The Blue Death Page 22

  When she got the call from Jakubowski, Rose packed up her equipment and flew to Georgia. When she arrived in Carrollton, she collected a thousand gallons of treated drinking water, enough to fill twenty bathtubs to the brim, and ran it through a filter. After the long, painstaking process of isolating the oocysts from the filter, Rose removed a tiny BB-size pellet from her centrifuge.

  She spread the pellet across a slide and added a drop of Sterling’s antibodies. Then she put the slide under a microscope and flipped on the ultraviolet light. As she scanned it, she began to see small glowing spheres. Cryptosporidium had found its way into the water supply.

  When the Carrollton outbreak was reported in the New England Journal of Medicine, it seemed like a curiosity. Waterborne outbreaks were assumed to happen in small towns when wellheads leaked or when inexperienced operators mismanaged antiquated treatment facilities. Most of the medical community paid it little attention. Even five years later, when I listened to Joan Rose describe the data that she and others had accumulated showing that cryptosporidium could be found in treated drinking water all over the country, few in the medical community listened and no one fully grasped its urgency.

  Jeff Davis and Steve Gradus had read about the Carrollton outbreak and were aware that cryptosporidium could cause waterborne disease. So when Steve Gradus got the phone call from Tom Taft, he immediately recognized its implications. Although he lacked conclusive evidence, it now appeared possible that Milwaukee’s water supply had been and might still be contaminated.

  The city now faced a high-stakes decision. If in fact the water supply had been compromised, failure to shut it down could lead to hundreds of cases of serious illness. If it had not, the city and its businesses would incur millions of dollars in unnecessary costs, the people’s faith in the water supply could be dramatically damaged, and the reputation of the city as well as the seventy-seven food and beverage companies around Milwaukee that relied on that water, including its famous beer industry, would receive a big black eye. For the moment the decision hinged on a single confirmed test from a single patient.

  Any pronouncement about the water supply was not for Gradus to make. That burden would fall on Paul Nannis and the mayor. His job was to make their deliberations easier. He had to find more data, and fast. He called the city’s hospitals to tell them to begin testing all samples for cryptosporidium, but those tests would take time. In the meantime he called Nannis to let him know about Tom Taft’s phone call.

  By four o’clock Paul Nannis was standing before the city’s press corps. Short with sandy hair and a closely cropped mustache, he did not have a commanding stature, but his friendly manner and ease in public allowed him to convey the difficult news. With his senior staff by his side, he announced that cryptosporidium had been detected and that this finding raised the possibility that Milwaukee was in the midst of a major outbreak of waterborne disease. The press pounced. What had been a local story about a curious disease outbreak had just become national news. For a moment the story teetered on a single laboratory finding, but the plot was about to thicken.

  As the press digested the implications of Nannis’s message, a member of the laboratory staff rushed down the hall outside the conference room. He whispered his findings to Kathy Blair and Steve Gradus. The results from three of the samples that Gradus had sent for special stains had come back. All three were positive for cryptosporidium oocysts.

  That evening, as Liz Zelazek sat in a Milwaukee restaurant and fingered the water glass the waiter had set before her, she hesitated and, for the first time in her life, wondered if she should drink it. She and many of the nurses that worked under her at the health department would be working far into the night to find out if the water was safe. She had taken a break from that search to meet several friends for dinner. As she looked around the restaurant she saw a sea of water glasses and realized that the danger they might hold was invisible to everyone in the room but her. Then, not quite prepared to accept the possibility that something she had always seen as healthy and refreshing could be the source of disease, she took a sip.

  When Zelazek left the municipal building earlier that evening, she knew that all the senior staff working on the outbreak would be meeting with the mayor to discuss the implications of finding cryptosporidium. As she walked back up Wisconsin Avenue to return to work, she saw that the lights in the conference room were still blazing. She knew in that moment that the crisis had reached a turning point. The meeting with the mayor had gone on far too long.

