Progress ReportGrocery Shopping in the Age of Explosive DiarrheaIllustration by Keith NegleySave this storySave this storySave this storySave this storyYou’re reading Progress Report, Jessica Winter’s column on family and K-12 education.On July 10th, a friend sent me a text message that spoke for an anxious nation. “What if I have the explosive-diarrhea disease?” she asked. She included a link to an article about a parasitic illness, called cyclosporiasis, that was spreading across multiple states, mostly clustered around the Great Lakes region. The outbreak in Michigan, which was the most afflicted state by far, had begun in May and was up to nearly a thousand cases (compared with fifty in a typical year). Confusingly, the Centers for Disease Control and Prevention’s nationwide tally of confirmed cases was just a hundred and forty-five—an order of magnitude less than the number reported in Michigan alone.Within an hour of receiving my friend’s text, I had forty-eight cyclosporiasis-related tabs open on my laptop. Cyclospora, I learned, is a protozoan parasite found in produce that has been tainted with human feces—perhaps because heavy rains flooded the porta-potties on the farm where the produce was grown, or because it was irrigated or washed with contaminated water. The cyclospora parasite travels inside an oocyst, a sturdy pod that can find purchase in the nooks and crannies of berries or cling to the ridges and folds of certain greens—and it will die there only if cooked. Once these oocysts reach the human digestive tract, the outer coating dissolves and the parasite unleashes a Visigoth invasion of the small intestine, causing nausea, cramping, and what has been described as “watery diarrhea,” “relentless diarrhea,” and, most vividly, “explosive diarrhea.”“It’s uncontrollable and it’s very liquid,” Joseph Eisenberg, an epidemiologist at the University of Michigan, told me. “If you’ve seen pictures from cholera wards, where the patients are on gurneys, and the gurney has a hole where your butt goes, and there’s a bucket underneath the hole—it’s very similar.” Cyclosporiasis can be treated with antibiotics and is usually not life-threatening, but the miserable symptoms may persist for a month or more.Tracking the origins of a food-borne illness traditionally demands painstaking lab work and exhaustive interviews with patients, who may struggle to recall what and where they ate weeks after the fact. Cyclospora is an especially elusive offender because, unlike such bacteria as E. coli or salmonella, it can’t be cultured in a lab. “The problem with cyclospora is that it does not grow outside of the human body, and first it needs a host,” Felicia Wu, who is a professor in the Department of Food Science and Nutrition at Michigan State University, told me. “You have to wait until somebody gets sick and then test the fecal sample, and say, ‘Yup, we see it.’ ”As cyclosporiasis cases continued to surge, amateur sleuths across social media began probing the enigma of America’s booby-trapped guts. Blueberries popped up a lot in these conversations, maybe because we were approaching peak blueberry season, or maybe because people conflated the cyclosporiasis outbreak with a concurrent E. coli outbreak—which, earlier in July, had prompted a recall of frozen blueberries sent to Publix locations in eight states. Strawberries also came under a cloud, at least in my household. At a farm stand in northern Connecticut, I bought a small basket of perfect late-season strawberries—plump and petite, a dappled shade of rose madder. But, back at home, when my eleven-year-old washed the berries, she worried that the usual flecks of harmless fuzz might be oocytes in disguise, and they sat in the fridge uneaten.The online cyclospora chatter soon coalesced around bagged lettuce and salad mixes, and, for once in my parenting career, I could feel good about my kids’ resistance to uncooked greens. On Reddit, Facebook, TikTok, and beyond, the primary suspect was the California-based Taylor Fresh Foods, a multibillion-dollar produce supplier—one of the largest in the U.S. The company has been implicated in numerous food recalls and food-borne illnesses, including a cyclosporiasis outbreak in 2013 and an E. coli outbreak in 2024. It has also been accused of union-busting and a litany of labor violations, including allegedly forcing employees to work amid a chemical spill at a California facility and failing to address unsafe conditions at a New Jersey plant, where a worker was fatally injured. (The company did not respond to a request for comment.)The consumer who wishes to avoid Taylor Fresh Foods and its subsidiaries, whether for reasons of conscience or reasons of diarrhea avoidance, can easily skip the Taylor Farms-branded salad mixes and prepared salads found at most chain supermarkets. But the company also sells produce