Last Friday morning, Extra Bladet, a Danish Tabloid, broke the story: "Noma: 63 hit by Roskildesyge (Norovirus in Danish)." Norovirus, a highly virulent and contagious virus, causing nausea, vomiting and diarrhea, or gastroenteritis, sickened 63 out of 435 guests over a two-day period in February according to reports by The Danish Veterinary and Food Administration.
For the world's top restaurant, this was not just a case of Noma catching the flu. The story went viral. Food websites such as Eater and Grub Street lapped up the story as soon as it was reported in Danish papers, and soon, all other established media sources, including National Public Radio, AP, UPI, The Huffington Post, ABC News and the LA Times followed suit.
While the Twittersphere was burning through its schadenfreude quota, the actual scientific details about the illness were buried under a pile of snark. Norovirus has been at epidemic levels, causing almost 21 million illnesses each year in the U.S. alone. According to the CDC, there is really no specific treatment and prevention, that is, proper hand and food hygiene, is often the best cure.
The problem is that norovirus is one tough bug. According to a paper in the Journal of Infectious Diseases, "Noroviruses are perhaps the perfect human pathogens... highly contagious, rapidly and prolifically shed, constantly evolving, evoking limited immunity, and only moderately virulent, allowing most of those infected to fully recover, thereby maintaining a large susceptible pool of hosts." In other words, it's a public health nightmare. Carriers often don't know they have it or continue to carry it after they recover, thus passing it on to unsuspecting victims. It can survive at a wide range of temperatures, from below freezing up to 140F, and can survive for nearly two weeks on many surfaces. And it doesn't need a high viral load to do its job: less than 20 viral particles are enough to cause illness. And it just needs one carrier to infect an entire community or institution.
Considering the prevalence, incidence and virulence of norovirus, it seems almost unbelievable that Noma didn't have a previous outbreak of norovirus or have more patrons puking their guts out. What happened at Noma could have happened anywhere and everywhere, as it did in London in 2009 when 240 diners contracted the virus at the three-Michelin-starred restaurant, The Fat Duck and a Chipotle outlet near Kent State University in Ohio in 2008.
But then the question is why didn't Noma have an outbreak earlier or have more guests holding their stomachs? Hygiene is one factor. While the Danish authorities cited hygiene problems, specifically a "lukewarm" hand washing faucet, chefs and waitstaff are given strict instructions to wash hands thoroughly with hot water and soap on a regular basis. Although norovirus has been known to withstand even a dishwasher, frequent hand washing often cuts transmission rates. But one policy that Noma has is critically important: paid sick days. The CDC has found that 89 percent of norovirus outbreaks occur in places were food is prepared and handled on a regular basis: schools, nursing homes, cruise ships and restaurants. As it takes only one infected person to cause an outbreak, keeping quarantine on ill or possibly infected workers is paramount. Noma has a strict illness policy in which any ill worker, from the office to the cleaning staff, is sent immediately home at the slightest sign of illness and is told to stay home for 48 hours after symptoms subside. And they are paid for those days.
Compare this to the United States. According to the CDC, in 2011, 12 percent of restaurant workers reported signs of norovirus. The CDC also reports that 50 percent of norovirus infections can be traced back to food service workers. According to the Institute for Women's Policy Research, 78 percent of hotel and food service workers do not have paid sick leave. Another food service workers advocacy group, ROC (Restaurant Opportunities Center) United estimates 90 percent of food service workers lack paid sick leave. Due to the low wages and the job instability of food service work, many of America's cooks, busboys, and servers can neither afford to stay home due to lost wages nor firing, only encouraging ill workers to come to work and infect their co-workers and patrons. Add the lack of health insurance to the absence of sick days, and you have a recipe for an ongoing epidemic.
But where is the will to change public health and labor policies to prevent such epidemics from happening? Small business owners complain that health insurance and paid sick days are too costly for them. Yet the cost of not giving workers sick days is much greater. According to the Integrated Benefits Institute, $227 billion is wasted due to lost productivity from illness. In an economy that is barely recovering from a recession, these are dollars we cannot afford to squander. According to Cornell University economist Sean Nicholson, for every dollar spent on employee health care, employers can save three dollars in costs.
While Noma tries to repair its unfairly damaged reputation, millions of other food service workers at no-name restaurants are just trying to work through another sick day. Too bad that they don't have Eater or Grub Street gleefully sneering at their misfortune. It might be the only way that their plight and that of millions of others working without sick days will finally be able to serve you and the public better.