The Blue Death

by Dr. Robert D. Morris

  Stan drove to the PUC shop where he learned that the chlorinator for well 7 was still sitting in its crate. Moments later Frank walked into the PUC shop.

  “Mind if I have the day off, being that I worked Saturday?”* Frank asked.

  Frank had spent most of that day repairing flooded electrical equipment at the high school. If it crossed Stan’s mind to say anything about the chlorinator, he held his tongue. His bigger, stronger, and smarter younger brother had always chafed under his leadership and Stan knew it.

  “Yeah, go ahead,” Stan said. The chlorinator could wait another day, but since it was Monday, they would need new water samples. “Just get Al to sample well seven before you leave.”

  Stan then drove over to highway 9 to check the work on the water mains. He arrived to find the excavation trenches filled with mud and rainwater. He called Al Buckle, a maintenance worker for the PUC, and asked him to bring over some sampling bottles. Once those bottles were full, he packed them in a box and sent them to A&L laboratories with a note. “Please rush. Thanks, Stan,” it read.

  Four years earlier the provincial leadership had joined the 1990s obsession with privatization and shut down the water testing laboratory at the environmental ministry. Suddenly all water utilities had to find a private laboratory to do their testing. Walkerton had found a lab at the time, but that company had just closed, forcing Stan Koebel to find a new lab. He had just started sending samples to A&L, a Canadian franchise of a large laboratory services company in the United States.

  Two days later, on the morning of May 17, Stan Koebel got a call from a supervisor at A&L Laboratories. Tests on the samples from highway 9 had come back positive for coliform bacteria. Water supplies do not test for all bacteria. Instead they use two tests for so-called indicator bacteria. The coliform test is one of the two tests and the positive test simply meant that live bacteria were in the water. It was news of the second test results that got the attention of Stan Koebel. Preliminary results from the second test, which looks for a particular species of bacteria known as E. coli, had come back positive. E. coli come almost exclusively from human and animal feces.

  All water suppliers occasionally find E. coli in their water. Often these bacteria are harmless. But they do not normally appear in groundwater. Still Stan Koebel was not overly concerned. He had an abiding faith in the safety of the town’s water. By that afternoon, however, more results arrived. Almost all of their samples were positive for coliform and E coli. Still worse, the quantitative tests showed that the contamination was massive. Stan Koebel couldn’t ignore the results. He decided it was time to install the chlorinator.

  Tens of thousands of different strains of E. coli inhabit the colons of vertebrates around the world. Although the majority of those strains are harmless, the remainder can cause gastrointestinal disease of varying severity. One of the most dangerous strains is E. coli O157:H7, a recently evolved form of the bacterium. The poisons it contains can shred the lining of the gut. Blood then pours into the victim’s colon, resulting in the bloody diarrhea that characterizes the disease. Its victim’s stools are often nothing but bright red blood. What follows, however, can be far worse.

  As E. coli O157:H7 makes its way into torn blood vessels, it continues to release its poison. In the bloodstream those toxins tear at the delicate cells that line the blood vessels and shower the body with blood clots. In severe cases it destroys the blood vessels in the kidneys causing them to fail. With no way to purify their blood, these patients begin to poison themselves. The normal products of their own body accumulate to toxic levels and they begin to drown in the by-products of their own existence. Many of these patients die. Those that survive the ordeal of intensive care and dialysis often have chronic medical problems.

  In addition to humans, E. coli O157:H7 can also infect cows, although it does not make them noticeably ill.

  On May 18, 2000, Kristen Hallet, one of only two pediatricians working in the region, was called to the emergency room of the Owen Sound Hospital to see a seven-year-old girl from Walkerton. Aleasha Reich had fallen ill the day before and spent the evening drinking fluids as her family doctor recommended. She arrived in the emergency department with intense cramps, vomiting, and bloody diarrhea.

