By Christine Rook
Lansing State Journal
At 8 a.m. on a recent Monday, a piece of paper detailing a weekend call from a woman complaining of possible food poisoning landed on Diane Gorch's desk.
The caller had eaten at two local restaurants and was certain which eatery was to blame for her flulike symptoms.
Gorch, who runs the food safety program for the Ingham County Health Department, didn't buy the caller's assumption. By 8:30 a.m., her staff was on the phone with the woman, taking notes on everything she had eaten for the three previous days.
The culprit, it turned out, was not the restaurant the woman had most recently visited - an assumption so common local scientists call it "last meal bias."
Investigators instead contacted the two restaurants; only one, Bravo Cucina Italiana in Eastwood Towne Center, had received similar complaints of diarrhea and vomiting from other patrons.
"That got our attention," Gorch said.
If that were a television crime drama, now is when the slick theme song and "CSI"-style special effects would kick in. Hollywood investigators get the cool lighting, but it's the Lansing bug busters who solve the local real-life mysteries.
Over the next week and a half, at least 360 Bravo patrons reported falling ill, prompting a voluntary closing of the restaurant and a thorough scrubbing before it reopened.
Investigators had a suspect: norovirus, a nasty little microbe blamed for a January outbreak that left at least 437 people ill after eating at Carrabba's Italian Grill in Delta Township and at least 100 sick in April after visiting a Wendy's in Grand Ledge.
An estimated 23 million U.S. illnesses a year are the result of norovirus, according to the Centers for Disease Control and Prevention. In fact, the bug is believed to cause half of all food poisonings.
Mystery solved in the Bravo case?
Hardly. Investigators wanted to be sure their suspect, norovirus, was guilty. They wanted to know how it got into Bravo, how it was spread and what could have been done to stop it.
County and state investigators put together an team, and within a few hours of hearing about the initial phone call, Gorch and others had interviewed dozens of restaurant goers.
She likened the non-stop process to playing tennis.
"It's like that thing shooting balls at you," she said, "only there are three of them."
Tapping experts
The investigative team drew experts in nursing, restaurant cleanliness, legal issues, administration, computers, public relations and something those Hollywood "CSI" programs never show - secretarial support. When there is work to be done, there is paper to file.
Although every bug-busting team does the same job, every outbreak is different.
"They each have their own personality," said Sharon Walker, a communicable disease nurse who has worked on teams that have tracked outbreaks such as those involving shigella bacteria.
The Bravo calls just kept coming. Among the sick were 52-year-old Meg Hensick of Howell, who had eaten at Bravo the day before Gorch received that initial report.
Hensick was celebrating her daughter's 23rd birthday, a day that now will be remembered for its gift of norovirus.
"We're talking intense pain and stomach cramping," she said.
It only takes 10 viral particles to make a person sick, according to the CDC. Norovirus is a tough bug, able to survive freezing, steaming and the chlorination in most public water systems.
Once inside a person, it inflames the lining of the stomach and intestines, causing cramps, nausea, vomiting, diarrhea, low-grade fever, chills, headache, muscle aches and fatigue.
A person vomits, wipes his mouth and washes his hands only to touch his mouth again and pass the illness to the next victim. There is no vaccine. There are just too many strains, which is why a person can fall ill with norovirus numerous times. Immunity built up during contact with one strain doesn't protect against another.
That is basic stuff to Lansing's science detectives, people such as state microbiologist Virginia Leykam. She speaks a foreign language, using words such as transcriptase and polymerase. It's her job to bust the bugs that make people sick - to catch them at the scene.
In the Bravo case, county investigators sent five stool samples to Leykam and her co-workers.
Tiny molecules
The medium-sized virus was too small to be seen through a standard microscope. An electron microscope wouldn't have offered much help either.
So chemicals were added to free the genetic molecules and make it easier to spot the virus.
And there it was, the gene sequence that confirmed norovirus.
Over the next several days, investigators at the county health department were to crunch the data collected from more than 500 questionnaires. The goal was to track how norovirus moved from patron to patron at the restaurant.
Bug busters call it "shoe-leather epidemiology" because the collection of data involves old-fashioned police-style interviews.
"The whole story could be behind the question you didn't ask," Gorch said, explaining the importance of asking just the right thing.
In the Carrabba's case in January, an employee was found to be sick with norovirus prior to the outbreak. In the Wendy's case, Barry-Eaton District Health Department said at least one employee tested positive for norovirus. Health officials haven't finished their report in the Wendy's case, but they suspect an employee brought the virus to work.
"That's our speculation," said Steve Tackitt, health officer for the Barry-Eaton office.
The public may never know how the norovirus snuck its way into Bravo. That's part of the job, though, knowing you may never know.
"It's a rare investigation that you get all the answers," Gorch said. "There are so many variables."
Contact Christine Rook at 377-1261 or clrook@lsj.com.
