In her first interview about an E. coli outbreak at Calgary daycares that spread to more than 300 children, Alberta Premier Danielle Smith said she's directed her government to come up with a proposal to financially help affected families.

Since the outbreak was declared on Sept. 4, prompting the closure of 11 daycares and the common kitchen where the outbreak is believed to have originated, there have been 329 lab-confirmed cases — almost all children. At least 20 have been severely ill with hemolytic uremic syndrome (HUS), although some have since recovered, and six are currently on dialysis.

Speaking to host Kathleen Petty on the CBC's West of Centre podcast Thursday, the premier hinted at the measures her government would take to aid parents and figure out how the outbreak occurred.

Smith was asked if the government was looking at compensation, since many people had to miss work to provide childcare or paid for daycare for the month of September and then shelled out more money to make alternate arrangements. 

"That's the direction I've given to the ministry, is to come forward with a proposal [Friday] and so we'll have a whole suite of things that we'll be proposing," said Smith. 

"There are some families that just simply don't feel comfortable returning their loved ones back to these facilities, so we've got to find another option for them."

LISTEN | Hear the full interview on the CBC's West of Centre podcast as Premier Danielle Smith addresses the E. coli outbreak that's impacted hundreds of Calgary children:

Smith is scheduled to hold a news conference on the issue Friday morning, where she is expected to provide more details about financial assistance and the possibility of new regulations for shared kitchens and food safety.

Her comments came a day after a number of parents who have children that attend the impacted daycares sent an open letter to the premier, where they addressed Smith's lack of public comment in the 10 days since the outbreak was declared and asking about government support.

Until Tuesday, all communication regarding the outbreak had come through Alberta Health Services. On that day, Alberta's chief medical officer of health, Dr. Mark Joffe, and Health Minister Adriana LaGrange took to the podium to answer questions and speak about the outbreak. Alberta Health Services said major health issues, including cockroach infestations, unsafe food handling and previous violations, were found at the common kitchen where the outbreak is believed to have originated.

"You don't, as a politician, want to interfere when the doctors are the ones who need to respond," Smith told CBC's West of Centre in response to a question about the letter.

"We had the doctors come out last week informing people what was happening, making sure that all of the parents knew what to expect."

Public inquiry not out of the question, Smith says

Smith said she's not ruling anything out, including a public inquiry, when it comes to finding out exactly how the outbreak occurred and the emergency unfolded.

"Whichever form it takes," she said. 

"I mean, we've got to get to the answers so that we can put the regulatory changes in place. Absolutely."

In a statement sent Tuesday, the Alberta NDP demanded a full inquiry into the outbreak, saying the families impacted deserve answers and accountability.

"The government needs to be focused on providing high-quality health care to Albertans impacted during this crisis while also delivering real answers on how we got here," Diana Batten, Alberta NDP critic for childcare, child and family services, said in the statement. 

WATCH | Alberta Premier Danielle Smith explains why she didn't speak up earlier about the E. coli outbreak:

Cases rising, hospitalization numbers decreasing

On Thursday morning, in its daily update regarding the E. coli outbreak, Alberta Health Services said that for the second consecutive day, the number of children in hospital with severe illness had declined.

The number of lab-confirmed cases connected to the outbreak has continued to climb, to 329.

However, as of Thursday morning, there were 13 patients receiving care in hospital, all children. Eight children had been discharged since Wednesday and were now recovering at home, AHS said.

In total, 20 patients had been discharged from hospital since the beginning of the outbreak, including 19 children and one adult.

There were still 11 patients confirmed as having hemolytic uremic syndrome (HUS) — six of which were on dialysis. 

Eight patients had recovered from HUS since Wednesday and one patient no longer required dialysis, AHS said.

"While case numbers continue to increase as test results come back from the lab, the number of patients in hospital is falling," AHS said in its statement. 

"Those patients with more severe illness are in stable condition and responding to treatment. Our frontline healthcare teams continue to provide them with the very best care and support possible."

AHS said there had been 22 secondary transmissions, all of which are within households linked to the outbreak.

