Prevention is next step in Flint Legionnaires' fight

Health officials in Flint are prepping for the warm season ahead to prevent another deadly outbreak of Legionnaires’ disease, which sickened at least 88 people and killed 10 the past two summer seasons.

“We’ll be better prepared this year," said Dr. Gary Johnson, medical director of the Genesee County Health Department, which is working with federal, state and local health agencies and experts. "With surveillance and education and prevention methods, we can be in the forefront of any situations that may arise.”

The agencies have combined to create a tool kit of best practices for monitoring and treating water systems for Legionella bacteria and information for health-care providers about diagnosing and caring for people with Legionnaires' disease. They are also developing guidelines for the public about symptoms and what to do if you suspect you have the illness.

The information should be ready in about two weeks, said Christine Rygiel, county health department epidemiologist. Officials will then distribute it to medical professionals, large buildings or other facilities that have HVAC systems or large water systems in the Genesee County area.

The agencies involved include Michigan Department of Health and Human Services, the Centers for Disease Control and Prevention and Wayne State University's Flint Area Community Health and Environment Partnership.

"Because of the heightened awareness, I think everyone is watching and trying to monitor this and the circumstances much more closely," said Matthew Seeger, a Wayne State University professor who is part of the Flint Water Health and Environmental Partnership.

As the temperatures rise, so does the risk of Legionnaire’s disease, which is caused by Legionella bacteria that tend to proliferate in warm, stagnant water in cooling towers, hot tubs, potable water systems, air-conditioning units, water heaters and decorative fountains. When contaminated water droplets are inhaled, it can cause an especially virulent form of pneumonia.

Johnson and Rygiel say the months of June to September are when people are most at risk for Legionnaires' disease in Michigan, which most often strikes people who are already vulnerable because of other medical conditions, such as diabetes, emphysema or cancer, or who take immune-suppressing medications, such as steroids.

Since June 2014, 62 out of the 88 people with confirmed cases of Legionnaires' disease were exposed to Flint's municipal water system, either at home or at a Flint health care facility — and in some cases both — before contracting the disease, a Free Press analysis of state data found.

The outbreaks weren't made public until January. Although there has been no definitive way to link the rash of Legionella outbreaks to the troubled water system, Dr. Eden Wells, chief medical executive for the Michigan Department of Health and Human Services, told the Free Press earlier this month that it's difficult to ignore the correlation.

"Because we don’t know all there is to know about the Flint water system, we want to make sure that any conditions that would have led to Legionella showing up in some of these large buildings ... that it does not occur again," Wells said. "Any large facility can be at risk."

Critics have said that if the state's top health officers had alerted the public and sought help from federal health officials with the outbreak in 2014, another outbreak the following year — and additional deaths — might have been averted.

The MDHHS is under investigation for how it handled the Legionnaires' cases and also for how it responded to reports of elevated lead levels found in residents' blood.

Frustration and grief

Although Michael Mulcahy of Lake Orion is glad to hear that a plan is in place to address the threat of Legionnaires' disease in Genesee County this year, he wishes health officials had notified the public during outbreaks in the two previous years and tried to prevent the 2015 surge in cases, when his father, Thomas Mulcahy, succumbed to the disease.

His 80-year-old father, a farmer from Corunna, had been treated at McLaren Flint Hospital after a fall last summer and was undergoing tests for cancer. A couple of weeks later, he was readmitted and treated for pneumonia. He died Aug. 22 in hospice care at his home on the Shiawassee County farm.

"There's no doubt in my mind that the pneumonia took away all our options," said Michael Mulcahy, 48, who has joined a class-action lawsuit against McLaren and the state, saying they did nothing to combat the first two Legionnaires' outbreaks during the Flint water crisis. "Once he got pneumonia, it's amazing how quickly he died."

Mulcahy said he didn't realize his father had the Legionella form of pneumonia until he reviewed the medical records after his death.