  Bloody diarrhea has only a handful of possible causes, none of them common. Dr. Hallet had seen this particular constellation of symptoms only twice before in her career. One was a child she had seen six months earlier who was suffering from an infection with E. coli O157:H7. The other, a nine-year-old boy, was lying in a hospital bed just upstairs.

  One patient with bloody diarrhea is an unfortunate victim in need of medical care. The simultaneous appearance of two such patients, however, suggests something worse and demands action on a broader scale. Dr. Hallet worried she might be seeing the results of a foodborne outbreak. By the time she called the regional public health official the next morning, all hell was beginning to break loose in Walkerton.

  On the afternoon of Friday, May 19, just before the start of the holiday weekend, Dave Patterson, assistant director of regional public health, learned about Dr. Hallet’s phone call and asked his staff to investigate. They soon discovered that something was indeed happening in Walkerton. At Mother Teresa School, the town’s Catholic elementary school, twenty-five students were home sick. Eight students were sent home from the public school. The disease had also begun to strike the local nursing and retirement homes. Eight people with bloody diarrhea arrived at the emergency room of the small local hospital. A local physician had seen twelve more people with diarrhea. It was Victoria Day weekend with a holiday on Monday, but as Dave Patterson listened, he could see his plans for the long weekend evaporate. He picked up the phone and called Stan Koebel.

  The tiny seeds of concern in Stan Koebel’s brain began to grow as he answered the call from Dave Patterson. Those seeds had been planted by two earlier calls from people in town worried that the water might have caused the growing outbreak. Just as he had with the other callers, Koebel insisted that the water was fine. Patterson asked if the heavy rain and flooding could have had any effect on the water, and Koebel reassured him that this was unlikely. He never mentioned the problems with the chlorinator or the positive test results.

  If there was a problem, Stan Koebel believed he could fix it. He worked late into the night, scuttling furtively between well 7 and a fire hydrant near Mother Teresa School. He collected water samples and tested them for residual chlorine beneath the light of an oblong moon. Driving home with midnight approaching, he still failed to fully understand that the house of cards he had constructed was collapsing all around him.

  That same night Tracey Hammel’s heart sank as she opened the diaper of her two-year-old son, Kody. He had been vomiting all day, but she was not prepared for a diaper full of blood. Through a miserable night, she hoped he would improve, but Kody only got worse. By ten o’clock the next morning, he was weak and listless. When she called the emergency room at the Walkerton Hospital, the nurse told her that the hospital was “backed up.”

  “When can I come?” she asked, unsure how much longer her son could wait. The nurse suggested she come at four that afternoon. In the meantime she advised her to keep Kody hydrated. On the advice of the nurse at the hospital, Tracey Hammel had spent the next two hours forcing water into her son’s mouth with a syringe. By noon Kody was limp and his eyes seemed to roll back in his head.

  Stan Koebel, meanwhile, had returned to well 7 before sunrise and continued to push chlorine into the system. Most of the passersby who saw the hose connected to the fire hydrant outside Mother Teresa School had no idea what Stan Koebel was doing. Bob McKay, however, knew all to well. He had worked under Stan for the past two years. He knew about the test results. He wanted to make sure someone else knew as well. Later that morning Christopher Johnston, one of the few people working through the holiday weekend at the Ontario Ministry of the Environment, received an anonymous phone call. The water in Walkerton, he learned, seemed
to have a problem.

  Early Saturday afternoon Christopher Johnston called Stan Koebel. He told Koebel he simply wanted to “find out what’s going on.”

  Koebel struggled for an answer. “We had a fair bit of construction and there is some concern—I’m not sure, we’re not finding anything…but I am doing this [flushing and chlorinating] as a precaution…”

  Then Johnston put the question to him directly, “So you haven’t had any adverse samples, then?”

  Koebel’s web had grown tangled, but he hoped he could continue to deceive. “We’ve had the odd one,” he conceded, “you know, we’re in the process of changing companies, because the other company, it closed the doors, so we are going through some pains right now to get it going.”

