Emails: State mum on Flint Legionnaires’ warning

Official said outbreak was over, but Genesee cases kept coming

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At least six Environmental Protection Agency officials discussed in late March Genesee County’s Legionnaires’ disease outbreak and a suspected link to Flint’s change in water sources — and were told the state would alert the public.

No pronouncements about the outbreak were made then. Two months later, a Michigan health official’s email to the Centers for Disease Control and Prevention declared “the outbreak is over.” The disease would kill four more people in the summer and fall and would not be brought to the public’s attention until the next year.

When the public was informed, the words came from Gov. Rick Snyder during a Jan. 13 press conference. Snyder maintained he had heard about the Legionnaires’ outbreak two days earlier.

Thomas Poy, the ground and drinking water branch chief of EPA Region 5, told those on the March phone call that “the state is currently figuring out a communication-with-the-public plan,” according to notes from Jennifer Crooks, the EPA’s Michigan drinking water program manager.

A trove of more than 24,000 pages of Flint-related documents among local, state and federal officials released by Snyder’s administration reveals EPA Midwest water experts held the March 26 conference call to discuss the Flint-area Legionnaires’ disease outbreak. Among those contributing was Region 5 water expert Miguel Del Toral, who at the time expressed concerns about the lack of corrosion controls and the likely risk of lead contamination in Flint’s drinking water.

Del Toral discussed the possibility that “extensive flushing” of Flint’s stagnant water by residents may have caused bacteria-fighting chlorine residual in the pipes to be washed away, leaving the pipes susceptible to Legionella bacterial growth, according to notes from the conference call.

Darren Lytle, an expert in Legionella from the EPA’s Cincinnati office, told his colleagues that his previous research showed that changes in water chemistry can cause disruption and “destabilize” water piping systems. Lytle “thought the incidence of Legionella must be fairly extensive for the (Genesee County Health Department) to notice and study,” according to the conference call notes.

Lytle offered to come to Flint and study the origins of the pneumonia-causing bacteria, records show.

But state and county officials appear to have never followed through with the offer for help, an EPA official said. As it did in Flint’s lead contamination, the agency stayed publicly silent about the threats to public health in Genesee County while state and local officials debated how to approach the problem, records show.

“There wasn’t any follow-up with them asking us to do anything,” EPA spokeswoman Monica Lee said Thursday. “There wasn’t any specific ask there, we were just kind of put on alert that they were looking at Legionnaires’ disease.”

Numbers alarmed EPA

Notes from the March 26 conference call suggest EPA officials had been briefed by state officials about what they were planning to do. Genesee County contacted the EPA about the outbreak in February 2015, and shared data on cases that had occurred by then. According to Lee, the agency was so alarmed by the numbers they immediately contacted the CDC to alert them.

Disclosure of the outbreak fell to state and local health officials as well as the CDC, Lee said.

“CDC has the lead on this. It’s not EPA at all,” Lee said.

CDC spokeswoman Kristen Nordlund on Thursday said the agency offered its epidemiologic expertise and laboratory support, but it required a direct state request.

“Based on the available information, CDC felt that a comprehensive investigation was warranted and offered to further assist Michigan,” Nordlund said in an email. “In this case, Michigan felt that they had the skills and resources needed to perform the investigation themselves.”

EPA’s Crooks emailed those notes on March 30 to Michigan Department of Environmental Quality water regulators Stephen Busch and Mike Prysby, state employees who oversaw Flint’s water. Busch is currently suspended.

“(EPA’s) Tom Poy said that we are laying a foundation now with resources for when the state goes public with the issue of Legionella,” according to the notes.

The Legionnaires’ disease outbreak that infected 87 Flint-area residents and caused nine deaths from April 2014 through November was not made public until Jan. 13, when Snyder announced them in a hastily called press conference in Detroit. Snyder had learned of the outbreak two days before, an aide said.

In January, state health officials finally requested support from CDC’s Legionella experts 11 months after it was offered, Nordlund said.

State unsure river to blame

Emails from federal, state and local government agencies emerging in the wake of the Flint water contamination crisis show a series of events that transpired behind the scenes last year as officials scrambled to understand the source of the illness before informing Flint-area residents of the public health threat. To this day, state health officials are still unsure whether the Flint River water is to blame for the outbreak.

The records show a slow and sometimes indifferent response by state and federal officials, starting in October 2014 when the Legionnaires’ spike was noticed by Genesee County health department officials.

Liane Shekter Smith, who was the DEQ official in charge of Flint’s April 2014 switch to Flint River water, made a phone call to Susan Bohm, an epidemiologist at the Michigan Department of Health and Human Services.

Bohm sent officials at DHHS who deal with communicable diseases an email about the phone call labeled “Genesee County Legionnaires’ Disease Cluster.”

The email shows Shekter Smith, who was fired last week for her role in Flint’s water crisis, sought to steer health department officials away from concluding that the spike in Legionnaires’ disease may have been related to Flint switching to river water six months earlier.

“She was concerned that we were going to be making some announcement soon about the water being the source of infection, so I told her the Flint water was at this point just a hypothesis,” Bohm wrote. “... What she did share with me was interesting — that there have been numerous complaints about the Flint water, that the Governor’s Office had been involved, and that any announcement by public health about the quality of the water would certainly inflame the situation.”

