Bulwark Takes - Epidemiologist’s Warning: STOP Buying Bagged Salad for Now

Episode Date: July 13, 2026

Jonathan Cohn talks with epidemiologist Katelyn Jetelina about the record-breaking cyclospora outbreak, which foods to avoid, why officials still haven’t found the source, and how cuts to public health could make outbreaks like this more common.

Hey everybody, welcome to Bullwork Takes. I am Jonathan Cohn, author of The Breakdown Newsletter, where we talk about health care and boy do we have a big health care story going on right now. An outbreak, the largest in modern history of cyclospora, parasite that causes severe GI distress. To discuss that, we brought on a true expert, Caitlin Jedalina. You know her as your local epidemiologist on Substack. I know her as one of the very best explainers of medical knowledge to those of us. us who are mortals. We have a bunch of questions, some from me, some that our readers have submitted on everything from, what is this disease? What can we do to prevent it? What should our government be

doing? So we have lucky to have her. We're here to help us answer those. Caitlin, thanks for joining us. Thank you for having me. Always excited to be here. Yeah, don't take this the wrong way, but as soon as I heard the phrase, explosive diarrhea, you were the first name that came to mind. What an honor. What an honor. Yeah, you guys just keep calling me with these random bug things that keep having at really high rates are nowadays, huh? Yeah, I think, you know, having you, not always the best thing to see you on our camera, but here we go. All right, let's, let's, joking aside, what is cyclospora?

How does it make you sick? And what does it do to your body? Yeah, so cyclospora is microscopic, really, really small, single-celled parasite. And the interesting thing about this parasite is humans are the only known host. So every contamination event traces back to, and I know this is disgusting, human waste or fecal matter, somewhere along the train and usually in water. So there are two ways a food source gets contaminated. One is at the farm level from like poor field sanitation such as like workers without adequate bathroom access or contaminated irrigation water or contamination can happen during. processing, usually through contaminated water at the packing or washing stage. We don't know which one it is yet. I hope we get answers eventually soon, but it does trace back to human

fecal matter hitting our produce and then us eating it and making us sick. And how when we get sick when you get this, let's get to it, what happens? What does it cause? So it's watery explosive diarrhea. And it is not fun. And partly because why it's not fun, right? You get cramping and bloating and fatigue and appetite loss and sometimes low fever. But also this bugger can drag out for weeks. There was this poor soul and a Nepal outbreak. They lasted 107 days with these symptoms.

So it comes and goes. So you feel like you're getting better. And then it'll come a few days. And it's really just not a fun bug to have. have. Thankfully, it's rarely fatal. There's no deaths reported with this outbreak. The real dangers dehydration from like weeks of diarrhea. And so it's usually hardest hit for the most vulnerable. We're talking like pregnant women, kids, older adults, immunocompromised. And with really severe cases among high risk, it can be treated with antibiotics, but it's usually the last

sort of move. Usually you just wait it out at home. Yeah. Well, this gets actually one of the reader questions. One of our readers said their son was having kind of watery diarrhea for a couple days and was curious. At what point do you seek help for this? When does it get that serious? Dehydration is the biggest concern. And so a few days should be okay as long as they can, you know, suck on ice cubes, but always call your clinical care team. They'll tell you when to come in. We usually know it's cyclospora compared to another disease that causes diarrhea because it lasts so long. And so if you're high risk, don't toughen it out. If you're pregnant immunocompromise, go to the doctor, call them.

All of us that are healthy can probably last it out for a few days, but always great to connect with the care team. Yeah. So we're going to talk in a minute about what government should be doing to detect and prevent. But I want to talk about on the individual level for right now, you know, what individuals can be hearing this. I don't want to get sick. I live in Michigan, which is the epicenter of the outbreak.

or it really says where we've had the most reported cases. A lot of times I know it doesn't go reported. So what is general advice or how we should be conducting ourselves to try to avoid this? Yeah. So unfortunately, we don't know the source yet. And it's delayed. I don't know why we don't know the source. I wish we had more answers, but we don't. And so, but what we typically know from past outbreaks in the United States is it's usually on produce with lots of grooves and bumps and folds because the parasite finds those folds and hides and the nucks and crannies. And so it's typically on lettuce. So like right now I'm avoiding bagged or box salads. I mean like the bags you get in the store, the like the ones. Yeah. Like those pre-made ones that make my life easier at

dinner. I'm not buying those. Because that's usually a big culprit of them. Whole heads of lettuce that you can wash and cut yourself is probably a safer bet. I read somewhere raspberries are one to avoid because it's also, which broke my heart because I love raspberries this time. That's right. Because you think about raspberries. Tons of those like grooves and the parasite, they can just stick in there. And so how I'm thinking about produce is things you can peel are usually good, like, you know, oranges or bananas are great. Or you can really wash thoroughly. Like a cucumber is easier to wash or definitely anything you can cook. So yeah, I would avoid leafy greens and those berries, especially like raspberries.