  As Stan Koebel tried to evade the probing questions, Tracy Hammel held her son, Kody, in her arms, the strength seeping out of his tiny body. She and her husband had finally rushed him to the Walkerton hospital to find it overflowing. The nearest empty hospital bed, they discovered, was in Owen Sound. They raced along the long straight roads that sliced through the farms of southern Ontario. When they finally reached Owen Sound, the hospital laboratory would confirm the presence of E. coli O157:H7.

  One of the perverse twists of E. coli O157:H7 is its response to antibiotics. As the drugs destroy the bacteria in the bloodstream, they burst open and release the poisons within. This sudden release of toxins dramatically increases the risk of kidney failure. The doctors in Owen Sound knew this and told Mrs. Hammel there was little they could do but give him fluids, watch, and wait. Then Kody’s kidneys failed.

  The Owen Sound Hospital was not equipped to manage kidney failure. The nearest hospital that could perform dialysis was more than a hundred miles away in London, Ontario. Paramedics rushed Kody to a waiting helicopter.

  Time and chance seemed to be conspiring against the tiny boy as the powerful motor of the helicopter spun into action and lifted him into the spring sky. The people of Walkerton who saw the helicopter flash overhead on its way to London had no idea that it carried one of their children. As the week wore on the red and white emergency helicopters continued to come, pounding the air like giant angry insects.

  As the helicopters rose, hovered for a moment, and veered to the south again and again, it seemed for a time as if Walkerton were at war. Among their passengers was two-year-old Mary Rose Raymond, the daughter of a physician from a neighboring town who had taken her daughter to Walkerton for a Mother’s Day dinner just one week earlier, and Lenore Al, a retired librarian. They would not return to Walkerton alive.

  In the end Stan Koebel’s frantic struggle to erase disaster failed. In a town of just 5,000 people, 2,300 fell ill during the outbreak. Hundreds were hospitalized, many in intensive care. In what his doctors termed a miracle, Kody Hammel survived the weeks of dialysis. Mary Rose Raymond, Lenore Al, and five other victims would die from their infections.

  A government inquiry would eventually trace the cause backward from well 5 to the manure on David Biesenthal’s farm. The invisible world beneath the surface of the farm did not provide the homogeneous thirty-foot-thick filter that the Koebels had imagined. It now appears that death had come to Walkerton through ribbons of gravel and fractured rock that allowed water and manure to pour into the aquifer beneath the well.

  The story of Walkerton might seem to hold few lessons for the future of water. How could the poor judgment of two brothers in a rural town be relevant to the safety of our entire water supply? This tragic tale offers a window into many of the challenges we face as we try to maintain safe drinking water into the future. The problems in Walkerton began with complacency and misplaced confidence in the safety of source water. Those problems were compounded by a failure of water treatment driven, in this case, by a failure of the plant operators. Perhaps most stark is its demonstration of the deadly threat posed by emerging pathogens and the potential for those pathogens to be waterborne.

  In the United States new rules for drinking water were still on hold as events in Walkerton unfolded. It had taken the EPA five years just to issue rules making the turbidity levels that preceded the Milwaukee outbreak illegal. Until then a utility could have produced water identical to the water that caused the cryptosporidiosis outbreak without violating federal standards.

  The final rules, the first rules to actually require communities to test for cryptosporidium oocysts in their water together with more stringent rules for chlorination by-products were due for release in 2002. As 2002 approached, with a new administration in place, the EPA balked. For three years, unseen hands held the final implementation of the new rules in limbo.

  In the summer of 2005, Erik Olson from the NRDC filed suit to force the release of the new rules on pathogens and disinfection by-products. The process ground slowly forward. Then, with their release still pending, a new, unprecedented disaster struck at America’s drinking water.