to Sysco, the largest wholesale food distributor in the U.S., and supplies ingredients for store-branded (or so-called private-label) salad bowls and kits at Costco, Trader Joe’s, Walmart, and the Kroger supermarket chain, among others. In other words, Taylor Farms’ lettuce is everywhere in our food systems but not necessarily visible as such, rather like microplastics and antibiotics and little bits of mold and earwig. It’s all one big wilted salad.Two days after I received my friend’s text, in the checkout line at my local supermarket, in Massachusetts, I noticed an elderly man behind us, who looked to be shopping for one. Amid his modest haul was a little bushel of blueberries and a bagged salad mix. “Make sure you wash everything really well,” I told him. He cupped a hand to his ear, and I repeated myself. “There’s that terrible virus going around,” I added. He gave me a polite nod, patiently awaiting the end of this uninvited encounter. It only occurred to me in the parking lot that cyclosporiasis is not a virus, and that I had been spreading misinformation.Robert F. Kennedy, Jr., the Secretary of the Department of Health and Human Services and the hero of the Make America Healthy Again movement, is a gold-standard superspreader of misinformation. But what has characterized his agency’s response to the cyclospora outbreak is the relative absence of information, and that owes partly to an absence of staff. Neither the Food and Drug Administration nor the C.D.C. nor the office of the Surgeon General currently has a Senate-confirmed leader. Since the start of President Donald Trump’s second term, when Elon Musk’s Department of Government Efficiency commenced disembowelling the federal civil service, the F.D.A. has lost about twenty per cent of its staff, including food-safety scientists and key support staff for food inspectors. The Department of Agriculture, which regulates poultry and most red meats, has lost about ten per cent of its food-safety-and-inspection team.The C.D.C. was hit even harder. It has shed roughly a quarter of its workforce, including scores of people from the agency’s Epidemic Intelligence Service, which trains and deploys “disease detectives” to trace and respond to outbreaks and other public-health challenges. “The people who are still at C.D.C. are working under incredibly constrained circumstances,” Arthur Reingold, a professor emeritus of epidemiology at the School of Public Health at the University of California, Berkeley, and a former disease detective at the C.D.C., told me. “We have a markedly reduced capacity to do the kinds of studies that underpin a lot of our prevention-and-control strategies, and there has been a huge exodus of highly qualified people.”The decimation of the national public-health apparatus has had a direct impact amid the cyclosporiasis crisis. The C.D.C.’s parasite-surveillance team, which was instrumental in tracing the origin of the 2013 cyclospora outbreak, had eleven scientists before DOGE, and now it has three. Until last year, the FoodNet program, a joint project of the C.D.C., F.D.A., and U.S.D.A., mandated proactive surveillance of eight pathogens in ten states, including cyclospora; that list of pathogens has been cut to two, and it no longer includes our diarrhea parasite. “That leaves states more and more on their own,” Eisenberg said.There are still scores of infections and conditions—including cyclosporiasis—that health-care providers are mandated to report to their state health departments; if a state observes a spike in cases, it will provide the relevant data to the C.D.C., which may decide to intervene. In the aftermath of DOGE, “that system still exists, but it’s been hindered by mass public-health layoffs,” Alexander Sundermann, an assistant professor of epidemiology at the University of Pittsburgh School of Public Health, told me. In tracing back the source of an outbreak, an especially time-intensive task for state epidemiologists is conducting interviews with afflicted patients. “It can take two to three hours to go through a questionnaire, and that’s for every single case,” Sundermann said. “We have a lot fewer people to do that work, and so it’s going to be much slower than it used to be.” The longer it takes for researchers to pinpoint a pathogen, the more people may get sick.It is entirely possible that hundreds or thousands of Americans could have avoided spending much of the early summer on the toilet if the federal Food Traceability Rule, which was finalized in 2022, had taken effect in January, as originally planned. The rule, once in place, would put far more investigatory onus on companies, requiring them to track and record data on most F.D.A.