As E. coli outbreak wanes, attention turns to response

BERLIN - The battle against Europe's deadly E. coli outbreak descended into cacophony and confusion. Now that the crisis is stabilizing, German officials acknowledge lessons to be learned.

Among the problems: a tangle of federal and regional authorities, chaotic communication and a system for reporting cases that many say is antiquated.

Cases began appearing at the start of May, and the outbreak swelled to crisis level over the next three weeks -- with the German city of Hamburg at the epicenter. It appears to be waning after sickening more than 3,000 people and killing 36.

"We must succeed in speaking with one voice in order to give citizens the necessary information, the necessary transparency," Health Minister Daniel Bahr conceded after officials on Friday finally declared sprouts from a farm in northern Germany to be the culprit.

A case in point: the sprouts were first fingered as a likely cause by regional officials nearly a week earlier, but authorities backtracked when initial tests turned out negative.

All the while, a warning against cucumbers, tomatoes and lettuce, based purely on patient interviews, remained in place, causing major losses for farmers -- especially in Spain.

Hamburg officials for days fingered Spanish cucumbers as the probable source, but tests cleared them.

The European Union's health commissioner at one point warned Germany against issuing more premature conclusions about the origin of contaminated food.

Critics say the outbreak exposed weaknesses in Germany's cherished but sometimes cumbersome federal system, in which -- alongside national institutions -- 16 state governments have their own health authorities, a state of affairs that can result in long, potentially time-consuming, reporting chains.

An editorial in the medical journal Lancet remarked that "co-ordination of the German public health response seems to have been utterly absent" and said that underlined a wider lack of co-ordination in Europe. It said "there is a strong case for a Europe-wide review of national and continental responses to infectious disease outbreaks."

The German press has been scathing.

"A jumble of responsibilities reigns," German daily Sueddeutsche Zeitung commented in an editorial. It noted that the battle involved at least four offices at the federal level, plus the states' health ministries and local health offices.

Some in the governing coalition think critics have a point.

"The cases that we are seeing today are brutal and come on very quickly, and in my opinion this diversity of official structures isn't suited to it," said lawmaker Hans-Michael Goldmann, head of parliament's consumer affairs committee.

The current system, he said, dates back to the crisis a decade ago over the human form of mad cow disease -- an infection that usually takes years to develop.

Goldmann told German radio that three federal authorities -- the disease control centre, the risk assessment and food safety agencies, which report to different ministries -- should now be merged into a single agency focusing on health.

Another problem: a reporting system under which hospitals' notifications of a serious illness still often wind their way to the national disease control centre by conventional post.

Karl Lauterbach, a health policy spokesman for the opposition Social Democrats, called for those notifications in the future to be emailed directly to the centre.

"We will examine in the (parliamentary) health committee how many infections could have been prevented by an obligation to report electronically," Lauterbach told the Bild am Sonntag newspaper.

Bahr, the health minister, conceded that the issue needs addressing "after a phase of calm."

"It's incomprehensible to me, too, that we are still using antiquated means of communication here," he said on ZDF television. Bahr said federal authorities were informed quickly of the infections by officials in Hamburg, but information needs to be exchanged faster in future "to get a nationwide overview quickly."

Paul Hunter, a professor of health protection at the University of East Anglia in England, said the outbreak could have been detected sooner if doctors regularly did lab tests on patients with diarrhea -- a standard practice in Britain.

"The health system in Germany should surely be able to pay for standard lab tests for people with bloody diarrhea," he said. "If they had been testing people earlier in Germany, this outbreak would certainly have been picked up far sooner."

Flemming Scheutz, the head of a World Health Organization collaborating laboratory in Denmark, said many European countries' health ministries "have no understanding" of the need to detect dangerous E. coli in the early stages.

"Once it hits like this, with a virulent strain, the entire diagnostic sector is not prepared for it because the techniques are not in place," he said.

"The outbreak detection is delayed maybe a week, so that means the interviews with the patients go back maybe two weeks instead of one week and how many people remember what they ate two weeks ago?"

German authorities also could have helped themselves by zeroing in on the few dozen cases of people who fell sick abroad after visiting the country, said Norman Noah, a professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine.

"Those people would have been far more likely to remember what they ate and where," he said.

German officials have defended their warning on Spanish cucumbers, saying the vegetables were contaminated with a different strain of E. coli.

But Noah said it should have been clear that was the wrong trail.

"A big clue was that the outbreak was so localized in northern Germany, yet Spanish cucumbers are sold everywhere," he said. "That really did not fit."