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Studies suggest millions could get sick

By Peter Eisler
USA Today, Oct. 14, 1998

There's no telling precisely how many Americans get sick each year from drinking bad water. But it's safe to say there are a lot more of them than anyone knows about.

From 1993 to 1996, the most recent years for which the Centers for Disease Control and Prevention (CDC) has records, there were 52 confirmed outbreaks of waterborne illness that sickened 408,000 people and killed 111. All the deaths and 403,000 of the illnesses were linked to a 1993 bad water outbreak in Milwaukee.

Researchers say those numbers barely scratch the surface of what's really going on. "I would say the cases we learn about are the tip of the iceberg," says Deborah Levy, a waterborne-disease expert at the CDC.

But it's extremely difficult to quantify the true toll. Consider the disparity in the studies:

An investigation by Robert Morris of the Medical College of Wisconsin and Ronnie Levin of the U.S. Environmental Protection Agency (EPA) concluded that about 7.1 million Americans suffer nausea or diarrhea each year from bad water. The inquiry suggested that as many as 1,200 die as a result.

Other reports, including a widely circulated CDC study, suggest the number of illnesses is closer to 1 million, with about 900 deaths.

And a soon-to-be published report by the EPA suggests only about 230,000 people get sick each year from contaminated drinking water, with about 50 deaths.

Pinning down the problem is "extremely difficult," says Ron Linsky of the National Water Research Institute, which was founded by water suppliers to study drinking water issues. "There are so many other ways that pathogens are transferred into the human condition -- you kiss somebody, you touch your face with dirty hands. How do you differentiate where the disease is coming from? It's very difficult."

There's no suggestion that the United States is returning to an era when waterborne plagues such as cholera and typhoid were leading causes of death. Today's drinking water problems are far more likely to cause nausea and diarrhea than any mortal epidemic.

But gastrointestinal illnesses from bad water have become increasingly common, according to academic and government studies. The illnesses pose what many researchers see as a serious public health threat with life-threatening consequences, particularly to people in weakened medical condition.

Waterborne illness "is not simply the concern of past generations, (it) must remain on the current public health agenda," Morris and Levin wrote in a 1995 study. But "addressing (those) concerns . . . will require more reliable data."

Most of the studies that have been done on waterborne disease focus on nausea and diarrhea from bacterial contamination, the most prevalent drinking water threat. There's virtually no data on less common water-related ailments, such as cancers linked to radon, radium and some industrial and agricultural pollutants. It's almost impossible to pin a specific cause in most cancer cases -- there are too many possibilities.

Even getting a handle on illness from microbes, such as cryptosporidium, the bug behind the Milwaukee outbreak, is a daunting task.

The problem is that people tend to attribute stomach problems to flu or food poisoning. They let them run their course over a few days and rarely see a doctor. Even if they do get help, doctors rarely do the kinds of tests that can peg bad water as the culprit.

In the rare cases when doctors find bad water is behind an illness, there generally is no requirement that they report it.

"Nobody really has any idea of how many people are getting sick and dying," says Rebecca Calderon, a waterborne-disease expert at the EPA.

The medical community is especially concerned by the threat that cryptosporidium and other bacteria pose to the rising number of people with weak immune systems, such as cancer patients getting chemotherapy, organ transplant recipients and AIDS patients. The elderly, pregnant women and infants also face greater risks from bad water.

For five years, the CDC has maintained a standing recommendation that Americans with those conditions should consider boiling their water before drinking it, regardless of its source.