He Warned Us About Bagged Lettuce. One Explosive Diarrhea Outbreak Later, It’s Clear We Should Have Listened.
Nick Florko doesn’t want to brag or anything, but more than a year ago he wrote an article that has come to seem prescient. Its title: “Now Is Not the Time to Eat Bagged Lettuce.”
Florko, a staff writer at the Atlantic, made that pronouncement long before the multistate outbreak of Cyclospora cayetanensis, a parasite associated with explosive diarrhea that has spread across 34 states and counting. Back then, he was focused on leafy greens because they’re the most common cause of foodborne illness, and he worried that the Trump administration was weakening the U.S. food safety system.
We don’t yet know what’s causing this outbreak of cyclosporiasis, but it’s apparent that lettuce is suspect. (Taco Bell specifically is being investigated, or scapegoated, by the White House.) Cyclospora has also been known to hang around in raspberries and cilantro. A key thing is that it’s tough, if not impossible, to wash off. And you can ingest the parasite and not feel the impact of it for weeks.
Luckily, the illness resolves with antibiotics and isn’t fatal. But symptoms can last for weeks. “It seems to go in waves,” Florko said. “You get really sick, you think you’re fine, you go about your day, you get sick again, and it keeps going. You keep riding that wave until you get it treated.”
On a recent episode of What Next, Mary Harris spoke to Florko about Cyclospora summer: how the parasite spreads, how much faith to place in our country’s public health infrastructure, and whether you can actually eat that lettuce. This conversation has been edited and condensed for clarity.
Mary Harris: So what is this “explosive diarrhea” bug? What is Cyclospora?
Nick Florko: It’s a parasite that is spread by human feces, specifically feces that is left out in the environment to mature and gets infectious. If it touches food, that food gets contaminated, and if you eat the food, you get explosive diarrhea.
How is a pile of poop sitting out for two weeks and then getting on the food? Can you draw me a picture here?
It’s a microscopic parasite—
So it’s not necessarily a pile of poop.
Yeah. A water source gets contaminated in some way, and that water is then used to irrigate a field. It’s a small amount of poop, and it gets onto the food. That’s most likely how this happened. It’s not something you can see.
It was only recently that this parasite was found to be domestic, right?
Exactly. That’s the part of this that, as a science nerd, I’m the most interested in. We used to think that this parasite was endemic to tropical regions. Then we started to see cases that were homegrown here. We still don’t know why that is. We don’t have a long history with this parasite—we discovered it in the 1990s, as I understand it. That was when the first outbreaks we were noticing happened. Science is still catching up here, and Cyclospora is harder to track than other foodborne outbreaks.
Why is it so hard to track? My understanding is that this is because of the lifespan of the organism: It takes a while to develop into something infectious. Once it’s inside you, it takes a while to show symptoms.
That’s part of it. The other part is that there are genetic tests that can be done for most pathogens where you essentially create a genetic fingerprint of that pathogen, either from food or stool that was collected. Public health officials will track all those cases together and say: Those are all exactly the same genetic fingerprint. They are definitely related. Let’s go talk to those people and find out exactly what they ate. Then you’d find the common source there. You can’t do that with this pathogen. You can’t grow it in the same way in the lab, and there’s just not enough of it in the stool to make it easy to study.
This outbreak seems to be in the sweet spot where a really bad outcome is possible if you get infected, but you’re probably going to be OK. It allows people to both be scared and think, This is kind of funny.
I feel like that’s what’s going through public health officials’ minds when they’re thinking about advice here. When we see something that’s potentially deadly, usually we see officials being like: “We think it might be this. Do not eat this right now.” That’s not what they’re saying. They’re not saying to avoid anything, really. Earlier this week, the Centers for Disease Control and Prevention held a press call, and they were essentially telling people to wash their vegetables.
Even though washing won’t get rid of it.
Exactly. It drives me crazy, hearing them say that over and over again. But I guess it’s the best advice you can give in the moment.
I’ve heard critiques of the Trump administration, specifically its scaling back of funding for programs like the Foodborne Diseases Active Surveillance Network. FoodNet used to monitor and track Cyclospora and other pathogens, like Listeria, and now it’s looking only for Salmonella and E. coli. Do you think that’s a reasonable criticism?
It’s certainly reasonable. The thing about FoodNet specifically, though—and I’ve heard this from folks who aren’t in the government as well—is that it’s used to develop intelligence about these bugs, but it’s not an active surveillance system in an outbreak. It’s not as if we don’t have tracking anymore. That’s a good thing. Those systems still exist.
At the same time, we’ve been talking about how this is a bug that we don’t know much about, that didn’t use to show up on our shores. Scaling back any sort of surveillance or intelligence system related to that bug is not going to be good. There’s also a legitimate critique over the fact that the CDC and the Food and Drug Administration have both experienced major turmoil over the past year or so. What do things look like at those agencies? When we lose a bunch of key leaders, folks who have dealt with these sorts of things over and over and over again, does that put us at a disadvantage?
FoodNet was at least a channel for information to flow toward. Now you have all of these individual state agencies, which may be dealing with funding challenges of their own, collecting their own data, holding it, maybe trying to find a way to get it to the CDC. It sounds herky-jerky.
The piece of this that has been most striking is the CDC’s lag in information. The states are reporting information so much more quickly than the CDC. Last week, when I wrote my first story on this, I think the CDC was reporting 200 cases, and Michigan [the epicenter of the outbreak] was saying that it had thousands at that point. What was going on? At that CDC press conference, officials said they’re doing more frequent updates. Now the numbers are much, much higher. So maybe it’s getting better, but what has been going on for the past few weeks? Why was the data coming out so slowly?
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He Warned Us About Bagged Lettuce. One Explosive Diarrhea Outbreak Later, It’s Clear We Should Have Listened.
I remember that during COVID, there was this whole issue of testing vs. not testing. Donald Trump’s whole idea was: If you keep testing, the numbers are going to keep going up, so maybe you don’t want to do that. Is that going to be an issue here?
Hopefully it won’t be an issue. The CDC did put out an alert to doctors: “If you weren’t aware, there’s a giant outbreak, and this is the test you should be running for it.” This is not a normal thing doctors typically test for, so having that information should help. I haven’t seen anything that explicitly said “Don’t test for this,” but things can always change. I don’t count out any possibility at this moment.
The CDC also said that there were thousands of tests just waiting to be tested, right? So there’s also a backlog situation.
Yes. Again, that goes to funding for public health infrastructure. Public health labs and all these groups are always struggling to work with minimal resources, and when there’s a huge influx of tests that need to be run, it becomes an issue. You would have thought we would have solved this sort of thing with COVID, but we haven’t.
