CHAPTER 10: LEGION

0.   .  This parallels the process of how the governor made a formal request to Washington before a federal emergency was declared. However, according to one of the emails released by the governor’s office, there was some flexibility to this rule. Captain Chris Kelenske of the Michigan State Police, who doubled as the deputy state director of emergency management and homeland security, wrote in an email to a governor’s aide on November 13, 2015: “As you know, the Governor can declare at any time for any reason.” There were advantages and disadvantages to acting before the local officials did, according to Kelenske’s outline of the issue. On one hand, it would open up the opportunity to seize leadership of the relief response and put key funding reserves toward it. But on the other hand, he added, state funding was being provided through other means, and not getting a request for help implied that local leaders didn’t need further resources. Moreover, “the state will formally own the event if we put a Governor’s Declaration in place,” Kelenske wrote. “This could be viewed as having owned up to how the water issue was caused (e.g., ‘The triggering event was caused by the state; the state is now declaring.’).” And it would also set a precedent “for issuing a state declaration for an infrastructure maintenance event. What if lead is found in other areas of the state’s drinking water due to infrastructure issues? This action opens the door to any other jurisdiction with water quality issues.” When asked about the discrepancy between this email and the repeated contention that the governor’s office could not act until local officials did, a spokesperson said that there had been “a misunderstanding.” Declarations of emergency by the state usually happened only in the wake of extreme one-time events, rather than a long-developing crisis, such as the one in Flint; that contributed to the confusion. Paul Egan, “E-mails: Snyder Could Have Declared Flint Emergency Sooner,” Detroit Free Press, February 28, 2016, updated February 29, 2016; Paul Egan, “Snyder Declares Emergency as Feds Probe Flint Water,” Detroit Free Press, January 5, 2016, updated January 15, 2016; and “Proclamation: Declaration of Emergency,” State of Michigan Executive Office, January 5, 2016. Incidentally, January 5, 2015, was also the same day that the U.S. Attorney’s Office confirmed that it was working with the EPA to investigate the crisis. Usually the Attorney’s Office neither confirms nor denies the existence of an investigation, but it made an exception on account of how many Flint residents were reaching out to it.

0.   .  Some of these details, and the quoted signs, come via the photos captured by MLive—Flint Journal (“9 Takeaways from Michigan Gov. Rick Snyder’s State of the State Address,” January 20, 2016); the Detroit News (“Snyder to Flint: I’m Sorry and I’ll Fix It,” January 20, 2016); and the Detroit Free Press (“Gov. Snyder’s Speech, with Flint Water Protests,” photo gallery, January 19, 2016).

0.   .  They also made an appearance in Flint during the sit-down strike in the 1930s.

0.   .  “Get Clean Water Locations,” Taking Action on Flint Water, Michigan.gov, last accessed March 4, 2018, http://www.michigan.gov/flintwater/0,6092,7-345-75251_75271—,00.html.

0.   .  Ryan Garza, “Living with Lead,” Detroit Free Press, January 31, 2016, pp.15A–17A.

0.   .  She testified about this during the public comments portion of the July 14, 2016, hearing in Flint by the Michigan Civil Rights Commission.

0.   .  Garza, “Living with Lead.”

0.   .  Lewis said that she went through the arduous routine of filling the cauldron of her slow cooker with bottled water, heating it, and pouring it into the tub until it was full enough for bathing because otherwise the tap water caused her skin to break out in painful rashes. Yvonne Lewis, phone interview with the author, September 9, 2017; and Yvonne Lewis, testimony before the Michigan Civil Rights Commission, Flint, Mich., July 14, 2016.

0.   .  Elderly people also often lacked a photo ID. The requirement was lifted on January 22, 2016. When word began spreading about the obstacles that undocumented people faced in getting water, a number of volunteer groups reached out with donations for them, including the Flint Jewish Federation, the Service Employees International Union, and a Baptist church in Rhode Island that delivered two semitrucks of water. Niraj Warikoo, “Immigrants Left in Dark,” Detroit Free Press, February 4, 2016, pp. 1A, 7A.

0. .  Ibid.