  In the conference room, John Norquist, the city’s lanky, curly-haired mayor was presiding over a debate that would decide the fate of the city’s water supply. Five more patients at city hospitals had tested positive for cryptosporidium. Nannis and his staff from the health department wanted action, while Kaminski and his staff continued to argue against declaring the city’s water unsafe. Doing so would have huge costs in terms of both finance and public confidence. Even with the new findings, the total number of cases was still only eight, and they had no direct evidence that cryptosporidium was in the water. Kaminski always seemed to have half a dozen secret levers he could pull, but this time none of them was working.

  Kaminski’s position crumbled when the mayor noticed that Jeff Davis, the state’s infectious disease epidemiologist, was drinking a Coke. The mayor asked Davis if he would drink the water. When Davis said no, the decision was made.

  Norquist’s staff quickly called a press conference and at nine o’clock he announced to the city’s reporters and photographers that he was recommending that all residents of the greater Milwaukee area boil their drinking water until further notice. In doing so, he admitted that there was still some uncertainty about the cause of the outbreak. “We are erring on the side of caution. We do not know enough of where it came from. We are not even sure it’s from the water supply.”

  In New Haven, my father was dying. As tumor cells dug into his bones, the hospice nurse increased his morphine dose in a losing battle against the excruciating pain. The whirlwind of memory, emotion, and family relations had put me in an unintended news blackout for almost a week. So when I called a friend at home on the night after Norquist’s news conference, I was unprepared for the news from Milwaukee. “Haven’t you heard? We’re national news,” she said. “We’re boiling our drinking water. I feel like I’m living in a developing country.”

  The premonition I had felt while listening to Joan Rose came rushing back to me. I had known it would happen, but I had never imagined it would find its way into my water pipes. As one of just a handful of people in the country who specialized in drinking water epidemiology, this was the opportunity of a lifetime and chance had just dropped it on my doorstep. But the same roll of the dice had put me a thousand miles away.

  The next day, Good Friday, my father succumbed to his cancer at his home in New Haven. That same day, in Milwaukee, people began to die from bad water. The first victim was a cancer patient whose chemotherapy had left her vulnerable to the disease. Cryptosporidium overwhelmed her, used her to create trillions of oocysts, and left her to die from dehydration. Mark Rahn, the forty-four-year-old leukemia patient, would spend ten weeks in intensive care before winning his fight with cryptosporidium but many others were less fortunate. The deaths that followed included the very young, the very old, and people with suppressed immune systems either from medication such as chemotherapy or from diseases, particularly AIDS.

  Also on Good Friday, five days after the initial recognition of the outbreak, the Howard Avenue Treatment Plant shut down its pumps. There was, however, still no guarantee that the water had caused the outbreak. No one had found the organism in the water and cryptosporidium had other ways of spreading.

  Within a few days, analyses had found small numbers of cryptosporidium oocysts in the water supply, but it didn’t seem like there were enough to cause the kind of outbreak that Milwaukee was experiencing. The task of finding the “hidden seed” fell to Paul Biedrzycki, head of the D
ivision of Environmental Health. With limited training in waterborne pathogens, working on his first waterborne outbreak, he now had to perform a magic trick. He needed to go back in time almost two weeks and collect several hundred gallons of water for testing.

  Biedrzycki needed to find someone who had collected huge samples of Milwaukee’s drinking water every day for the past several weeks and stored them. The water treatment plants and many of the city’s industries such as the breweries collected and sampled water, but the samples were small and were usually discarded after analysis. The “smoking gun” for the outbreak, it seemed, had long ago been flushed down Milwaukee’s drains and sewers.

  As the hope of finding the instrument of disaster dwindled, a health inspector on Biedrzycki’s staff had an idea that would lead him to it. The search had failed because it had been directed at the wrong target. The “smoking gun” was not lying on the bottom of a vat of aging water. It was frozen in a block of ice.

