The parasite outlasted the recall

Missouri joined the outbreak on Wednesday, Aug. 5. Not the getting-sick part, which has been going on for months. The official part: the state was added to the CDC’s multistate outbreak map, confirmed by a state health department spokeswoman before the CDC itself had announced it. Per the department, the addition “does not change how public health officials investigate the cases reported in Missouri.”

Here is what the map caught up to. The Missouri Department of Health and Senior Services reported 1,095 cyclosporiasis cases as of Aug. 2, more than double the week before. Then it did not stop: the state’s Sunday release put the count at 1,577, up another 44 percent in a week, the third-highest figure of any state on the CDC’s confirmed-case ledger. A department epidemiologist offered the first hopeful sentence of the summer Monday: cases will keep rising, but the rate of the rise has started to come down. Note what that sentence is: a slower climb, announced four weeks after the recall that was supposed to be the turn in this story.

The machinery of that addition is on the FDA’s investigation page, updated Aug. 5, a page that has itself been renamed since July, from a nine-state investigation to a fifteen-state one, the old address left to 404. The CDC widened the case definition from people who ate at Taco Bell to anyone exposed to the recalled lettuce, and the linked outbreak grew accordingly: what was nine states on July 24 is fifteen now, Missouri and Kansas both on the list, with 6,358 illnesses, 278 hospitalizations and two deaths. Many of those illnesses, the page notes, began before the recall existed. Missouri didn’t join the outbreak Wednesday so much as the outbreak’s definition grew until it included Missouri.

The recall that keeps not ending it

The timeline is worth laying flat, because every part of it is public and no part of it resolves.

Taylor Farms recalled its central-Mexico iceberg lettuce on July 17. Per the FDA’s page, the linked illnesses began as early as June 22, weeks before any product came off a shelf, and the most recent onset on the page is July 31. People were still getting their first symptoms two full weeks after the recall.

The lab record is where it was. The one sample that tested positive was re-reviewed and declared a false positive; as of the page’s last word on testing, confirmed product positives stand at zero. The FDA’s answer, stated plainly in its July 24 update, is that the lab results don’t decide this: the epidemiology and the traceback “continue to converge” on the one supplier, and the recall stands on that. The agency also notes it can take as long as six weeks to determine whether a sick person belongs to the outbreak — its own explanation for why the count keeps rising after the recall. Take both points as offered. A system whose proof of contamination cannot survive its own laboratory, and whose case count runs six weeks behind the sickness it counts, is making the traceability argument for me either way.

At the end of July the FDA’s active outbreak table listed a dozen ongoing foodborne investigations — four of them Cyclospora. By last week it was six separate Cyclospora investigations, including a brand-new one — ten people sick, food not identified, traceback underway. Six concurrent investigations into the same parasite means the system cannot reliably tell you whether the person sick in Ohio and the person sick in Kansas got it from the same field, the same distributor, or from unrelated sources moving through the country at once. Missouri’s own health officials say not all of the state’s cases connect to a single source.

The two deaths are on the FDA’s own case-count table, which is a federal primary source rather than a wire number. Reporting has placed both in Michigan, in people with underlying health conditions. The linked outbreak is also the smaller of the two numbers that matter: the CDC’s national surveillance count, refreshed Aug. 4, stands at 10,468 laboratory-confirmed domestic cases since May, with more than 12,000 additional reports still awaiting confirmation, call it 22,000-and-climbing against the outbreak page’s 6,358. Same parasite, two ledgers, and this season both of them are still climbing. Michigan, the state at the top of both, lifted its bagged-salad advisory Aug. 6, its ER visits finally declining, a sentence Missouri cannot yet write.

How close, and why neither side of the line will quite say

Here is the proximity question every reader actually has, and the strange shape of the answer.

Kansas updates weekly, on Wednesdays, and the latest number (Aug. 5) is steep: 615 cases statewide, up from 461 the week before, 154 new in seven days, in a state that counted 55 in mid-July. The next figure lands Wednesday. Kansas also publishes county detail, which is more than Missouri does.

The catch is who printed it. Wednesday’s county breakdown ran through a Topeka station and a Wichita station, each listing the counties in its own viewing area: Shawnee County at 97, the highest figure published anywhere; Sedgwick at 80; then Douglas, Riley, Osage, Jackson and a short tail of northeast Kansas counties in single digits. Johnson County, the most populous county in the state and the one that matters to anyone reading this in Kansas City, appears in neither.

Its last published figure is 143, from July 30, when the state total was 461 — printed not by either of Wednesday’s stations but by the Johnson County Post, which has been carrying the county’s number while the metro’s larger outlets have not. Kansas has grown by a third again since. What Johnson County looks like tonight is a number sitting in a KDHE table that nobody has printed this week.

Which also retires the frame this outbreak carried in July. Two weeks ago Johnson County held about a third of Kansas’ cases and this was a suburban Kansas City spike. Wednesday the largest published county figure belongs to Topeka. The thing has spread out, and the coverage has not caught up to the spreading.

Missouri, for its part, still publishes how much and not where. The statewide count arrives as a single number with no county table under it. But Monday evening a Kansas City station put the question to the metro’s health departments directly and got numbers: 69 in Clay County, 34 in Cass, 14 in Platte, and a Jackson County figure that arrived wearing two hats, the same 244 attributed both to the county and to the Kansas City Health Department, jurisdictions that cover different people. At least one of those attributions is off, and with no state table to check against, a reader cannot tell which.

So a person standing on State Line Road can now see county numbers in both directions: a week old on the Kansas side, hours old and self-contradicting on the Missouri side, and none of it published by the agency that holds the actual table. Somebody at DHSS can still fix this with a spreadsheet column, and this column is still asking. The rest is a coverage problem, and the coverage moved this week: those numbers exist because a station asked. It should not require asking.

The part where I admit my bias

Standing disclosure, same as every time this outbreak comes up: I write for an outlet betting that a metro ought to be able to know what’s on its plate without a federal agency reverse-engineering it after the fact. Weigh accordingly.

But the argument from July hasn’t needed my help. “Iceberg lettuce from central Mexico” is still not a place. It’s a supply chain, and the recall built on it has now been outlived by the thing it was recalled for. The clusters are still defined by where people ate, because where the food came from is still the part nobody can see. A traceability system that produces four simultaneous investigations, zero confirmed product positives, and a case curve that ignores the recall date is not a system having a bad month. It is a system doing what it is built to do, which is not much.

The outbreak has not gone away. It is not going away on any schedule the recall set. At best it is now getting worse more slowly, which is what passes for good news in week four. Missouri’s map dot made it official on Aug. 5; the 1,577 people now behind it knew already.

Wash your greens. Know your grower. Still.

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A note on what’s not in this column: no Kansas City-area restaurant, grocer, or vendor is named here in any connection to this outbreak, deliberately and by standing policy. Every figure above traces to federal and state agencies and national-level producers already in the public record; recall specifics, including affected brands and dates, are at the FDA link above. Our previous column on this outbreak ran July 25 and is here.