Kyle came down with flu-like symptoms on Friday, Sept. 15. His mom had worked hard to make sure her kids got good nutrition. A favorite trick was the veggie smoothie. "If you put enough berries and juice and yogurt in them, you can put spinach in, so I did," she says.
But it soon became clear that Kyle had something much more serious than the flu. The whole family got sick, but his mom, dad and his older sister fought it off. Kyle couldn't. He was rushed to the local hospital, then to Primary Children's Medical Center in Salt Lake City.
There, Kyle developed hemolytic uremic syndrome (HUS). His kidneys shut down. On Wednesday, Sept. 20, he had a heart attack and died, his parents at his bedside.
The last death occurred on Jan. 26, 2007, when Betty Howard of Richland, Wash., succumbed to heart failure after a long battle with HUS. Howard, 83, got sick after eating a turkey sandwich garnished with spinach. She went into the hospital on Sept. 7 and from there to a convalescent facility, never returning home.
Howard and Dunning were not counted in the Centers for Disease Control and Prevention's final list of victims. Seattle-based Bill Marler, considered the nation's pre-eminent E. coli lawyer, who represents Howard's and Dunning's families, says the bacteria that felled both matched the spinach outbreak strain. Their medical bills were paid by Natural Selection's insurer, Marler and Dole say. Natural Selection declined to comment.
Dozens of others would become dangerously ill. Of the 200 confirmed cases of sick people, 102 were hospitalized and about 15% would suffer kidney failure — a condition that could affect them for the rest of their lives.
In Milwaukee, two of Ana Maria Zientek's children, David, then 6, and Caroline, then 3, were sickened by the spinach salad they'd eaten at dinner on Aug. 28, suffering severe cramps and diarrhea.
Blood "literally poured" out of Caroline as her mom bundled her up in a sheet and raced to the hospital. David was hospitalized for six days, his sister for 13.
For Jillian Kohl of Milwaukee, the nightmare began on Wednesday, Aug. 30, with a spinach salad. Being a thrifty grad student, she ate a lot of it, because the expiration date on the bag was that day.
Over the next few days the 25-year-old marathon runner started to feel tired and worn out. By the weekend she was feverish and nauseated. She called her mother, who told her to rest and take aspirin. But on Monday, the bleeding started, putting her in a hospital's intensive care unit for eight days.
At one point, as her body began to shut down, she thought, "I give up. I had a good 24 years in life, and I hate that my family is going to have to see me die like this."
In the early days of the outbreak, Wisconsin and Oregon, both known for their strong public health departments, took the lead in trying to figure out what was making people sick.
Wisconsin, which has an aggressive E. coli monitoring network, was the first state to realize that something was wrong.
When the week of Sept. 4 began, chief state epidemiologist Jeffrey Davis knew that he had a cluster of five E. coli O157:H7 cases. But most of the victims had gone to the Manitowoc county fair — a common place for E. coli to spread, because cows and other animals excrete the bacteria in feces.
And small clusters aren't uncommon; in any year Wisconsin may have around 200 cases. Davis adopted a wait-and-see approach.