How do consumers find out about an outbreak or a recall? Is information too little or too late? Or can news about a public health concern cause a problem simply because of how it is framed?

Perhaps even in this age of social media and viral videos, we should consider the importance of a newspaper headline. Much discussion on social media related to the news of the day still originates from original reporting in traditional news outlets. Newspaper headlines are still one of the most powerful contributors to readers’ opinions and actions related to public health or consumer behavior. However, as the 2014 media study, The Personal News Cycle by the AP-NORC Center for Public Affairs Research and the American Press Institute found, only about four of 10 Americans surveyed delve deeper into a particular news subject beyond the headlines. Thus, in a non-read article, the headline is the only contributor to such action. As a result, “headlines have become almost like articles in and of themselves,” as was stated in the 2016 Forbes article, 59 Percent Of You Will Share This Article Without Even Reading It by J. DeMers. Additionally, the 2016 study, Social Clicks: What and Who Gets Read on Twitter? from Inria scientists, discussed how news is influenced and how it becomes influential, supporting the idea that public opinion related to politics, and even natural disasters, is influenced by editorial decisions and the source of the information.

If we look at newspaper headlines from the landmark 1993 Jack in the Box E. coli outbreak, a clear pattern can be seen. An analysis of the headlines from articles covering the 1993 outbreak reveal differences in the words used and, thus, the message communicated. I must note that the reporters and investigative journalists at that time faced the same challenges as consumers in that E. coli and outbreaks such as this were a relatively new phenomenon.

I recently presented the above images to state officials in Virginia whose jurisdiction focuses on agriculture and consumer safety. The words in the images represent the key nouns and verbs, while the size of the font indicates the number of times the word appeared in headlines. The word bubble on the left reflects key words found in the headlines from The New York Times, Los Angeles Times, and Washington Post from January to April 1993. While these papers originated a great distance from the actual outbreak, they have long been regarded as leading and influential papers from which other papers derive content.

In contrast, the word bubble on the right reflects key words found in the headlines from papers at or close to the outbreak, including the Seattle Times, the Seattle Post-Intelligencer, and the Bellingham (WA) Herald from January to April 1993. The attendees immediately noticed that the national papers never mentioned E. coli, focused on the names of the companies involved, and, perhaps more concerning, sent messages that focused more on the problem of the product and less on the public health concern. In contrast, they described the local papers’ headlines as focusing on the victims, community, public health, and the true burden of disease. Ultimately, they concluded that the local papers’ headlines seen in 1993 would have impacted consumer opinion and behavior more than those in national papers.

I do not want to fault the national papers for this observation of difference in message. The overall culture change related to food safety since that 1993 outbreak has impacted national news and the words used to describe outbreaks and recalls. Events as recent as the Chipotle outbreaks and the incidents with Romaine lettuce highlight the fact that the media covers these food concerns more and with greater accuracy. Further, industry journals such as Quality Assurance and Food Safety (QA) magazine invest an enormous amount of research and advisory input to their articles.

The impact on the food safety officials in my audience was clear: We, as food safety experts and as consumers, cannot assume that all media sources — print or online, investigative journalism, or social media — convey the same message about a public health concern. The headlines are a key element in communicating critical information that can influence not only consumers’ actions, but also those who work in the food industry.

Where is the document? I know we did the job. How can I prove it without that record? Quality assurance and food safety professionals are becoming overwhelmed with documentation and recordkeeping. “No job is done until the paperwork is finished” is an old axiom. “No job is done until the paperwork can be quickly retrieved” might be a new axiom. The Global Food Safety Initiative (GFSI), Food Safety Modernization Act (FSMA), Hazard Analysis Critical Control Points (HACCP), and other quality assurance and food safety schemes require documentation to prove a job was done and done right. What is a practical solution?

A practical solution is challenging. The internet is awash with information readily available via global fingertips; all from devices connected almost anywhere. The food industry’s documentation and recordkeeping should be similar. Data could be transferred automatically from digital processing, measurement, and tracking equipment into electronic devices connected from almost anywhere, then repurposed into a customized document, with the record readily accessible via our fingertips.

