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The Executive Briefing - Tuesday, February 14th

What restaurants need to know about the rise in noro


  • COVID deaths were 5x lower after the bivalent booster versus the original monovalent booster. (CIDRAP)
  • For Americans over 65, the pandemic is not over - they make up three of every four COVID deaths. (NY Times)
  • The ACIP, the CDC’s committee that makes vaccine recommendations for the US, met last week and added COVID-19 bivalent vaccines to routine vaccination recommendations for both children and adults going forward. (CDC)
  • A recall was issued for 56,000 rapid tests under the brand name Skippack that were distributed without FDA approval and may not provide accurate results. (CNN)
  • COVID infection increases diabetes risk by 66%. (SF Chronicle)
  • A group of doctors tried early on to warn that COVID was airborne, even as we focused incorrectly on sanitizing surfaces. (CIDRAP)

Public Health News:

  • Noro is on the rise, with nearly one in five lab tests in the midwest coming back positive. (SF Chronicle)
  • Flu activity remains low, but 100 children have died from it so far this year. (CIDRAP)
  • Spain detected an atypical strain of mad cow disease in a cow that did not enter the food chain. (Reuters)
  • Equatorial Guinea has confirmed its first-ever outbreak of Marburg virus, an Ebola-related disease that has killed nine people there. (ABC)
  • ‘Dr. Lisa on the Street’ busts health myths and focuses on being a trusted health source by breaking things down in everyday terms. (NPR)
  • San Diego county is starting a vaccination campaign for unhoused people after a Hepatitis A outbreak there. (San Diego Union Tribune)
  • Another school, this time in Michigan, closed after 115+ students were affected with likely norovirus. (Detroit Free Press)

Mental Health News:

  • The pandemic compounded challenges for those struggling with eating disorders, which rose nationwide. (Baltimore Sun)
  • A new study found that half of kids don’t get the follow-up mental health care they need after an ER visit. (CNN)
  • A new CDC report shows that teen girls in particular are experiencing an “overwhelming wave of violence and trauma.” (NBC)
  • Hamilton College is training peer counselors to support their fellow students, an innovative approach that addresses the growing need and limited number of therapists. (WSJ)

If you or someone you know may be considering suicide, call 988 or message the Crisis Text Line by texting HOME to 741741.

Best Questions:

Why is norovirus on the rise right now?

It’s noro season, and while cases can happen year-round, they’re highest from late fall to early spring. Norovirus is spreading globally right now, with a particularly high rate in the UK, about 66% higher than it usually is at this time of year in a non-pandemic year. In the US, the overall rate isn’t actually any worse than it was this time of year pre-pandemic, but rates have been very low over the past three years because COVID precautions were also preventing the spread of noro. So here, we’re seeing a return to normal levels of norovirus, though cases aren’t consistent across the US, but spread through outbreaks and hotspots. Right now, cases are highest (and still rising) in the midwest.

How do you know if it’s norovirus or food poisoning or some other stomach bug?

Norovirus generally causes repeated diarrhea and vomiting - sometimes at the same time. It can also include fever and stomach pain, but its hallmarks are GI distress. It happens 12-24 hours after exposure and generally lasts one to three days. It can be hard to know just based on symptoms whether you have noro or some other “stomach bug” or foodborne illness without lab testing, which is generally only done if someone is sick enough to go to the emergency room (which with norovirus is rare, and usually for dehydration). If it lasts more than 3 days or has symptoms other than vomiting, diarrhea, fever, headache, and body aches, it may be some other illness.

What can restaurant operators do to prevent noro during this uptick?

Norovirus is responsible for a full 50% of foodborne illness outbreaks, and restaurants are the most common setting for noro outbreaks. According to a Johns Hopkins study, a single norovirus outbreak can cost a casual restaurant $2.2 million, so the stakes are high. First and foremost, make sure employees do NOT work while sick, especially if they have vomiting or diarrhea. Share the symptoms of noro and make sure employees know it’s a big deal if they work sick with GI symptoms. If someone gets sick at work, send them home ASAP and make sure to clean up properly with a body fluid clean-up kit. Do a full cleaning with a noro-approved sanitizer (see the list here and remember that QUAT doesn’t kill noro!). Pay extra attention to bathrooms and their highest touch areas, and step up handwashing and glove use to the next level for a few days. Employees who are sick can return when they’re 48 hours symptom-free for noro.

What should we do if someone gets sick at our restaurant?

If a guest or employee becomes sick, first, make sure they’re safe and then send them home as soon as possible. If they vomited anywhere but the toilet, use a body fluid cleanup kit. Put one person in charge of clean up to reduce the number of people exposed and ensure they wear proper PPE. If you think it could be norovirus, you’ll need to do a full cleaning and sanitizing of the space. Norovirus in particular is incredibly transmissible - a sick person sheds billions of virus particles, but it only takes eighteen to get someone else sick! If someone is sick with noro, they’re likely to be quite ill - this isn’t one isolated vomit or case of diarrhea, but ongoing. Be sure to do a full noro sanitizing protocol if someone got sick with noro-like symptoms in the restaurant, even if it was in the bathroom.

Best Read:

Closing the Toilet Lid Before Flushing is Important - MedPage Today

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Disclaimer: This post is meant for general information and educational purposes only and does not constitute, and is not intended as, any form of medical, legal or regulatory advice or a recommendation or suggestion regarding the same.  No recipient of this information should act or refrain from acting on the basis of this information without first seeking legal advice from counsel in the relevant jurisdiction.