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10 years ago, crypto gripped Milwaukee
Water contamination lessons lead to safer system 10 years later
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 system.

"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.

Life-threatening germ
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 Milwaukee physician.

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 water.

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 water.

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," Taft said.

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 attorneys' fees.

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 and video-monitored.

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 in 1996.

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 Infectious Diseases.

"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 health.

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."

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