Scenario E

Disaster has struck - hard on the heels of the COVID-19 pandemic, another disease outbreak has hit your fair city, Rosmakirk. Residents are outraged and worried. There have already been 36 deaths.

The cause of the outbreak appears to be Listeria monocytogenes. (Please refer to the WHO Listeriosis Fact Sheet for more information about the pathogen.)

Transmission Electron Microscopy (TEM) image of Listeria monocytogenes. Image credit: [CDC](https://phil.cdc.gov/details.aspx?pid=10828)

Figure 1: Transmission Electron Microscopy (TEM) image of Listeria monocytogenes. Image credit: CDC

Each member of your group will play one of the following roles as you attempt to tackle the disease outbreak and save your city:

  1. Provost (head of the city council)
  2. Representative from a national public health org. (Public Health Scotland)
  3. Epidemiologist (on secondment from Public Health Scotland)
  4. Director of the city’s main hospital (Horizon NHS)
  5. City planner/civil servant
  6. Microbiologist (working in one of the NHS Scotland clinical labs)
  7. Public communications expert (past and current sci comm campaigns)
  8. Doctor at a major surgery in Rosmakirk
  9. Epidemiologist from the local university, an expert on L. monocytogenes transmission

You must work together, using the information that has been provided for you in the attached information packets, and decide what action(s) should be taken to control the outbreak currently plaguing your city, Rosmakirk. Your actions should be evidence-based – use the peer-reviewed literature to decide on measures that will stop the pandemic in your scenario.

Your action points may include directives to gather more information (e.g., contact tracing of current cases, microbiological testing of food/water, etc.), or specific directives (e.g. public health measures, non-pharmaceutical interventions, etc.). Use the data/expertise of all group members. Be clear, concise, and specific.

You may choose to include mathematical modeling as part of your decision making (for example, using an epidemic calculator or other models); if you do so, you should provide details of your modelling and predictions when you submit your group’s pro forma.

You should submit 3-5 specific actions to control the pandemic, using the workshop 3 pro forma (also available on MyPlace). Submit this by noon, Friday March 1st, via the submission link on MyPlace.

Information Packet E1

You are the provost of Rosmakirk, elected in 2015.

Photograph of Rosmakirk city centre. Image credit: DALL-E

Figure 2: Photograph of Rosmakirk city centre. Image credit: DALL-E

The current population of Rosmakirk (as of December 2022) is 159685. The demographic data for the city is shown below.

Rosmakirk demographics (Source: Office for National Statistics)Rosmakirk demographics (Source: Office for National Statistics)

Figure 3: Rosmakirk demographics (Source: Office for National Statistics)

You were elected as a member of the popular “Peace and Change” party and made a number of election promises regarding a “Green New Deal” for Rosmakirk.

Voting intention by Rosmakirk residents (Source: YouGov polling)

Figure 4: Voting intention by Rosmakirk residents (Source: YouGov polling)

There are currently 42 elected councillors, representing the 5 main political parties in Rosmakirk as follows:

Political Party Number of Seats
Sovereign Democrat 1
Future First 14
Peace and Change 17
Rational Change 8
Gold 2



The overall budget (expenditures) for the 2022-2023 financial year was £522239901. A summary of expenditures by category for this financial year is shown below.

Public expenditures by category for the 2022-2023 financial year (Source: Rosmakirk City Council)

Figure 5: Public expenditures by category for the 2022-2023 financial year (Source: Rosmakirk City Council)

Your office has recently received a great deal of correspondence regarding the pandemic in Rosmakirk. A representative sample of these e-mails is shown below.

From:
To:
Cc: Subject: This Terrible Pandemic

Dear Provost,

I am devastated to hear about this new pandemic in Rosmakirk. Too many people have already died from COVID and it seems completely cruel to have another pandemic strike our city again so soon.

I wish that your office is going to do something about dreadful state of affairs as soon as possible.

All the best,
Anna

From:
To:
Cc:
Subject: Pandemic Disaster for Businesses

Dear Provost,

This new pandemic in Rosmakirk has the potential to destroy our businesses. I run a coffee shop on the high street and nearly went bankrupt due to COVID.

Businesses must be free to operate, not prosecuted by some nanny state.

I expect that your office is going to do something about tragedy as soon as possible, keeping in mind the economic interests of businesses in our city and the fact that we cannot afford restrictions that cripple our businesses.

Yours truly,
Gordon (Around the Corner, proprietor)

From:
To:
Cc:
Subject: Government Overreach

Dear Provost,

I abhor the idea that you and your office are going to use this new pandemic as yet another excuse for government overreach into citizens’ lives. This last pandemic was just a typical example of what governments do when given a little too much power.