The centralized kitchen that supplied food to the impacted daycares remains closed until further notice.

A Calgary-based food safety advocate says new methods are needed for health officials to hold restaurants and kitchens to account when they’re found to have critical health violations.

In the wake of a large-scale pediatric E. coli outbreak — which health officials believe is linked to a central kitchen shared between several local daycares — Domenic Pedulla, the president of the Canadian Food Safety Group, says critical health violations don’t even currently carry a fine.

“I think maybe there needs to be fines imposed for critical violations,” he said.

Three such violations were found as health inspectors visited the Fueling Minds kitchen on Sept. 5, a day after the E. coli outbreak was declared and the facility — alongside 11 child-care centres — was ordered closed. The inspection report found evidence of improper food handling and transportation, a cockroach infestation, improperly mixed sanitizing solutions and a “sewer gas smell” in a prep area.

More than 300 people — mostly children under five — have been sickened in the outbreak, with some becoming severely ill.

Pedulla said the results are concerning, but they’ve shone a light on gaps in accountability for food safety across the industry, and governments need to take a look at new methods of deterrence and compliance.

Fines, letter grades among accountability options

Imposing fines for violations is one way to do that. Another would be a mandate for health inspection scores to be posted on the doors of public-facing food service facilities.

Similar letter grade-based methods of accountability are seen in several U.S. cities and a colour-coding system has been in place in Toronto since 2000. Pedulla said such initiatives can “change the attitude” of the industry, as restaurants don’t want to put a bad health inspection result on their door.

“Right now, we have a disclosure system, but you have to go to the website to see it,” he said. “Scores on doors is proven to work.”

Pedulla would also like to see more required training for kitchen staff across the board, noting that Alberta currently only mandates that one worker per shift needs to have a food safety certification.

“We don’t know how many people there have training or not. They haven’t said that,” he said.

“Our advocacy is for certification for everybody. And maybe not as intense, but more often — annually.”

Ultimately, he said, the onus lies on the operator to ensure they serve food that’s safe.

“It’s not up to the health inspector to make sure that the place is clean and they’re cooking properly and following the regulations. The facility, the owners, the managers, the supervisors, all the way down to the cooks and the cleaners — they have a responsibility to make sure that it’s safe. That is 100 per cent on them.”

Cases rise to 329; 13 children remain in hospital

As of Thursday, the outbreak had caused 329 lab-confirmed cases of the bacterial infection. Thirteen children remained hospitalized and 11 had hemolytic uremic syndrome, a complication affecting the blood and kidneys. Six children are being treated for kidney failure with dialysis.

Thursday was the second day in a row that the number of children in hospital with severe illness declined. Twenty patients — 19 children and one adult — have been discharged since the outbreak began.

AHS said patients with more severe illness are in stable condition and responding to treatment. Additionally, there are 22 secondary transmissions, all within households linked to the outbreak.

Dr. Tania Principi, section chief of pediatric emergency medicine at Alberta Children’s Hospital, told media Wednesday afternoon that case numbers may continue to rise as delayed test results come in, but “in terms of sick children and people, we should be at the tail end.”

She said the emergency department is seeing a significant decrease in the number of children presenting with illness.

Lawsuit will move ahead ‘in due course’: lawyer

A local law firm continues work on a proposed class-action lawsuit regarding the outbreak, for which lawyers filed a statement of claim last Friday.

The claim, naming the involved daycares and the shared kitchen, alleges “negligent, unsanitary and unsafe food storage, preparation and handling practices” led to the infections. The allegations have not been tested in court.

“Our firm is actively investigating issues surrounding the claim, including the source of the alleged outbreak and the cause,” said Craig Gillespie, a partner with Cuming and Gillespie Lawyers, adding that a “significant number of the families have reached out and we expect that to continue.”

“While we will be advancing the litigation in due course, the primary focus now is on the kids and families affected and their recovery.”

mrodriguez@postmedia.com

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As the magnitude of a Calgary daycare-related E. coli outbreak becomes clear, questions are being raised about what went wrong, calls are emerging for increased food safety surveillance and the Alberta government is vowing to get to the bottom of it.