So this gets a couple of reader questions. I'm going to throw them at you real quick, and you can give me some answers. So Natalie, one of our readers, said, does it matter if I'm washing them in hot water? Should I be using soap to wash my produce? Oh, that's a good question. So, you know, washing helps, but it won't fully remove the parasite because water removes some of it and all the, because, again, it cleans and hides in these nooks and crannies. And so cooking is the better bet to cook it. And in order to cook it, you have to cook the, you know, spinach leaf or whatever it is to hit a temperature of 158 degrees. Once you hit that, it completely kills this parasite. And so you're good. Fries doesn't really work as well. Microwaves also don't work as well because the temperature is so inconsistent. So what we see in studies is like at least, at least, at least,

least 45 seconds, but even 45 seconds doesn't kill it all. So really the best bed is putting it on your stove. I know you can't put like your bag salad on his stove. That doesn't sound very great. So for me, at least, that means just avoiding it for now. So one question we got from a lot of readers, including Martha and Connie, was about, are you better at? What if you're buying your produce from like a local farm stand rather than this? Is that safer? Can you trust that? I'm seeing that question a lot too. I think it's a great question. The problem is cyclospora lives in the soil or contaminated water sources. So local produce could be contaminated as well.

We just don't know how this started, right? If this started at a processing plant, sure, those local farms are much more safe, but it actually started at a source of a farm from water contamination. It could be still infected. I think the most important thing to think about is the cooking or boiling and really clearing that that parasite from the food rather than, you know, what farm particularly it comes from until we have more answers of the investigation. So this is, like I said at the top, this is now considered the largest outbreak in recent history. I think we're up to almost 3,000 cases, maybe even more

in Michigan alone. More. Oh, boy. Yeah. I mean, that's a lot of cases. Is there any reason to think the disease itself is like this is a worse outbreak for some reason? Do we know? Do we think we're maybe detecting it? Why this sudden spike this year? Well, so we have spikes every year around this time. So let me just say that. Like every year we have about 3,000 to 4,000 cases, total, annual total. Right now we have about more than 3,000 cases for this particular outbreak. So this is definitely a big outbreak. It is not something we really expected. The question of why is a really good question. And I'll be honest, I don't think we know yet. You know, it could be that it was just spreading undetected for a long time.

And now we're catching a lot of cases. We're going to get more cases. The more that people are asking questions and the knowledge base is increasing. More people are going to be testing. More physicians are going to be willing to use the test. And it's going to balloon. Unfortunately, the only way to really stop an outbreak like this is to take the source out from distribution. and we can only do that over time, right?

That certain lettuce from that farm just stops getting circulated, or we do find a specific thing that's pulled from the market. And so far, neither of those have really happened. So I expect this outbreak to continue to increase, at least we're little. Yikes. All right, let's talk about policy. You and I have talked about this before. But we've both written about there have been a lot of cuts to the public health

infrastructure of this country under the Trump administration. That includes a scaling back of some of the data tracking for cyclospora, as I understand it. Now, you've written about this, and you seem skeptical that was actually part of the story here. I wanted to, could you talk about that for a second? Yeah. So what a lot of people are pointing their fingers to you is this program that was cut called FoodNet. And that was cut last September. The reason I'm very skeptical about that is that FoodNet was never used for outbreak detection or response. It was used more to detect trends in the background that researchers use to study this parasite over time or other bugs over time. There was an impact on cutting that. Don't get me wrong, but I don't think that there's a direct link to this

outbreak. What I do think is happening is not rocket science. I mean, if you cut public health funding. You cut our force. You have lack of transparency. You have no centralized communication efforts. Maybe sprinkle in some corporate interests in there. We have siloed health systems. And these teams are chronically underfunded, especially parasite teams. And, you know, this work is very laborious. And local public health departments are being pulled in a billion directions right now, right? We have the highest measles cases we haven't ever had in 30 years. We're dealing with Ebola and people traveling from Ebola. We have really high whipping cough. Like we have the World Cup. We have like so much going on. And I think the bottom line is if the American public wants a public health system and one that works,

then the United States has to pay for it and support it. And what we've seen over the past 18 months is the decimation of it instead. And this is just what's going to happen. Us epidemiologists say that bugs have ears, and it certainly feels like that is true. And these are going to happen more and more. These are going to happen more and more. How, I mean, I've thought a lot of it. I'm curious what you think, because you've been inside, you do epidemiology, you've been in part of these efforts.

A lot of this damage has been done. I mean, you lose people, we lay off people as you can't just snap your fingers and flip a switch. How long do you think it's going to take us to rebuild this kind of infrastructure, just to get back to where we were before these cuts, assuming we get some elected officials in power who actually want to rebuild that public health infrastructure. I don't think you're going to like my answer, but I think it's going to be at least 10 to 20 years. Wow. I think it's, oh, yeah, I think we're going to go backwards.

We are going backwards before we go forwards again. I think the biggest question is how backwards do we go and what sense of urgency is met with it? But you're right. I mean, these systems have been destroyed. And not like the status quo was great before it. Like, let me just be clear about that. But we lost a lot of historical knowledge. We're losing a lot of scientific research and funding right now.

And it's not like a subscription where you can turn on and turn off. I mean, we need these pipelines of brilliant scientists, of these surveillance systems, and also reimagine how these systems work. So we can all do better in the future as well. So it's going to take a while. So that means you may be calling me more often, Jonathan, to join Borg with these outbreaks. But it is what us in public health expected would happen. I'm not surprised that this is the state of affairs right now.

Yeah, that was not the answer I wanted to hear. But, you know, I appreciate your honesty. And, you know, I will proceed with avoiding the bag, lettuce and sticking in the peeled vegetables. Caitlin, thanks so much helpful as always. readers, viewers, subscribe to the board, hit like on the algorithm if this was helpful because we do pay attention

to these kinds of issues and we understand how important they are. Thanks a lot and we'll see you next time.