  Biedrzycki rushed to the vast freezer owned by Milwaukee’s largest commercial ice supplier. As he entered the cavernous building, a snake of frigid air crawled into his lungs. It seemed as if they had uncovered winter’s lair. Once inside he gazed at rack after rack filled with massive, glasslike blocks of ice. Each four-hundred-pound block marked a moment, literally frozen in time.

  As the plant manager guided him through the crystal maze, he peered into the massive blocks of ice, staring through to the clear center as workers at the plant raised them from the vats in which they were stored. The tour took them back into the past until they reached the blocks frozen a week before the outbreak began. As he stood there, Biedrzycki felt sure he had found what he had come for. Looking into them, he could see that the heart of each block was dark, almost black with fine particles.

  Whatever had made the drinking water cloudy was locked in the ice. To go back in time, all Biedrzycki had to do was melt the ice. The blocks were too big to move, so he set up a pump and filter at the plant. As the ice blocks slowly melted, the particles began to float freely in the water just as they had weeks before when they flowed from the faucets and water fountains of Milwaukee. He filtered the water and sent the specimen to a lab in Illinois, one of only three in the country that could find cryptosporidium in water. When the results came back, the answer was clear. Each block contained thousands of cryptosporidium oocysts.

  On April 19, the last piece of the puzzle fell into place as the results emerged from the core epidemiological survey of the outbreak. The health department staff had initially believed that the outbreak had attacked a few hundred people. As the outbreak wore on, they began to think that it might have hit as many as a thousand. No one fully grasped the power of water to spread disease. When Jeff Davis completed his analysis of the data, he estimated that 400,000 people had fallen ill. Of those, 4,000 had been hospitalized and, according to initial estimates, more than 100 had died. Some had avoided the disease either by drinking little or no tap water from the Howard Avenue plant, or by having some immunity from a previous bout of cryptosporidiosis. One thing, however, was clear. Milwaukee had just experienced the largest outbreak of waterborne disease in the history of the United States. A jagged mountain of illness had crashed to the surface, but how much of the iceberg remained hidden across the United States remained to be seen.

  Carrollton Water Treatment Plant

  Collecting water in Mali

  PART III

  At War with the Invisible

  Water, water, everywhere,

  And all the boards did shrink;

  Water, water, everywhere,

  Nor any drop to drink.

  —SAMUEL T. COLERIDGE

  12

  DRINKING THE MISSISSIPPI

  Washington rushes to correct environmental problems with all the speed and agility of a glacier on quaaludes. During the 1980s the legislative glacier ground to a halt as the Reagan administration systematically eliminated funding for drinking water research and the EPA refused to issue new regulations. In 1986 Congress ordered the EPA to issue an array of new tap water regulations, but the EPA simply did nothing until an alliance of citizens’ groups took them to court. The agency finally buckled under a court order and issued new rules in the early nineties. In 1992 the arrival of new administration brought hope that the process would again move forward, but treatment plants are expensive, and the drinking water industry resisted. Then came Milwaukee.

  In many ways the evisceration of the EPA budget for drinking water research and the subsequent failure to correct that imbalance made the disaster in Milwaukee possible, even inevitable. That outbreak could have been predicted and should have been prevented. Several studies, not only by Joan Rose and others in academia, but by the industry’s own experts, had shown that cryptosporidium oocysts routinely occurred in surface water throughout the United States and were frequently present in treated drinking water. The outbreak in Carrollton served notice that a massive outbreak in a treated water supply was far more than a theoretical possibility. Despite all those warnings, neither the EPA nor the industry sounded the alarm. That silence made it possible for the water supply of a major city to operate as if cryptosporidium did not exist.

  After Milwaukee, the drinking water industry could no longer ignore the threat. Or so it seemed.

  In the fall of 1996, I got a call from Erik Olson, an attorney with the Natural Resources Defense Council (NRDC). As the head of the drinking water program at NRDC, Olson had become a persistent, effective, and often lonely voice for tighter federal rules for drinking-water quality. This made him the official thorn in the side of the drinking-water industry. Even after Milwaukee, it had taken three years of wrangling before the EPA was ready to bring stakeholders together to talk about new rules for drinking water. Olson wanted me to come to their next meeting.

