Inspectors found three critical violations at a central kitchen serving Calgary daycares affected by an E. coli outbreak, Alberta's chief medical officer of health said Tuesday.
The violations stem from a Sept. 5 inspection and relate to food handling, sanitation and pest control, said Dr. Mark Joffe, adding there were also two non-critical violations related to an odour and utensil storage.
There have been 264 lab-confirmed cases of the bacterial infection since the outbreak at 11 daycares was declared on Sept. 4.
"This has been an extraordinary outbreak, both in terms of the numbers and the severity," Joffe told a news conference.
"It is certainly the largest outbreak in Alberta that I'm aware of and it's particularly serious given that it has largely impacted young children who are at most risk of severe outcomes."
Twenty-five patients are in hospital, 22 of whom have hemolytic uremic syndrome, a complication affecting the blood and kidneys. Six patients are on dialysis at Alberta Children's Hospital.
Dr. Tania Principi, section chief of pediatric emergency medicine at Alberta Children's Hospital, said many parents are still worried about the potential for complications.
"We know it's very challenging for all these families," she said. "We've seen a huge influx of patients requiring care and getting tests."
Joffe said the kitchen was almost certainly the source of the infections. He said closing it immediately on Sept. 4 likely prevented the outbreak from being much worse.
The inspection report on the kitchen, released publicly Tuesday, shows solutions used for sanitizing equipment and utensils weren't appropriate or were not maintained at adequate concentrations.
An operator also told the inspector that cold foods were being transported to other locations for 90 minutes or more without temperature control.
"Food must be maintained below 4 C or above 60 C during transport," the report said.
The inspector also found two live adult cockroaches and at least 20 dead ones on sticky pads.
"Significant evidence of a pest infestation was found at this food establishment," said the report.
Previous inspection reports also found violations, including cleanliness and sanitation issues, an expired food handling certificate and inadequate handwashing facilities dating back to July 2021.
"This information, all together, is part of the ongoing investigation," Joffe said.
No one from Fueling Brains has returned a request for comment, but a statement on its website said it's working closely with Alberta Health Services to reopen its facilities safely, including testing and cleaning, as the closure orders are lifted.
Eleven food samples from the central kitchen and eight from daycare sites are being tested to determine the exact source of the outbreak.
Dr. Kirsten Fiest, an epidemiologist whose 18-month-old son attends one of the Fueling Brains daycares that didn't have any E. coli cases, said she and her husband struggled with sending him back on Tuesday.
"We did have to bring our own lunch, which I think made me a little bit more comfortable because I knew that food was coming from home," she said.
Fiest said she's disappointed to hear about the violations at the kitchen.
"How many chances does one organization get to resolve these issues? Should there not be more frequent followups if they are a repeat offender? Should they not be under high scrutiny, especially because they are feeding children?"
She said also wonders why it took the government so long to respond.
"There should have been some acknowledgment about the severity of the problem and what should be done," said Fiest.
"I certainly hope there's an inquiry into this to understand how this could happen. If it happens in one place, it can happen somewhere else."
Asked why the province hadn't addressed the outbreak publicly before Tuesday, Joffe said Alberta Health has received daily reports but "there wasn't urgency to (speak to Albertans and answer questions) until this point."
He later clarified in an email that the issue has been addressed with urgency from the start.
"Our focus has been the affected children and the investigation," the statement said. "The priority was first and foremost getting people looked after and then to provide the public with a fulsome update on the situation."
Provincial ministers also defended the province's response at the news conference.
"I can assure everyone that we are committed to getting to the very bottom of this, and I will do whatever it takes to ensure the health and safety of all children in Alberta," said Health Minister Adriana LaGrange.
Searle Turton, minister of children and family services, added that the government is doing everything it can to support affected families.
"We need to do everything we can to prevent this from ever happening again."
Opposition NDP Leader Rachel Notley said the government needs to explain why a commercial kitchen with a history of repeat offences was not checked for months before the outbreak.
Notley said a public inquiry is needed to determine whether systemic problems with the public health system played a role in the outbreak.
"I believe this tragedy was avoidable," said Notley.
"What these six inspections show was a clear pattern, in fact, of a failure by the people running this place to keep the children they serve safe.
"(And) from what we can tell, inspectors just walked away from this problematic site for almost five months. Why? We need answers on this."
