FIGURE 1
Rate and Number of Enteric Illness Outbreaks by State, 2009–2019 ( N = 38,395)
667
229
312
681
258
2077
651
1982
187
3017
1833
87
2483
224
1516
697
Rate ( 4 uartiles)
816
2313
764
288
389
514
2399
165
593
<8.3
2203
479
908
619
437
557
2296
1272
566
770
1039
8.3–<15.8
974
835
373
137
184
983
396
399
212
15.8–<23.6
DC (85)
247
1266
165
816
PR (162)
≥23.6
285
Source: Wikswo et al., 2022. Note. DC = District of Columbia; PR = Puerto Rico.
50% of unvaccinated COVID-19 cases. Epide- miologist Ziyad Al-Aly has noted, “The pub- lic does not react very well to saying ‘between 15% and 50%’” (Ledford, 2022).
ited, and 7.2% of the time it was the fourth or an even earlier restaurant. Some misconceptions of foodborne ill- ness on the part of public health profession- als appear to show up in the attention given to foodborne disease in dierent states in the U.S. According to Figure 1 from CDC’s population-based National Outbreak Report- ing System (NORS), the reported number of outbreaks per million population varies widely, with the highest reporting rate being more than 20 times higher than the lowest reporting rate (Wikswo et al., 2022). Wikswo et al. (2022) attribute much of the dierence to the expansion of the surveillance pro- gram to include person-to-person spread in 2009. The public, however, has a role to play in reporting their illnesses, such as seeking medical care and providing a stool specimen, which could lead to more accurate reporting of foodborne illness numbers. Charles Bartleson, then of the Washing- ton State Department of Social and Health Services, reported to the 1986 Conference for Food Protection that possibly because of “untrained or poorly qualified sta” or “lack of concern,” some states report foodborne
outbreaks at 1/200th the rate of other states (Bartleson, 1987). To provide guidance for environmental public health sta, Torok et al. (2022) published recommendations for train- ing on how to detect, investigate, and respond to foodborne illness outbreaks. Misconceptions About COVID-19 It is important to acknowledge that there were people across the world who believed the pandemic was a hoax. An article in Hu Post discussed “what makes COVID-19 pandemic myths so easy to trust, and who is more likely to believe them” (Ries Wexler, 2020). A Busi- ness Insider article proclaimed, “Recent study indicated that nearly one third of Americans believe in a conspiracy theory about the coro- navirus, such as one that claims the outbreak is linked to 5G internet” (Guzewich, 2020). There is some evidence that political division and partisanship in the U.S., combined with social isolation during the pandemic, set the stage for conspiracy theories about COVID- 19 to take root (Allen, 2021). Another popular but baseless theory is that doctors and hospitals were exaggerating deaths due to COVID-19 for profit (Fichera,
Misconceptions
Misconceptions About Foodborne Disease
The most widespread misconception about foodborne disease is reflected in the term “food poisoning,” which many people use. This term leads to the common miscon- ception that the last meal consumed was the one that caused the illness, leading to erroneous conclusions about the incuba- tion period and implicated food. According to FINDER (Foodborne IllNess DEtector in Real time), a project developed by Google and the Harvard T.H. Chan School of Pub- lic Health (Hartman, 2020a; Sadilek et al., 2018), the restaurant most likely to have caused a person’s illness was the one they visited most recently only 62% of the time, and furthermore,19.4% of the time it was the second most recently visited, 11.5% of the time it was the third most recently vis-
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September 2025 • Journal of Environmental Health
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