State, Genesee talked river, illness link in '14

Jim Lynch
The Detroit News

State and Genesee County health officials discussed the potential link between a rise in cases of Legionnaires’ disease and Flint’s switch to a new water source as early as October 2014 — 15 months before Gov. Rick Snyder went public about the spike in Legionnaires’ cases.

Emails released Tuesday by Michigan’s Department of Health and Human Services offer details on a sometimes tense relationship between state and local officials over the outbreak and its handling. Between June 2014 and November 2015, Genesee County reported 87 cases of Legionnaires’ disease, including nine deaths.

The timeframe mirrors the period immediately after Flint began drawing its water from the Flint River in April 2014.

In an October 13, 2014, email among state health officials, the possible link between the water source and the health issues was discussed.

“The current hypothesis is that the source of the outbreak may be the Flint municipal water,” wrote Shannon Johnson, a state health department infectious disease epidemiologist. “I ran five-year (statistical analyses) for the six counties (Saginaw, Shiawasee, Livingston, Oakland, Lapeer and Tuscola) surrounding Genesee and none of those counties are experiencing an increase similar to what Genesee was experiencing.”

Despite the suspicions, state officials did not alert the public to the spike in Legionnaires’ cases in Genesee County until Snyder’s announcement on Jan. 13.

Legionnaires’ disease is caused in warmer months by a bacteria in warm fresh water that leads to pneumonia and sometimes death. The bacteria can be found in large plumbing systems, hot tubs, air-conditioning units and fountains.

Dr. Eden Wells, the state’s chief medical executive, said in mid-January that the state couldn’t “draw a direct linkage to the general water supply at this time.”

Wells said the state was unable to do enough tests of patients to establish a link between the river water and the rise in Legionnaires’ cases.

In releasing the emails, the state health department said: “Recent comments in the media are inconsistent with the collaboration that has taken place between the Michigan Department of Health and Human Services and the Genesee County Health Department.”

“We want Flint to know we take these concerns seriously (about Legionnaires’) — that we have investigated these cases and committed our staff to support and guide the local investigations,” Wells said in a statement.

But the released emails indicate that both state and local officials were worried about whether “the hypothesis” about a link between the city’s water and Legionnaires’ should reach the public.

One of the state officials was Liane Shekter Smith, former head of the Michigan Department of Environmental Quality’s Office of Drinking Water and Municipal Assistance. Shekter Smith’s office was responsible for overseeing Flint’s April 2014 switch from the Detroit Water and Sewerage Department to river as a water source.

An Oct. 17, 2014, email indicates Smith expressed concerns to state health officials that the quality of the water would become public.

On the same day, the state health department’s respiratory illness epidemiology manager Susan Bohm wrote of Smith: “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.”

Four days later, Bohm again wrote of Smith’s concerns over a public airing about the quality of Flint’s water: “She was concerned that an announcement was going to be made soon about the water as the source of infection; I told her the Flint water was at this point just a hypothesis.”

After being reassigned from her position in October, the DEQ last week fired Smith.

The Detroit News first reported Jan. 23 that an expert on Legionnaires’ disease for McLaren Regional Medical Center said Flint’s contaminated water likely contributed to the Legionnaires’ outbreak in Genesee County, where the bacteria was found in a hospital’s water supply.

Water testing during the outbreak found Legionella bacteria at the Flint hospital, where the University of Pittsburgh’s Janet Stout concluded the organism likely came from the city’s tainted water.

Further, a state analysis showed that a high number of those diagnosed with Legionnaires’ in Flint had been patients at McLaren during the 14 days prior to showing symptoms.

The released emails also reflect a state-Genesee County relationship in which each side seemed to wait for the other to share information.

On Jan. 23, 2015, Jim Collins, who heads the state health department’s Communicable Disease Division, wrote to Genesee County health officials looking for an update on the Legionnaires’ investigation.

“I’ve gotten some mixed messages around the level of follow-up that has been completed on these cases so far,” he wrote. “It seems that, if complete follow up is taking place, the information is not being entered into the (Michigan Disease Surveillance System). This information can provide the critical first step toward directing environmental assessments of exposure, source identification and, hopefully, elimination.”

A week later, Suzanne Cupal, public health supervisor for Genesee County, indicated the state had failed to identify experts her staff could contact on specific matters in the investigation. In addition, it appears the two sides were attempting to decide how the rise in Legionnaires’ cases should be reported.

“If we are referring to this as an outbreak, we would like to request that we designate it as such and include an outbreak identifier in (the Michigan Disease Surveillance System),” Cupal said in a Jan. 30, 2015, email to state and Genesee health officials. “We would also like to discuss criteria for inclusion for this outbreak.”

The following two months produced a back and forth between the Michigan Department of Health and Human Services and Genesee County over what steps needed to be taken and the drafting of a questionnaire for Legionnaires’ patients. But at no point did officials discuss alerting the public to the Legionnaires’ outbreak.

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