012