“First of all, it’s frustrating to think about the whole Flint water crisis with the lead in the water and where they didn’t treat the water properly, and all of that more than likely factored into the Legionella," he said. "There’s a lot of blame to go around, I think, both at the government level, and absolutely the public should have been notified a long time ago, when this first happened back in 2014, with the first round of Legionella cases. It’s very frustrating. I feel bad for the whole city of Flint and all the families that have suffered and lost loved ones."

Flint e-mails: CDC voiced concerns over Legionnaires' actions

Flint residents complained about foul smells, discoloration and health effects almost immediately after the city stopped getting its water from the Detroit Water and Sewerage Department in late April 2014. The Michigan Department of Environmental Quality failed to require that the city add crucial corrosion-control chemicals to the water. Soon after the switch, boil-water alerts were issued for E. coli bacteria contamination. Chlorine was added to control the bacterial growth, which led to an excess of trihalomethanes (TTHMs) that cause a wide range of health problems. There were the Legionella outbreaks, and there also was contamination from lead, which had leached from lead pipes, solder and fixtures.

Genesee County Legionnaires' death toll rises to 10

The guidelines health officials now recommend for preventing Legionella bacteria from growing in water systems were developed by the American Society of Heating, Refrigerating, and Air Conditioning Engineers, and are commonly known as the ASHRAE-188 risk management standard, Rygiel said.

"We’re advising all large building facilities to do the recommendations," she said, acknowledging that there's no way to enforce compliance; health officials can only urge hospitals and other large buildings to follow the guidelines.

"It’s not necessarily enforcing, but it's educating and showing them the plans and giving them people they can talk to if they want to implement the plans," she said. "Then, if they decide to go with the guidelines, we’ll keep following up with them.

"I know a lot of the large water systems in the county are very, very interested in these guidelines and possibly implementing them, especially with what’s going on. We’re going to suggest it for other counties as well. We want to make sure everyone is learning from this experience and doing the best they can with their water systems."

At Hurley Medical Center in Flint, Dr. Michael Jaggi, chief medical officer, said a water-safety plan is in place.

"We use a water specialist company and pathogens laboratory, the leader in Legionella surveillance across the country," he said. "We’ve educated the medical community about Legionella, about making sure it gets cultured appropriately and reported through the local and state health departments.

"There’s a multidisciplinary effort to screen, surveil and mitigate the risk to the public, and we’re actively engaged in that plan."

Contact Kristen Jordan Shamus: 313-222-5997 or kshamus@freepress.com. Follow her on Twitter @kristenshamus. Staff Writer Elisha Anderson contributed to this story.

What is Legionnaires' disease?

Legionnaires' disease is a particularly aggressive form of pneumonia caused when Legionella bacteria infect the lungs. The bacteria can also cause a less-serious infection called Pontiac fever, according to the U.S. Centers for Disease Control and Prevention.

Legionella bacteria grow in warm, stagnant water most often found in cooling towers, hot tubs, potable water systems, air-conditioning units, hot-water heaters and decorative fountains. Legionnaires' disease most often occurs when people breathe in contaminated water through vapor in the air, or when a person chokes and inhales water contaminated with Legionella bacteria.

The bacteria are relatively common in the environment, and can be found in water and soil. A few cases of the disease tend to crop up every year across the United States, and often a source is never found.  

 "It’s also important to recognize that children rarely get this disease," said Matthew Seeger, a Wayne State professor who also is part of the Flint partnership. "Children are less likely, based on the clinical evidence. We want the public to understand the ... symptoms of Legionnaire’s disease so should there be any concerns, they know to go to their physician immediately."

Dr. Paul Kilgore, another Wayne State University professor who is  part of the Flint Water Health and Environmental Partnership, says recognizing the symptoms of Legionnaires' disease and seeking medical attention quickly are vital. Among the symptoms:

• High fever
• Dry cough, sometimes producing sputum, but not always
• Difficulty breathing
• Chills
• Sometimes diarrhea

Those most at risk for the disease are people who are:

• Age 50 or older
• Current and former smokers
•  Those with chronic lung or respiratory conditions, such as emphysema
• Those with other medical conditions such as cancer, diabetes, kidney failure or HIV/AIDS
• Those who take drugs that may reduce their ability to fight off infections