Why romaine is the deadliest lettuce

I was surprised when I went to the produce department of three local grocery stores and couldn’t find lettuce mixes in bags or boxes. 

It should not have been a surprise. I knew that romaine lettuce had been cleared off of store shelves because of an E. coli outbreak. I realized that of course those lettuce mixes have some romaine in them.

I had assumed, though, that heads of romaine were the most dangerous; but in fact, according to an article in the Washington Post, it was the pre-cut lettuce mixes that sickened so many people.

The first illnesses were reported in early October; as of Nov. 20, the Centers for Disease Control had reported 43 people infected with E. coli in 12 states and Canada. 

This is the third time in the past two years that there have been E. coli infections caused by romaine. Which leads one to wonder what the heck is going on with romaine lettuce?

The problem apparently is not that romaine is more susceptible to disease; it’s more that romaine is a very popular lettuce and a lot of lettuce mixes have a lot of romaine in them. If you’re wondering how the disease experts were able to link the E. coli infections specifically to the romaine, I can’t answer that question. 

All I can tell you is that lettuce and other vegetables can be infected with E. coli in several ways and that all of those ways somehow involve the transfer of poop. Sometimes the poop comes from farm machinery; sometimes it comes from water that floods low-lying farm fields; and sometimes it comes from the hands and cutting tools of people who are handling the lettuce.

For that reason, some experts are warning that if you feel inclined to eat romaine, you should avoid the box and bag mixes and buy whole heads that you chop up yourself. 

This sounds easy but perhaps it’s not. For many of us, it’s lovely and easy to open a container of nice clean little lettuce leaves and pour a light dressing on top. Voila: salad. 

Even more challenging: Many of the E. coli infections occurred at restaurants that were serving salads made with lettuce mixes. 

The article in the Washington Post suggested that, even though it’s much easier to have someone else make our salads for us, perhaps it’s time that we mix our greens ourselves, because the fewer hands (and knives and machines) that touch our food, the fewer opportunities for infection. 

Naturally, of course, we are all going to feel a little nervous now about buying lettuce. There doesn’t seem to be a lot of soothing information available for us salad eaters (and just for the record, a majority of the victims of this outbreak were women, who are statistically more likely than men to eat salad). 

On this particular outbreak, you’re being warned not to eat romaine grown in the central coastal region of California. This advice seems to be a little too late; everyone has (presumably) already thrown away any romaine that was linked to the outbreak.

But what about the next one? Not to be a cynic but the best thing I can do, really, is tell you the signs of an E. coli infection.

Here is what the CDC says: The symptoms “vary for each person, but often include severe stomach cramps, diarrhea (often bloody), and vomiting. Some people may have a fever, which usually is not very high (less than 101˚F/38.5˚C). Most people get better within 5 to 7 days. Some infections are very mild, but others are severe or even life-threatening.

“Most people … start feeling sick 3 to 4 days after eating or drinking something that contains the bacteria. However, illnesses can start anywhere from 1 to 10 days after exposure. Contact your healthcare provider if you have diarrhea that lasts for more than 3 days or is accompanied by high fever, blood in the stool, or so much vomiting that you cannot keep liquids down and you pass very little urine.”

This time around, no one has died from an E. coli infection, which is great. It’s possible that’s because no elderly people or young children ate the infected lettuce; they are the two population groups who are at greatest risk for all types of foodborne illnesses. 

In the unhappy event that you are infected, there isn’t much you can do except to drink a lot of liquids. The CDC recommends that you not take antibiotics, because they can cause kidney failure.

If you want more information, go to www.cdc.gov/ecoli/2018/o157h7-11-18/index.html.