Welcome to Trump’s America, The i Paper’s World Insight series presenting the sharpest, deepest thinking on an era-defining shift in history and politics, investigating how Donald Trump and his administration have changed the US and the world – and where we go from here.

• America can’t afford to retire
• The White House I worked for would have condemned this image. Trump refuses
• Trump isn’t damaging America. He’s reinventing it
• The US is becoming impossible to live in
• The Golden State is being left to burn – because it voted Democrat
• 
• The rise of ‘Mar-a-Lago face’ – and what it says about sexism in America

Moe Ayyad says he has never felt more sick in his life after falling victim to the cyclosporiasis outbreak that is gripping the US.

“I’m a healthy 25-year-old man who enjoys physical activity,” the Ohio car dealer told The i Paper. But after two visits in June to his local Taco Bell fast food restaurant, 17 miles south of Cleveland, “I felt like my body was losing the battle … it was unlike anything I’ve ever experienced,” he says, describing symptoms that include explosive diarrhoea, severe stomach cramps, and extreme bloating.

Ayyad believes that either Taco Bell’s Cheesy Fiesta Potatoes or the eatery’s Avocado Ranch Chicken Stackers brought him to his knees. In a lawsuit seeking unspecified compensatory damages, he accuses the restaurant and five unidentified suppliers of being responsible for contaminated lettuce or other produce that was “unreasonably dangerous for its ordinary and expected use”.

“I felt like my body was losing the battle to the parasite,” Ayyad says. “I contracted Covid very early in the outbreak, but that was fairly easy to get past. Cyclospora left me unable to move.”

Ayyad is one of thousands of Americans who have been affected by an illness that is caused by the cyclospora parasite. Contaminated or unclean foods including salad, herbs and fresh fruit can carry the parasite, and once it takes root in the small intestine, it can lead to the “explosive diarrhoea” that afflicted Ayyad, with some patients reporting having to use the toilet up to 30 times per day. Two people have now died in the worsening US health crisis.

The UK Health Security Agency said last week that 67 cases had been reported in Britain since April, many of them among holidaymakers who had visited Mexico. It warned that more are expected as a result of travel this summer.

It is still not clear exactly how the parasite, spread through faeces, got into the US food supply. One supplier, Taylor Farms, has recalled shredded lettuce sent to the US market from central Mexico. In a statement, Taco Bell said that “out of an abundance of caution we moved swiftly to voluntarily remove potentially impacted ingredients from select stores”.

It is testament to the damage wrought by the Trump administration on the US public health system that it is hard even to know how many cases of cyclosporiasis there are in America.

The Centers for Disease Control claims 10,468 people have been infected across 47 states, with more than 12,255 awaiting investigation. The website GenomicEpi – a hub for those working in genomic and molecular epidemiology – reports that by 1 August, 17,197 cases had been reported. A third tracker maintained by Mappr reports that Michigan alone logged 12,485 cases by 6 August, up 710 in a day, one of the largest single-day rises of the outbreak.

While most cases resolve on their own, some require a course of antibiotics and even hospitalisation. People have been advised to avoid bagged lettuce, especially where linked to certain suppliers, and drink bottled water and cooked food when holidaying in Mexico.

The CDC has faced intense criticism over its delays in tracking and responding to the crisis. Critics have blamed more than $12bn in funding cuts implemented during Elon Musk’s stewardship of the so-called Department of Government Efficiency (Doge). Coupled with subsequent changes introduced by Donald Trump’s controversial Secretary of Health and Human Services, Robert F. Kennedy Jr, they have sparked a notable decline in the trajectory of Americans’ public health.

Michigan is home to the largest number of cyclosporiasis victims, and the outbreak’s first two fatalities. The state’s health department said the deaths resulted from underlying health conditions “that may have been impacted by cyclosporiasis and dehydration”. The disease can also cause loss of appetite, weight loss, stomach cramps, wind, nausea, fatigue and flu-like symptoms.