-regulated foods—including fruits and vegetables, fish, and dairy products—and to provide that data to the government within twenty-four hours of a request. But, in March, 2025, following intense Big Ag lobbying, Congress pushed back implementation of the rule to 2028, reflecting the deregulatory spirit of Trump II. (The attorney and public-health advocate Matthew Cortland recently dug up Federal Election Commission forms showing that Taylor Fresh Foods made a million-dollar donation to MAGA Inc., a pro-Trump super PAC, also in March of last year.)After the Food Traceability Rule was delayed, the C.E.O. of the Food Industry Association, a trade group, expressed relief, saying that the rule would impose “unnecessary complexity that would burden the supply chain and increase food costs to consumers.” Perhaps the cyclospora outbreak provides an image of an unburdened supply chain, and what it costs.By July 13th, Michigan had logged two thousand six hundred and forty cases of cyclosporiasis. (The C.D.C.’s national count of confirmed cases still trailed behind, at eight hundred and forty-three.) That same day, Michigan flagged a breakthrough in the investigation, announcing that lettuce was the likely villain of the outbreak. Across social media, speculation about Taylor Farms escalated. Kennedy, who still had not made a public statement about cyclospora, remained mum on the subject. He posted a brief video urging his followers to reverse America’s “chronic-disease burden” through the power of personal responsibility: “It begins with you taking back your own health,” he says. Then Rob Schneider, the anti-vaxxer and star of “Deuce Bigalow: Male Gigolo,” steps into the frame. “You can do it!” he exclaims. “Get active! Eat real food!”Three days later, the C.D.C. and F.D.A. finally made a concrete and actionable statement on cyclosporiasis—one that, if anything, was bizarre in its specificity. The statement described a “multistate outbreak of Cyclospora infections linked to shredded iceberg lettuce served at Taco Bell locations in 5 states.” Its advice to consumers was narrow: “Do not eat shredded iceberg lettuce at Taco Bell locations in Indiana, Kentucky, Michigan, Ohio, and West Virginia.” The lettuce came from an unnamed “single supplier” in Mexico. “Shredded iceberg lettuce sold in grocery stores or served in other restaurants is not affected,” it said.To those who were following the outbreak closely, the statement was confounding. Cyclosporiasis was afflicting thousands of people outside the five named states: three hundred and seventy-four cases had been reported in New York, three hundred and seven in North Carolina, and two hundred and twenty-seven in Illinois. The Taco Bell connection was not in question—the F.D.A. cited one group of patients in Michigan where nine out of ten had eaten a product containing lettuce at the chain before falling ill—but that still left a lot of sick Michiganders who didn’t report eating there. And certainly one would not need to be a partisan of the Doritos Locos Tacos Supreme, the Nachos BellGrande, or other potentially iceberg-involved menu items to wonder why Taco Bell, which does not grow its own lettuce, was being cast as the lone villain of the cyclosporiasis disaster.The Washington Post and the Times soon reported what many alcoves of the internet had long since concluded: Taylor Farms—specifically, its branch in central Mexico, where cyclospora is endemic—was the likely source of the tainted lettuce. On July 17th, one day after the federal government singled out Taco Bell, Taylor Fresh Foods announced that it was “voluntarily removing all iceberg lettuce sourced from central Mexico from the U.S. market,” which had been shipped to distributors, big-box stores, and restaurants in twenty-seven states.The company’s recall notice, which the F.D.A. later pasted onto its own site, took a near-cryptographic approach to full disclosure, listing the affected products and stores by obscure codes such as “PV” and “MKTSD” and “BLEND LETT/ROM 80/20 WITH SEP BAGGIES 4/5#.” Bill Marler, an attorney specializing in food safety whose blog has been indispensable in understanding the cyclosporiasis crisis, wrote that, had the Food Traceability Rule been implemented on schedule, the states and codes listed in Taylor Fresh Foods’ recall notice “would have been in FDA’s hands in a day—in May. Instead we got them in the third week of July, from a corporate website, as abbreviations.”Kennedy broke his silence at last, and chose a morning-drive talk-radio show in Tampa, Florida, as his forum. Cyclosporiasis is very treatable, he told the host, Ryan Gorman. There are “outbreaks every summer,” he said. (This is true, but those outbreaks typically affect a few dozen people per state; Kennedy made similarly context-free comments about the deadly measles outbreak of the late winter.) The notion that cyclosporiasis wasn’t being actively tracked was “fake news,” Kennedy scoffed, and listeners could hop onto the F.D.A. website to see the “result of our