  14

  SURVIVING THE STORM

  A storm was coming. The workers at the Carrollton Water Treatment Plant on the west side of New Orleans braced themselves, like an army at the ramparts preparing for a siege. They had packed extra food and clothes and had sent their families to higher ground. They felt sure that they would be safe at the plant. Its thick white walls, hidden steel skeleton, and heavy red tile roofs gave testament to the golden era of civil engineering in which it was built. All the workers at the plant had been through other hurricanes. The plant itself had survived whatever monsters had emerged from the swirling waters of the Gulf of Mexico for almost one hundred years. This storm, however, would defy their collective experience. This storm was called Katrina.

  As darkness fell the winds began to rise. Sheets of rain raked across the seventy-acre campus of the plant. For days the storm had sucked energy from the warm waters of the gulf. As she hit land and unleashed that energy, Katrina began to rip the cities of the Gulf Coast to pieces. She peeled off roofs, sucked out windows, and uprooted trees. As power lines snapped and transformers exploded in sparks, the coast of Louisiana and Mississippi plunged into darkness.

  In New Orleans the Carrollton Water Treatment Plant seemed prepared. In a city of storms, one could never take electricity for granted. Beneath the two smokestacks that tower over the Carrollton Water Treatment Plant six boilers power huge generators capable of producing enough energy for a small city. As the power grid went down, the power plant whirred into action. In a darkened city, the water treatment plant didn’t miss a beat. But then things got bad.

  As the winds rose above a hundred miles an hour, an ornate eight-foot-high window in the power plant exploded, sending glass and bits of the mangled window frame across the floor of the power station. Rain flooded through the opening, soaking the electrical equipment. Within minutes the motor control unit short-circuited and burst into flames. Acrid smoke began to fill the building.

  In the control room of the plant, another crisis was unfolding. On a normal day, the huge water pumps at the plant would send 120 million gallons to the city through six massive water mains with the flow rising and falling in response to the demand for water. Just before the storm arrived, with the city half-empty and industries shut down, the demand for water had dropped and the plant was pumping out clean water at a reduced rate of only 50 million gallons per day. But then, as Katrina tore through the city, the demand for water suddenly doubled. The huge pumps whined in a struggle to match the demand. In an empty city, this sudden increase in demand for water could mean only one thing. Somehow Katrina had broken an immense drinking water pipe. With each passing minute, somewhere out in the raging blackness, another thirty thousand gallons of drinking water were flooding from a ruptured pipe and into the streets of New Orleans.

  Nine miles to the east, nine miles closer to the ferocious winds that spiraled around her eye, Katrina tore at the sheet metal buildings of the East Bank Sewage Treatment Plant. Built in the 1990s, the plant offered an essential improvement in the treatment of New Orleans sewage, but no o
ne had wanted it for a neighbor. Needed by all and wanted by none, the plant had been banished to a man-made island amid a purgatory of swampland and open water east of the city. Most of the city’s wastewater flowed through the grid of treatment basins etched into a rectangle of landfill. The location, chosen for its financial and political expediency, was an invitation to disaster. In the darkness of August 29, the four workers assigned to ride out the storm watched disaster arrive.

  As the storm surge began to flood the island and the narrow road connecting it to solid ground, the four men climbed three floors to the control room of the sludge incinerator to escape the rising water. The howling wind strained and tested every seam in the corrugated steel building. Like a ferocious cat toying with a birdcage, Katrina seemed determined to find an opening. Suddenly she ripped out a large window overlooking the plant and reached into the control room with claws of fury.

  The four men rushed to the stairwell. Their first thought was to climb higher, away from the rising water. They ran to the forth floor as the storm raged outside. They had escaped Katrina for a moment, but she continued to scrape and claw at the steel skin of the building. Inside, the men could only wait and listen as she searched again for a weak point. Again, she found it. In an instant she took hold of the roof and peeled it back in a horrific explosion of bursting rivets and twisting metal.

  As the building disintegrated around them, the men scrambled down the stairs toward the rising water. On the second floor, they found their last, best refuge, a bathroom with concrete walls and no windows. As they huddled there, Katrina’s winds seemed to diminish. They began to hope that the worst was over, but the hurricane had other plans. Wind was not her greatest weapon.