Records released to Bloomberg News show that Michigan's Department of Health and Human Services spoke with Yum! Brands - Taco Bell's parent company - on July 2 about cyclospora. The documents were obtained under Michigan's open-records law. In a follow-up email, state officials asked to meet with the company's supply-chain quality assurance and communications teams "for a discussion about any intervention or notification that could be taken this week to aid in reducing the number of cases in the future." An email sent to Yum showed the chain had already received a reporter's question about several of its Michigan restaurants.
State epidemiologist Sarah Lyon-Callo wrote to Yum: "Although it was reassuring to hear that you had not received complaints and your staff were not reporting illness, we have a strong signal from our epidemiologic interviews that we need to continue to work with Taco Bell."
On July 4, Michigan told businesses and commercial kitchens that work with raw produce to use extra care with lettuce and other leafy greens. Two days later, the state's rapid response team pressed Taco Bell again to provide documents, explaining that the number of cases and speed of spread demanded timely information to protect public health.
Taco Bell became publicly tied to the episode after a July 7 news report displayed signs said to be on some of its Michigan restaurants warning about an ingredient recall. At that moment, neither the CDC, state health officials, nor Taco Bell had announced a recall.
Monday brought a 2.9% slide in Yum's share price. The fast-food chain said it moved quickly based on Michigan's advice, adding in a statement: "Out of an abundance of caution we moved swiftly to voluntarily remove potentially impacted ingredients from select stores, in line with Michigan guidance."
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The company did not publicly confirm the removal until July 14, saying it had removed "limited ingredients" at certain restaurants as a precaution because of the outbreak. Taco Bell added that no authorities had yet established a link to the chain, any ingredient, or a supplier.
On July 17, federal authorities first publicly tied Taco Bell to the outbreak and advised customers not to eat shredded lettuce at its locations in five states. The FDA then linked the illnesses to iceberg lettuce from Taylor Farms, whose recall reached 27 states. Taco Bell removed that affected lettuce.
Cyclospora is a microscopic parasite that causes the infection, usually after contaminated food is eaten. Lettuce, herbs, and raspberries are common carriers. Because the organism cannot be reproduced in a lab, and because the responsible meal is often gone by the time symptoms appear, investigators depend on patient interviews. Michigan had conducted more than 700 by July 10.
State counts are often ahead of federal totals because case reports take time to reach the CDC. The CDC counted more than 6,707 cases in 45 states, while Michigan counted more than 11,200 cases and two deaths on Monday. Michigan is the center of a nine-state Midwest cluster.
The two deaths involved people with underlying health conditions that were probably made worse by cyclosporiasis and dehydration. People can suffer nausea, exhaustion, and severe watery diarrhea lasting as long as two months. Doctors typically treat it with antibiotics and supportive measures such as fluids.
The U.S. normally sees fewer than 100 diagnosed cyclospora cases in a year, with numbers rising in warm months.
Yum's stock fell about 4% in July. Other restaurant chains that use lettuce, such as Sweetgreen, Cava, and Chipotle, also saw share declines even though none was connected to the outbreak; Sweetgreen was hit hardest.
Michigan's health department said Monday that detailed food diaries suggested lettuce, tomatoes, and onions were possible sources, though other items could not be ruled out. It added that eating at Taco Bell was commonly, though not exclusively, identified. That information was shared with Yum, the CDC, and the FDA.
Taco Bell restaurant visits declined because of the outbreak, but Yum executives said last week the decline in sales has "moderated materially" with help from promotions including a $1 burrito covered in enchilada sauce and a "Mexican pizza" for the same price.
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