Progress Report

Grocery Shopping in the Age of Explosive Diarrhea

爆发性腹泻时代的买菜困境
The cyclospora outbreak lays bare our underfunded and overwhelmed public-health system.
圆孢子虫疫情暴露了我们资金不足、不堪重负的公共卫生体系。
A person shopping for produce wary about bacteria.
Illustration by Keith Negley

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.

7月10日,一位朋友给我发了条短信,道出了这个焦虑国度的普遍心声。“我要是得了那种爆发性腹泻病怎么办?”她问道,并附上了一篇关于一种名为圆孢子虫病(cyclosporiasis)的寄生虫病的文章链接。这种病正在多个州蔓延,主要集中在五大湖地区。密歇根州是迄今为止疫情最严重的州,疫情始于5月,目前已接近一千例(而往年通常只有五十例)。令人困惑的是,美国疾病控制与预防中心(Centers for Disease Control and Prevention)全国确诊总数仅为一百四十五例——比密歇根一州报告的数字少了一个数量级。

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.”

收到朋友短信后不到一小时,我笔记本电脑上就打开了四十八个与圆孢子虫病相关的网页。我了解到,圆孢子虫(Cyclospora)是一种原生动物寄生虫,存在于被人类粪便污染的农产品中——或许是因为暴雨淹没了种植农场的移动厕所,或是灌溉、清洗时用了受污染的水。圆孢子虫寄生在卵囊(oocyst)内,这是一种坚固的囊状物,能藏身于浆果的缝隙褶皱,或附着在某些绿叶菜的卷边褶皱里——只有高温烹煮才能将其杀死。一旦这些卵囊进入人体消化道,外壳便会溶解,寄生虫就像西哥特人入侵般攻占小肠,引发恶心、痉挛,以及被描述为“水样腹泻”、“顽固性腹泻”,以及最形象的“爆发性腹泻”。

“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.

“那种腹泻无法控制,而且非常稀,”密歇根大学的流行病学家约瑟夫·艾森伯格(Joseph Eisenberg)告诉我。“如果你看过霍乱病房的照片,病人躺在轮床上,轮床上有个洞对着臀部,洞下面放个桶——情况非常相似。”圆孢子虫病可用抗生素治疗,通常不危及生命,但痛苦的症状可能持续一个月甚至更久。

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.’ ”

追踪食源性疾病的源头,传统上需要艰苦的实验室工作和详尽的患者访谈,而患者往往在事发数周后难以回忆起自己吃了什么、在哪儿吃的。圆孢子虫是个尤其难以捉摸的元凶,因为它不像大肠杆菌或沙门氏菌那样可以在实验室培养。“圆孢子虫的问题在于它无法在人体外生长,首先需要一个宿主,”密歇根州立大学食品科学与营养系教授吴菲莉(Felicia Wu)告诉我。“你得等到有人生病,然后检测粪便样本,才能说,‘对,我们找到它了。’”

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.

随着圆孢子虫病病例持续激增,社交媒体上的业余侦探们开始探究美国肠道频频中招之谜。蓝莓在这些讨论中频频出现,也许是因为我们正接近蓝莓旺季,又或许是因为人们将圆孢子虫疫情与同期爆发的大肠杆菌疫情混为一谈——后者在7月初已导致八个州Publix超市的冷冻蓝莓被召回。草莓也蒙上了阴影,至少在我家是这样。在康涅狄格州北部的一个农场摊位,我买了一小篮完美的晚季草莓——饱满小巧,带着斑驳的玫瑰茜红色。但回到家,我十一岁的女儿清洗草莓时,担心那些常见的无害绒毛斑点可能是伪装的卵囊,于是它们就原封不动地躺在了冰箱里。

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.)

网上的圆孢子虫讨论很快聚焦到袋装生菜和沙拉拼配上,在我为人父母的生涯中,头一回能对孩子们抗拒生吃绿叶菜感到欣慰。在Reddit、Facebook、TikTok等平台上,主要嫌疑对象是总部位于加州的泰勒新鲜食品公司(Taylor Fresh Foods),这是一家价值数十亿美元的农产品供应商,也是美国最大的供应商之一。该公司曾卷入多起食品召回和食源性疾病事件,包括2013年的圆孢子虫疫情和2024年的大肠杆菌疫情。它还曾被指控破坏工会及一系列劳工违规行为,包括据称强迫员工在加州一家工厂发生化学品泄漏时继续工作,以及未能解决新泽西州一家工厂的不安全状况,导致一名工人因工伤死亡。(该公司未回应置评请求。)

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.

