Nurses chase Cyclospora using grocery receipts, food apps and detailed interviews
Linda Kim, a nurse at the Washtenaw County Health Department in Michigan, has been helping to investigate more than 900 cases of cyclosporiasis locally. Foodborne illnesses are some of the most complex public health investigations, especially with the Cyclospora parasite. That’s because symptoms may not appear for up to two weeks after someone’s eaten contaminated food.Kate Wells/KFF Health Newshide caption
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Kate Wells/KFF Health News
More than 900 people in Washtenaw County, Michigan have been sickened with cyclosporiasis since mid-June. Linda Kim, a public health nurse, has spoken to more than 100 of them
This story was produced in partnership with KFF Health News
Almost everyone’s said the same thing: It’s excruciating, and one of the worst illnesses they’ve experienced
But on a Wednesday in July, she called one man who said he wouldn’t mind having it again, actually
“You’re enjoying the weight loss?” Kim said, laughing as she took notes in a small conference room at the Washtenaw County Health Department building, just outside Ann Arbor. “Well, I’m glad to hear that. At least you got something good out of it!”
From one crisis to the next
Normally, Kim’s supposed to be working downstairs in the clinic, where families wait in the gray plastic chairs in the lobby for free or low-cost immunizations. But she hasn’t been there in months
In March, Kim was transferred to a different department to help deal with a local measles outbreak that sickened seven people in the county, five of them children. It was an all-hands-on-deck situation; everyone worked overtime. The state issued an advisory urging families in Washtenaw and surrounding counties to get their babies 6 months or older vaccinated ahead of schedule, if possible
Those contact-tracing calls for measles could be contentious, Kim said. People were suspicious, asking her how she knew they had tested positive, or why they should give her any information
“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,'” she said. “It’s like, no, we’re actually not doing that at all.”
Public health nurse Linda Kim also did contact tracing during a measles outbreak in Washtenaw County, Mich. She says the cyclosporiasis patients have been much more forthcoming, even volunteering intimate details about their distressing gastrointestinal symptoms. In contrast, some of the people she called regarding measles were more suspicious about her questions and her reasons for trying to track exposures.
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Kate Wells/KFF Health News
As she tried to explain to them, tracing the spread of the highly contagious virus and publicizing possible exposure sites was an effort to “keep it contained, so it doesn’t become something huge.”
The county’s measles outbreak ended in late May. Then in June, reports of cyclosporiasis cases started pouring in: more than 10,000 so far in Michigan
The cyclosporiasis surveillance has been different, Kim says. Now, people seem eager to divulge even the most graphic details of their illness, such as “pooping their beds, and, like, putting down towels and it’s not enough.”
Since she’s a nurse, such confessions don’t faze her, Kim said. Still, they have hundreds of these calls to make, so they try to keep each conversation to under an hour
Before reports of cyclosporiasis cases started pouring in this summer, Washtenaw County Health Department staff in Michigan were working to contain a measles outbreak with contact tracing and testing. The county’s outbreak ended in May.
Kate Wells/KFF Health Newshide caption
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Kate Wells/KFF Health News
But foodborne illness investigations are complex. Especially for this parasite, Cyclospora. Symptoms can take as long as two weeks to appear after people have eaten contaminated food. And no one remembers what they ate two weeks ago, public health staffers said. The interview process can be extremely detailed. Kim and her colleagues ask people to pull up their restaurant receipts, scroll through purchases on their grocery store apps, even try to recall details such as the exact brand of bagged salad mix they bought, or the type of taco they got at Taco Bell.
“Is that the crunchy one or the soft one?” Kim asked on a recent call, typing on a laptop decorated with cat and vaccine-themed stickers
Tracing the
Kim has been working with the health department for two years, a period defined by federal funding cuts
Laina Stebbins, a spokesperson for the Michigan Department of Health and Human Services, said the Trump administration’s sweeping cuts to public health grants eliminated a contract between the state health department and 44 of the state’s 45 local departments that funded 123 full-time employees
Those cuts also impacted the state’s disease surveillance labs, “reducing funding for equipment maintenance contracts, data modernization and the ability to innovate laboratory processes during emerging disease response,” Stebbins said
Some of that funding was restored after Michigan won a temporary restraining orderagainst the Trump administration. But Washtenaw’s health department still had to scale back some disease surveillance and outbreak response work. Currently, employees who leave or retire aren’t replaced, except for those on the nursing team, which is hiring but still understaffed
Staff at the Washtenaw County Health Department in Ypsilanti, Michigan, work to trace the iews with hundreds of people.
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Kate Wells/KFF Health News
The county’s Health Equity Council, which aims to reduce health disparities, including in mental health, was also shuttered suddenly in early 2025. Nearly a year later, it resumed its work, with funding at least through this September
An employee from the Centers for Disease Control and Prevention had been stationed at the department. During the funding chaos, the worker wasfired, then rehired, then furloughed
A frustrating federal response
The federal response to cyclosporiasis has felt frustratingly slow a nursing supervisor at the Washtenaw health department
“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,” she said
It’s not unusual for it to take a long time to identify a specific source for cyclosporiasis — if it’s identified at all, said Gwen Biggerstaff, Deputy Director of the CDC’s Division of Foodborne, Waterborne, and Environmental Diseases during a July 14 press call. That’s partly due to the lag time between exposure and the appearance of symptoms, and the complexity of tracing this particular parasite.
Meanwhile, Zilke’s been stocking the coffee station and bringing in pizza, trying to keep up staff morale. It’s not a reward, she said. “It’s more like, ‘Here’s some food for survival. Here’s a break so you don’t quit.'”
Linda Kim, for her part, remains enthusiastic about the job, but says it’s been a surreal introduction to a public health career: First measles, now Cyclospora
“If nationally they don’t know what’s going on, how are we locally expected to know what’s going on?” she said. “And also just frustrating to be like, ‘Wow, I don’t think even our government knows how important public health is.'”
But there’s no time to dwell. She has to move on to the next call, as soon as she can wrap up this one. She gives each person her work number, so people can call or text with any follow-up questions
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