0. .  David W. Lurvey, letter to Mark Bouvey, SOM Board of Education, January 21, 2016, http://www.michiganschoolforthedeaf.org/sites/michiganschoolforthedeaf.org/files/1.21.16_re_flint_water_crisis_response_0.pdf.

0. .  Robert Allen, “Readers Help Flint Brothers Who Trek Miles for Water,” Detroit Free Press, January 24, 2016, p. 15A.

0. .  Sherman McCathern, phone interview with author, January 2016.

0. .  Madison Eggert-Crowe and Scott Gabriel Knowles, “Bicentennial (1976),” Encyclopedia of Greater Philadelphia (New Brunswick, N.J.: Rutgers University, 2013).

0. .  Lawrence K. Altman, “In Philadelphia 30 Years Ago, an Eruption of Illness and Fear,” New York Times, August 1, 2006.

0. .  Not too far, as it happens, from where the Centre Square Pump House stood, the heart of one of America’s first efforts at providing public water. Carl Smith, City Water, City Life: Water and the Infrastructure of Ideas in Urbanizing Philadelphia, Boston and Chicago (Chicago and London: University of Chicago Press, 2013).

0. .  Theodore Tsai et al., “Legionnaires’ Disease: Clinical Features of the Epidemic in Philadelphia,” Annals of Internal Medicine (April 1, 1979); Lily Rothman, “This Is How Legionnaires’ Disease Got Its Name,” Time, August 12, 2015; and “The Philadelphia Killer,” Time, August 16, 1976.

0. .  Altman, “In Philadelphia 30 Years Ago.”

0. .  Andrea Farnham, Lisa Alleyne, Daniel Cimini, and Sharon Balter, “Legionnaires’ Disease Incidence and Risk Factors: New York, New York, USA, 2002–2011,” Emerging Infectious Diseases 20, no. 11 (November 2014): 1795–1803.

0. .  Rothman, “This Is How Legionnaires’ Disease.”

0. .  Altman, “In Philadelphia 30 Years Ago.”

0. .  Ibid. The author is using its current name as a narrative convenience, but at the time, this institution was known as the U.S. Public Health Service’s Center for Disease Control.

0. .  “… here was an invisible, impersonal mass killer on the loose. The knowledge rekindled, despite all the advances of modern medicine, humanity’s ancient memories of epidemics beyond understanding or control” (“The Philadelphia Killer”).

0. .  Boyce Rensberger, “Testing Casts Doubt on Nickel Carbonyl as Cause of Legionnaires’ Illness,” New York Times, September 11, 1976; “The Philadelphia Killer”; Altman, “In Philadelphia 30 Years Ago”; and F. William Sunderman. “Perspectives on Legionnaires’ Disease in Relation to Acute Nickel Carbonyl Poisoning,” Henry M. Scharf Lecture on Human Affairs, Annals of Clinical and Laboratory Science 7, no. 3 (1977).

0. .  In 1968, the same bacteria had caused a less serious infection about forty miles from Flint, in Pontiac, Michigan. The duly named Pontiac fever had bedeviled visitors to the city’s Health Department, causing fever and muscle aches. But no one had yet realized that the bacteria could also induce what we now call Legionnaires’ disease. The 1977 discovery also solved the mystery of an outbreak in Washington, D.C., in the summer of 1965, when a severe respiratory illness at St. Elizabeth’s Hospital overtook at least eighty-one patients, fourteen of whom died.

0. .  Abby Goodenough, “Legionnaires’ Outbreak in Flint Was Met with Silence,” New York Times, February 22, 2016; and Lenny Bernstein and Brady Dennis, “Did Flint’s Contaminated Water Cause Legionnaires’ Outbreaks?” Washington Post, February 27, 2016.

0. .  Monica Davey and Mitch Smith, “Emails Reveal Early Suspicions of a Flint Link to Legionnaires’ Disease,” New York Times, February 4, 2016; and Roberto Acosta, “Survivor ‘Stunned’ by Spike of Legionnaires’ in Genesee County,” MLive—Flint Journal, January 21, 2016.

