Epidemiologist’s Warning: STOP Buying Bagged Salad for Now

Summary

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

Host: Jonathan Cohn
Guest: Caitlin Jettalina, epidemiologist (Your Local Epidemiologist, Substack)
Date: July 13, 2026
Episode Theme:
A deep dive into the largest Cyclospora outbreak in modern U.S. history, its causes, health risks, individual preventive measures, and the broader implications for public health policy and infrastructure.

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Episode Overview

Jonathan Cohn invites acclaimed epidemiologist Caitlin Jettalina to discuss the alarming surge in Cyclospora infections, a microscopic parasite causing severe gastrointestinal illness. With a focus on evidence, clarity, and practical advice, they cover what the public needs to know about the outbreak, the science behind the parasite, why bagged salads are a particular risk, and urgent systemic challenges in the U.S. public health infrastructure.

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Key Discussion Points & Insights

1. What is Cyclospora?

[02:28] Caitlin Jettalina:

• Cyclospora is a “really really small single-celled parasite,” with humans as the only known host.
• Transmission is always traced to human waste—from poor field sanitation or contaminated water, typically at the farming or produce processing level.
• The pathogen is picked up through contaminated produce—most commonly where human fecal matter has entered the food or water chain.
• Notably graphic but important: “every contamination event traces back to...human waste or fecal matter somewhere along the train and usually in water.”

2. Symptoms & Risks

[03:36] Caitlin Jettalina:

• Primary symptom: “watery, explosive diarrhea.”
• Associated with cramping, bloating, fatigue, appetite loss, and sometimes low fever.
• The illness can last for weeks. Cases can “come and go,” mimicking improvement before returning—sometimes dragging on for over 100 days.
• Not typically fatal, but dehydration poses a serious risk, especially for vulnerable groups: pregnant women, children, older adults, immunocompromised.
• Most people can recover at home; antibiotics are a last resort for severe/high-risk cases.

Notable Quote [02:00]:
“As soon as I heard the phrase explosive diarrhea, you were the first name that came to mind.” —Jonathan Cohn, joking with Caitlin Jettalina

3. When to Seek Medical Help

[04:49] Caitlin Jettalina:

• Dehydration is the biggest concern—monitor fluid intake (“suck on ice cubes” if needed).
• Several days of symptoms: “should be okay as long as they can...suck on ice cubes” but always call your provider, especially for high-risk individuals.
• If symptoms last, especially for those who are pregnant, immunocompromised, or otherwise at risk, don’t hesitate to contact a care team.

4. How to Protect Yourself

[05:45] – [07:05] Caitlin Jettalina:

• The source isn’t confirmed yet but, “from past outbreaks...it's usually on produce with lots of grooves and bumps and folds because the parasite finds those folds and hides in the nooks and crannies.”
• Most implicated: Bagged or boxed salad greens.
  • Avoid “those pre-made ones that make my life easier at dinner.” Opt for whole heads of lettuce you can wash and cut yourself.
• Other high-risk foods: Berries (especially raspberries), anything with a lot of grooves (“you think about raspberries, tons of those like grooves and the parasite, they can just stick in there”).
• Safer options: Produce you can peel (oranges, bananas), produce you can thoroughly wash (like cucumbers), and especially items you cook.
• “I would avoid leafy greens and those berries especially like raspberries.”

Notable Quote [05:45]:
“Right now I’m avoiding bagged or boxed salads.” —Caitlin Jettalina

5. Produce Washing and Cooking Advice

[07:16] Caitlin Jettalina:

• Washing helps but “won’t fully remove the parasite” as Cyclospora “clings and hides” in produce crevices.
• Cooking is best—heating produce to at least 158°F destroys the parasite.
• Freezing and microwaving are unreliable for killing Cyclospora.
• “So for me at least that means just avoiding [bagged salads] for now.”