You must not allow the city to suffer through another round of lockdowns, face-masks, and other punitive restrictions that destroy people’s lives.

Yours sincerely,
Alise (a concerned voter)

From:
To:
Cc:
Subject:

Dear Provost,

I have just learned that my my nana’s best friend has passed away due to the new pandemic in Rosmakirk. You cannot begin to imagine the grief that we are feeling.

The family are all devastated by this loss.

I really wish that our government had better learned its lessons from the COVID-19 pandemic and could have prevented this terrible tragedy.

Kind regards,
Kieran

As Provost of Rosmakirk, you are of course familiar with the work of the Standing Committee on Pandemic Preparedness. You are also familiar with:

Information Packet E2

You are a representative from Public Health Scotland, sent to Rosmakirk to help with the Listeria outbreak.

Your briefing packet includes the following documents:

Information Packet E3

You are an epidemiologist working for Public Health Scotland, sent to Rosmakirk to help with the Listeria outbreak.

A team of scientists working together have in a PHS lab have isolated and cultured Listeria (following standard procedures) from a number of patient samples taken during this outbreak; isolated DNA from these cultures; sequenced this DNA using an Illumina MiSeq platform; assembled the short paired-end reads; and compared these assemblies to the extant Listeria genome sequences available in the NCBI databases. The results of these experiments are summarised in the table below.

Patient NCBI accession of closest database match
1 GCA_015583955.1
2 GCA_022215545.1
3 GCA_015583955.1
4 GCA_015444825.1
5 GCA_015583955.1
6 GCA_015444945.1
7 GCA_015444945.1
8 GCA_015444945.1
9 GCA_015444945.1
10 GCA_015444825.1



Your briefing packet also includes the following documents:

  • Public Health Scotland: Annual Summary of Listeria Infections

  • McLAUCHLIN, J et al. “Listeria monocytogenes in Cooked Chicken: Detection of an Outbreak in the United Kingdom (2016 to 2017) and Analysis of L. monocytogenes from Unrelated Monitoring of Foods (2013 to 2017).” Journal of food protection vol. 83,12 (2020): 2041-2052.

  • Burnett, Elton et al. “Whole-Genome Sequencing Reveals Multiple Subpopulations of Dominant and Persistent Lineage I Isolates of Listeria monocytogenes in Two Meat Processing Facilities during 2011-2015.” Microorganisms vol. 10,5 1070. 23 May. 2022, doi:10.3390/microorganisms10051070

  • Félix, Benjamin et al. “A European-wide dataset to uncover adaptive traits of Listeria monocytogenes to diverse ecological niches.” Scientific data vol. 9,1 190. 28 Apr. 2022, doi:10.1038/s41597-022-01278-6

Information Packet E4

You are the director of Rosmakirk’s main hospital, the Horizon NHS, which has 550 beds across 9 different wards and 10 operating theatres.

The Horizon NHS hospital in Rosmakirk. Image credit: [DALL-E

Figure 6: The Horizon NHS hospital in Rosmakirk. Image credit: [DALL-E

The annual operating budget for financial year 2022-2023 was £1.5 million, and average expenditures are shown by category in the figure below.

Hospital expenditures by category for financial year 2022-2023 (Source: NHS Scotland)

Figure 7: Hospital expenditures by category for financial year 2022-2023 (Source: NHS Scotland)

The Horizon NHS has units specialising in coronary care; maternity care; dermatology; gastroenterology; an ear, nose, and throat clinic; an eye clinic; and an orthopedic unit.

There are currently 25 ICU beds (with ventilators) available, an increase from the 14 ICU beds in the Horizon NHS in November 2019. Average ICU bed occupancy before and during the COVID-19 pandemic is in the figure below.

ICU bed occupancy for the Rosmakirk Horizon NHS hospital (Source: NHS Scotland)

Figure 8: ICU bed occupancy for the Rosmakirk Horizon NHS hospital (Source: NHS Scotland)

There are approximately 1.3m admissions to the Horizon NHS hospital annually, the majority of these being to the emergency (A&E) department.

Admissions to the Rosmakirk Horizon NHS hospital by category (Source: NHS Scotland)

Figure 9: Admissions to the Rosmakirk Horizon NHS hospital by category (Source: NHS Scotland)

A&E waiting times have been called “disastrously high” in recent months, both by the press and by tthe hospital ombudsman.

ICU waiting times for the Rosmakirk Horizon NHS hospital (Source: NHS Scotland)

Figure 10: ICU waiting times for the Rosmakirk Horizon NHS hospital (Source: NHS Scotland)

The Horizon NHS has been set a goal of 25% reduction in sepsis mortality (compared to past years)and 50% reduction in the nosocomial transmission of superbugs such as methicillin-resistant Staphylococcus aureus (MRSA), Clostridiodes difficile (C. diff), and Candida auris (C. auris).

