Hepatitis highway

Why is there hepatitis hysteria and a syphilis scare along I-95 in North Carolina?


Geoff Edgers
August 26, 1999 8:00PM (UTC)

Any health-department wonk worth his tongue depressor knows there's more than a fine line between a genuine outbreak and a needless freak-out. But give hepatitis, the common and misunderstood liver disease, some credit: As a fecal-oral virus, hepatitis is as nasty as it sounds. Dr. Samuel Katz of Duke University's Medical Center, explains why the hepatitis bug causes particular panic in the restaurant world: "It's a problem if people wipe their bottoms after going to the bathroom and don't wash their hands carefully," he says.

What he doesn't say is what can happen next: that what ends up on the careless wiper's hands could somehow get into your mashed potatoes. Unpleasant? Yes. A reasonable fear? I don't know.

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I'd never really thought about these sorts of things until a nearby restaurant became the not-so-proud host of the country's most recent hepatitis hysteria. And, to be fair, I didn't really have reason to. Never mind that hepatitis A -- which showed up two weeks ago in the blood of a waiter at the Texas Steakhouse & Saloon in Smithfield, N.C. -- is a strain that, despite a host of unpleasant symptoms (nausea, jaundice, diarrhea), rarely if ever turns fatal. There's also a pretty low risk of restaurant transmission. Over the last seven years, 54 North Carolina restaurants have reported an infected employee; not a single diner got the bug.

But hepatitis never sounds good on a menu. And looking at the Smithfield case, it was startling to see how quickly word of the scare spread, in large part because of the government's attitude toward the virus.

Part of it I understand. We all have our quirky hysterias. A friend of mine is so germphobic she won't turn doorknobs and is prone to pre-lunch disappearances in search of a bathroom sink in which to wash her hands. Another friend used to massage in generous gobs of a hand disinfectant -- "KILLS 99.9 % OF GERMS," the label read -- until she heard that such practices might lead to stronger, cream-resistant monster germs. I have issues, too, demonstrated particularly by the fact that I have never, not in my 28 years, knowingly sat on a toilet seat I did not either own or rent. And when I wash my hands in a public restroom I'm inevitably faced with a crisis: Turn off the water and thereby reinfect myself on the faucet or leave it running and commit one of the top three environmental sins?

Here's how the hysteria went down in Smithfield: On Aug. 9, a gentleman walked into the emergency room at Johnston Memorial Hospital. It didn't take a doctor to tell that his skin was yeller, as they say down here, a pretty sure sign of jaundice. The fellow said he'd been working as a waiter at the nearby Texas Steakhouse. Badaboom. Just like that, the wheels started turning in a process that would leave many North Carolinians in the rare position of actually thinking about their livers.

Take note: This is a state that ignored its hog factories until their waste lagoons overflowed into rivers, leaving schools of dead, lesion-covered fish behind.

So now we're worried that some punk waiter didn't wipe his ass right?

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As soon as the waiter's tests came in positive for hepatitis A, the state ordered Johnston County health officials to mobilize. They were to inject antibodies -- which can be given up to two weeks after exposure -- not just into the folks this waiter served, but into anybody who had passed through during his five most recent shifts. That's a serious number, since the steakhouse is just off I-95.

The point is, the flow of I-95 traffice into the steakhouse meant that by county Health Director L.S. Woodall's count, as many as 2,970 people could have been under the same roof as the infected waiter.

Woodall speaks in that special, Southern way that tells you he doesn't want to come right out and say he's angry, but he wants to make it clear these gamma globulin lines weren't his idea. "If I had the force of making the decision, I think I probably would have said, 'Let's see who this man served and find those folks,'" says Woodall. "The chances of a waiter passing the virus on to somebody else is pretty slim, though it's not impossible."

Of course, the county follows orders. So Woodall's office got the word out, contacting local TV, radio and newspaper outlets. It didn't take much, just the word "hepatitis." The response was so strong that on Aug. 13, when the Johnston County Public Health Department opened to deliver shots, the nurses had to ask people in line to return the next day.

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"I'll feel better now that I've got the shot," Patricia Williams, 27, told the Raleigh News & Observer. "I'll sleep easier."

I, on the other hand, wanted to take a closer look. I'd tried, and failed, to get a comment from an actual steakhouse employee the previous week. All I had was a quote in the local paper in which a higher-up described the situation as "very unfortunate." I had also failed to persuade anyone to head to Smithfield with me. My friends and loved ones seemed reluctant, no matter how many times I explained the principle of a fecal-oral disease.

