Public health nurses like Linda Kim, who has called more than 100 infected residents, are tasked with tracing a parasite that takes up to two weeks to present symptoms. The investigative process is painstaking, requiring staffers to ask residents to scroll through grocery store apps, dig up fast-food receipts, and recall specific details like the exact brand of bagged salad they consumed weeks prior.
Tracing a Complex Foodborne Illness
Investigating cyclospora requires a level of detail that often surprises the public. Kim, a nurse with the Washtenaw County Health Department just outside Ann Arbor, spends her calls asking highly specific questions to pinpoint the contamination source. On a recent call, she asked a resident about a Taco Bell order: “Is that the crunchy one or the soft one?”
Patients, experiencing what many describe as one of the most excruciating illnesses of their lives, are often eager to share graphic details about their symptoms. Kim noted that people readily divulge messy specifics, such as “pooping their beds, and, like, putting down towels and it’s not enough.” While the confessions do not faze her as a nurse, the sheer volume of cases means staffers try to keep each conversation under an hour.
The state health department confirmed that the two individuals who died from the outbreak had “significant underlying health conditions that may have been impacted by cyclosporiasis and dehydration.” Department spokesperson Lynn Sutfin emphasized that deaths from the parasite are uncommon in the U.S. and the illness is generally not life-threatening.
From Measles to Cyclospora: A Relentless Cycle
The current crisis follows closely on the heels of a measles outbreak that sickened seven people in Washtenaw County earlier this year, five of them children. That outbreak, which ended in late May, prompted an all-hands-on-deck response and a state advisory urging families to vaccinate babies ahead of schedule. Kim was transferred in March to help manage the measles contact tracing.
The contrast between the two outbreaks is stark. Measles contact tracing was often contentious, with residents suspicious of government overreach. “People were like, ‘Oh, you’re just trying to restrict my life,’ or ‘You’re just trying to get information out of me and get me in trouble,’” Kim recalled. She spent her time explaining that tracing the highly contagious virus was meant to “keep it contained, so it doesn’t become something huge.”
Cyclospora surveillance, by comparison, has been met with eager cooperation from patients desperate to pinpoint the source of their suffering.
Federal Funding Cuts Hobble Michigan Public Health
The Cyclospora outbreak arrives during a chaotic period for Michigan’s public health infrastructure. Earlier this year, the Trump administration’s sweeping cuts to public health grants eliminated a critical contract between the state and 44 of its 45 local health departments. The cuts defunded 123 full-time employees and stripped disease surveillance labs of resources for equipment maintenance and data modernization.
Laina Stebbins, a spokesperson for the Michigan Department of Health and Human Services, confirmed the cuts severely reduced the state’s ability to innovate laboratory processes during emerging disease responses. Although a temporary restraining order restored some funding, the damage lingered. Washtenaw County had to scale back disease surveillance and outbreak response work. The department is currently not replacing retiring employees outside of an understaffed nursing team.
The instability extended to community programs and federal partners. The county’s Health Equity Council, which focuses on reducing health disparities, was abruptly shuttered in early 2025 before resuming operations with funding secured only through September. Meanwhile, a Centers for Disease Control and Prevention employee stationed at the Washtenaw department was fired, rehired, and then furloughed during the funding chaos.
Slow Federal Response Frustrates Local Staff
Local health officials have expressed frustration with the pace of the federal response. Christina Zilke, a nursing supervisor at the Washtenaw health department, noted that fast-food restaurants were already removing lettuce from their menus before the CDC officially identified it as the outbreak source.
“It took them forever to say that this was lettuce, and fast-food restaurants were taking it off the shelves before the CDC ever said what it was,” Zilke said.
During a July 14 press call, Gwen Biggerstaff, deputy director of the CDC’s Division of Foodborne, Waterborne, and Environmental Diseases, acknowledged the delay. Biggerstaff stated that identifying a specific source for cyclosporiasis is inherently slow due to the lag time between exposure and symptom onset, coupled with the complexity of tracing the parasite. Sometimes a source is never identified.
What Happens Next
The convergence of a massive foodborne illness outbreak and a depleted public health workforce underscores a precarious reality for disease surveillance in the United States. As Washtenaw County nurses work through hundreds of remaining cases, morale is sustained by sheer necessity. Zilke has resorted to stocking coffee and bringing in pizza, framing it not as a reward but as survival rations. “It’s more like: ‘Here’s some food for survival. Here’s a break so you don’t quit.’”
For Kim, the back-to-back crises—a measles outbreak in the spring and the current Cyclospora surge—have been a surreal introduction to a public health career spanning just two years. She remains enthusiastic but deeply concerned about the broader implications of a fractured system.
“If nationally they don’t know what’s going on, how are we locally expected to know what’s going on?” Kim said. “And also just frustrating to be, like, ‘Wow, I don’t think even our government knows how important public health is.’”
With federal funding still uncertain and local departments operating on temporary reprieves, health experts warn that the next major outbreak could find an even less prepared frontline. The current response in Michigan may serve as a stark indicator of the vulnerabilities built into a defunded public health system. As long as infrastructure remains compromised, the burden of protecting community health will continue to fall on an overextended few.
— Aisha Mensah, health desk, AXO News