Key Performance Indicators (KPIs) related to infectious diseases for the Rosmakirk Horizon NHS hospital (Source: NHS Scotland)

Figure 11: Key Performance Indicators (KPIs) related to infectious diseases for the Rosmakirk Horizon NHS hospital (Source: NHS Scotland)

There are currently 170 patients in the Horizon NHS with confirmed or suspected Listeriosis, with 15 of these patients currently in the ICU.

The hospital follows the guidelines set out in the National Infection Prevention and Control Manual.

As a hospital director, you are familiar with the literature surrounding hospital pandemic preparedness, and regularly read papers such as:

  • Mer, Mervyn et al. “Critical Care Pandemic Preparation: Considerations and Lessons Learned from COVID-19.” Critical care clinics vol. 38,4 (2022): 761-774.

  • Tacconelli, Evelina et al. “Challenges of data sharing in European Covid-19 projects: A learning opportunity for advancing pandemic preparedness and response.” The Lancet regional health. Europe vol. 21 (2022): 100467.

  • Adelaja, I., Sayma, M., Walton, H., McLachlan, G., de Boisanger, J., Bartlett-Pestell, S., Roche, E., Gandhi, V., Wilson, G. J., Brookes, Z., Yeen Fung, C., Macfarlane, H., Navaratnam, A., James, C., Scolding, P., & Sara, H. (2020). A comprehensive hospital agile preparedness (CHAPs) tool for pandemic preparedness, based on the COVID-19 experience. Future healthcare journal, 7(2), 165–168.

Information Packet E5

You are a civil servant working in Rosmakirk, working closely with the provost, city council and various agencies including the NHS, the UK Health Security Agency (UKHSA), and the Scottish Environment Protection Agency (SEPA).

Some of the key Rosmakirk facts and figures at a glance are summarized in the table below.

Community Amenities Details
Schools 8 primary schools, 4 secondary schools, 1 college
Care Homes 2, each with ~30 bed capacity
Restaurants and Cafes 118
Parks and Playgrounds 13
Economic Indicators Details
GDP/capita £43657
Unemployment Rate 4%
Traffic and Transport Details
Traffic fatalities (average/month) 17



Your briefing packet on Listeria includes the following information.

  • Listeria Information and Guidance (Food Standards Scotland)

  • Malley, Thomas J V et al. “Seek and destroy process: Listeria monocytogenes process controls in the ready-to-eat meat and poultry industry.” Journal of food protection vol. 78,2 (2015): 436-45.

  • EFSA Panel on Biological Hazards (BIOHAZ) et al. “The public health risk posed by Listeria monocytogenes in frozen fruit and vegetables including herbs, blanched during processing.” EFSA journal. European Food Safety Authority vol. 18,4 e06092. 20 Apr. 2020, doi:10.2903/j.efsa.2020.6092

  • Okpo, Emmanuel et al. “An outbreak of an unusual strain of Listeria monocytogenes infection in North-East Scotland.” Journal of infection and public health vol. 8,6 (2015): 612-8. doi:10.1016/j.jiph.2015.05.009

Information Packet E6

You are a microbiologist working in the microbiology department at the Greater Rosmakirk Clinical Laboratory. Your laboratory is equipped to handle a range of culture samples (including anaerobic and microaerobic bacteria, as well as viruses), and you routinely process1615 samples monthly.

You are familiar with the culture requirements for growth of Listeria monocytogenes, and the UK SMI for identification of Listeria species.

Listeria monocytogenes colonies on blood agar. Image credit: [CDC](https://phil.cdc.gov/Details.aspx?pid=21009)

Figure 12: Listeria monocytogenes colonies on blood agar. Image credit: CDC

You are also familiar with the literature surrounding Listteria monocytogenes identification, and often read papers such as:

  • Moura, Alexandra et al. “Whole genome-based population biology and epidemiological surveillance of Listeria monocytogenes.” Nature microbiology vol. 2 16185. 10 Oct. 2016, doi:10.1038/nmicrobiol.2016.185

  • Lucchini, R et al. “Molecular typing and genome sequencing allow the identification of persistent Listeria monocytogenes strains and the tracking of the contamination source in food environments.” International journal of food microbiology vol. 386 (2023): 110025. doi:10.1016/j.ijfoodmicro.2022.110025

  • Highmore, Callum J et al. “Viable-but-Nonculturable Listeria monocytogenes and Salmonella enterica Serovar Thompson Induced by Chlorine Stress Remain Infectious.” mBio vol. 9,2 e00540-18. 17 Apr. 2018, doi:10.1128/mBio.00540-18

  • Kalinin, Egor V et al. “Combination of growth conditions and InlB-specific dot-immunoassay for rapid detection of Listeria monocytogenes in raw milk.” Journal of dairy science, S0022-0302(23)00027-9. 27 Jan. 2023, doi:10.3168/jds.2022-21997

Information Packet E7

You are a public communications expert, often employed by the Rosmakirk city council to manage the PR response to different initiatives or crises.