"That's just what I need," said Carlene, who will become my wife on Sunday. "Hepatitis for our wedding."

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So I headed alone to Smithfield, home of the world's only Ava Gardner museum.

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The Texas Steakhouse & Saloon is pretty much your average McGap dining experience. Think Applebees or T.G.I.F.'s, except with mounted deer heads, plastic cacti and soft, commercial Nashville beats.

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It was two weeks after the infected waiter's last shift, and business, despite a few whiny quotes to the contrary in the local paper, seemed to be booming. I had to wait a good 10 minutes for a table. The parking lot was packed with cars from Virginia, South Carolina and New York. Some health scare. While waiting for my table, I headed to the men's room first. This is where, according to Health Director Woodall, there should be "a great big sign, requiring the workers to use soap and a nice towel." No dice. The chamber was nicely decorated, with Budweiser bikini-girl posters on the walls and a USA Today politely taped above the urinals. (Nothing like staring at George W.'s mug while taking a leak.) Nowhere did I find a reminder to employees to wash up after they're done.

Back at the table, I wanted to pretend I wasn't a reporter, to experience this like a regular guy. I wanted them to think I was a lonesome wanderer passing through on his way to South Carolina or a grad student a few days late for the fall semester, even a trucker looking for some grub before heading off to one of the countless roadside "clubs" with names like Dockside Dolls.

(I might mention to anyone thinking of getting some rest-stop nookie that North Carolina's rural counties bordering I-95 are notoriously riddled with syphilis. From 1985 to 1994, they had 38 cases per 100,000 people, compared to a national average of 3.2, according to the Centers for Disease Control.)

I certainly felt out of place. The Texas Steakhouse is a place for families on the way to Orlando, Jacksonville or some other American hell. They eat fried appetizers and drippy, barbecued-chicken sandwiches. They don't think a bit about their livers. At least that's what I determined when I asked the first two groups of minivan visitors. One man, wearing a Redman chewing tobacco hat and emerging from a truck with Virginia plates, just grunted when I mentioned the word virus. He shuffled into the steakhouse with his girlfriend.

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After that, I pretty much gave up on parking-lot interviews. Why alarm the public and ruin a perfectly average lunch?

Inside, my waitress Beth proved utterly agreeable. She refilled my Coke without my asking. At one point, she tapped me on the left shoulder and asked, "You doin' all right, sir?" I couldn't think of how to ask her. Did she wash her hands regularly? Did she worry more after the incident with the infected waiter? Did she know the guy? Has this changed the way she used the facilities?

I didn't ask a thing. It didn't seem appropriate, with so many folks surrounding me. I also figured I'd get kicked out. I ate my lunch and got up to go. As I was leaving, I noticed three college-age women getting into a red car. By chance, they were just in front of me and turned left out of the lot, as I had planned to do. A mile or so down, the red car turned in to a busy shopping center. Emboldened to be off-site, I followed and parked a few spots over.

I caught up to them inside a store selling cheap rings. Turns out this girl, who wouldn't give her name, had been a hostess at the steakhouse. Her sister still worked there. And she knew the waiter. I asked if she was worried about hepatitis A.

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"No," she said. "My mother was more upset than I was."

I asked if she knew how the infected waiter was doing.

"Fine, I'm sure," she said. "He wasn't that sick when I saw him."

I asked if she could tell me his name. Nope. Then I asked if she was happy with how the situation was handled.

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"I don't like how the hospital handled it or the people who were there. I think the employees should have been taken in first."

There was so much more I wanted to ask but she'd had enough. She was looking for a particular ring and turned away from me. When I didn't give up after that body language directive, she simply said, "I think you've got enough."

And she was right. I headed home, just thinking of how I would once more make my argument to Carlene, who, like most Americans, seemed to believe there was some sort of long-living hepatitis bug in the kitchen, just waiting to do the jig into my guacamole. Nobody was infected by the waiter, I had repeated several times; come and get a free lunch. Somewhere during the drive I started thinking of a curious exchange I'd had with Woodall.

He had just told me how a few Texas Steakhouse officials had stopped in at the office to commend him on a job well done, while also asking if in the future such an incident could be handled more carefully with the press.

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"Maybe they have a point," I said. "The fact is, the chances of feces getting on my French fries is pretty slim."

"It'd be the same any place you go," Woodall told me. "Any restaurant you go to, that's a possibility. I don't think any more so here."

It was then, with Smithfield behind me, that I decided that tonight we'd be eating in.


Geoff Edgers

Geoff Edgers is a writer at the Raleigh News & Observer and a frequent contributor to Salon.

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