Doctors, mothers and a leading expert on the cryptosporidium parasite are wondering why Lawrence and state health officials took so long to warn the public it faced possible exposure to the illness.

“If you do have a problem, you need to get it to the public immediately,” said Steve Upton, a Kansas State University biology professor who has published numerous scholarly articles about the parasite.

That didn’t happen in Lawrence.

Instead, health authorities waited until late August — a month after two swimmers were confirmed with the disease — to alert the public to the outbreak. By then, 11 people were known to carry the parasite. Thursday, 76 cases were confirmed.

Officials have said they didn’t want to start a panic. But word-of-mouth alerts among individuals about the cases during the intervening weeks prompted doctors and lay people to take action to combat the disease long before the rest of the community knew it was at risk.

Elyse Towey, for example, began warning her friends against swimming in early August, after her young son was confirmed with the disease. A nurse at the doctor’s office told her the city’s pools were a prime suspect in the transmission.

Towey, who has lost 13 pounds from what she thinks is cryptosporidiosis, passed along the warning to as many people as she could. But she couldn’t warn everybody.

“Every time I would pass that pool and see it full of people, it would make my stomach hurt,” she said Thursday. “Because I knew those people were being exposed to that.

Alert or investigation?

¢ 6News video: Reported numbers of crypto cases may be tip of iceberg¢ Toddler’s crypto bug has mom seething (9-11-03)¢ 6News video: Crypto infection outbreak numbers updated¢ News of crypto withheld 1 month (9-10-03)¢ 6News video: Authorities waited to warn public about parasite¢ Parasite continues to spread (9-06-2003)¢ Lawrence-Douglas County Health Department Executive Director Kay Kent (9-5-03)¢ Crypto found at child center (9-5-03)¢ 6News video: Search for outbreak’s cause continues¢ Cryptosporidium cases on hold at 22 in county (8-31-03)¢ 6News video: City plans to test water supply (8-30-03)¢ Audio clips from city and county officials¢ Parasite outbreak strikes more victims (8-29-03)¢ 6News video: Outbreak spurs search for parasite’s source (8-29-03)¢ Letter to parents (pdf)¢ Questionnaire for parents (pdf)¢ Swimmers flock to pools opened after bacteria scare (8-25-03)¢ Outbreak closes city pools (8-23-03)¢ 6News video: Parasite discovered in city pools¢Centers for Disease Control information

Cryptosporidium is a microscopic parasite that causes diarrhea, loose or watery stool, stomach cramps, upset stomach and a slight fever. The parasite can be fatal to patients with weakened immune systems, such as the young, elderly or people with HIV. More than two-thirds of those who contract cryptosporidiosis are children.

There is no treatment for the disease in adults, but federal officials approved a drug for children last year. Those who contract the parasite but are otherwise healthy usually recover within two or three weeks.

The parasite is passed through oral ingestion of even microscopic amounts of tainted feces.

This week, the Journal-World learned that the Lawrence-Douglas County Health Department sent letters to the 200-member Lawrence Aquahawks swim team July 25, the day after the first case was confirmed. But it was a month before the broader swimming public was alerted.

Health authorities have said the letter was not a warning but part of their investigation to see if there were more cases.

But recipients of the letter, it appears, took it as a warning. Dr. Anne Van Garsse, Towey’s physician, said she became aware of the outbreak because an Aquahawk parent called her after receiving the letter.

As a result, Van Garsse said she began looking for cryptosporidium among her diarrhea patients more than a week before the Health Department told her office to be alert.

“That sort of seems strange to me,” Van Garsse said. “We kind of wondered why we didn’t hear more about it sooner.”

Aware of the Aquahawks letter, Van Garsse began mentioning possible problems at the pools to patients. Though she never told anyone not to swim, she said patients would have taken her comments as a “beware-of-the-pool” warning.

“I was wondering when they would close the pools and clean them out,” Van Garsse said.

The Journal-World is seeking a copy of the letter under the Kansas Open Records Act.

Expectations

Dr. Gianfranco Pezzino, the state epidemiologist who has advised the Health Department’s handling of the matter, was not available for comment Thursday.

During a Wednesday interview, though, he told the Journal-World the decision to wait on public notice was a “judgment call.” Authorities weren’t — and still aren’t — sure the parasite had been passed in the pool.

“At the time, we didn’t feel we had enough information to do that,” Pezzino said.

But Upton, the expert at K-State, said certain assumptions can be made.

“Certainly, if two people got cryptosporidium on the same team, you would expect they would have gotten it from the pool,” he said.

And once cryptosporidium appears in a community, Upton suggested, there are apparently numerous opportunities to pass it along in a pool.

“A pool in a large-scale city can expect a fecal accident once a day, is what the water industry guys tell me,” he said. “A city like Lawrence might have it every few days. But you usually don’t notice.”

Lawrence pool officials also learned about the cases through the Aquahawks letter but waited until the Health Department ordered the closure to notify the public.

No review

City Manager Mike Wildgen said Thursday there were no plans to review the decision not to notify.

“It’s not that we don’t care about it, but there are numerous health factors in this kind of situation. We follow the professionals, and the advice of the professionals,” he said. “At this point, I’m sure the summer’s events will be reviewed by (aquatics supervisor) Jimmy Gibbs and the staff.”

Towey said she hadn’t been tested to confirm she had the parasite. But her 1-year-old son, Jack, had one of the earliest confirmed cases; she and 7-year-old son Zackary developed similar symptoms soon after.

Authorities should have acted more quickly, she said.

“Here’s my thought: Use your brain,” Towey said. “If there’s something that’s going around that’s contagious, close the pool down. Close the pool.”