‘Beginning Of An Epidemic’: Email Shows State Waited 6 Days To Publicize Legionnaires’ Outbreak

Illinois public health officials delayed informing the public for nearly a week about a deadly 2015 Legionnaires’ disease outbreak at a state veterans’ home in Quincy despite knowing the facility was facing “the beginning of an epidemic,” according to internal emails from Gov. Bruce Rauner’s office obtained by Illinois Public Radio's member station in Chicago, WBEZ.

That delay was called “mind boggling” by one of the nation’s top infectious disease experts. And it comes at the same time WBEZ has learned the actual number of Legionnaires’ cases at the downstate Illinois Veterans Home during 2017 was double what state officials previously had reported as recently as two weeks ago.

Both disclosures throw into question how forthcoming the Rauner administration has been with the public about the true scope of the Legionnaires’ crisis confronting the largest state-run veterans’ home in Illinois. Over three outbreaks in as many years, 13 veterans have died at the Quincy home after exposure to the waterborne bacteria that causes Legionnaires’, a type of pneumonia, including one fatality in October.

Rauner’s administration has declined numerous requests for an interview with the governor about a WBEZ investigation into the outbreaks. On Wednesday, the Republican was asked twice by reporters at an unrelated event whether he bore a “moral responsibility” to the families who lost loved ones. Neither time did Rauner accept that responsibility.

“Bottom line, I work every day to support our veterans,” he responded. “They are our heroes, and I will never, ever back down or give up on fighting and working to keep our veterans safe.”

‘The beginning of an epidemic’

On Oct. 16, 2015, Illinois Public Health Director Nirav Shah wrote an email to Linda Lingle, the former state chief operating officer who appeared to be acting as an intermediary between Rauner and his cabinet members during the first Legionnaires’ outbreak in the summer of 2015, which would ultimately kill 12 people and sicken dozens more.

According to emails obtained through a public records request, Lingle requested a detailed timeline about the administration’s public communications efforts during the period when the disease initially began unfolding. The first public news release on the outbreak came Aug. 27, 2015, when the state disclosed eight confirmed cases of Legionnaires’ at the facility. The next day, two residents were reported dead from the bacteria, which can cause the fatal form of pneumonia associated with Legionnaires’.

 In the email, Shah made clear the state had known for days — since Aug. 21 — that it was contending with a serious public health emergency.

“In short,” Shah wrote, “we issued our first press release six days after we realized that the situation was the beginning of an epidemic. That timing is in line with our typical reporting protocol.”

In the email, Shah underlined “six days” for added emphasis, but it is not clear why. His reference to a “typical reporting protocol” also is not fully explained, with a spokeswoman on Wednesday saying there is no “hard and fast rule” about when the public must be notified about an infectious disease outbreak.

Citing a family emergency, Shah was unavailable for comment after canceling a scheduled interview with WBEZ on Tuesday.

The timeline in Shah’s email indicates that on August 21 — one day before the first recorded fatality — that two Legionnaires’ cases had been reported at the home. At that point, Shah said in the email, the state had begun shutting off potential sources of Legionella bacteria , including showers and outdoor decorative fountains. The memo also notes the state had begun attempts to disinfect a cooling tower and water chiller units at the facility.

A Shah spokeswoman did not directly address the logic behind waiting six days after the onset of the 2015 Legionnaires’ epidemic to notify the public, including family members of veterans who were killed and who have been interviewed by WBEZ.

“As soon as [the Illinois Department of Public Health] can provide confirmed information to help the public make informed decisions, we share that information,” state public health spokeswoman Melaney Arnold told WBEZ in a prepared statement.

 She said her agency was in “constant communication” with the state Veterans’ Affairs department, administrators at the Quincy veterans’ home, and public health authorities in Adams County, where Quincy is located. She added that the state public health department “does not communicate directly with long-term care facility residents or staff about outbreaks.”

Expert: Delay in publicly reporting 2015 outbreak ‘mind-boggling’

One of the nation’s top infectious disease experts said it’s “mind boggling” that the state would wait six days to notify the public about the initial outbreak at the Illinois Veterans Home.

“I think it’s really inexcusable,” said Dr. Amesh Adalja, senior scholar at the Center for Health Security in the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. “It takes you six days from seeing an epidemic to tell people that you’re seeing an epidemic? That’s six days that you’ve allowed that disease to spread in a manner that probably wouldn’t have happened if you would have known earlier because people would have been taking action. People would have been asking questions.

“If you know there is an epidemic, you need to tell people immediately,” Adalja said.

The state’s decision not to notify the public immediately did not display even minimal standards of caution, he said.

“I think six days — once there’s a recognition of an epidemic — is not really something that would be considered standard of care even if it was in line with what prior reporting should be,” Adalja said.

Asked if the lack of notice represented a serious enough offense to warrant the firings of any state official, he said, “I think there are important questions that need to be asked about the performance and how that performance can be justified in 2017 in the era when we know what infectious diseases do [and] we know about crisis communications. I think there definitely are questions that need to be answered about the way this was handled.”

Criticism of the state’s slow response was backed up Shah’s predecessor, former state Public Health Director LaMar Hasbrouck, who served in former Democratic Gov. Pat Quinn’s administration between 2012 and 2015.