消费者若想避开泰勒新鲜食品公司及其子公司,无论是出于良知还是避免腹泻,都可以轻松绕开大多数连锁超市里泰勒农场(Taylor Farms)品牌的沙拉拼配和预制沙拉。但该公司也向美国最大的食品批发分销商西斯科(Sysco)销售农产品,并为好市多(Costco)、乔氏超市(Trader Joe's)、沃尔玛(Walmart)和克罗格(Kroger)连锁超市等商家的自有品牌(或称贴牌)沙拉碗和套装提供配料。换句话说,泰勒农场的生菜遍布我们的食品体系,却未必可见,就像微塑料、抗生素、霉菌斑点和蠼螋一样。这整个就是一大盘蔫掉的沙拉。

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.

收到朋友短信两天后,在马萨诸塞州我本地超市的收银台前,我注意到身后一位老人,看起来是独自生活。在他不多的采购物品中,有一小篮蓝莓和一袋沙拉拼配。“一定要把所有东西都好好洗干净,”我对他说。他用手拢着耳朵,我又重复了一遍。“最近有种可怕的病毒在流行,”我补充道。他礼貌地点点头,耐心地等着这场不请自来的交谈结束。到了停车场我才意识到,圆孢子虫病不是病毒,而我刚刚传播了错误信息。

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.

小罗伯特·F·肯尼迪(Robert F. Kennedy, Jr.),美国卫生与公众服务部部长、“让美国再次健康”(Make America Healthy Again)运动的领军人物,堪称传播错误信息的金牌超级传播者。但其机构对此次圆孢子虫疫情的应对,特点却是信息的相对缺失,这在一定程度上归咎于人员缺失。无论是食品药品监督管理局(Food and Drug Administration)、疾控中心,还是卫生局局长办公室,目前都没有经参议院确认的领导人。自唐纳德·特朗普(Donald Trump)总统第二任期开始,埃隆·马斯克(Elon Musk)的政府效率部(Department of Government Efficiency)开始掏空联邦公务员队伍以来,食药监局已流失约百分之二十的员工,包括食品安全科学家和食品检查员的关键支持人员。负责监管禽肉和大多数红肉的农业部(Department of Agriculture),其食品安全与检验团队也流失了约百分之十的人员。

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.”

疾控中心受到的打击更为严重。它裁减了大约四分之一的员工,其中包括数十名来自该机构“流行病情报服务”(Epidemic Intelligence Service)的人员,该部门负责培训和派遣“疾病侦探”追踪和应对疫情及其他公共卫生挑战。“仍留在疾控中心的人,工作环境受到了极大的限制,”加州大学伯克利分校公共卫生学院流行病学荣休教授、疾控中心前疾病侦探阿瑟·莱因戈尔德(Arthur Reingold)告诉我。“我们开展那些支撑许多防控策略的研究能力已显著下降,大量高素质人才已经流失。”

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.

国家公共卫生体系的严重削弱,在圆孢子虫病危机中产生了直接影响。疾控中心的寄生虫监测团队,曾在追踪2013年圆孢子虫疫情源头中发挥关键作用,在政府效率部介入前有十一名科学家,现在只剩三名。直到去年,由疾控中心、食药监局和农业部联合开展的FoodNet项目,还强制要求对十个州的八种病原体(包括圆孢子虫)进行主动监测;如今病原体名单已缩减至两种,不再包括这种导致腹泻的寄生虫。“这让各州越来越只能靠自己了,”艾森伯格说。

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.

仍有包括圆孢子虫病在内的大量传染病和病症,医疗提供者依法必须向州卫生部门报告;如果某个州发现病例激增,会向疾控中心提供相关数据,疾控中心可能决定介入。在政府效率部介入后,“那个系统依然存在,但受到了大规模公共卫生裁员的影响,”匹兹堡大学公共卫生学院流行病学助理教授亚历山大·桑德曼(Alexander Sundermann)告诉我。在追溯疫情源头时,对州流行病学家来说,一项特别耗时的工作是访谈受感染的患者。“完成一份问卷可能需要两到三个小时,而且每个病例都要这么做,”桑德曼说。“做这项工作的人少了很多,所以速度会比以前慢得多。”研究人员确定病原体的时间越长,可能就会有越多的人生病。

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.)

如果联邦《食品可追溯规则》(Food Traceability Rule)能按原计划在1月生效,完全有可能成百上千的美国人本可以避免在初夏的大部分时间里困在马桶上。该规则于2022年最终确定,一旦实施,将把更多的调查责任放在企业身上,要求它们追踪并记录大多数受食药监局监管的食品数据——包括水果蔬菜、鱼类和乳制品——并在接到要求后二十四小时内向政府提供这些数据。但在2025年3月,由于大型农业综合企业的强力游说,国会将该规则的实施推迟至2028年,这反映了特朗普第二任期的放松监管精神。(律师兼公共卫生倡导者马修·科特兰(Matthew Cortland)最近挖出的联邦选举委员会表格显示,同样在去年3月,泰勒新鲜食品公司向支持特朗普的超级政治行动委员会MAGA Inc.捐赠了一百万美元。)

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.

