Legionnaires’ Outbreak in Flint Was Met With Silence

 It was the Fourth of July, a warm summer night in 2014, but Tim Monahan was shivering in a thick blanket as he watched fireworks from his front yard here. By the next afternoon his temperature had shot to 104.6, and doctors at the hospital he had checked into puzzled over what was wrong.

Two days later, they had an answer: Legionnaires’ disease, a virulent form of pneumonia caused by a type of bacteria that can multiply in water systems. Mr. Monahan, now 58, was given antibiotics and eventually recovered, but his case turned out to be at the leading edge of a Legionnaires’ outbreak that sickened at least 87 people in the Flint region, killing nine of them, from June 2014 through October 2015.

State officials still say they cannot conclusively link the outbreak to Flint’s contaminated water supply, partly because sputum cultures were not collected from patients. But the possibility of a link was raised in internal government emails as early as October 2014, and state officials did not inform the public of the outbreak until last month.

The Legionnaires’ cases started popping up as Flint residents were complaining about the foul-smelling, discolored water flowing into their homes after the city switched to a new water source, the Flint River, in April 2014. Soon they were reporting rashes and stomach ailments, and whistle-blowers eventually pointed to alarming levels of lead in the water supply and in children’s blood.

An examination of government emails, and interviews with people who survived Legionnaires’ and relatives of those who died, shows the government response to the Legionnaires’ outbreak followed the same pattern that prevailed throughout the Flint water crisis: a failure to act swiftly to address a dangerous problem or warn the public.

Even as more residents became critically ill with Legionnaires’ disease, and some died, the officials remained mired in jurisdictional battles, according to emails released by the Michigan Department of Health and Human Services and the health department in Genesee County, which includes Flint. Some at the state level seemed more concerned about following bureaucratic protocol, and not raising public alarm, than protecting residents.

Janet Stout, an expert on Legionnaires’ disease at the University of Pittsburgh whom county health officials asked for help last year, said she believed state health and environmental officials had impeded the investigation — health officials by refusing to invite the Centers for Disease Control and Prevention to dispatch experts to help with the investigation, and environmental officials by not helping the county get the answers it needed about Flint’s water.

“The people that were pushing this aggressively were at the bottom, the county, and they were not getting cooperation from the levels above them,” Dr. Stout said.

State health officials said the county had repeatedly rebuffed their advice and offers of assistance during the outbreak, although they did step in starting early in 2015. Jennifer Eisner, a spokeswoman for the State Department of Health and Human Services, said that while it “presented the Genesee County Health Department with the investigation requirements,” the county “either did not fulfill them or did not acknowledge a need for additional support from the state.”

‘A Ridiculous Tragedy’

The revelations in January about the extent of the outbreak left Mr. Monahan and several others who contracted Legionnaires’ disease during that period stunned and furious.

“What gets me is how fast the state has just denied — ‘We can’t prove it’s the water,’ ” Mr. Monahan said. “I think they’re so afraid of tying nine deaths to this. The whole thing is just such a ridiculous tragedy.”

Low levels of Legionella bacteria are commonly found in cold water coming into buildings, and they usually do not make people sick. Problems arise when the bacteria multiply in warm-water distribution lines, with large buildings like hospitals and hotels at particular risk. People get Legionnaires’ disease from inhaling mist that contains the bacteria, or by getting contaminated water in their lungs by choking on it, sometimes without notice.

The switch to Flint River water caused pipes to rapidly corrode, because the city and state failed to treat it with anti-corrosion chemicals. Dr. Stout said she believed the corrosion, combined with the dislodging of other materials that typically line pipes, allowed Legionella to grow in city water as it warmed over the summer in building distribution systems.

The state concluded that about 30 percent of the people who became sick had no known exposure to Flint water in the two weeks before their illness.

Most of those who contracted the disease during those 18 months remain anonymous. Some names emerged in court documents, as three Genesee County residents who recovered from Legionnaires’, and the family of a fourth who died from it, have sued McLaren Flint, a hospital that many who fell ill with Legionnaires’ had visited in the two weeks before they got sick.

The lawsuit says the hospital failed to “exercise reasonable and ordinary care” to warn them of “dangerous conditions” there. It also names as defendants several current and former employees of the State Department of Environmental Quality, which has been widely faulted for its slow response to Flint’s water crisis.

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Taxonomy

• Waterborne Pathogens