And I apologize for not having anything prepared for the group to follow along with. It was just confirmed on Monday that I was coming here today. At the time I was at a conference in Kananaskis, Alberta, so I wasn't at my office.
Anyway, I was asked to come here to provide comments and our views, from a provincial viewpoint, regarding our communication and how we work with the CFIA. Neither I nor our department was directly involved with the listeriosis outbreak or the investigation of the plant. We certainly were involved in the recall and in helping ensure the product was removed from the shelves.
I'm with the BCCDC, the BC Centre for Disease Control. It's an agency of the Provincial Health Services Authority. My department specifically is food protection services, and our business is to prevent food-borne illness.
I'll just give a short introduction of what we do, just some of the things we do in our department. We provide inspection services to provincially licensed processing plants, such as dairy, meat, fish, etc. We provide technical support to the regional health authorities, in terms of food safety and policy guideline development for the province. Where we start to work with the CFIA, from an outbreak or a recall viewpoint, is that our department participates in and coordinates outbreak investigations. Often there'll be an outbreak before the food is identified. In fact, that's the more usual route.
The other thing we do is liaise between the CFIA and the regional health authorities, the folks on the ground, the public health inspectors in the field.
So when the province works with the CFIA, there are really two areas we work in. I'll just divide them up into non-recall outbreak-related work and then everything else.
On everything else, operational programs, we actually work really well with the CFIA. This is day-to-day work we do. There's overlap, say, with the dairy program. Plants may be federally registered, but they're also provincially licensed, so there's an overlap there. And we work extremely well with our CFIA colleagues in those operational day-to-day operations. As well, even with the folks in Ottawa, we're involved in federal-provincial-territorial committees. Again, we have a very good working relationship.
Now, turning to food recalls and outbreaks, during routine food recalls—these might be allergens or outbreaks where there are no illnesses involved—again, we have a good working relationship, good communication with our CFIA colleagues. Where things seem to go off the rails is during recalls where there are illnesses involved, or potential for illnesses, or potential adverse publicity, or even prior to a recall, when we as a province are doing an illness or outbreak investigation. This is the point, in those kinds of examples, where the CFIA becomes very reluctant to share information openly and freely.
To illustrate why this is important for us, as a province, doing these investigations, I'll just explain quickly what happens during an illness investigation.
Typically, what happens is that a patient is sick and they go to their doctor or to the emergency; they present themselves. The doctor examines them, diagnoses them, suspects that it might be food-borne illness, and may take a stool or blood sample to confirm the illness.
I want to back up a little bit. Almost all outbreaks are first identified in the field by public health officials; they're not identified by lab tests or results of plant inspections. That's not where they're identified. They're identified in the field by identifying these cases. So the people submit stool samples or blood samples, they're tested, and an organism, species, might be identified. If an organism is found, it'll be genetically fingerprinted.
At the same time, after the organism is confirmed, the patient will be interviewed. We'll do a case history on the patient, get a food history, and find out what they ate, because at this point we have no idea what it might be. It's an investigation that really starts in the dark.
Now that, in itself, is problematic, because you're often interviewing people and you have to find out what they ate two weeks ago, three weeks ago, because there's a time delay in lab tests. In fact, for a lot of organisms—what they ate—the symptoms don't present themselves for several days. With listeria monocytogenes, it can be as long as 70 days between the time the person eats the food and begins to present symptoms.
We do the case history, and then what happens is we start to find clusters. All the results from all of these case histories are gathered provincially and we look at them. We start getting clusters, where maybe you'll see a blip in the number of cases of salmonella and they all have the same genetic fingerprint, so you realize there's potentially a connection.
So you go to their food histories. You look at what commonalities there might be. If you're lucky, you find commonalities. If you don't, you have to re-interview the people. At some point, hopefully, you get similar foods that were consumed by the different people.
If it's a food that was produced in a processing plant or if it's an imported food, this is the point at which we would contact the CFIA. It's the point at which we need additional information in order to be able to confirm or identify what food made them sick, because sometimes you might get more than one hit, and it might be that more than one food is related between people.
You want to get information like distribution patterns. Was that food distributed where your patients lived? Was it distributed with a certain lot number or code number? Was it distributed at the time when the person would have been buying the food?
Other information that's useful is information about the processing plant that it might have come from. Are there any test results from that processing plant? Or were the results from the inspection quite poor? This is just additional information that we need as a province and as outbreak investigators in order to be able to identify and confirm a food.
This is the information that the CFIA is often reluctant to give and to share with us. Not sharing that information makes it very difficult for the province to confirm or identify the contaminated foods.
I'm almost done, but I will say that an outbreak investigation is a lot like putting together a puzzle. You start out with just a very few pieces. As you're going along, additional pieces to that puzzle keep getting added. If you don't get all the pieces of the puzzle, it's very hard to finish the puzzle. That's part of the problem that we sometimes have with the CFIA. They are sometimes reluctant to freely and openly share that information we need at the beginning of an outbreak investigation.