Epidemiologist’s Warning: STOP Buying Bagged Salad for Now

0:00 Hey everybody, welcome to Bull Work Takes. I am Jonathan Conn, author of the Breakdown Newsletter where we talk about healthcare. And boy, do we have a big health care story going on right now. An outbreak, the largest uh in modern history of cycllospora, parasite that causes severe GI distress. To discuss that, we brought on a true expert, Caitlyn 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 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 lucky to have her. We're here to help us answer those. Caitlyn, uh, thanks for joining us.

0:45 >> 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 uh explosive diarrhea, um 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 happening at really high rates nowadays. Huh. >> Yeah, I 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 uh joking aside, what is cycllospora? How does it make you sick and what does it do to your body? Yeah. So cycllospora is microscopic really really small single-sellled 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

1:31 disgusting human waste or fecal matter somewhere along the train and usually uh in water. So there are two ways um 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. Um, but it does uh trace back to human fecal matter hitting our produce and then us eating it and

2:17 making us sick. >> And how when we get sick, when you get this, let's 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 booger can drag out for weeks. There was this poor soul in 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. Uh there's no deaths reported with this outbreak. The real danger is dehydration

3:04 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, imunompromised. Um, 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. Um, 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 cycllospora

3:51 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, imuno compromised, 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 hearing this, I don't want to get sick. I live in Michigan, which is the epicenter of the outbreak. 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 for how we should be conducting ourselves to try to avoid this? >> Yeah. So unfortunately we don't know the source um yet and uh it's delayed. I

4:38 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 pest outbreaks in the United States is it's usually on produce with lots of um grooves and bumps and folds because the parasite finds those folds and hides in the nooks and crannies. And so, it's typically on lettuce. So, like right now, I'm avoiding bagged or boxed salads. >> Mean like the bags you get in the in the store, the like the ones Yeah. >> Yeah. Like those pre-made ones that make my life easier at dinner. I'm not buying those. um because it's that's usually a 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 a good one to avoid cuz it's also which which

5:24 broke my heart cuz I love raspberries this time of year. >> Cuz you think about raspberries like tons of those like grooves and the parasite they can just stick in there. Um, 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. Uh, or definitely anything you can cook. So yeah, I would avoid leafy greens and those berries, especially like raspberries. >> So this gets to a couple 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

6:11 removes some of it of nova because again, it clings and hides in these nooks and crannies. Um, and so cooking is the better bet um to cook it. Uh, 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, um it completely kills uh 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 it 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

6:56 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 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 cycllosphora 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 um and really clearing that that

7:42 parasite from the the food rather than, you know, what form 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? What is there? 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 um 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

8:30 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. Um, 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. Uh unfortunately, the only way to really stop an outbreak like this is to take the source out from distribution. And uh we can only do that over time, right? that certain lettuce from that that farm just stops getting circulated or we do find a specific thing that's pulled from the market. Um

9:17 and so far neither of those have really happened. So we I expect this outbreak to continue to increase at least for a little. >> Yikes. Um all right, let's talk about policy. Um you and I have talked about this before. You've written about we've both written about there have been a lot of cuts to the public health infrastructure of this country under the Trump administration. um that includes a scaling back of of some of the data tracking for cycllospora as I understand it. Now I I you've written about this and you seem skeptical that was actually part of the story here. I I wanted to could you talk about that for a second? >> Yeah. So what a lot of people are pointing their fingers to is this program that was cut called food net and that was cut last September. Um the reason I'm very skeptical about that is that food net was never used for outbreak detection or response. It was

10:04 used more to detect trends in the background that researchers use to study this um parasite over time or other other bugs over time. There was an impact in 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 uh local public health

10:50 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. Um, and these are going to happen more and more. >> These are going to happen more and more.

11:35 how I mean I' I've thought a lot about this. I'm curious what you think because you you you've been inside, you do epidemiology, you've been in part of these efforts. A lot of this damage has been done. Um 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 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. Um, I think it's Oh, yeah. I I think we're going to go backwards. We are going backwards before we go forwards again. Um, I think the biggest question is how backwards do we go? Um, and what sense of urgency is met with it? But you're right. I mean, these

12:22 systems have been destroyed and not like the status quo was great before. Like, let me just be clear about that. But um 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 of and also reimagine how these systems work um so we can all do better in the future as well. So it's going to take a while. Um, so that means you may be calling me more and more often, Jonathan, to join work 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.

13:07 >> Yeah, that was not the answer I wanted to hear, but you know, I appreciate appreciate your honesty and uh, you know, I will proceed with avoiding the bag lettuce and washing sticking the peeled vegetables. Caitlyn, thanks so much. Helpful as always. readers, viewers, uh follow the, you know, subscribe to the bull work, hit like on the algorithm if this was helpful, um because we do pay attention to these kinds of issues and we understand how important they are. Thanks a lot and uh we'll see you next