  I had made many trips to Washington to help Olson push for tighter regulations for safe drinking water. He and I had often shared our frustration at the inaction of the federal government. The stakeholders’ meeting seemed to offer our best hope of progress, but there was sure to be a fight. Nothing could make me miss this showdown.

  A few days later, on a cool, gray November morning, I met with Olson at a coffee shop in Georgetown. With an unruly splash of receding light brown hair, wire-rimmed glasses, and a slightly disheveled look that reflects intensity of purpose rather than lack of care, Erik Olson seems an unlikely man to take on an entire industry single-handed, but in many ways he has. A former EPA employee, Olson had joined the mass migration out of the agency that began in response to Reagan’s unabashed anti-environmentalism. He began work for the NRDC in 1991.

  As I sipped a cup of overcooked coffee, Olson explained the game. The EPA was prepared to establish new rules to reduce both the levels of disinfection by-products and the risk of waterborne pathogens in drinking water, rules required by the latest revision of the Safe Drinking Water Act. Any rule change would trigger a federal law known as the Federal Advisory Committee Act, which required that the agency seek input from those affected by the rule in the form of a consensus recommendation. This initial meeting would lay the groundwork for the committee and its task. The precise composition of the committee had yet to be determined, but that would happen in the next few weeks. After that, traveling the path to consensus could take months or even years.

  I choked down the remnants of an overly sweet bran muffin, finished my coffee, and we crossed the street. I knew my reputation among those in the industry and approached the meeting with some trepidation. The civil engineers who have taken on the relatively unglamorous task of cleaning dirty water spend their careers making sure that water is clean and safe. Coming from the world of academic public health research, I was an outsider. Although I had never intended to do so, my research, particularly the study on chlorination by-products, suggested that they weren’t doing their job right. In the same stroke, I had implied that the regulators had allowed this to happen. I had stumbled into a nest of busy bees and had manage
d not only to infuriate the bees, but to provoke the beekeeper as well.

  The room bustled with experts and consultants from every segment of the drinking water industry. The American Water Works Association, the Association of Metropolitan Water Agencies, the National Rural Water Association, and the Chlorine Chemistry Council were all well represented. Senior managers from water utilities all over the country had come to observe. Erik had managed to bring in a few voices from the public health community, but we were clearly outnumbered and absolutely outfunded.

  Because of my infamy among the drinking-water industry and the regulatory community, most of the people in the room seemed to know my name. Few of them, however, knew me by sight, including Lynn Pappas from the EPA drinking water office in Cincinnati. Much of the meeting was devoted to describing EPA’s work on drinking water. On the first day of the meeting, Pappas rose to describe the state of the agency’s work on epidemiology related to drinking water.

  Pappas began by announcing that work by the EPA’s Office of Research and Development on “the Morris study” was almost complete. She explained that Charlie Poole, an epidemiologist at Boston University, was repeating my study of chlorination by-products. This was the centerpiece of their work on drinking water epidemiology. In fact it was their only work on drinking-water epidemiology at that time. The final results, she assured the audience, would soon be ready for release.

  I sat in the audience, stunned. Ordinarily if a study is of such great interest to government scientists, they talk to its author, possibly invite him to come present the work in more detail and make plans to extend the research. But no one from the EPA had ever contacted me to discuss my original study. Until that moment I did not even know they had planned to reanalyze it. I did know Dr. Poole and knew that he was one of the few environmental epidemiologists who had been critical of the study, but he had no special expertise in drinking water or meta-analysis. I later learned that the initial instructions from the EPA to Dr. Poole specifically instructed him to reanalyze only the papers I had considered in my original meta-analysis despite the fact that several major epidemiological studies of chlorination by-products and cancer had been published since its release that would have provided critical new data. Why was the EPA so interested in rehashing a study that was now six years old rather than moving the science forward?