A total of 329 cases of shiga toxin-producing E. coli have been linked to the outbreak. While hospitalizations are now declining, 33 people have been hospitalized since the outbreak began in early September, including 32 children and one adult.

Young children, specifically those under the age of five, are particularly vulnerable to this type of E.coli.

More than twenty kids have been diagnosed with a severe kidney complication, known as hemolytic uremic syndrome (HUS) since the outbreak was first declared.

As of Thursday, six children remain on dialysis.

Alberta Health Services believes the outbreak is linked to food prepared at a central kitchen and distributed to a number of daycares that share the facility.

But the investigation has yet to pinpoint an exact source.

"This is really a tragedy in my mind," said Claudia Narvaez, a professor in the department of food and human nutritional sciences at the University of Manitoba. 

"The first thing that came to my mind is…perhaps, because this is a centralized kitchen catering for children, it should be treated with more care in terms of inspections?"

A number of health violations were documented at the kitchen immediately following its closure, including the presence of cockroaches and unsafe food handling practices.

Other violations, cited months earlier, had been resolved according to the health authority.

"I would like to see more inspections and [authorities] to be more stringent when you have a central kitchen that's delivering to so many daycares," said Narvaez.

According to AHS, food facilities are generally inspected annually and sites with violations are visited more often — something that did happen in this case.

Premier, health minister promise action

In an interview on CBC Radio's The Homestretch on Thursday, Alberta Health Minister Adriana LaGrange said she wants to do all she can to prevent something like this from ever happening again.

"This is a very serious situation," LaGrange said. "I want to ensure that we get down to the root cause and get the results of this investigation."

When asked if more frequent inspections are needed for facilities providing food to children, she said finding the source is key.

"It's not just daycares…we have over 2,600 schools, many of which have food programs," LaGrange said.

"And if it requires more investigations— more oversight — then those will be recommendations that we will look at and take very seriously."

And Premier Danielle Smith is not ruling out a public inquiry.

"If there is some deficiency in our regulatory environment, we've got to correct that," Smith said during an interview on CBC's West of Centre podcast on Thursday.

"I'd certainly be open to doing a more thorough investigation once we have some of those answers." 

When asked to clarify her commitment on the idea of a public inquiry, Smith said: "Whichever form it takes, I mean we've got to get to the answers so that we can put the regulatory changes in place, absolutely."

Smith also said she believes more stringent rules are necessary for common kitchens which prepare and distribute food to facilities feeding children.

"What we need to look at is having a common kitchen for 11 facilities and all of the different potential problems that can cause," she said.

"So there will be new regulations around that. I want to make sure that we do a consultation to find out what that should look like."  

Lessons learned

Doctors, who've been scrambling to care for dozens of sick children, also want to know what went wrong.

"This is a very large outbreak of a preventable, contagious disease," said Dr. Jim Kellner, a pediatric infectious diseases specialist at Alberta Children's Hospital.

"Something fell apart here. Something didn't work."

According to Kellner, who is also a professor of pediatrics at the University of Calgary, without an identified source, it's hard to speculate what changes could be made.

He said there is already a lot of knowledge about E. Coli infections and how to prevent them and there are many safety standards governing the span of the food production chain, from farm to table.

"Are we going to learn new lessons from this? Or are we going to be reminded of lessons that we should already have learned about this?" said Kellner, adding there is nothing new or unusual about the strain of E. Coli in this outbreak.

Dr Michael Rieder, a professor of pediatric pharmacology at Western University, said answers may not come right away because these investigations can take time.

It's possible, he said, that the contaminated food was gone by the time inspectors started collecting samples.

"It could be hard to find because you may not be able to track the source which is very frustrating for a lot of people," said Rieder, whose lab looks for ways to identify E. coli in food samples.

He believes this outbreak, which has garnered national attention — for its size and severity — highlights the need to take food safety seriously.

"Public health isn't sexy until it is," Rieder said.

"I think it will help spur the discussion on how much food testing should we do, when should we do it and where should we do it."