Flint — Sixteen months after it was identified as a likely source of a deadly Legionnaires' outbreak, Flint's water supply still hasn't been tested for the Legionella bacteria.
None of five government agencies aware of the outbreak in Genesee County investigated the water system for Legionella despite concerns raised by the county's Health Department over the water as early as October 2014. That was six months after the city left Detroit's system and began drawing its water from the Flint River.
Experts say the lack of a water evaluation made it impossible to know if the city's new water source contributed to the respiratory disease outbreak that sickened 87 people between May 2014 and November 2015, killing nine. And to date, no source for the bacteria has been determined.
In March 2015, the state Department of Environmental Quality considered taking samples from Flint's water system to be tested for Legionella at the Michigan Department of Health and Human Services' laboratory. But neither agency followed through.
That same month, the Environmental Protection Agency also suggested city water should be tested for Legionella during an EPA meeting about the outbreak and expressed that opinion to the DEQ in an email reviewed by The Detroit News. Again, no testing was done.
Experts, including Marc Edwards, the Virginia Tech professor whose research uncovered the problem of lead contamination in Flint water, argue the municipal water should have been tested for Legionella because the outbreak could be tied to changes in the water system. Genesee County Environmental Health Supervisor Jim Henry also called for such testing. Experts say had the source of the Legionella been confirmed as the water system, targeted chlorine treatments could have been applied to kill the bacteria.
"MDEQ should have done such testing, especially after they were alerted to Legionella problems by the Genesee County Health Department," Edwards said. "Better yet, they should have allowed CDC to come in and do that testing for them."
Besides the state's DEQ and health department, the federal EPA and Centers for Disease Control and Prevention also confirm to The News they've done no water testing for Legionella in Flint. The Genesee County Health Department says it does not have the expertise to do so.
The reasons why Flint's water supply wasn't tested aren't entirely clear, although the local, state and federal agencies now largely blame each other or claim that typical procedures don't involve testing municipal water supplies.
State epidemiologist Shannon Johnson, in an October 2014 email to colleagues, wrote "the current hypothesis" was that "the source of the outbreak may be the Flint municipal water." Johnson noted that county epidemiological mapping revealed most Legionnaires' cases had occurred downstream of Flint's municipal water plant, where chlorine and other bacteria-killing chemicals would be more diluted.
"I let (the county health department) know that we could assist with and facilitate environmental testing, whether it be through our lab or DEQ," Johnson wrote.
Darren Lytle, acting chief of the Treatment Technology Evaluation Branch at the EPA in Cincinnati, also expressed concern that changes in Flint's water system could be behind the outbreak during a meeting with federal colleagues on March 26, 2015, according to the meeting summary sent to the DEQ.
"Maybe this isn't happening in people's homes, but it is happening in the distribution system pipes," Lytle suggested to fellow EPA staffers. "First we must find the source — is Legionella there? If Legionella is present, in the tanks/pipes then disturbance of changing the water quality and flushing could cause it to proliferate."
At the same meeting, the EPA's Miguel Del Toral added that extensive flushing then being done to address bacterial growth in stagnant water in parts of the system could also foster Legionella growth, according to meeting notes.
Lytle offered to take municipal water samples and test them for Legionella. He noted the EPA had tested for Legionella at two Ohio hospitals as part of a research study, so a lab was already set up for Legionella testing.
But the EPA never "received a request for assistance from the state, city or county" to get further involved, EPA spokeswoman Monica Lee told The News.
Asked why the DEQ didn't test then for Legionella in Flint, spokeswoman Mel Brown said the state health department was "the lead agency to look into the matter."
State had tests from patients
In materials sent in conjunction with Gov. Rick Snyder's Jan. 13 press conference announcing the outbreak, Michigan health officials said it was impossible to know if the cases were connected to Flint city water because of a "lack of clinical isolates" — samples of Legionella collected from patients.
"There's investigations still going on to try and make that determination," Snyder said at that time when asked if the outbreak was linked to changes in Flint's water system. "But from a scientific or medical point of view, I don't believe that determination can be made today."
The state laboratory, in fact, had 12 clinical isolates from Legionnaires' patients in Flint, the state health department confirmed. Of those isolates, molecular typing was completed on the eight that tested positive for Legionella.
Investigators could then search for a DNA match in the environment. But since water samples were never were tested, there was nothing to compare the clinical isolates with.
State health officials point to CDC guidelines as their reason for not sampling or testing Flint's water system, or any other environmental source, for that matter. Health department spokeswoman Jennifer Eisner noted the CDC advises against testing the municipal water system, focusing instead on testing buildings that epidemiological studies indicate are associated with the outbreak.