0. .  Monahan’s case was in the summer of 2014. Goodenough, “Legionnaires’ Outbreak in Flint”; Bernstein and Dennis, “Did Flint’s Contaminated Water”; and “MDHHS Issues Update to 2015 Legionnaires’ Disease Report for Genesee County,” press release, Michigan.gov, April 11, 2016, https://www.michigan.gov/som/0,4669,7-192-29942_34762-381701—,00.html.

0. .  Daniel Bethencourt, “Snyder: Flint Has Seen Spike in Legionnaires’ Disease,” Detroit Free Press, January 13, 2016, updated January 15, 2016; and Michigan Department of Health and Human Services and Genesee County Health Department, “Legionellosis Outbreak-Genesee County, June, 2014–March 2015, Full Analysis,” January 15, 2016, https://www.michigan.gov/documents/mdhhs/6-14_to_3-15_Legionellosis_Report_Full_Analysis_Results_511708_7.pdf.

0. .  Henry filed the public records request on January 25, 2015. Goodenough, “Legionnaires’ Outbreak in Flint”; and Emma Winowiecki, “How Flint’s Legionnaires’ Disease Outbreak Led to Five Charges of Involuntary Manslaughter,” Michigan Radio, June 14, 2017.

0. .  Wurfel ended his long email by saying that “regardless, the accusation is serious and the nature of the communication leaves me thinking we would be advantaged to bring together all the agencies asap to share what information we have and develop a response/screening strategy before the weather gets warm again” (Brad Wurfel, “Part II,” email to Harvey Hollins, cc Dan Wyant, March 13, 2015). This email was part of the communications released by the Office of Governor Snyder on a Michigan.gov site. The author viewed this email in a collection collated by Channel 4/Click on Detroit, http://media.clickondetroit.com/document_dev/2016/02/04/297679613-Wurfel-to-Hollins-Email-Legionnaires_2061126_ver1.0.pdf. (Mara MacDonald, “Email warned Snyder’s aide early of possible link between Legionnaires’ surge, Flint water,” February 4, 2016.)

0. .  The MDEQ was wary enough of the outbreak, though, for Brad Wurfel to tell the governor’s office in January 2015 that they were waiting for “the results of some county health department traceback work” before his agency would feel able “to say publicly that the water in Flint is safe.” Jonathan Oosting, “Legionnares’ Fear Led Staffer to Warn Against Calling Water Safe,” Detroit News, February 26, 2016.

0. .  Sarah Kaplan, “Flint, Mich., Has 10 Fatal Cases of Legionnaires’ Disease; Unclear If Linked to Water,” Washington Post, January 14, 2016; and Goodenough, “Legionnaires’ Outbreak in Flint.”

0. .  “Flint Water Advisory Task Force Final Report,” March 2016, p. 19. The quoted CDC researcher is Laurel Garrison. Matthew Dolan, Elisha Anderson, Paul Egan, and John Wisely, “Flint E-mails: CDC Voiced Concerns over Legionnaires’ Actions,” Detroit Free Press, February 9, 2016.

0. .  Kaplan, “Flint, Mich., Has 10 Fatal Cases”; and Goodenough, “Legionnaires’ Outbreak in Flint.” This message came from Jim Collins, MDHHS’s communicable disease division director, to Jim Henry and other Genesee County officials in a June 8, 2015, email. It was also Collins who concluded in June 2015 that “the outbreak was over,” as the last reported case was the previous March. “The lack of clinical Legionella isolates precludes our ability to link cases to an environmental source.” Chad Livengood and Karen Bouffard, “Emails: State Mum on Flint Legionnaires’ Warning,” Detroit News, February 12, 2016.

0. .  This was from a report that the Genesee County Health Department submitted to the CDC’s outbreak reporting system in November 2015. For its part, the MDHHS complained that the county had not accepted its advice or help. Sarah Cwiek, “State’s Chief Medical Officer: Flint Legionnaires’ Probe Followed ‘Standard Practice,’” Michigan Radio, February 15, 2016.

0. .  Goodenough, “Legionnaires’ Outbreak in Flint.”

0. .  Kaplan, “Flint, Mich., Has 10 Fatal Cases.”

0. .  Jim Lynch and Jonathan Oosting, “Snyder: Legionnaires’ Cases Spike in Flint Area,” Detroit News, January 13, 2016.

