It looks like the press conference went as well as anyone could have hoped. The company has agreed to a voluntary recall and they are working with the Consumer Product Safety Commission (CPSC) to get the dolls off the market. While there have certainly been some frantic calls from parents, your FAQ helped them at press conference to communicate that the outbreak is being safely contained and to answer many of the questions the people who called in had.

There has been a new wrinkle, however. I have just received a couple of emails that deserve your attention. The first is from Don Cooper, the State Epidemiologist in Arizona, requesting assistance with Toyco on their concerns and further investigating the cause of the outbreak. The second email is from Jim Mayer, a representative from the Toyco plant in Arizona. I need to respond to Jim as soon as possible, but before I do, we need to develop a plan to address his concerns. Please send me an email summarizing your plan for next steps, including any recommendations you may have for safety in the interim (e.g., should the workers wear masks or other protective gear?). Please use your ISP to document your plan.

Sam Lyons, MD

I have just received notice from Jim Mayer, a representative from the Toyco plant in Tempe, AZ, that there is widespread concern among the plant workers about the recent cocci outbreak that the NDCC sourced to the plant. I directed Jim to contact the NDCC, and I welcome any effort that the NDCC can make on behalf of this investigation.

Don Cooper

I have recently attended the press conference that was held regarding the outbreak at the Arizona manufacturing plant where your name was given to me as a contact. I have a responsibility to the workers at the plant and to the company to determine the best way to minimize the impact of this outbreak on our employees. The workers know that the dolls were contaminated and are concerned for their safety. Management wants to make sure our employees are safe and to take care of the problem and decontaminate any areas that have cocci spores in them. On the other hand the Toyco plant is large and produces many products. I can’t possibly justify the expense of decontaminating the entire plant without knowing that it is necessary for the safety of the workers. We sent a sample of each of the products we make at the plant to the lab and all of them came back negative for coci genetic material, including the Snuffles dolls we're making now. So I would like to know:

• Who is at risk at the plant?
  
• Is it safe anywhere in the plant?
  
• Do we need to shut down the plant (or certain areas of the plant) until the risk is better understood?
  
• If it is somewhat safe, what can we do to minimize the risk to the workers?
  
• Should all the plant workers get tested for cocci?

I’d appreciate hearing from you as soon as possible. I have already had at least five workers tell me that they have been experiencing symptoms of cocci though they haven’t gotten test results back from their doctors yet. I’m sure there are other workers with symptoms that I don’t know about yet. The plant has had a dip in productivity since this information came to light, and I do not currently have enough information to make the workers feel safe again.

I would appreciate some guidance to help our company through this tough time and to ensure the safety of our workers. I've attached a map of our plant to give you an idea of the layout.

Jim Mayer