Snyder’s office has said its involvement in Flint’s water in October 2014 was limited to responding to complaints from citizens about the smell, taste and color of the water. The governor’s administration also was inquiring about boil water advisories Flint issued in August and September of that year after E. coli and total coliform bacteria had infiltrated the water supply.

Agency tensions building

By January 2015, Flint’s water problems were bubbling up after bacteria-killing chlorine caused high levels of the byproduct total trihalomethanes — known as TTHM — and tensions were building between government agencies, records show.

On Jan. 26, Jim Henry, a Genesee County environmental health supervisor, sent county health officials an email about his inquiry to multiple government agencies in his probe of the Legionnaires’ outbreak. At the DEQ, Henry said he ran into a road block.

“Mike Prysby and Steve Busch declined to meet with our office,” Henry wrote.

Shekter Smith, who supervised Busch and Prysby at the DEQ, later said in a March 12 email that Busch denied that his office refused to meet with Henry.

The next day, Busch pushed back in an email to Henry about his focus on the Flint River as the source of the outbreak.

“Conclusions that Legionella is coming from the public water system without the presentation of any substantiating evidence from your epidemiologic investigation appears premature and prejudice toward that end,” Busch wrote to Henry.

On April 8, DEQ’s Shekter Smith discussed gathering data to determine the source of Legionella with EPA’s Crooks. Crooks was involved in the March 26 call with other EPA officials about the Legionnaires’ disease outbreak.

According to Crooks’ notes of the meeting with Shekter Smith, DEQ officials were “having trouble keeping” the county health department focused on investigating the source of the Legionella bacteria.

“Seems that (the county health department) is continually distracted by side issues going on with the Flint distribution system, such as the lead service line issues,” Crooks wrote in the April 8 memo, six months before state officials admitted Flint had lead leaching from the water service lines.

‘The outbreak is over’

In the following months, state health officials began battling Genesee County’s health department.

On June 4, DHHS communicable disease division director Jim Collins sent his summary report on 45 cases of Legionnaires’ disease from June 6, 2014, through March 9, 2015, records show.

“The outbreak is over,” Collins’ report declared. “The last reported case occurred in March 2015. The lack of clinical Legionella isolates precludes our ability to link cases to an environmental source.”

Henry responded with skepticism that the outbreak was over, noting there had been two confirmed Legionella cases earlier that week, according to county records obtained by The News through a public records request.

“The executive summary regarding the Legionella outbreak is appreciated, but I don’t know if there is consensus that it is over,” Henry wrote in an email response. “... There has been a lot of finger pointing and miscommunications, which continues even in the email below from Jim Collins, today. I think us reaching out to CDC and EPA was appropriate. We were not gaining much ground with the state agencies and now the warmer weather is upon us.”

CDC officials had said they needed a request for assistance from the state, not the county.

“Relative to communications around the investigation, I believe that CDC is in agreement that their involvement really should be at the request of the state rather than the local health department,” Collins wrote in a June 8 email to Henry and other Genesee County officials.

Lag, then issue resurfaces

From there, the records trail goes cold until Nov. 30, when county officials sent EPA’s Lytle a draft press release that would have alerted the public to the Legionnaires’ disease outbreak and a second wave that ended earlier that month. Lytle forwarded the email to members of EPA’s Flint water task force on the morning of Dec. 1.

“I have been trying to get to the bottom of reports of increases in reported cases of Legionnaires’ Disease in Genesee County and finally reached the correct people,” Lytle wrote. “They shared some data that is very concerning and although they can’t pinpoint the exact source of Legionella, drinking water can’t be ruled out.”

Lytle’s email was forwarded along to other government agencies, arriving in the inbox of a CDC official in Atlanta that afternoon. Laurel Garrison, who tracks Legionella outbreaks for the CDC, became alarmed by a statement that the CDC had been formally engaged in the issue, according to her email to Collins and another state health official.

“As you’re aware, we haven’t received a formal report from MDHHS and haven’t received a request to review anything in any formal or informal way since June,” Garrison wrote. “Of course, we are ready to assist if there is a need, but I’m concerned that this statement is misrepresenting CDC’s current involvement.”

Genesee County never issued the news release and it’s unclear why. Henry did not return a message seeking comment.

Keith Creagh, the new DEQ director, said Thursday the months of nondisclosure of the Legionnaires’ disease outbreak by his agency and others shows the need for new public reporting requirements.

“There is a reason to be thoughtful and methodical in a crisis, but I think we have an obligation to let people know,” Creagh told The News.

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clivengood@detroitnews.com

(517) 371-3660

Twitter.com/ChadLivengood

Staff Writer Jonathan Oosting contributed.

ABOUT THIS REPORT

The News reviewed more than 24,000 pages of documents from state agencies involved in Flint’s water crisis. They were gathered under Freedom of Information Act requests and provided by Gov. Rick Snyder’s administration and Genesee County. They cover the Michigan Department of Environmental Quality, Michigan Department of Treasury, Michigan Department of Health and Human Services, Genesee County Health Department, U.S. Centers for Disease Control and Prevention and U.S. Environmental Protection Agency.

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