investigation.” He did not note that the investigation was still ongoing—that there was no “result” to see—nor did he explain why the agencies he oversees had briefly marked all non-Taco Bell lettuce as safe. “Now that we know the probable culprit,” Kennedy said, “I think it’s going to be much easier for people to make healthy choices.” Michigan had just crossed five thousand cases.How do people “make healthy choices” under these circumstances? How do you “take back your health,” per Kennedy, in the age of explosive diarrhea? The “MAHA moms” and other MAHA-aligned influencers have responded according to type, by hawking what they claim to be parasite-killing supplements and musing aloud about deep-state PsyOps to keep us from our leafy greens. The public-health messaging from Kennedy’s agencies has been so garbled and spotty that your average grocery shopper may not know how to respond at all. Last time I checked TikTok, the algorithm showed me someone tossing bleach solution on their leafy greens. My kids, at present, will only eat fruits with a peel, because then the poop can’t get in. They knew all along that salad was bad for you.Over the weekend of July 18th, the F.D.A. announced that a sample of iceberg lettuce from Taylor Farms—a sample, importantly, not from the recalled lettuce but from greens still in circulation—had tested positive for cyclospora, then swiftly retracted the finding, calling it a “false positive.” The casual observer might hear this news and understandably assume that there was no evidence linking Taylor Farms to the outbreak after all. The company alleged that the F.D.A. had apologized for the false positive and emphasized that the agency “has not identified a single positive product test result for Cyclospora.” (The F.D.A. denied apologizing.)It’s one mystery among many why the F.D.A. would choose to publish such a consequential finding without first double-checking its work, sowing yet more doubt in our blighted public-health systems. But the false positive did nothing to undercut the epidemiological and trace-back data linking Taylor Farms to the outbreak, Sandra Eskin, the C.E.O. of the Chicago-based nonprofit Stop Foodborne Illness, told me. “A huge number of people who got sick ate lettuce at Taco Bell, and that lettuce came from Taylor Farms,” Eskin said. “When you have strong epidemiological evidence and strong trace-back, you don’t need product testing to prove the connection, and Taylor Farms knows that.” The F.D.A. and the C.D.C., she added, “just really weren’t good at communicating this.”By July 21st, the C.D.C. had received reports of cyclosporiasis from forty-one states. Michigan was approaching seven thousand; northwest Ohio had more than two thousand. At a press conference, Kennedy said, “We do have the outbreak under control.” This statement appeared to contradict statements from his own staff at the F.D.A., which was and still is investigating possible sources of cyclospora in the food chain. “It’s hard to know what ‘under control’ means when there are so many mixed messages about what food products are involved and why people are getting sick,” Eskin said.When “taking back your health,” it helps if public-health leaders are good at communicating basic information about dangers in our food supply; it helps if they don’t leave this work to busybodies in the supermarket. It helps if the agencies entrusted with our health have proper funding and staffing. It helps if you’re able to find out where your food is coming from, and which company produced it. It helps if corporations are compelled by law to provide exacting data to public-health agencies, and barred from making enormous monetary donations to the entities that regulate them. And it helps if the person tasked with making America healthy again doesn’t appear to view most diseases as akin to an especially rigorous juice cleanse, meant to test our mettle and leave us even stronger.“It’s hard for the public to recognize when public health is working, because when it works, you don’t see it,” Sundermann told me. “This is where the U.S. has struggled, in demonstrating that prevention matters and we should invest in it.” He invoked President Trump’s withdrawal of the U.S. from the World Health Organization, in January. “Ten or twenty years from now, when there’s rampant antimicrobial resistance and we can die from an infection because no antibiotics work against it, we’ll look back and say, ‘Hmm, maybe we shouldn’t have left the W.H.O.’ Those are the long-term consequences. But the short-term consequences are what we’re seeing right now. We are only going to see more of this going forward.” On July 22nd, the day after Kennedy declared cyclospora to be “under control,” the F.D.A. announced that it was investigating a new outbreak of the parasite, seventy-two cases to date, origins “not yet identified.” ?