Two People Have Died in the Cyclospora Outbreak. The Fifty-State Count Is Now 21,913. | Marler Blog

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Providing Insight on Food Poisoning Outbreaks & Litigation

Marler Blog

Providing Insight on Food Poisoning Outbreaks & Litigation

Two people are dead. The Michigan Department of Health and Human Services said so on Monday morning, August 3, and they are the first deaths anywhere in an outbreak that began in May and has now been reported by all fifty states.

Here is the whole of what Michigan said. Two deaths have been identified as part of the cyclosporiasis outbreak affecting the state. According to medical records, both individuals had significant underlying health conditions that may have been impacted by cyclosporiasis and dehydration. No additional information will be provided on these two cases. Cyclosporiasis is generally not a life-threatening illness, and death resulting from it is uncommon in the United States.

May have been impacted by is contributory language. It is not a cause-of-death finding, and I am not going to write that this parasite killed two people when the health department has not said that. What I will say is that this is exactly how foodborne deaths in medically fragile people read on the page — a serious underlying illness, a diarrheal infection, dehydration, and a death that could be entered a dozen different ways depending on who fills out the certificate. That ambiguity is not a reason to discount these two. It is the reason deaths from this kind of illness are undercounted everywhere.

The same Monday morning update moved Michigan’s count to 11,234 cases, up 461 from the 10,773 the state reported on Friday. Hospitalizations held at 193, which is still the previous Thursday’s figure, because Michigan refreshes that number weekly.

That takes the fifty-state total from 21,452 to 21,913, against the 18,207 people the federal government describes when you add its two published figures together. The two counts are now 3,706 apart. The gap has passed twenty percent of the federal base for the first time since I started keeping this table. The named nine-state outbreak, at 1,947 people, is 8.89 percent of the illness this country is reporting.

The federal government moved on Monday for the first time since July 24, and it moved on this and nothing else. CDC’s investigation page now states that it is aware of two cyclosporiasis-related deaths in people with underlying health conditions from Michigan as part of this outbreak, and that it will update its website to include laboratory confirmed cases, hospitalizations, and deaths. Read that second sentence again. It is a promise to update rather than an update. The case count on that page has not changed. The FDA advisory is still stamped July 24 and still carries a line reading Deaths: 0, which is now contradicted by a sister agency on the page it links to.

There is a question buried in the phrasing that matters more than it looks, and I am asking it rather than answering it. CDC says the two deaths are part of this outbreak, and on that page this outbreak means the nine-state Taco Bell cluster of 1,947 people. Michigan says they are part of the cyclosporiasis outbreak affecting Michigan, which is 11,234 people. Those are not the same denominator. They differ by a factor of about six. Whether these two people are inside the federal 1,947 or inside the state’s 11,234 changes every fatality rate anyone tries to calculate this week, and neither agency has said which it is.

Ask yourself how a third death would be found. It would be found the way these two apparently were, which is that somebody who already knew a patient had cyclosporiasis went and looked at what happened to that patient afterward. In a state with 11,234 cases and 193 hospitalizations, that is a manageable exercise. In the other forty-nine states, where nobody is systematically reviewing death certificates for a parasite that would rarely appear on one, it is not being done at all. Zero deaths has never meant zero deaths. It has meant that no one was looking.

These two deaths also land on a claim the produce industry has been making all summer. The International Fresh Produce Association’s consumer FAQ still tells the public that Cyclospora outcomes are generally favorable even in immunocompromised patients and that no significant long-term health consequences have been reported. I do not think that FAQ was written in bad faith. I think it was written before anybody had bothered to look at the severe end of the curve, and it should be rewritten today.

One more thing surfaced in Monday’s coverage that has not been part of this story until now. The Windsor-Essex County Health Unit in Ontario is urging its residents to take precautions when travelling to Michigan. It has identified twenty-four cyclosporiasis cases in 2026 against a typical year of about three, and its investigations found...