As a public communications expert, you are familiar with the literature surrounding science communication in a pandemic, including papers such as:

  • Matta, G. Science communication as a preventative tool in the COVID19 pandemic. Humanit Soc Sci Commun 7, 159 (2020).

  • Abdool Karim, Salim S. “Public understanding of science: Communicating in the midst of a pandemic.” Public understanding of science (Bristol, England) vol. 31,3 (2022): 282-287.

  • Royan, Regina et al. “Use of Twitter Amplifiers by Medical Professionals to Combat Misinformation During the COVID-19 Pandemic.” Journal of medical Internet research vol. 24,7 e38324. 22 Jul. 2022, doi:10.2196/38324

  • Tait, Margaret E et al. “Serving the public? A content analysis of COVID-19 public service announcements airing from March - December of 2020 in the U.S.” Preventive medicine reports vol. 29 (2022): 101971.

You have assembled the following information/resources for this meeting:

Information Packet E8

You are one of the doctors at the largest surgery in Rosmakirk. In the past fortnight, 68 of your patients have recently presented to the surgery with symptoms consistent with Listeriosis. You have therefore recently been familiarising yourself with the relevant literature:

Information Packet E9

You are an epidemiologist working at the University of Rosmakirk, and have been studying L. monocytogenes transmission dynamics for the past 3 years. As such, you are very familiar with the relevant literature, including papers such as:

  • Gu W, Cui Z, Stroika S, et al. Predicting Food Sources of Listeria monocytogenes Based on Genomic Profiling Using Random Forest Model. Foodborne Pathog Dis. 2023;20(12):579-586. doi:10.1089/fpd.2023.0046

  • Félix B, Capitaine K, Te S, et al. Identification by High-Throughput Real-Time PCR of 30 Major Circulating Listeria monocytogenes Clonal Complexes in Europe. Microbiol Spectr. 2023;11(3):e0395422. doi:10.1128/spectrum.03954-22

  • Brown P, Kucerova Z, Gorski L, et al. Horizontal Gene Transfer and Loss of Serotype-Specific Genes in Listeria monocytogenes Can Lead to Incorrect Serotype Designations with a Commonly-Employed Molecular Serotyping Scheme. Microbiol Spectr. 2023;11(1):e0274522. doi:10.1128/spectrum.02745-22

  • Voronina OL, Ryzhova NN, Aksenova EI, et al. Genetic Diversity of Listeria Detected in the Production Environment of Meat Processing. Mol Gen Microbiol Virol. 2023;38(1):21-28. doi:10.3103/S0891416823010111

  • Lakicevic B, Jankovic V, Pietzka A, Ruppitsch W. Wholegenome sequencing as the gold standard approach for control of Listeria monocytogenes in the food chain. J Food Prot. 2023;86(1):100003. doi:10.1016/j.jfp.2022.10.002

  • Fagerlund A, Idland L, Heir E, et al. Whole-Genome Sequencing Analysis of Listeria monocytogenes from Rural, Urban, and Farm Environments in Norway: Genetic Diversity, Persistence, and Relation to Clinical and Food Isolates. Appl Environ Microbiol. 2022;88(6):e0213621. doi:10.1128/aem.02136-21

  • Hurley D, Luque-Sastre L, Parker CT, et al. Whole-Genome Sequencing-Based Characterization of 100 Listeria monocytogenes Isolates Collected from Food Processing Environments over a Four-Year Period. mSphere. 2019;4(4):e00252-19. Published 2019 Aug 7. doi:10.1128/mSphere.00252-19

  • Orsi RH, Jagadeesan B, Baert L, Wiedmann M. Identification of Closely Related Listeria monocytogenes Isolates with No Apparent Evidence for a Common Source or Location: A Retrospective Whole Genome Sequencing Analysis. J Food Prot. 2021;84(7):1104-1113. doi:10.4315/JFP-20-417

  • Orsi RH, Liao J, Carlin CR, Wiedmann M. Taxonomy, ecology, and relevance to food safety of the genus Listeria with a particular consideration of new Listeria species described between 2010 and 2022. mBio. 2024;15(2):e0093823. doi:10.1128/mbio.00938-23