《食品可追溯规则》被推迟后,行业组织食品工业协会(Food Industry Association)的首席执行官表示宽慰,称该规则会带来“不必要的复杂性,加重供应链负担,并增加消费者的食品成本”。或许,这次圆孢子虫疫情就为我们描绘了一幅“无负担供应链”的图景,以及它所付出的代价。

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!”

截至7月13日,密歇根州已记录了两千六百四十例圆孢子虫病病例。(疾控中心全国确诊病例数仍落后,为八百四十三例。)同一天,密歇根州通报了调查取得突破,宣布生菜很可能是此次疫情的元凶。社交媒体上,对泰勒农场的猜测进一步升级。肯尼迪仍未就圆孢子虫发表公开声明,对此事保持沉默。他发布了一段简短视频,敦促其追随者通过个人责任的力量来扭转美国的“慢性病负担”:“这要从你夺回自己的健康开始,”他说。然后,反疫苗人士、电影《憨直舞男》(Deuce Bigalow: Male Gigolo)主演罗伯·施奈德(Rob Schneider)走进镜头。“你能行的!”他喊道。“动起来!吃真正的食物!”

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.

三天后,疾控中心和食药监局终于就圆孢子虫病发表了一份具体且可操作的声明——这份声明,要说有什么特别,就是其具体程度古怪得离奇。声明描述了一场“与五个州塔可钟(Taco Bell)门店供应的生菜丝有关的跨州圆孢子虫感染疫情”。它给消费者的建议非常狭窄:“不要食用印第安纳州、肯塔基州、密歇根州、俄亥俄州和西弗吉尼亚州塔可钟门店的生菜丝。”这些生菜来自墨西哥一家未具名的“单一供应商”。“杂货店出售或其它餐厅供应的生菜丝不受影响,”声明说。

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.

对于那些密切关注疫情的人来说,这份声明令人困惑。圆孢子虫病正困扰着上述五个州之外的数千人:纽约州报告了三百七十四例,北卡罗来纳州三百零七例,伊利诺伊州二百二十七例。与塔可钟的关联本身并无争议——食药监局引用了密歇根州的一组患者,其中十分之九的人在发病前曾在该连锁店食用过含生菜的产品——但这仍然留下了大量未报告在塔可钟用餐的密歇根州患者。而且,肯定不需要是“多力多滋玉米卷至尊”(Doritos Locos Tacos Supreme)、“至尊墨西哥玉米片”(Nachos BellGrande)或其他可能含生菜丝菜单产品的拥趸,也会纳闷:为什么自己不种生菜的塔可钟,被单独拎出来当作圆孢子虫灾难的唯一罪人。

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.

《华盛顿邮报》和《纽约时报》很快报道了许多网络角落早已得出的结论:泰勒农场——具体是其位于圆孢子虫流行地墨西哥中部的分厂——很可能是受污染生菜的来源。7月17日,即联邦政府单独点名塔可钟一天后,泰勒新鲜食品公司宣布“自愿从美国市场撤下所有源自墨西哥中部的生菜”,这些生菜已运往二十七个州的分销商、大型卖场和餐厅。

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.”

该公司的召回通知(食药监局后来将其粘贴到自己的网站上)在全面披露信息方面采取了近乎密码学的方式,用诸如“PV”、“MKTSD”和“BLEND LETT/ROM 80/20 WITH SEP BAGGIES 4/5#”等晦涩代码列出受影响的产品和门店。食品安全专业律师比尔·马勒(Bill Marler)的博客对理解此次圆孢子虫危机不可或缺,他写道,如果《食品可追溯规则》按时实施,泰勒新鲜食品公司召回通知中列出的各州和代码“本应在一天之内——在5月份——就交到食药监局手中。结果我们是在7月的第三周,从一家公司网站上,以缩写的形式看到它们。”

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.

肯尼迪终于打破沉默,并选择了佛罗里达州坦帕市一档早间驾车谈话广播节目作为他的发声平台。他告诉主持人瑞安·戈尔曼(Ryan Gorman),圆孢子虫病很容易治疗。他说,“每年夏天都有疫情爆发”。(这没错,但那些疫情通常每个州只影响几十人;肯尼迪对去年冬末那场致命的麻疹疫情也发表过类似脱离背景的评论。)肯尼迪嗤之以鼻地说,所谓圆孢子虫病未被积极追踪的说法是“假新闻”,听众可以登录食药监局网站查看“我们的调查结果”。他没有指出调查仍在进行中——根本没有什么“结果”可看——也没有解释为什么他监管的机构曾短暂地将所有非塔可钟生菜标记为安全。“既然我们现在知道了可能的元凶,”肯尼迪说,“我想人们做出健康的选择会容易得多。”此时,密歇根州病例数刚刚突破五千。

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.