6. Local Farms vs. Grocery Stores

[09:37] Caitlin Jettalina:

• Buying from local farms does not eliminate risk: “Cyclospora lives in the soil or contaminated water sources. So local produce could be contaminated as well.”
• Unless the contamination is known to originate at a processing plant, local farm produce isn’t automatically safer.
• Focus should remain on “cooking or boiling...rather than, you know, what farm particularly it comes from.”

7. Why Is This Outbreak So Big?

[10:40] Caitlin Jettalina:

• Typical cyclospora spikes occur this time of year, normal annual U.S. cases total about 3,000–4,000.
• This outbreak already exceeds 3,000 cases (“more than 3,000 cases for this particular outbreak”).
• Possible factors: Undetected spread, increase in awareness and testing, but, “the only way to really stop an outbreak like this is to take the source out from distribution...that certain lettuce from that farm just stops getting circulated.”

8. Policy & Public Health Failure

[11:49] Jonathan Cohn & Caitlin Jettalina:

• Discussion of public health funding cuts, especially under the Trump administration.
• Specific program cuts (like FoodNet) probably not the direct cause of this surge, but overall loss of personnel, funding, and coordination is critical.
• “If you cut public health funding, you cut our force, you have lack of transparency, you have no centralized communication efforts...We have siloed health systems and these teams are chronically underfunded, especially parasite teams.” —[12:16] Caitlin Jettalina
• “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...” —[14:33] Caitlin Jettalina

9. How Long to Rebuild?

[14:26] Caitlin Jettalina:

• Due to deep loss of expertise and structural breakdown, “it’s going to be at least 10 to 20 years” to rebuild public health workforce and systems—even if action is taken now.

Notable Quote [14:33]:
“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.”

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Notable Quotes

• Jonathan Cohn [02:00]:
  “As soon as I heard the phrase explosive diarrhea, you were the first name that came to mind.”

• Caitlin Jettalina [05:45]:
  “Right now I’m avoiding bagged or boxed salads.”

• Caitlin Jettalina [12:16]:
  “If you cut public health funding, you cut our force, you have lack of transparency, you have no centralized communication efforts...We have siloed health systems and these teams are chronically underfunded, especially parasite teams.”

• Caitlin Jettalina [14:33]:
  “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.”

---

Important Timestamps

• [01:13] — Introduction, outbreak context, guest intro
• [02:28] — Cyclospora: what it is, transmission explained
• [03:36] — Symptoms, duration, why it’s serious
• [04:49] — When to seek medical help; reader Q&A
• [05:45] — Practical avoidance guidelines; foods at risk
• [07:16] — Washing & cooking produce: what works/doesn’t
• [09:37] — Buying local: farm stands vs major supply chain
• [10:40] — Why is this outbreak different/bigger?
• [11:49] — Policy, funding cuts, and systemic failures
• [14:26] — The long road to rebuilding public health

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Summary Takeaways

• Avoid pre-washed/bagged salads and bumpy, hard-to-wash produce like berries and packaged greens during the outbreak.
• Peelable, cookable, or thoroughly washable produce is safest.
• Washing may reduce risk, but only cooking to 158°F is proven to kill Cyclospora.
• Risk with local farm produce is not eliminated—contamination can happen at the farm level, too.
• The outbreak is exacerbated by a gutted public health system, and repair will take over a decade.
• Stay vigilant, especially if you are in a high-risk group or live in an affected area (notably Michigan).
• Public health investment and restoration are urgent long-term needs.

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For further information and ongoing updates, follow Caitlin Jettalina and The Bulwark, and consult your local health authorities for the latest recommendations.

Transcript

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[Jonathan Cohn]

Welcome to Bulwark Takes. I am Jonathan Cohn, author of the Breakdown newsletter where we talk about healthcare and boy, do we have a big healthcare 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 Jettalina. 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 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're lucky to have her. We're here to help us answer those. Caitlin, thanks for joining us.

[Caitlin Jettalina]

Thank you for having me. Always excited to be here.

[Jonathan Cohn]

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.