0. .  “Legionellosis Outbreak—Genesee County, June 2014–March 2015: Summary Analysis,” Michigan Department of Health and Human Services and Genesee County Health Department, updated January 15, 2016, https://gchd.us/wp-content/uploads/2016/08/6-14-to-3-15-Legionellosis-Report_Investigation-Summary-Analysis.pdf.

0. .  Fifty-two of the fifty-four cases that were associated with hospital/health care facilities in Genesee County were also at McLaren, including forty-five of the forty-six inpatient cases. “MDHHS Orders McLaren Flint to Comply with Action to Address Legionella Risk,” press release, Michigan Department of Health and Human Services, February 14, 2017.

0. .  The problem of insufficient patient samples was acknowledged in the May 2015 report from the MDHHS, but apparently there was not a push to collect more of them during another spike of Legionnaires’ cases that summer. It’s believed that samples weren’t collected because patients were presumptively treated with antibiotics after a positive urine test for Legionella. After that, specimens would be too indeterminate to be used as evidence.

0. .  Flint Water Advisory Task Force, “Final Report,” March 2016; and Davey and Smith, “Emails Reveal Early Suspicions.”

0. .  There were seventeen cases of Legionnaires’ disease in 2016, according to the Genesee County Health Department, two of which were associated with McLaren Flint. This was still higher than in the years before the outbreak began, but far less than its peak. Some concerned activists have doubted the official numbers, wondering how often the disease was misdiagnosed.

0. .  Steve Carmody, “New Tests Raise Questions About the Source of Legionnaires’ Disease Outbreak,” Michigan Radio, February 16, 2017.

0. .  Measurements from samples collected from homes in and around Flint were compared to measurements from baseline U.S. water surveys conducted by both this research team and the EPA, and from Flint buildings that were still connected to a Lake Huron water source. Interviews with Amy Pruden, Siddhartha Roy, and Marc Edwards, Blacksburg, Virginia, June 6, 2017; and Janet Pelley, “Legionnaires’ Outbreaks in Flint Linked to Corrosive Water,” Chemical & Engineering News, July 25, 2016. The team described the potential for an outbreak of Legionnaires’ disease when it submitted its grant application to the National Science Foundation in July 2015: “We are also concerned about possible health effects that have not yet been investigated. For example, in March 2015 Region 5 EPA was provided reports of higher incidence of Legionnaires’ disease associated with bacteria growth in premise plumbing in the Flint area. Legionnaires’ disease has recently been acknowledged to be the primary source of waterborne disease outbreaks (and associated deaths) in the U.S. Despite that acknowledged risk, there is currently no required monitoring for this important pathogen in consumers’ homes, where it proliferates and can lead to human exposure and infection in showers.” Marc Edwards, Amy Pruden, and Joseph Falkinham, “RAPID: Synergistic Impacts of Corrosive Water and Interrupted Corrosion Control on Chemical/Microbiological Water Quality: Flint, MI,” p. D-2, submitted in July 2015, http://flintwaterstudy.org/wp-content/uploads/2015/08/rapid-proposal-final.pdf.

0. .  David Otto Schwake, Emily Garner, Owen R. Strom, Amy Pruden, and Marc A. Edwards, “Legionella DNA Markers in Tap Water Coincident with a Spike in Legionnaires’ Disease in Flint, MI,” Environmental Science & Technology Lett. 3, no. 9 (2016): 311–15. See also William J. Rhoads, Emily Garner, Pan Ji, Ni Zhu, Jeffrey Parks, David Otto Schwake, Amy Pruden, and Marc Edwards, “Distribution System Operational Deficiencies Coincide with Reported Legionnaires’ Disease Clusters in Flint, Michigan,” Environmental Science & Technology 51, no. 20 (2017): 11986–95.

0. .  Flint Water Advisory Task Force, “Final Report,” March 2016.

0. .  G. Brenda Byrne, Sarah McColm, Shawn P. McElmurry, Paul E. Kilgore, Joanne Sobeck, Rick Sadler, Nancy G. Love, and Michele S. Swanson, “Prevalence of Infection-Competent Serogroup 5 Legionella pneumophila within Premise Plumbing in Southeast Michigan,” mBio 9, no. 1 (February 6, 2018); and Sammy Zahran, Shawn P. McElmurry, Paul E. Kilgore, David Mushinski, Jack Press, Nancy G. Love, Richard C. Sadler, and Michele S. Swanson, “Assessment of the Legionnaires’ Disease Outbreak in Flint, Michigan,” PNAS (February 2018).

