The "Great Escapes Resort" Can’t Escape Scrutiny After Viral Outbreak
The Norovirus Outbreak
A Six Flags water park and resort complex in up-state New York known as "Great Escapes", is the focus of a large norovirus outbreak. Norovirus is transmitted from infected human carriers to food, water, and environmental surfaces. The US Centers for Disease Control and Prevention recognize norovirus (and related viral strains) as the leading cause of foodborne illness in the US. The gastrointestinal illness is highly communicable and easily spread by hand to hand contact and even through the air. Outbreaks occur in resorts and other facilities when ill persons contaminate the environment, food and water through vomit and feces. Rapid and effective measures well-known to the public health community are needed to stop transmission. Many of these measures are developed by the US Public Health Service. Cruise lines have experienced many norovirus outbreaks and therefor there is much known about the pathogen and how to address it.
Untimely Responses to the Problem
According to the local health department a case of norovirus at the Great Escapes is defined as a person with norovirus symptoms at the resort on or after March 7, 2008. The health department therefore belives the date of March 7 was the beginning of the outbreak, but did not for some unexplained reason begin an investigation for ten days. It is not known to this writer when the operator of the facility was first aware of that employees and patrons were becoming ill. We are also unaware of how or when the health department was officially notified of the problem. The official coordinated response to this outbreak began on March 17, a full 10 days after the outbreak apparently began. By March 21, there were already 200 cases. The number of reported cases eventually reached at least 435 as news of the incident spread.
Rapid tests using sophisticated molecular testing platforms are available to provide confirming results of norovirus infection in 24 hours, yet investigators over 1 week into the investigation still didn’t have a confirming diagnosis from the state lab. The slow state lab results were an unnecessary delay, as approved private labs are available.
Early recognition of this problem is critical. Once it is known that norovirus is in the environment, investigators can implement timely and appropriate sanitation and safety precautions to combat transmission. One example of appropriate response was the closing of the food service. But this only occured after numerous employees of the kitchen reported symptoms of norovirus. The pools, food and lodging facilities are undoubtedly regulated. Delay in the the implementation of this and other preventive measures at this public, regulated facility likely increased the potential for the exposure of large numbers of unsuspecting people to the pathogen over several days. The operator’s delay in recognizing and reporting a large number of ill patrons and staff, the response of the authorities once notified, and the timeliness and effectiveness of prevention measures taken are critical questions.
Four members of a family sickened by the resort have filed a lawsuit. Key issues that must be scrutinized are the delay between the start of the outbreak and notification of the health authorities, the large number of food service staff ill and whether they worked while ill, the basis to close the kitchen, and the basis for management’s decision to allow the rest of the facility to remain open..
Ill patrons have also filed a class action suit against Six Flags Great Escape Lodge and Indoor Waterpark.
A detailed analysis of the cases and their relationships to the food service or other environmental exposures will be key to determining the causes of this large and serious outbreak and whether the operator responded in an effective and timely manner to protect both it’s employees and guests.
Could the large number of cases of illness been reduced if more timely and effective prevention measures were implemented at Great Escapes?
To read more, select the links below.
Health Department official statement
1st article from the Post Star. March 21st, 200 cases reported
2 nd article from the Post Star, March 16th, 435 cases reported
Channel 6 report. Lawsuits filed.
For our manual on Norovirus Contamination and Control send an email to firstname.lastname@example.org
In norovirus outbreaks in lodging facilities the scenario is usually an infected guest experiencing a sudden attack of vomiting in a room or somewhere on the property. If an area of contamination is not properly cleaned and disinfected the virus can easily spread to the rest of the facility. Norovirus is very difficult to inactivate and can remain viable in the environment for extended periods, up to 30 days. Once spread through the facility it will commonly infect both employees and guests. The disease transmission may continue for months.
Although norovirus is not particularly lethal, it ranks in the top 5 killers of persons through contaminated foods. A very serious situation can develop with very young children and older adults as vomiting and diarrhea may go on for days resulting in extreme exhaustion and dehydration. Many deaths are reported in nursing homes and hospitals during outbreaks.
In this particular outbreak, we see a number of difficult problems.
1. Many days into the outbreak the state lab had still not identified the agent in patient stools.
2. Numerous ill food workers
3. The facility remains open despite angry guests and ongoing transmission.
4. Cases reach at least 435, making it one of the largest outbreaks in the last few years ( Las Vegas has had several outbreaks with over 1,000 victims).
5. There appears to be serious delays in addressing the problem.
The wide dissemination of the agent, its ability to resist disinfection, and the large numbers already ill at this resort means a protracted period of mitigation before the transmission stops. The question becomes when to close a facility This is a very tough call when economic and political concerns are factored in to the decision. At some point it may be in the best interest of public health for the facility to close temporarily, but that would likely require be voluntarily. Health Departments don’t like making these types of decisions and unless there is a mortality they will probably not require closure.
But the operator still has a duty to protect his guests and employees and must act in their best interest.