The hepatitis A outbreak that began with contaminated green onions is spreading to the green in your wallet.
While the worst of the local outbreak appears to be over, the money problems for many families and businesses are just beginning.
There are medical costs owed, wages lost from missed work, the costs of providing 9,100 immunization shots as well as ongoing government investigations, the lost restaurant business, a double-digit dip in sales at the Beaver County Mall, where the outbreak started at a Chi-Chi's restaurant. Perhaps, there's even decreased productivity at area businesses whose workers have fallen ill or simply become preoccupied with events.
There is not one local business "where I cannot think of a person affected," said Beaver County Chamber of Commerce director Cynthia Gitnik.
The work of tabulating the financial impact of the nation's worst outbreak of hepatitis A is just beginning, and so far it is hard to predict how much it will cost.
Bill Marler, a Seattle attorney representing more than 80 hepatitis A victims here, predicts that as much as $25 million has already been spent on medical costs and lost in wages. Eventually, he said, the costs could top $100 million, once pain and suffering charges are tacked on to damage claims in court.
"What you are looking at is a substantial economic loss to the citizens of Pennsylvania," he said.
Other attorneys involved in the case backed away from Marler's $100 million prediction. An examination of past outbreaks shows that the impact most likely will run into the millions but certainly will not dent a local economy that generates output of about $112 billion annually and total annual wages of about $37 billion.
Looking to the past as a guide, similar outbreaks in other parts of the country have varied in economic impact, averaging a cost per person of anywhere from $1,817 to $3,837. A 1996 Denver food-borne outbreak affected 43 people and cost the community $800,000, according to one study. A 1997-1998 Hepatitis A attack in Spokane, Wash., sickened 590 people and resulted in an economic impact of $2.25 million, according to another study.
But Pittsburgh's case is arguably much more severe -- and thus more expensive.
In Spokane, for example, there were no deaths and only eight people were hospitalized. Here, three have died and at least 110 of the 504 people affected have been hospitalized, according to figures provided by five area hospitals. The average cost of hospitalizing a hepatitis A patient, according to Rockville, Md.-based Agency for Healthcare Research and Quality, is $10,820, meaning that a minimum of $1.2 million has been spent locally just on hospital costs.
Then, there are the special cases that will surely drive that figure higher, such as a liver transplant recipient who is still in the hospital and already has bills of $600,000 to $700,000. Tack on to that countless, albeit less expensive, visits to the doctor, brief stops in the emergency room and lab tests.
Yet another medical cost is the administration of 9,100 immune globulin shots, at $15 a pop, to people worried about contracting the virus. The state said it has spent more than $136,000 on those shots to date, plus unknown costs involved in supporting the work of 35 health workers and another 35 investigators on site in Beaver County.
People affected by the illness hail from all professions, according to their attorneys. There are airline mechanics, professors, nurses, engineers, graduate students and the unemployed. How long each has missed work is unknown, but past studies have found that the average ranges from 9 to 27 days. This calculation, though, is further complicated by the three deaths. Families of the dead have already contacted attorneys about what they might be able to recover to compensate for lost wages that might have been earned if not for the hepatitis A outbreak.
"Those are very expensive cases," Marler said.
Among businesses, Chi-Chi's stands to lose the most as a result of the outbreak. In a court filing last week, the company admitted to a "drastic decrease in business sales" at its Pennsylvania restaurants, particularly in the Pittsburgh area and Youngstown. The national hepatitis A publicity also has caused a "significant reduction in sales revenue at virtually all" Chi-Chi locations nationwide.
Next to Chi-Chi's, local businesses hurting most from the outbreak are those in the Beaver County Mall, where the virus began. Mall restaurants are reporting that sales are down 40 percent to 50 percent and retail is down as well, with concerns that the negative publicity could slow the upcoming holiday shopping season.
In Beaver County, though, the news is not all bad.
"The further away from the mall, the less the impact," Gitnik said.
Gateway Rehabilitation, located about a mile from the mall, has had zero cases of hepatitis A among its staff of 600, despite the fact that employees often went to the mall Chi-Chi's for lunch and dinner. Some received shots but chief executive officer Ken Ramsey insists that the distraction has not been enough to lower productivity. Another company to emerge relatively unscathed was Monaca-based PGT Trucking, where a group of 20 went to the restaurant before the outbreak and remain healthy, according to Gitnik.
While nearby restaurants are hurting, the net effect to the local economy is probably evened out by increased grocery sales, with people choosing to prepare their own food instead of eating out.
And the likelihood of any hepatitis A stigma being attached to Beaver County, or to Pittsburgh, is slim, according to Fred Rueter, vice president at East Liberty think tank Consad Research Corp. and an professor of economics at Carnegie Mellon University.
Certainly, a viral outbreak has the potential to affect tourism and business attraction efforts, but as with past environmental disasters such as those at Love Canal and Three Mile Island, the effects are "likely to be short term and transitory," Rueter said.
"Chi-Chi's has a lot to worry about, but that doesn't mean southwestern Pennsylvania has a lot to worry about."
Staff writers Pam Gaynor, Chris Snowbeck and Anita Srikameswaran contributed to this article.