CDC spokesman Kristen Nordlund confirmed it "does not recommend routine testing of municipal water" for Legionella.
"Because Legionella can grow to high levels and are spread to people by water systems inside buildings, we need building owners and managers in Michigan and elsewhere to ensure that they have programs in place that will prevent growth and spread," Nordlund added.
Michigan's investigation was limited to results of epidemiological surveys of patients infected in each of two waves of the outbreak, the first from June 2014 through March 2015, and the second from May 2015 through November 2015.
Based on results of the first study, state health officials concluded that Flint's McLaren Medical Center was most strongly "associated" with the outbreak. Health officials wouldn't name hospitals studied in the second survey. McLaren hired University of Pittsburgh microbiologist Janet Stout, one of the nation's top experts in Legionnaires' disease, to assess the situation at the hospital. She recommended remediation.
Among the 12 Legionnaires isolates at the state laboratory, two were from McLaren, including one that tested positive for Legionella. Among a total of eight isolates that tested positive for the pathogen, one genetic match was found, between the McLaren isolate and one from Flint's Hurley Medical Center. The other six did not match, indicating these were all different strains of Legionella bacteria.
Results from the isolates suggested a need for testing throughout the water system, according to Amy Pruden, part of a team of Virginia Tech researchers studying water problems in Flint.
"If they demonstrated that there were multiple strains infecting patients, then the bacteria likely originated from trace background levels at many locations in the distribution system or in building plumbing, where the water chemistry shift may have stimulated them to start growing," Pruden said.
"Given that Legionnaires' is now the leading cause of illness spread by tap water, there is a need to be more responsive to outbreaks and better track the sources and causes of infection."
No fed help sought until '16
According to Nordlund, the CDC was approached by Genesee County's health department in February 2015 and the CDC "felt that a comprehensive investigation was warranted and offered to further assist Michigan by providing epidemiologic and laboratory support from Atlanta or in Michigan."
But the state health department "felt that they had the skills and resources needed to perform the investigation themselves," Nordlund said.
The state health department instead declared that the outbreak ended in March 2015, a finding released in June 2015, when more Legionnaires' patients were being seen in area hospitals.
It wasn't until last month that the state health department asked the CDC for on-the-ground assistance in Flint, when the outbreak was made public by Snyder — 20 months after it started. The CDC is focusing its investigation at the building level, rather than investigating the municipal water system.
"We felt we had enough capacity between our department and the Genesee County Health Department to conduct an investigation," health department spokeswoman Angela Minicuci said. "We have never said that this is not related to the water. We have never discounted that theory."
According to Eisner, the state health department also believed it was up to the Genesee County Health Department to test the water for Legionella, if the county wanted it tested.
The Genesee County Health Department feared the Legionella outbreak could be linked to changes in the municipal water system and alerted the state by October 2014. According to Henry, the county's environmental health supervisor, county personnel didn't have the expertise to test a municipal water system for Legionella, so they asked the state DEQ to investigate.
Then-DEQ spokesman Brad Wurfel scorned Henry's suspicion of city water in a March 13, 2015, email to Harvey Hollins, director the state Office of Urban and Metropolitan Initiatives, and a top Snyder aide. Hollins has since been tapped to lead the state's response in Flint. The memo was copied to then DEQ Director Dan Wyant.
"This is beyond irresponsible, given that this is his department that has failed to do the necessary traceback work to provide any conclusive evidence of where the outbreak is sourced," Wurfel fumed.
" ... Legionnaires is NOT among the 90 water contaminants screened in the Safe Drinking Water Act, but in the absence of action by county health, our staff are now considering taking samples from various points in the system and working with (the health department's) lab to test for it, if for no other reason than to rule it out."
According to Henry, the Genesee County Health Department was learning about the municipal water system on the fly.
Henry said the state has primacy over municipal water systems. Counties oversee Type 2 wells, serving more than 25 people, and private wells. Operators of Type 2 wells handle their own water testing.
"We typically don't get involved with municipal water," Henry said. "The water plant processes is something that we don't know, I've only been learning about it because of this."
County health officials didn't have a map of the water system, and couldn't get one from Flint's Department of Public Works. Department of Public Works did not return numerous emails and calls from The News.
Initially, according to Henry, the city water department talked about testing for Legionella. To his knowledge, they didn't follow through.
"It was the distribution system, the water main breaks, the brown water events, these are all red flags," Henry said. "These were all indications that something is seriously going wrong — the boil water advisories, we have an uptick in Legionnaires' disease — that was enough to look into (the water system) so we can prevent another case."
kbouffard@detroitnews.com
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