在这种情况下,人们如何“做出健康的选择”?在爆发性腹泻的时代,如何按照肯尼迪的说法“夺回你的健康”?那些“MAHA妈妈”们和其他与MAHA结盟的网红们做出了符合她们人设的回应,兜售她们声称能杀死寄生虫的补充剂,并公开揣测这是深层国家(deep state)的心理战,目的是让我们远离绿叶蔬菜。肯尼迪旗下机构发布的公共卫生信息如此混乱零散,以至于普通买菜人可能根本不知如何应对。我上次刷TikTok时,算法给我推送了有人在绿叶菜上泼漂白剂溶液。我的孩子们目前只吃带皮的水果,因为那样粪便就进不去了。他们一直都知道沙拉对健康没好处。

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.)

在7月18日的那个周末,食药监局宣布,一份来自泰勒农场的生菜样本——重要的是,这份样本并非来自被召回的生菜,而是仍在市面上流通的——检测出圆孢子虫阳性,随后又迅速撤回了这一发现,称其为“假阳性”。不经意的观察者听到这消息,可能会理所当然地认为,根本没有证据将泰勒农场与疫情联系起来。该公司声称食药监局已为假阳性结果道歉,并强调该机构“尚未发现任何一份圆孢子虫产品检测呈阳性”。(食药监局否认道过歉。)

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.”

食药监局为何选择在未先核实工作的情况下,就公布如此重大的发现,从而在我们本已受损的公共卫生体系中播下更多疑虑,这本身就是一个谜。但总部位于芝加哥的非营利组织“阻止食源性疾病”(Stop Foodborne Illness)的首席执行官桑德拉·埃斯金(Sandra Eskin)告诉我,假阳性结果丝毫没有削弱将泰勒农场与疫情联系起来的流行病学和追溯数据。“大量患病的人在塔可钟吃了生菜,那些生菜来自泰勒农场,”埃斯金说。“当你有强有力的流行病学证据和清晰的追溯链条时,你不需要产品检测来证明这种联系,泰勒农场对此心知肚明。”她补充说,食药监局和疾控中心“在沟通这件事上确实做得不好。”

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.

截至7月21日,疾控中心已收到来自四十一个州的圆孢子虫病报告。密歇根州病例数逼近七千;俄亥俄州西北部超过两千。在一次新闻发布会上,肯尼迪说:“我们确实控制住了疫情。”这一声明似乎与他自己在食药监局的下属的说法相矛盾,该局当时正在、并且仍在调查食物链中圆孢子虫的可能来源。“当关于涉及哪些食品以及人们为何生病的消息如此混杂时,很难知道‘控制住了’是什么意思,”埃斯金说。

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.

在“夺回你的健康”时,如果公共卫生领导者善于沟通关于我们食品供应中危险的基本信息,会有所帮助;如果他们不把这项工作留给超市里爱管闲事的人,会有所帮助。如果受托保障我们健康的机构拥有适当的资金和人员配置,会有所帮助。如果你能弄清楚你的食物来自哪里,由哪家公司生产,会有所帮助。如果法律强制企业向公共卫生机构提供精确数据,并禁止它们向监管自己的实体提供巨额捐款,会有所帮助。如果肩负让美国再次健康重任的人,不把大多数疾病看作一场尤其严苛的果汁净化排毒,旨在考验我们的意志并让我们变得更强,那也会有所帮助。

“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.” ♦

“公众很难认识到公共卫生在起作用,因为它起作用时,你是看不见的,”桑德曼告诉我。“美国一直在挣扎的地方,就在于证明预防很重要,我们应该投资于预防。”他提到了特朗普总统一月份让美国退出世界卫生组织(World Health Organization)的决定。“十年或二十年后,当抗菌素耐药性肆虐,我们可能因感染无抗生素可用而死亡时,我们会回过头来说,‘嗯,也许我们当初不该退出世卫组织。’那些是长期后果。但短期后果我们现在就看到了。未来我们只会看到更多这样的情况。”7月22日,即肯尼迪宣布圆孢子虫已“得到控制”的第二天,食药监局宣布正在调查一起新的该寄生虫疫情,迄今已有七十二例,源头“尚未确定”。 ♦

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