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Chlorine works: 12 dead, 87 sick from Legionnaires’ linked to Michigan water supply 2014-15

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An outbreak of Legionnaires’ disease that killed 12 people and sickened at least 87 in Flint, Mich., in 2014 and 2015 was caused by low chlorine levels in the municipal water system, scientists have confirmed. It’s the most detailed evidence yet linking the bacterial disease to the city’s broader water crisis.

Rebecca Hersher of NPR reports that in April 2014, Flint’s water source switched from Lake Huron to the Flint River. Almost immediately, residents noticed tap water was discolored and acrid-smelling. By 2015, scientists uncovered that the water was contaminated with lead and other heavy metals.

Just months after the water source changed, hospitals were reporting large numbers of people with Legionnaires’ disease.

“It’s a pneumonia, but what’s different about it is, we don’t share it like we do the flu or common cold,” explains Michele Swanson of the University of Michigan, who has been studying Legionnaires’ for 25 years. “It’s caused by a bacterium,Legionella pneumophila, that grows in water.”

The bug can enter the lungs through tiny droplets, like ones dispersed by an outdoor fountain or sprinkler system, or accidentally inhaled if a person chokes while drinking.

“If you don’t have a robust immune system, the microbe can cause a lethal pneumonia,” she says. In a normal year, the disease is relatively rare — about six to 12 cases per year in the Flint area, according to Swanson. During the water crisis, that jumped up to about 45 cases per year.

Although the outbreak of Legionnaires’ happened at the same time as the Flint water crisis, it was initially unclear how the two were connected. After earlier research suggested that chlorine levels might be the key, Swanson and colleagues at the University of Michigan in Ann Arbor, Sammy Zahran of Colorado State University and a team of researchers at Wayne State University in Detroit, began analyzing detailed water and epidemiological data from the six-year period before, during and after the crisis.

“We know that Legionella is sensitive to chlorine in the laboratory,” says Swanson. The chlorine makes it difficult for the bacteria to replicate, which is one reason water companies often add chlorine to their systems. But when Flint’s water source changed, the chlorine level dropped and cases of Legionnaires’ disease spiked. “It was the change in water source that caused this Legionnaires’ outbreak,” Swanson says.

The new research was published in a pair of studies in the Proceedings of the National Academy of Sciences and the journal mBio on Monday. The conclusion may bolster parts of the case being brought against Nick Lyon, the former Michigan Department of Health and Human Services director, who is being tried for involuntary manslaughter in connection with the Legionnaires’ deaths.

From April 2014 to October 2015, the Flint River served as Flint’s water source. During the same period, cases of Legionnaires’ disease increased from less than a dozen per year to about 45 per year, and 12 people died of the waterborne disease.

The new studies also suggest that a complex set of factors may be responsible for low chlorine levels during the crisis. In addition to killing microbes, chlorine can react with heavy metals like lead and iron, and with organic matter from a river. That means lead and iron in the water may have decreased the amount of chlorine available to kill bacteria.

Shigellosis outbreak in Flint, Mich. because people afraid to wash hands

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Don’t eat poop (and if you do, make sure it’s cooked).

Wash your hands.

handwash_south_park2These are the basics of public health.

Most of us are taught from a very early age that hand-washing is an easy, essential way of keeping ourselves clean and healthy. But residents of Flint, Michigan and surrounding areas have been forgoing this common practice out of fear of the water’s toxicity. Genesee county, of which Flint is a the largest city, and the adjacent county of Saginaw combined have experienced an outbreak of 131 cases of Shigellosis (named after the bacteria that causes it, Shigella). It’s a bloody diarrheal disease transmitted via tiny amounts of contaminated fecal matter. It typically lasts about a week, but can also cause patients to feel like they have to go to the bathroom even when they have no more waste in their systems. Additionally, the US Centers for Disease Control (CDC) also notes that “may be several months before [patients] bowel habits are entirely normal.”

In 2013, there were just under five cases reported per every 100,000 people in America. The outbreak in Michigan far exceeds that number, and it’s likely because residents in the area are afraid to use their tap water, which was found to have toxic levels of lead, a heavy metal that can cause neurological problems when it builds up in the body, in 2015. Even though the water was deemed safe for consumption with a proper filter, people in the area are still scared to wash their hands at all, according to the Washington Post.

Instead, they’re cleaning themselves using baby wipes—aren’t nearly as effective as disinfectant as good old-fashioned scrubbing—which should take about 20 seconds to ensure that any potential pathogens are washed down the drain.

“Some people have mentioned that they’re not going to expose their children to the water again,” Jim Henry, Genesee County’s environmental health supervisor, told CNN.