The complexities of compliance with the GFSI, FSMA, HACCP, and other standards and regulations are a challenge for food companies and those in the supply chain. Each food manufacturing facility must be without flaws in their documentation and recordkeeping actions. Each facility must maintain records related to the manufacture, processing, packing, distribution, receipt, holding, and/or importation of their food products. But the four basic rules of documentation have not changed:

1. Do it legibly.
2. Do it now.
3. Do it right.
4. Do the organizing.

Basic questions of who, what, when, where, why, and how also have not changed. This may seem like a lot of documentation but six months later, after hundreds of jobs, you may be asked to bring a specific record to court that is vital to your defense. Words are not enough. Because this record will be subject to examination by attorneys, expert witnesses, judges, and juries, it could be used to prove liability and build jury sympathy for a punitive damage case and settlement. The documents also could become an important tool in securing a fair and reasonable compensation for an injured food consumer.

This information might be important later — which makes it very important now. We are judged by how well we do the documentation and recordkeeping. There may be times when someone covers up their actions, due to undesired consequences. Be alert for these actions. Good documentation, with proper checks, balances, and timely backup, can allow one to defend oneself anytime from anywhere.

Food Attorney Bill Marler stated: “Find a smoking gun by identifying the improper procedure that led to the contamination of the food consumed by your client.” Is your documentation and recordkeeping ready for such examination? Perhaps not. Many manufacturers are failing the HACCP requirement of documentation and recordkeeping (Principle #7).

A solution is within electronic documentation of desktop, laptop, and tablet computers, smart phones, smart watches, smart TVs, smart cameras, smart vehicles, smart drones, etc. But the transition from paper-based documentation to electronic documentation is still underway. Outdated documentation processes make it difficult to improve food safety conditions and properly manage escalating data.

The complexity of managing multiple processing lines with an impressive array of digital measurement devices from multiple manufacturing facilities — while tracking the holding and distribution of food products — is creating a digital technology crossroads. In-line real-time testing provides a means to make timely adjustments assuring process control, but these devices should be directly connected to the documentation program. The rekeying of data is not efficient, and now is not a good time to be inefficient.

Moving into total electronic documentation by linking food manufacturing throughout the supply chain to the farm and throughout the food distribution system to consumption, including testing results from many measurement devices, will have its challenges — and will not be a cure-all.

As Dell Technologies CEO  and  Founder Michael Dell said, “Technology doesn’t solve the world’s problems, people do. We should use technology better to help ourselves.”

Just how well do you know what is happening in your food plant? Are you aware of the actual or potential food contamination issues lurking in the product stream of your process? Are you prepared for what is needed to address such issues? Are your personnel following the procedures necessary to preserve the integrity of your products consistently?

If these thoughts only come to you when FDA or a serious customer inspection occurs, then things need to change. Far too many food plant programs rely on documentation review as a verification of program compliance. Documentation does not give you visual confirmation that the tasks were actually done in conformance with procedures.

As an example, while visiting a facility to develop material for a training program, we checked the testing of the metal detectors on the six production lines. The documentation sheet for this task listed the blanks as non-ferrous 2.0, ferrous 1.5, and stainless 3.0. The line had been running for about six hours when we checked it. All checks were recorded as completed.

We asked the quality assurance technician to run a challenge test for us, and it was done and documented. Unfortunately, it was readily apparent that the tech had taken the wrong test pieces that day and rather than a 3.0 for stainless, they were using a 3.0 non-ferrous test piece. You can imagine the reaction to this discovery since the past six hours of production on six lines was placed on hold to be re-run through a detector properly verified for stainless 3.0. We had to wonder just how many times this had happened before.

Did that contracted sanitation person actually clean the equipment to meet your expectation, or did you rely on them telling you they did on paper? Are critical systems properly disassembled for cleaning each time, or have shortcuts been introduced by personnel? Without someone physically verifying it, how confident should you be in your program?