0. .  It was Harvey Hollins who made the request, the governor’s urban affairs specialist who saw the warning email from Jim Henry at the Genesee County Health Department. McElmurry said that Hollins told him that money for the study “was no issue, no problem.” Karen Bouffard, “Flint Water Switch Led to Most Legionnaires’ Cases,” Detroit News, February 5, 2018, updated February 6, 2018. The research team worked in partnership with Flint residents and was supported with funding from the MDHHS, the National Science Foundation, the National Institutes of Environmental Health Sciences, Wayne State University, Michigan State University, and the University of Michigan. It also discovered that the specific Legionella strain that was found in Flint residences was not one that was detected by ordinary Legionella tests. After Flint returned to a Lake Huron water source, the prevalence of Legionella bacteria in local homes fell back to normal levels. In response to the studies, an MDHHS spokesperson issued a statement, using the acronym for the research team’s formal name, the Flint Area Community Health and Environment Partnership: “By publishing these inaccurate, incomplete studies at this point, FACHEP has done nothing to help the citizens of Flint and has only added to the public confusion on this issue.” It also submitted a rebuttal. MDHHS discontinued funding for the studies in December 2017—it provided $3.1 million in 2016 and had promised $1 million more—after the researchers rejected the oversight of an outside firm, KWR Watercycle Research Institute. MDHHS hired KWR to provide an “external, independent third party” review of the studies after they were released. It’s worth noting that even as MDHHS director Nick Lyon faced criminal charges for the agency’s role in the Legionnaires’ outbreak, including for involuntary manslaughter, he was still directing the agency all this time. Likewise with Dr. Eden Wells, who continued in her role as chief medical executive while she faced charges. In November 2017, a few months before the studies were released, McElmurry was a witness for the prosecution in the preliminary exams against Wells and Lyon.

0. .  Edwards went so far as to file a formal complaint with Michigan regulators, arguing that McElmurry used false pretenses to secure substantial grant funding. It specifically described “his lack of competence and expertise” and suggested that he appropriated another person’s ideas in one of his research proposals. An aggressive case against him and his team was further developed on FlintWaterStudy.org, indiciating that their research was leading to trumped-up criminal charges against MDHHS officials—two of whom Edwards had backed up with testimony for the defense during their preliminary examinations. The Virginia Tech team pointed to its two peer-reviewed studies that said that the Flint River switch “was one key factor contributing to the Legionnaires’ Disease outbreak and associated deaths,” but it also emphasized that “At no point did anyone at MDHHS or the governor’s office discourage or impede our teams ground-breaking research that helped reveal the Flint Legionella outbreak” (“FACHEP vs. The People of the State of Michigan: Part I Dr. Shawn McElmurry,” FlintWaterStudy.org, March 29, 2018). McElmurry and his FACHEP team (the Flint Area Community Health and Environment Partnership) passionately defended themselves. “The claims made against our group are false and they are examples of unprofessional and destructive conduct.… It is very unfortunate when individuals resort to personal and unfounded attacks. Such attacks do not help us advance understanding or help the people of Flint. Rather, they confuse, contribute to rumors and create more harm. Sadly, there is a well-established pattern of distortions and misinformation by some of the individuals and investigators associated with Flint.” (Statement in Response to False Accusations about FACHEP, March 30, 2018). The multidisciplinary FACHEP team included experts from the University of Michigan, Michigan State University, Colorado State University, the Henry Ford Health System, and Kettering University, one of whom was Dr. Laura Sullivan. FACHEP also worked closely with Flint residents to carry out their work. In a separate news release, Wayne State University also responded to the allegations: “We have the utmost respect for the commitment and character of Dr. McElmurry and the FACHEP research team. As scientists and members of the community, we all have a responsibility to maintain the highest standards in all we do. We have no doubt that Dr. McElmurry and his colleagues take this responsibility very seriously, and work tirelessly toward these goals for the public good” (Wayne State University statement on accusation, press release, Wayne State University, April 4, 2018).