[Caitlin Jettalina]

What an honor. What an honor. Yeah, you guys just keep calling me with these random bug things that keep happening at really high rates nowadays, huh?

[Jonathan Cohn]

Yeah, I think, you know, having you and not, 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?

[Caitlin Jettalina]

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.

[Jonathan Cohn]

And how, when we get sick, when you get this, let's get to it, what happens? What does it cause?

[Caitlin Jettalina]

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 booger can drag out for weeks. There was this poor soul and a Nepal outbreak. They lasted 107 days with these symptoms. So it can, it comes and goes. So you feel like you're getting better and then it'll come a few days and it's, it's really just not a fun bug to have. Thankfully, it's rarely fatal. There's no deaths reported with this outbreak. The real danger is 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.

[Jonathan Cohn]

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 of days and was curious. At what point do you seek help for this? When does it get that serious dehydration

[Caitlin Jettalina]

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, immunocompromised, 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.

[Jonathan Cohn]

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 hearing this. I don't want to get sick. I live in Michigan, which is the epicenter of the outbreak or at least that's where we've had the most report A lot of times I know it doesn't go reported. So what is general advice for how we should be conducting ourselves to try to avoid this?

[Caitlin Jettalina]

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 nooks and crannies and so it's typically on lettuce. So like right now I'm avoiding bagged or boxed salads.

[Jonathan Cohn]

Like the bags you get in the, in the store. The like the ones.

[Caitlin Jettalina]

Yeah, yeah. Like those pre made ones that make my life easier at dinner. I'm not buying those because it's, that's usually a big culprit of them. Whole heads of lettuce that you can wash and cut yourself is probably a safer bet.

[Jonathan Cohn]

I read somewhere raspberries are a good one to avoid because it's also which broke my heart because I love raspberries this time of year. Right.

[Caitlin Jettalina]

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 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.

[Jonathan Cohn]

So this gets to 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?

[Caitlin Jettalina]

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. If not because again, it clings 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. Freezing 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 45 seconds. But even 45 seconds doesn't kill at all. So really the best bet is putting it on your stove. I know you can't put like your bag salad on a stove. That doesn't sound very great. So for me at least that means just avoiding it for now.

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[Jonathan Cohn]

question we got from a lot of readers, including Martha and Connie, was about are you better? What if you're buying your produce from like a local farm stand rather than is that safer? Can you trust that?

[Caitlin Jettalina]

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.

[Jonathan Cohn]

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?

[Caitlin Jettalina]

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 where 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 we. I expect this outbreak to continue to increase, at least for a little.

[Jonathan Cohn]

Yikes. All right, let's talk about policy. You and I have talked about this before. You've written, 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 seemed skeptical. That was actually part of the story here. I wanted to. Could you talk about that for a second?

[Caitlin Jettalina]

Yeah. So what a lot of people are pointing their fingers to 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. 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 have ever had in 30 years. We're dealing with Ebola and people traveling from Ebola. We have really high whipping cough rate. 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. U.S. epidemiologists say that bugs have ears, and it certainly feels like that is true. And these are going to happen more and more.

[Jonathan Cohn]

These are going to happen more and more. How? I mean, I've thought a lot about them. 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 know, you lose people. We lay off people. 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.

[Caitlin Jettalina]

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.

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[Caitlin Jettalina]

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. 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 and more often, Jonathan to join Bulwark with these outbreaks, but it is what us in public health expected would happen. I'm not surprised that this is a state of affairs right now.

[Jonathan Cohn]

Yeah, that was not the answer I wanted to hear. But you know, I appreciate appreciate your honesty and you know I will proceed with avoiding the bagged lettuce and watching sticking to the peeled vegetables. Caitlin, thanks so much. Helpful as always. Readers, viewers, follow the you know, subscribe to the Bulwark 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.

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Join Stephen Fry and the makers of QI for fun filled and fact laden GPS enabled audio tours. Enjoy on location or at home. To get started visit qi.com walkingtours.