In Hamburg's Eppendorf Clinic, three haggard-looking teams of medical staff are struggling to discover the causes of – and solutions to – Germany's biggest postwar epidemic, writes DEREK SCALLYin Berlin
THE COMMON garden salad contains few calories but tens of millions of bacteria. Perhaps you ate such a salad recently, during a meal where the lively banter, rather than the food, was the focus. A salad like that has come back to haunt trade-union officials who attended a three-day seminar in the northern city of Lübeck early last month. Something they ate, most likely a salad, contained a new “supertoxic” strain of the E.coli bacteria.
Two weeks ago the first texts about sickness began to circulate among the 34 officials who had attended the seminar. Soon, vague headlines about mysterious stomach cramps in northern Germany turned into a real health crisis. By this week, eight of the 34 had been hospitalised with E.coli infection; of these, four have contracted the serious haemolytic uraemic syndrome and are battling kidney failure. One woman in the group has just died, one of the 17-and-counting victims of what doctors grimly admit is postwar Germany’s worst epidemic.
With 25 new admissions daily, Germany’s E.coli ground zero is Hamburg University’s Eppendorf Clinic, a modern building in the north of the city. Three teams of medical staff are at work there, the first of them treating the symptoms of infection, including kidney failure, epileptic fits and other signs that a patient’s nervous system is under attack.
“We are worried because we had hoped the number of cases would decrease in recent days, something that, sadly, has not happened,” says Prof Jörg Debatin, medical director of the clinic. “This leads us to presume that the source of the infection is still active.”
The second, more haggard-looking team comprises half a dozen doctors working day and night analysing the structure of the bacteria. Thursday’s good news that they had identified the bacteria was followed by the bad: the adversary is a new and unknown supertoxic bacterial mutation that is resistant to antibiotics.
In private, staff at the Eppendorf Clinic admit to a growing feeling of helplessness. The only known treatment so far is an experimental procedure that costs up to €100,000 a time and has delivered only mixed results.
The clinic’s third team is drawn from the Robert Koch Institute, the federal agency for disease prevention and control. For days, researchers have padded up and down hospital corridors with questionnaires. Patients well enough to talk are asked about everything they ate in May. It’s a difficult business to recall a month’s meals but, given E.coli’s two-week incubation period, the time-consuming investigation is vital. All the information gleaned is fed into a central system in Berlin, where the detective work begins.
“As soon as we have an indication about a particular food that seems to be a clue, we pass it on to the authorities,” says Dr Gérard Krause of the institute.
Earlier this week it was one of these clues that led investigators to Spanish cucumbers and the first apparent breakthrough. Two days after shelves around Europe were emptied of Spanish produce, officials realised that the E.coli strain behind the epidemic was different from that found on the cucumbers.
An ugly diplomatic spat resulted between Berlin, Madrid and angry Spanish farmers. Meanwhile, the prospect of a wider trade war with Russia is looming, after EU vegetable imports were banned there.
In northern Germany, so far the epicentre of the epidemic, market sellers and restaurant owners report a noticeable drop in vegetable consumption.
“Restaurant customers are asking more questions about where the vegetables are from,” says Stefanie Heckel of the gastronomy lobby group Dehoga. “Many kindergartens and hospitals aren’t offering raw vegetables any more, and salad bars have vanished from many workplace canteens.”
And what of ordinary Germans? Despite a reputation for being calm, sober people, Germans have a record of emotional reactions to threats, real and imagined. Claims in 1981 that acid rain would kill the country’s forests within five years prompted huge public protests. When, in 1986, the forests had not yet died, the German angst express had already moved on, firstly to fears about rearmament, then to the consequences of the Chernobyl radiation leak.
But the succession of health scares in the past decade – BSE, dioxins, swine flu, bird flu and Sars – has left even Germans emotionally exhausted. Experts suggest this is why the first weeks of the E.coli outbreak were marked by a boy-who-cried-wolf reflex.
“The first reaction was that this was just going to be like the others: huge hype but relatively harmless,” says Prof Ortwin Renn, a sociologist and risk analyst at Stuttgart University.
With reports that the bacterium is a mutation from an unknown source, with no known treatment, ordinary Germans feel torn about how to react. “There’s this tension between urban paranoia and sensible concern, particularly when something like this is happening around you,” says Michael Schmidt, an executive from Hamburg. “Neighbours of mine have a son, a doctor in a hospital here, who has taken his child out of kindergarten. None of them are the paranoid type, so it makes you think.”
Risk analysts suggest that this continued calm among ordinary Germans is a worrying telltale sign. “If something happens far away some people like to allow themselves the luxury of abstract panic, like buying iodine tablets after Fukushima,” says Renn. “But people universally react more soberly when the risk is perceived as more real and present.”
E.coli The long-term damage
There’s nothing new about E.coli bacteria – millions of them lurk in the digestive tracts of humans and animals. The problems begin when E.coli bacteria from cattle and sheep contaminate the human food chain. Some 800 cases of regular E.coli sickness are reported every year in Germany, with about one in 10 turning more serious.
The current outbreak in Germany has so far infected 1,733 people. It involves a more virulent mutant form of the bacterium, which has caused life-threatening illness in every fourth case of infection. The bacterium latches on to the intestinal wall and produces toxins that cause bloody diarrhoea and, later, haemolytic uraemic syndrome and kidney failure. The consequences can be fatal, but, even for survivors, the long-term consequences are grave. Patients with damaged kidneys need transplants, and damage done to the nervous system may never be reversed.
German toddlers Anne and Maja fell victim to a serious E.coli infection last year. After suffering from bloody diarrhoea and falling into a coma for 10 days, one can no longer walk or talk; the other is blind. The two children are in rehabilitation but will never return to full health.
The World Health Organisation says that 12 other European nations have reported a total of 80 people sick in the current outbreak, most of whom recently visited northern Germany. Until the source of the infection has been identified, health authorities have warned against eating raw vegetables in northern Germany. The bacterial infection is highly infectious, and the best method of prevention is to observe good hygiene, washing hands after toilet visits and before and after cooking.