Some would argue that we have our monthly inspection program, and we check our plant. Really? Are you just as clean after your walk-about inspection as you were when you started, or is there clear evidence on your clothing that you conducted an in-depth inspection of your plant? Were you on the floor looking up under your equipment? Were you up in the overhead? Did you break that drain line under the product tank post cleaning to verify that all the cleaning solution was drained and rinsed properly, or is that drop in the line still full?

These are questions for which answers are not found in the documentation. Food plant inspections are serious business. FDA investigators take it seriously and so should you. Every food plant needs a person who will take a critical look at the facility and search for the issues; a person who has the knowledge about how things should be and uses that as the criteria for the inspection.

These personnel should be recognized by upper management as their eyes and ears in the plant to keep them informed of conditions that may need their attention for changes. Management should empower them to access what is needed when they deem it necessary. If handled properly, it will not be an adversarial position; it will be one that identifies potential risks for product integrity before they can become actual issues and affect the brand.

Most of us food microbiologists are really bacteriologists and feel incapable of working with viruses or parasites. At least I feel that way! For that reason, I’ve tried to avoid having to deal with Cyclospora, but with almost 2,300 domestically acquired, presumably food-related cases last year, it’s worthy of attention. The most concerning issue with Cyclospora is not the nature of illness it causes; while unpleasant, it’s generally not life threatening, and we’re not currently aware of long-term sequalae. The main problem with Cyclospora cayetanensis is that, compared to other foodborne pathogens, we know essentially nothing about it, except that humans are the only host.

A little background: Cyclospora cayetanensis is truly an emerging pathogen, with the first U.S. outbreak associated with Guatemalan raspberries less than 25 years ago. Historically, cases have been associated with foreign travel; however, in recent years, there have been many domestically acquired cases. Until last year, on the rare occasions when a food vehicle could be identified, imported fresh produce was the culprit. Last year represented the first time the pathogen was detected in U.S.-grown produce, and it happened more than once.

Two major outbreaks were identified last year: one associated with romaine lettuce, the other with fresh vegetables. However, illnesses epidemiologically related to these outbreaks accounted for only about a third of the roughly 2,300 cases of domestically acquired illnesses last year. The cause of the other two-thirds is unknown, partly due to our limitations in typing this organism. Fresh Express, a major leafy green processor implicated in one outbreak, assembled a Blue Ribbon panel which has published an interim report and a corresponding fact sheet in an attempt to raise awareness and offer suggestions to address this unusual pathogen.

Doing whole genome sequencing (WGS) on a eukaryote is much more complicated than applying the technique to bacteria. To date, WGS and other typing approaches are still in development. The organism has a complicated life cycle, requiring a week or two outside the host to morph into an infectious form. At this point, researchers debate how to determine if the organism is actually alive and viable, if it is infectious, how long it remains infectious once sporulated, and other basic information.

We are clearly in our infancy in understanding this pathogen. The lack of typing means we cannot distinguish multiple, concurrent outbreaks based on characteristics of the organism. There is a complete reliance on epidemiology to try to discern different outbreaks. Infected individuals begin showing symptoms roughly one week after exposure. Because the illness is not particularly severe (and the organism is not considered to cause a serious adverse health consequence [i.e., SAHCODHA hazard]), people may be unlikely to seek medical attention, delaying the recognition of an outbreak.

Very few researchers study this pathogen, and even fewer are in academia. Most research is being conducted by FDA and CDC, and the Center for Produce Safety, which is largely industry funded, has awarded several research grants to better understand the prevalence of in U.S. waterways.

Because humans are the only known host (so far), the obvious mitigation is preventing contact between human feces and fresh produce. In the absence of more information, the produce industry will continue to implement Good Agricultural Practices, such as handwashing and appropriate servicing of portable toilets. But unlike other organisms transmitted via the fecal-oral route, the one- to two-week life cycle required to become infectious means that direct contact (e.g., lack of handwashing) is unlikely to cause illness. And since Cyclospora is resistant to chemical treatment, who knows how spores may travel through and persist in the environment? This begs the question: Is fresh produce really the only vehicle for cyclosporiasis? The burden of illness won’t decrease until we invest in developing the tools needed to answer some pretty basic questions.