New statistics on Genesee County pneumonia deaths in 2014 and 2015 align with some expert opinions that the Flint water crisis most likely resulted in more than the 12 Legionnaires’ disease deaths already linked to it.
The state’s Department of Health and Human Services recently made public the number of deaths in the county from pneumonia during the period when Flint residents were receiving improperly treated water, lacking corrosion controls, through the city’s distribution system. In April 2014, the city ended its long-standing contract with the Detroit Water and Sewerage Department and began drawing from the Flint River.
Ninety county residents died from pneumonia in 2014, a 70 percent surge from 2013’s total of 53. In 2015, when Flint continued to use river water until mid-October, the number of deaths was 87 — a 65 percent increase over 2013.
It’s a trend that matches a previously identified rise in cases of Legionnaires’ disease — a virulent form of pneumonia — over the same period. And it raises the possibility that Flint’s water supply may have contributed to more than the dozen fatalities already recorded.
Janet Stout, a clinical and environmental microbiologist with the Special Pathogens Laboratory in Pittsburgh, assisted Genesee County’s Health Department in 2015 when it attempted to analyze the rise in legionella. On Friday, she said the bacteria was likely involved in many of the pneumonia cases from around that time.
“I would say at least some of those deaths that have been linked to pneumonia are likely to be attributable to Legionnaires’...,” she said. “It’s consistent with what we’ve learned in over 30 years of following this disease.”
Once a diagnosis of pneumonia is made, additional testing is necessary to determine if legionella bacteria are present. Such follow-up is not always completed, meaning many pneumonia deaths perhaps caused by legionella are recorded as simple pneumonia.
Marc Edwards, a Virginia Tech professor whose research team helped identify the presence of lead in Flint’s drinking water in 2015, agreed it is likely that some pneumonia deaths may have been caused by legionella. In fact, he predicted an increase in legionella growth in Flint’s water system that year.
“We wrote a research proposal ... in the summer of 2015 where we actually said they should have expected a Legionnaires’ outbreak,” Edwards said Friday. “We’d just done research that said if someone doesn’t add corrosion controls, you should should expect higher cases of Legionella.”
The newly released pneumonia numbers, first reported by Bridge Magazine, resurrect questions about the handling by state and county officials of a growing Flint health crisis in 2014 and 2015 and whether different actions might have saved lives. Last year, the Legionnaires’ cases prompted a $100 million class-action lawsuit against McLaren Flint hospital, where many of Legionnaires’ cases were reported, and several state employees.
Dr. Mona Hanna-Attisha, a Hurley Medical Center researcher who helped identify lead contamination in the blood work of Flint children, said she would not be surprised if the numbers of Legionnaires’ deaths were underestimated.
“...We now know the untreated corrosive water created a perfect milieu for the overgrowth of such opportunistic pathogens like Legionella,” she wrote in an email response to questions. “It’s heartbreaking since these are deaths, and it could have been entirely prevented and/or it could have been minimized if the public and providers were alerted during the spike.”
After seeing Legionnaires’ cases rise in early 2014, Genesee County Health Officer Mark Valacak said the topic was discussed at a regular June meeting with the area’s three major hospitals. That meeting, he said, was attended by the state’s regional epidemiologist and resulted in a heightened vigilance among the partners.
Records show that state investigators were aware of the Legionnaires’ spike and concerns of a link to Flint water in October 2014.
Early in 2015, Genesee County consulted with Stout, who said she suggested bringing in the resources of the U.S. Centers for Disease Control and Prevention. Jim Henry, the county’s environmental health supervisor, contacted both the CDC and U.S. Environmental Protection Agency.
The Michigan Department of Community Health’s infectious disease division chief rebuked Henry, saying in an email that CDC involvement “should be at the request of the state, rather than the local health department.”
In a June 4, 2015 email, that same division chief, Jim Collins, declared the outbreak “over.” At least five more deaths from legionella would occur after that date.
A spokesperson at McLaren Flint could not be reached Friday for comment. A state Health and Human Services spokeswoman responded to question on the pneumonia numbers in a statement.
“...Beginning in the fall of 2014 and on multiple occasions in 2015 and 2016, MDHHS advised the Genesee County Health Department to notify the health care community of the increase in Legionella cases and provided clinical guidance that addressed increased clinician awareness and testing,” wrote spokeswoman Angela Minicuci. “MDHHS also advised broad dissemination of this information to the health care community in the county.”
She also pointed out that other counties showed a similar spike in pneumonia deaths in 2014, which may have drawn the focus off of the significance of Genesee’s numbers.