Quick state action to involve federal agencies and inform the public might have shortened an outbreak of Legionnaires’ disease in the Flint area and saved lives, a national expert on the respiratory disease told The Detroit News.
Michigan turned down help from the U.S. Environmental Protection Agency and the Centers for Disease Control and Prevention, according to a Detroit News analysis of more than 24,000 pages of emails released by the Snyder administration and Genesee County.
State agency officials also tried to steer Genesee County health officials away from examining the municipal water system as a potential source of the Legionella bacteria that sickened 87 people between May 2014 and November 2015, killing nine.
Legionnaires’ disease is caused in warmer months by a bacteria in warm, fresh water that leads to a severe form of pneumonia and can be found in large plumbing systems, hot tubs and air-conditioning units.
The state’s handling of the crisis contrasts markedly with how New York state officials dealt with a Legionnaires’ outbreak last summer in the Bronx, said Dr. Janet Stout, a research associate professor with the University of Pittsburgh who assisted with both outbreaks. The Bronx spate included 133 cases, resulting in six deaths.
“New York City and New York state were very, very aggressive in terms of doing the testing and informing the public, and as a result they were able to contain the outbreak very quickly,” said Stout, president of Special Pathogens Laboratory, which conducted water testing in the Bronx.
The outbreak lasted about a month — from July 8 to Aug. 3 — and was traced to a cooling tower on top of a hotel, according to New York City.
“As a result, they were able to contain the outbreak very quickly,” Stout added. “If you don’t make that progression of doing the testing of the environment, the cases continue — which is what we saw in Flint.”
A study by state of Michigan epidemiologists of 45 Flint area cases that occurred from June 2014 through March 2015, resulting in five deaths, found that 16 cases were associated with McLaren Regional Medical Center in Flint.
Stout, who was hired by McLaren as a consultant, concluded Legionella bacteria likely entered the hospital through brown water from the municipal water system. But the cache of emails between state, county and federal health agencies documents the state’s reluctance to search the water system for clues or relinquish control of the scientific investigation.
EPA officials were so alarmed after they were contacted by Genesee County health officials in February 2015 that they immediately alerted the CDC to the outbreak in Flint, EPA spokeswoman Monica Lee told The News. Both agencies offered on-the-ground expertise. Michigan didn’t follow through by requesting the agencies’ assistance, which is required for federal participation.
“Michigan felt that they had the skills and resources needed to perform the investigation themselves,” said CDC spokesman Kristen Nordlund.
On June 4, 2015, Jim Collins, the state health department’s communicable disease division director, issued a memo declaring, “The outbreak is over” — a contention immediately disputed by Genesee County Environmental Health Supervisor Jim Henry, noting there were two confirmed Legionnaires’ cases that week.
“That memo put the brakes on things that were going forward, including getting the CDC to come to Flint,” Stout said. “That was a critical error because that help would have done a lot of things, including sampling of the water system for Legionella.
“There was no plan for systematic assessment by systematically culturing for Legionella, and testing for Legionella is not something that most departments do very well. A very important opportunity was missed to get that help.”
Legionella samples weren’t available from Flint area Legionnaires’ patients, so it’s impossible to make the “strain match” required “to make a definitive statement on environmental causation,” according to the Michigan Department of Health and Human Services.
Making the public aware of the outbreak would also have been beneficial because early treatment can stem the progression of Legionnaires’ disease, Stout said.
“The first spike was in summer of 2014, and they were still trying (to grasp the situation),” she noted. “The second spike occurred in summer 2015, and certainly at that time it should have been clear to public health officials that this was real and not to wait to inform people.
“Certainly a warning about the potential health effects of this water would have been very helpful. Early diagnosis and early treatment with the appropriate antibiotic results in a better disease course, and reduced mortality.”
In mid-January, a task force appointed by Gov. Rick Snyder predicted another surge in Legionnaires’ this spring when the weather warms and recommended the city’s health care facilities extend disinfection safeguards to all air treatment and cooling systems.
When asked on Jan. 19 why the state health department didn’t alert the public sooner, director Nick Lyon said experts linked multiple Legionnaires’ cases to a single hospital and thought the problem might be resolved if the hospital took appropriate actions.
“It’s important for us to inform the public,” Lyon said. “It’s also important for us to stay open-minded and ensure that we’re really checking any sort of possibility for Legionnaires’, including anything that could be associated with the water source change.”
Legislation introduced in the Senate, but not yet voted on, would require the EPA to directly inform citizens of a public health risk from unsafe water due to lead if the state doesn’t act within 15 days of learning about the risk. The bill was co-authored by Michigan Democratic Sens. Debbie Stabenow and Gary Peters. Similar legislation already passed in the U.S. House.
"It is shocking that state health officials turned down federal support nearly a year ago to study the outbreak in Legionnaires' disease,” Stabenow said in an email to The News on Sunday. “This is yet another extremely disturbing example of the state failing to meet its responsibility to protect the public health of families in Flint.
“As investigations continue, I will continue to do everything I can to hold decision makers accountable," Stabenow added.
In the past week, the state Department of Health and Human Services contended that during the first wave of Legionnaires’ disease, the Genesee County Health Department wasn’t following scientific standards for investigating the outbreak and refused state help.
“I don’t know if we’ve had a situation before where the local health department hadn’t done the steps … or taken advantage of state assistance,” Geralyn Lasher, a deputy director at Health and Human Services, told The Detroit News.
‘A select email’
Lasher said Genesee County also did not alert all doctors in the state about the Legionnaires’ outbreak on the Michigan Health Alert Network, a state-run portal for communicating threats to public health. Instead, a handful of Flint-area doctors were told about the outbreak, she said.
“For some reason the … Genesee County Health Department chose to send a select email to 15 individuals at the three hospitals,” Lasher said.
County Environmental Health Supervisor Jim Henry said the county requested help from the state Department of Health and Human Services. Local health departments don’t commonly post alerts on the state-run Michigan Health Alert Network. He questioned why the state didn’t post an alert on its network.
“All this information goes into the Michigan Disease Surveillance System. They have a person at the state assigned to Legionnaires’ that looks at this every day,” Henry said. “Why didn’t they step up?”
Keith Creagh, the new state Department of Environmental Quality director, said Thursday the nondisclosure of the Legionnaires’ disease outbreak by his agency and others for months shows the need for new public reporting requirements.
“There is a reason to be thoughtful and methodical in a crisis,” Creagh told The News, “but I think we have an obligation to let people know.”
Stout dismissed the contention that the county was to blame for the spread of Legionnaires’ disease.
“Based on the outcome of all of this, people could have done much more, except the people at the Genesee County Health Department. They went down every potential avenue to raise concern about the uptick of Legionnaires’ disease,” she said.
“The state was in the driver’s seat, and they made it very clear to the county that they wanted to be in charge of the investigation and wanted the county to stand down in informing the CDC. Certainly the responsibility lies at the feet of the state.”
Staff Writers Jonathan Oosting and Chad Livengood contributed.
Specific tests are needed to determine if a case of pneumonia is Legionnaires’ disease.
The most common symptoms of Legionnaires' disease include:
■Shortness of breath
Symptoms usually begin 2 to 10 days after being exposed to the bacteria, but it can take longer so people should watch for symptoms for about two weeks after exposure.
Source: Centers for Disease Control and Prevention (CDC)