“In my experience, if you’re investigating an epidemic of any infectious disease outbreak, once you’re sure or fairly certain that there is an epidemic and you have confirmed cases, diagnostic cases and laboratory confirmed cases, then at that point there really is no reason to hold out in terms of informing residents or other folks that might be in harm’s way,” he said in an interview.

“I think it’s a matter of public trust and transparency,” Hasbrouck said.

‘It don’t sit very well with me’

Last week, WBEZ aired and published an investigation into the ongoing cases of Legionnaires’ at the Quincy home and spotlighted how veterans who endured unspeakable experiences on the battlefield died at the facility after being sickened by bacteria-contaminated water. In a series of exclusive interviews, some of their families contend their loved ones weren’t diagnosed nor given antibiotics quickly enough to fend off what typically is a treatable form of waterborne pneumonia.

Despite nearly $6.4 million in water treatment upgrades, there was another outbreak in 2016, and more cases — including another outbreak — in 2017.

Eleven of those families with parents who died in the 2015 outbreak are suing the state for negligence.

In a new interview, the family member of one of those victims, World War II veteran William J. Schrand, said she believes the state did not properly inform residents, their families, or even the nursing staff about the fast-evolving outbreak of Legionnaires’ in 2015.

Shrand’s daughter, Barbara Kiefer, said her 94-year-old father was otherwise healthy before he mysteriously went comatose on Aug. 25, 2015. That same day, she was told he was suspected of having Legionnaires’ disease even though the state wouldn’t notify the public of the outbreak for another two days.

Formal results confirmed Schrand’s diagnosis on Aug. 28, she said. By Aug. 30, Shrand was dead.

Kiefer, a former certified nursing aide at the home from 2002 through 2010, said she believes her father would still be alive had she and others been informed by the home that it believed a Legionnaires’ epidemic was unfolding on Aug. 21, 2015, the date Shah acknowledged it in his email to a top Rauner aide.

“It don’t sit very well with me,” Kiefer said. “None of this that happened out there sits very well with me. I think the way they went about it, it was like they didn’t really want anybody knowing about it, and it’s a shame because it should’ve been put out there.”

Like other families, Kiefer said she doesn’t want to see the state shut down the facility because it is an important community employer and provides a homey atmosphere to its residents. Instead, she believes the state needs to invest in necessary repairs to permanently eradicate the Legionnaires’ bacteria — a threat that she said many on the staff take seriously enough to avoid drinking the water there, even after the state’s multimillion-dollar upgrade to the facility’s water treatment system.

The head of the Illinois Department 0f Veterans’ Affairs, Erica Jeffries, had earlier suggested it could be impossible ever to eradicate Legionella bacteria from the Quincy veterans’ home. She said the one potential remediation step the state has not tried is replacing “miles and miles and miles and miles” of original plumbing in the more than 130-year-old facility, which she said could be prohibitively expensive. Last June, the Centers for Disease Control and Prevention cited that plumbing as a “persistent” source of Legionella.

State reveals previously undisclosed Legionnaires’ cases

Meanwhile, Illinois public health officials are now telling WBEZ that five residents and one employee at the Illinois Veterans’ Home in Quincy were sickened by Legionnaires’ in 2017. That outbreak included one fatality, an 88-year-old Korean War veteran from west suburban Lisle in early November.

As recently as two weeks ago, the Illinois Department of Veterans’ Affairs, which manages the Quincy home, had confirmed just three cases to WBEZ and disputed that Legionnaires’ caused the veterans’ death last month. But the coroner in Adams County confirmed Legionnaires’ as a cause of death on the resident’s death certificate.

In late October, when the state confirmed two cases of Legionnaires’, including the fatality, WBEZ explicitly asked a state Veterans’ Affairs spokesman whether there had been any additional cases. The spokesman responded by email saying there had not been. In a Dec. 6 interview with WBEZ, Jeffries also cited three cases.

But this week, after learning more cases did exist in 2017 beyond those two — and a later case in November that the state disclosed — WBEZ was told by state public health authorities that, in fact, six Legionnaires’ cases have been logged this year at the Quincy facility.

Arnold, the state Public Health spokeswoman, said on Wednesday that one case occurred in March, another in May, another in September, two in October, and one in November. She did not provide any other details about those cases.

Veterans’ Affairs spokesman Dave MacDonna did not explain on the record why the state did not divulge all six cases from 2017 to WBEZ.

“The Illinois Department of Veterans’ Affairs has properly reported all possible Legionella cases to the Adams County Health Department and the Illinois Department of Public Health,” MacDonna said in a prepared statement. “In October, two cases were reported within days, which indicated an outbreak.”

In another development Wednesday, a bipartisan bloc of Illinois House members signed on to a resolution urging Rauner’s administration to provide a report to the General Assembly that “includes detailed timelines of what information the Illinois Veterans’ Home at Quincy, the Illinois Department of Veterans’ Affairs, the Illinois Department of Public Health and Governor Rauner’s administration knew, and when they knew it” with regard to the Legionnaires’ disease outbreaks.

There is a joint legislative hearing on the Quincy Legionnaires’ cases scheduled for Jan. 9 in Chicago.

Kiefer has her own opinion about how Rauner himself has handled the Legionnaires’ crisis at Quincy.

“I’m a lady so I’ll keep it clean: Not good. I think he could do more.”