Michigan’s public health facilities have been hard-hit by Trump administration funding cuts that resulted in one of the state’s regional laboratories closing and 146 jobs lost, with 23 positions eliminated in its Bureau of Infectious Diseases. On Friday, Michigan officials said it was safe for people to start consuming lettuce again, amid evidence that the peak of the outbreak has now passed in the state.

The Association of Public Health Laboratories, a non-profit representing labs run by state and local governments across the US, says the cuts mean fewer states are “testing food for harmful pathogens and chemical contaminants, increasing the likelihood that more people will get sick from their food, and more of those people may die”.

Deep cuts to the US Food and Drug Administration’s funding for state laboratories effectively “dismantle the nation’s integrated food safety system” and threaten the country’s capacity to respond to multi-state events like the cyclospora outbreak, the association argues. That has led to allegations of a sluggish initial response when the outbreak first began, delayed federal tracking and ongoing arguments over the quality and reliability of the data the CDC has collected.

“Outbreaks like this underscore the importance of a strong public health system,” says Dr Susan Kansagra, chief medical officer at the Association of State and Territorial Health Officials. “Having a workforce that can quickly detect and respond to emerging health threats can help prevent illness and protect communities.”

Those days in the US appear to be over.

Some organisations that receive federal funds appear unwilling to brook public criticism of the Trump administration over the cyclosporiasis outbreak. Last week, the American Association for the Advancement of Science held a virtual press briefing on developments. Two experts brought in to brief reporters deflected questions about whether Kennedy or the Trump White House bore any culpability for the outbreak and its spread.

“The outbreak is getting under control,” insisted Dr Kali Kniel, professor of microbial food safety at the University of Delaware. “Communication has been good, product has been removed,” she told The i Paper during the briefing.

The second analyst, Dr Craig Hedberg from the University of Minnesota’s Division of Environmental Health Sciences, conceded that case counts were “the one area where I think we haven’t really had as timely updates from the CDC … as we would like to see”. But he also claimed that the budget cuts to CDC oversight system FoodNet have “generated a lot of headlines … but it hasn’t really had any effect on our ability to identify or investigate outbreaks”.

Pressed over the impact of government funding cuts, both experts tip-toed around the problem, with Kniel insisting “the CDC and FDA still have good consumer health information” even while she recommended members of the public sought data on cyclosporiasis from the non-governmental GenomicEpi website instead. Meanwhile, Hedberg urged members of the public to “not overly dwell on the events that happen and keep a healthy attitude about food in general”.

But other experts pointed the finger of blame firmly at the Trump administration’s door.

“This is like we have a house, and we’ve just decided to start taking the smoke detectors out,” says Bob Custard, president of the West Virginia Association of Sanitarians. He claims that “at every level the system has been weakened”, with local funding cutbacks diminishing the quality of data being reported nationally.

The White House disagrees. On 24 July, spokesman Kush Desai told reporters that “any notion that the White House or the Trump administration would ever compromise on the health and safety of the American people is absolutely false” and claimed the FDA “is conducting a thorough and evidence-based outbreak investigation”.

But this is a country where last month cases of measles hit a 35-year record high. The Pan American Health Organization will decide in November whether the US should be stripped of its measles elimination status. Since Kennedy took office, routine childhood vaccination rates have steadily declined, and once-ubiquitous government information campaigns urging parents to inoculate their children and newborns have evaporated.

In a testy appearance on CNN last Sunday, Kennedy indicated that his top priority in preparing for any future public health emergency is “to protect our constitutional rights”. He suggested that during the Covid-19 pandemic, dissident doctors promoting debunked treatments were being “marginalised and vilified”.

While Kennedy works on protecting the rights of Americans including Trump, who suggested in 2020 that the public might try injecting themselves with disinfectant in a bid to combat Covid-19, back in Ohio, Moe Ayyad is still trying to get over his explosive diarrhoea.

“It’s definitely added a lot of stress,” he says. “It’s uncomfortable to talk about: I haven’t passed a solid stool since I’ve had the parasite.”