10 years ago, crypto gripped Milwaukee
Water contamination lessons lead to safer system 10 years
By Marilynn Marchione
Milwaukee Joural Sentinel
Most Milwaukeeans can't remember exactly where they were
10 years ago today, but it was probably in the bathroom.
It was a real tragedy for the community, but even more
for the individuals affected by it.
A tiny parasite with a big name, Cryptosporidium, had
gotten into city water and thousands of people's guts,
causing severe diarrhea and a weeklong order to boil water
before drinking it.
It happened even though the water met all federal and
state standards. It happened without health officials
being aware of it for many days.
It made history as the largest waterborne disease outbreak
in the industrialized world.
The official toll: 403,000 sickened, 44,000 doctor visits,
4,400 hospitalized, more than 100 deaths, 725,000 lost
work or school days, $96 million in lost wages and medical
expenses and $90 million for a new water purification
"It was a real tragedy for the community, but even
more for the individuals affected by it," Milwaukee
Mayor John O. Norquist said.
The epidemic led to fundamental changes around the nation
in public health, disease surveillance, water treatment
and testing . . . even the way people view drinking water.
Years later, many still mistrust water from the tap, though
experts say Milwaukee's is now extremely safe.
Most people who got the germ had a week of misery and
no long-term consequences. But it cost some their lives,
primarily AIDS patients whose weak immune systems couldn't
fight it off without the modern AIDS drugs available today.
"It was just a terrible experience. I had several
requests for assisted suicide, for euthanasia. People
were just suffering so much," said Ian Gilson, a
Some cancer patients also died, unable to survive a grave
medical condition and a parasitic infection. Other people
didn't lose their lives, but had to fight for them.
One woman ran up $35,000 in medical bills and lost a
spleen. Some transplant patients battled organ rejection
all over again. Several people developed a rare blood
disorder that doctors said may have been triggered by
an overstimulated immune system trying to defeat the parasite.
Michael Ryszkiewicz lost kidney function and had a transplant
the following year.
"I went from living a normal life to being on dialysis,"
said Ryszkiewicz, who now lives in Oconomowoc. "It
cost me a lot of anguish, a lot of pain. I didn't know
if I was going to live."
People worried about things big and small: pets getting
it, rinsing contact lenses, washing dishes, whether hot
chocolate and ice at County Stadium would be safe for
the Brewers' home opener. Women feared babies could get
the germ through breast-feeding. Some wondered if it caused
miscarriages they suffered.
Tentacles of the outbreak reached around the nation.
One East Coast man got sick because he drank from a drinking
fountain at the Milwaukee airport during a brief layover
on a cross-country flight.
The source of the germ that sickened them still isn't
known and probably never will be.
Following the trail
Cryptosporidium is a protozoan, a one-celled organism
that stays dormant in water inside an egg-like shell,
which splits open and lets the germ multiply in the intestines.
It's common in standing water and is a well-known cause
of illness in cattle, especially calves, so investigation
initially focused on farm runoff as a potential source.
But the picture blurred when genetic analysis by the Centers
for Disease Control and Prevention revealed that stool
samples from infected Milwaukeeans contained a human strain
of Cryptosporidium, not a bovine one.
Although the source remains a mystery, how the germ got
in city water is well known.
Chlorination doesn't kill Cryptosporidium; it must be
filtered out. At the time, that depended greatly on chemicals
to precipitate impurities out of raw water. City officials
had been experimenting with a new chemical that apparently
did this quite poorly, especially at the Howard Avenue
Purification Plant on the south side.
For weeks, residents called the water department, complaining
of cloudy, foul-smelling water, and officials kept using
more of the chemical to try to fix the problem, not realizing
it was ineffective.
There were unusual weather conditions - a snowy, wet
spring with lots of runoff into streams, and wind patterns
that affected currents and how water flowed around the
intake pipe in Lake Michigan, the source of the city's
City officials also discovered an illegal sewer connection
that had been allowing waste from a slaughterhouse to
enter sanitary sewers.
"It was an unbelievable confluence of events. There
were so many things going on at the same time," said
state epidemiologist Jeff Davis.
By April 5, a Monday, calls were flooding the Milwaukee
Health Department from the public, the media and pharmacies
saying that people were sick, and diarrhea medications
were flying off shelves.
Water under microscope
For several days, officials tested for bacteria and viruses
and came up blank. The protozoan didn't come to light
until the afternoon of April 7, when community doctor
Thomas Taft called the Health Department to say that another
doctor, Anthony Ziebert, had an older patient who tested
positive for Cryptosporidium.
City health officials had started to test for protozoans
and immediately sent faxes to hospitals, asking them to
do the same. By sunset, eight cases were confirmed.
In a meeting to discuss what to do, the mayor set a glass
of water in front of Davis, the state's chief medical
officer, and asked whether he'd drink it. Davis said no.
Norquist called a 9 p.m. news conference and ordered residents
in Milwaukee and 10 suburbs that use city water to boil
it until further notice.
The Milwaukee Journal and the Milwaukee Sentinel abandoned
competitive publishing and jointly put out a special edition
in Spanish and English, warning people not to drink the
The Howard Ave. plant was closed, and the water treatment
problems became public knowledge. But by then, thousands
were sick. The former Milwaukee County Medical Complex
was seeing 75 cryptosporidiosis patients a day and getting
calls from hundreds of others.
Until the cause of the illness was known, "they
were giving people water, which just made it worse,"
Hospitals had their own problems, as at West Allis Memorial,
where many nurses were sick.
"The diarrhea was so severe they could not make
it to the regular restrooms and would have to use patient
restrooms," Taft said.
Flurry of lawsuits
Many people wanted justice. More than 4,000 people filed
notices of injury with the city, and 1,400 filed claims
seeking damages of $25 million. The cases were consolidated
into a class-action lawsuit, and rulings eventually narrowed
the number to about 540.
The city ultimately settled for $100,000, and General
Chemical Corp., which made the water treatment chemical,
settled for $1.5 million. About 50 cases, all involving
people who died, got the largest amounts - $13,500 after
Meanwhile, Norquist said he tried to focus on preventing
future outbreaks by overhauling water treatment. An ozone
purification system started operating in October 1998.
The water intake pipe was extended 4,200 feet farther
into Lake Michigan to draw in a purer supply. Better filters
and monitors were installed. Security was improved; the
city's two water plants now are fenced, lighted, policed
Health officials boosted efforts to detect and track
illness in the community - the very kind of surveillance
being done now in communities across the country as part
of bioterrorism preparedness.
"It started very small and simple - weekly calls
to nursing homes and pharmacies just to find out what
they're seeing. But today, we're tracking about 20 different
indicators of illness on an ongoing basis across the city,"
said Health Commissioner Seth Foldy, who came to Milwaukee
If there had been such a system including pharmacies,
nursing homes and labs in 1993, "that outbreak would
have been detected much earlier than it was," said
Jim Hughes, director of the CDC's National Center for
"I wished it would have never happened in Milwaukee,"
said Paul Nannis, an Aurora Health Care executive who
was health commissioner at the time. But he said he was
proud of the Health Department's response, and the knowledge
the epidemic produced about water and its links to public
Could it happen again?
"I would never say that," Davis said. "But
the likelihood in Milwaukee is pretty low because of all
the safeguards that have been taken."