When You’re Sliding Into First and You Feel You’re Gonna Burst, Read This Story

“EXPLOSIVE DIARRHEA” IS NOT A PHRASE YOU WANT to be hearing in your household, let alone on the national news. But it is happening a lot these days, thanks to an outbreak of a parasitic infection called cyclospora that has already sickened thousands of people across the country.

So far the largest number is in Michigan, my home state. But it’s not simply a Michigan problem: More than thirty states have recorded cases. And although officials have said they think contaminated lettuce might be the culprit, or one of the culprits, as of Wednesday morning they still were not sure.

That last part has raised a lot of questions about how federal public health agencies are handling the outbreak, given their weakened condition following all of the funding cuts, layoffs, and leadership purges by the Trump administration.

But those aren’t the only questions on people’s minds. There are practical questions too: What is this disease? How do you get it? What can you do to not get it? And what should you do if you get it?

To answer those sorts of questions—including some submitted by readers of The Bulwark—I turned to Katelyn Jetelina, an epidemiologist and data scientist who consults with organizations like the CDC but is probably best known as the founder and writer of the Your Local Epidemiologist newsletter.

Jetelina knows the relevant science. She is also gifted at explaining it to non-scientists. That is no small thing, especially in a time when government agencies have lost their veteran leaders and the public’s trust.

A lightly edited transcript of our conversation follows.

JONATHAN COHN: Katelyn, thanks for joining us. 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.

KATELYN JETELINA: 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?

COHN: Yes, it is not always the best thing to see you on our camera. But all joking aside, let’s start with the basics. What is cyclospora? How does it make you sick and what does it do to your body?

JETELINA: Cyclospora is a microscopic, 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.

There are two ways a food source gets contaminated. One is at the farm level, from poor field sanitation. It could be 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 soon. But it does trace back to human fecal matter hitting our produce, and then us eating it and making us sick.

COHN: And when you get sick, what happens?

JETELINA: So it’s watery, explosive diarrhea. It is not fun. And partly it’s not fun because you get cramping and bloating and fatigue, and appetite loss and sometimes low fever.

But this bugger can drag out for weeks. There was this poor soul in a Nepal outbreak, they went 107 days with these symptoms. It comes and goes, you feel like you’re getting better and then it’ll come back for a few days.

Thankfully it’s rarely fatal. There are no deaths reported with this outbreak. The real danger is dehydration from weeks of diarrhea. And it’s usually hardest hit for the most vulnerable—we’re talking pregnant women, kids, older adults, immunocompromised.

With really severe cases among high-risk groups, it can be treated with antibiotics. But that is usually the last move. Usually you just wait it out.

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COHN: This gets to one of our reader questions who said their son was having watery diarrhea for a couple of days and wanted to know, at what point do you seek help for this?

JETELINA: Dehydration is the biggest concern. And so a few days should be okay as long as they can suck on ice cubes. But always check with 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 tough 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 it’s always great to connect with the care team.

COHN: We’re going to talk in a minute about what the government should be doing to detect and prevent the disease, but I want to stay on the individual level for right now. People listening to this, they’ll be thinking, I don’t want to get sick. What is some general advice for how we should be conducting ourselves, to try to avoid this?

JETELINA: Unfortunately we don’t know the source yet. It’s delayed. I don’t know why we don’t know the source. I wish we had more answers, but we don’t.

What we know from past outbreaks in the United States is that cyclospora is usually on produce wi