There has been a lot of passing the buck among Michigan state agencies in the weeks since Governor Rick Snyder announced to the public in January that there has been an ongoing – but unreported – outbreak of Legionnaires’ disease in Genesee County since April 2014.
After Flint’s state-appointed emergency manager changed the city’s water to local Flint River water in a cost-saving effort in April 2014, the region’s number of Legionnaires’ disease cases almost immediately increased from around a dozen each year to more than 40 annually. 87 Flint residents were infected with the dangerous Legionella bacteria; 9 died.
And yet, as recently released emails reveal, state epidemiologists and other health officials had noted and were concerned about the rise in Legionnaires’ disease cases as early as October 2014 – and yet none of the agencies they appealed to for assistance would agree to test the municipal water system for Legionella.
Legionnaires’ Disease Outbreak Investigation Time Line in Flint, MI
In response to Governor Snyder’s January 13 press conference, the Michigan Department of Health and Human Services (MDHHS) “claimed that water tests were impossible as they did not have samples of the bacteria from infected patients” – a claim that later proved false when reporters at Detroit News discovered that samples were compiled from at least 12 patients. (1)
The time line of discussions between five different agencies reveals how strongly the need for Legionella testing was being argued among internal decision makers, even as residents continued to fall ill:
1) October 13, 2014: Shannon Johnson, an infectious disease epidemiologist with Michigan Department of Community Health, alerted MDHHS officials to the surge in new Legionnaires’ disease cases and recommended that local hospitals be advised of the need to obtain clinical isolates from patients. She also offered to assist the Genesee County Health Department with environmental testing of the municipal water, either at her lab or at the Michigan Department of Environmental Quality (MDEQ) lab. (2)
2) February 2015: The Genesee County Health Department approached the Centers for Disease Control (CDC) about the situation; the CDC offered to “provide epidemiologic and laboratory support from Atlanta or in Michigan.” MDHHS, however, declined this assistance, stating that “they had the skills and resources needed to perform the investigation themselves” – something which never happened. (1)
3) March 2015: MDEQ consulted with MDHHS about testing Flint’s water for the bacteria at the MDHHS laboratory; both agencies chose *not* to do the testing. (1)
4) March 2015: The Environmental Protection Agency (EPA) recommended Legionella testing of the municipal water to the DEQ but was ignored. Darren Lytle, acting chief of the Treatment Technology Evaluation Branch at the EPA in Cincinnati, offered to have water samples tested at a specialized lab, but neither the state, city, or county responded.
5) June 2015: MDHHS declared that the LD outbreak had ended in March 2015.
6) January 13, 2016: MDHHS announced that LD cases could not be linked to the municipal water supply because of the lack of clinical isolates from patients.
According to Detroit News, both Genesee County Environmental Health Supervisor Jim Henry and Marc Edwards, head of a task force from Virginia Tech charged with investigating the Flint water’s lead contamination, called for environmental testing for Legionella in 2015.
After MDHHS changed its story and told Detroit News that the state lab did actually have 12 clinical isolates from patients, it argued that these isolates were nonetheless useless because MDHHS had failed to perform concurrent environmental testing based on the Centers for Disease Control guidelines that individual buildings, not municipal water systems, be tested for Legionella. To date, the city water still has not been tested; instead, the CDC is working with Genesee County to test different building water systems for the bacteria.
With no environmental water samples and limited clinical isolates, it is very hard to confirm a Legionnaires’ disease outbreak (even one which strikes 87 victims).
Sources:
1. Bouffard, Karen. “Flint water never tested for Legionella.” The Detroit News. Web. 24 February 2016.
2. Press Release. “MDHHS releases emails related to the Genesee County Legionnaires Disease investigations.” Michigan Department of Health and Human Services. Web. 9 Feb. 2016.
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