0. .  Leonard N. Fleming, “WSU Prof: Flint Water Switch Prompted Outbreak,” Detroit News, November 15, 2017.

0. .  Melissa Mays, written testimony to the Michigan Joint Select Committee on the Flint Water Public Health Emergency, Flint Public Hearing, Flint, Mich., March 29, 2016.

0. .  Taylor became part of a lawsuit against McLaren. Goodenough, “Legionnaires’ Outbreak in Flint”; and Kidd v. McLaren Flint Hospital, Case No. 16-106199-NO, Genesee County Circuit Court. Taylor wasn’t the only patient whose Legionnaires’ diagnosis may have been buried. Betty Marble, a sixty-eight-year-old woman from Grand Blanc, died during her second visit to McLaren in March 2015. Her death certificate cites cardiac arrest brought on by septic shock due to pneumonia. Her medical files twice mention Legionella. As Chastity Pratt Dawsey pointed out in Bridge Magazine (“In Flint, Questions About Legionnaires’ Death Toll,” June 28, 2016), the hospital was well aware of its Legionella problem at this point, but it didn’t try to test Marble for the disease until her second visit, just days before she died. By that point, she was unable to produce urine for a test, and a throat culture was ruled inconclusive. As one of her sons told Dawsey, “Why didn’t they tell us they had Legionella in their hospital and they were testing her for it?” It’s stories like this one—along with a 64 percent spike in pneumonia and flu cases in 2014—that have left many wondering if the official toll of Legionnaires’ disease leaves out many who had contracted it. In early 2016, McLaren announced that it was spending $300,000 on an upgrade to its water system.

0. .  National Advisory Commission on Civil Disorders, Kerner Report, p. 20.

0. .  The jobs program was called Flint WaterWorks, and it was funded by private donations. Young people were paid for their work on door-to-door outreach and mapping lead service lines. Kathleen Gray, “Message from Flint to Trump: Where the Hell Have You Been?,” Detroit Free Press, September 14, 2016; and Amy Crawford, “In Flint, Providing Safe Water Is a Full-Time Job,” CityLab, January 25, 2017.

0. .  Susan Selasky, “Ways to Cut Water Use in the Kitchen.” Compiled with help from the Free Press Test Kitchen, Erin Powell, and Bethany Thayer, Detroit Free Press, February 14, 2016, p. 7A; Susan Selasky, “Program Gets Flint Residents to the Grocery,” Detroit Free Press, February 14, 2016, p. 7A.

0. .  Susan Hedman, written testimony to the House Committee on Oversight and Government Reform, Washington, D.C., March 15, 2016, https://oversight.house.gov/wp-content/uploads/2016/03/Hedman-Statement-3-15-Flint-Water-II.pdf.

0. .  Oona Goodin-Smith, “U. of Mich. 8-Part Course Explores Flint Water Crisis,” USA Today College, January 22, 2016; and University of Michigan–Flint, “Flint Water Crisis Course—January 21, 2016,” University of Michigan–Flint, uploaded to YouTubeVideo, 2.06.10 hours, January 27, 2016, https://www.youtube.com/watch?v=ulowd6DgS-k&list=PLXTcWgqRYbI15MwCzeQhFK1ASsxoI416u&index=12.

0. .  Some of the material that follows first appeared in slightly different form in the New Republic (“Flint Prepares to Be Left Behind Once More,” March 3, 2015).

0. .  Matthew Dolan, “Scared Residents Search for Hope,” Detroit Free Press, January 24, 2016, pp. 1A, 13A.

0. .  Mark Tower, “$2 Billion for Blight Elimination Efforts Approved by Congress,” MLive—Flint Journal, December 18, 2015. As for the neighborhood-specific efforts, there was, for example, a series of public meetings to develop the South Flint Community Plan, such as one on February 17, 2016, at the Atherton East community center that included a presentation and discussion around the history of public housing in Flint, according to a contemporary status on the City of Flint Master Plan Facebook page.

0. .  Lindsey Smith, “Not Safe to Drink,” Michigan Radio, December 15, 2015.