How can Alberta prevent future E. coli outbreaks? Politicians promise answers as experts weigh in

As the magnitude of a Calgary daycare-related E. coli outbreak becomes clear, questions are being raised about what went wrong, calls are emerging for increased food safety surveillance and the Alberta government is vowing to get to the bottom of it.

A total of 329 cases of shiga toxin-producing E. coli have been linked to the outbreak. While hospitalizations are now declining, 33 people have been hospitalized since the outbreak began in early September, including 32 children and one adult.

Young children, specifically those under the age of five, are particularly vulnerable to this type of E.coli.

More than twenty kids have been diagnosed with a severe kidney complication, known as hemolytic uremic syndrome (HUS) since the outbreak was first declared.

As of Thursday, six children remain on dialysis.

Alberta Health Services believes the outbreak is linked to food prepared at a central kitchen and distributed to a number of daycares that share the facility.

But the investigation has yet to pinpoint an exact source.

"This is really a tragedy in my mind," said Claudia Narvaez, a professor in the department of food and human nutritional sciences at the University of Manitoba. 

"The first thing that came to my mind is…perhaps, because this is a centralized kitchen catering for children, it should be treated with more care in terms of inspections?"

A number of health violations were documented at the kitchen immediately following its closure, including the presence of cockroaches and unsafe food handling practices.

Other violations, cited months earlier, had been resolved according to the health authority.

"I would like to see more inspections and [authorities] to be more stringent when you have a central kitchen that's delivering to so many daycares," said Narvaez.

According to AHS, food facilities are generally inspected annually and sites with violations are visited more often — something that did happen in this case.

Premier, health minister promise action

In an interview on CBC Radio's The Homestretch on Thursday, Alberta Health Minister Adriana LaGrange said she wants to do all she can to prevent something like this from ever happening again.

"This is a very serious situation," LaGrange said. "I want to ensure that we get down to the root cause and get the results of this investigation."

When asked if more frequent inspections are needed for facilities providing food to children, she said finding the source is key.

"It's not just daycares…we have over 2,600 schools, many of which have food programs," LaGrange said.

"And if it requires more investigations— more oversight — then those will be recommendations that we will look at and take very seriously."

And Premier Danielle Smith is not ruling out a public inquiry.

"If there is some deficiency in our regulatory environment, we've got to correct that," Smith said during an interview on CBC's West of Centre podcast on Thursday.

"I'd certainly be open to doing a more thorough investigation once we have some of those answers." 

When asked to clarify her commitment on the idea of a public inquiry, Smith said: "Whichever form it takes, I mean we've got to get to the answers so that we can put the regulatory changes in place, absolutely."

Smith also said she believes more stringent rules are necessary for common kitchens which prepare and distribute food to facilities feeding children.

"What we need to look at is having a common kitchen for 11 facilities and all of the different potential problems that can cause," she said.

"So there will be new regulations around that. I want to make sure that we do a consultation to find out what that should look like."  

Lessons learned

Doctors, who've been scrambling to care for dozens of sick children, also want to know what went wrong.

"This is a very large outbreak of a preventable, contagious disease," said Dr. Jim Kellner, a pediatric infectious diseases specialist at Alberta Children's Hospital.

"Something fell apart here. Something didn't work."

According to Kellner, who is also a professor of pediatrics at the University of Calgary, without an identified source, it's hard to speculate what changes could be made.

He said there is already a lot of knowledge about E. Coli infections and how to prevent them and there are many safety standards governing the span of the food production chain, from farm to table.

"Are we going to learn new lessons from this? Or are we going to be reminded of lessons that we should already have learned about this?" said Kellner, adding there is nothing new or unusual about the strain of E. Coli in this outbreak.

Dr Michael Rieder, a professor of pediatric pharmacology at Western University, said answers may not come right away because these investigations can take time.

It's possible, he said, that the contaminated food was gone by the time inspectors started collecting samples.

"It could be hard to find because you may not be able to track the source which is very frustrating for a lot of people," said Rieder, whose lab looks for ways to identify E. coli in food samples.

He believes this outbreak, which has garnered national attention — for its size and severity — highlights the need to take food safety seriously.

"Public health isn't sexy until it is," Rieder said.

"I think it will help spur the discussion on how much food testing should we do, when should we do it and where should we do it."