Communication a key question on the boil advisory

At a Hill County Commission business meeting last Thursday, a Havre City Council member said issues arising from the water boil advisory, and restrictions on businesses due to that advisory, have shown a need for greater communication between the local public entities and with the public.

That will likely be one of the topics at a special City Council meeting Monday, May 20, at 7 p.m. in Havre City Hall when the council reviews the issue and issues raised at the May 6 meeting.

After some issues arose with the water treatment plant in February, and then three cases of Giardiasis were confirmed in Havre by April 18 — three times the average number of confirmed cases per year in the prior five years - Havre issued a boil advisory to let people know that, while the actual source of the parasite that caused the illness was not known for the three cases, it could be the city water system and they might want to boil city water before using it or use bottled water.

The boil advisory was issued April 19, and at a Havre City Council meeting May 6 Public Works Director Trevor Mork said they had met with DEQ and U.S. Environmental Protection Agency officials May 3 and it was decided to keep the boil advisory in place for at least 15 more days, through today.

The city issued a boil advisory, but businesses using city water have been told they can’t serve it to customers.

Last Thursday, Hill County Health Officer and County Health Department Director Kim Berg said she could give the reason for that difference. It is state law.

“If an establishment is on public or non-public water supplies and that supply is subject to a restricted use order, a boil advisory or a health advisory, they cannot use the system until (Montana Department of Environmental Quality) clears it,” Berg said.

Berg was responding to a question from Havre City Council member Wade Bitz, who said a number of people at the Havre City Council meeting May 6 raised questions about notification and about why the city issued an advisory to residents and the county issued a restriction to businesses.

Multiple people at the City Council meeting said they were unhappy with how they were notified about the issue and about the boil advisory.

Berg said one of the procedures from a grant the health department receives includes after-action reports, with documents to guide them through the process.

“We would be happy to do that,” she said. “… I think a lot can be learned from those.”

Different rules for businesses explained

Berg said the reason for the differences in rules is that residents and businesses have different regulation. She said retail establishments are held to a different standard, and Administrative Rules of Montana are in place specifically for retail food and drink establishments.

“And that is because they serve the public, and that is a huge risk of an outbreak possibility. ... and we have to enforce those,” Berg said.

She said the county has a sanitarian-in-training who started in March and has passed some required examinations and is preparing to take the registered sanitarian examination. He is being supervised and mentored by two registered sanitarians on the state level, and is under her as the county health officer and under the county board of health, she added.

He must follow the laws and rules of the state in administering his duties, she said.

Berg said that for Aquatana, for example, “that is strictly form the regulatory authority of DEQ, because they are permitted through DEQ, and the permit that they have does not allow hem to clean water that is not already OK to be consumed.

She added that different permits would allow it, but it also would require different equipment and Aquatana doesn’t have that.

Berg said she has talked to the owners of Aquatana and they are working to bring in some water from other sources, but it will be a limited supply.

“And its the retail food establishment rules that our businesses should know, because that is their license,” she said. “... So there’s confusion on that, but they’re all getting the same message. ... They can boil the water and use it, or they can use bottled water.

“I understand it’s a financial burden, and I wish I could help with that,” Berg added. “I have no funding at the state level that can come in and help with that at this point. ... If I could make it easier, I (would), but I can’t. I have standards and regulations that we have to follow. We have administrative rules that we have to follow. I hav Montana Code Annotated, that tells me exactly what I have to do for my job.”

Update on Giardiasis

The illness, Giardiasis, is caused by a microscopic parasite and typically is a water-borne illness. Centers for Disease Control and Prevention’s webpage said the symptoms include diarrhea; gas; foul-smelling, greasy feces — poop — that can float; stomach cramps or pain; upset stomach or nausea, and dehydration. Symptoms typically begin one to two weeks after being infected. Symptoms typically last two to six weeks, but can last longer especially for people with weakened immune systems.

Berg was asked during last Thursday’s meeting how many cases have been confirmed in Havre, with people noting that the rumor is flying that hundreds of cases have been confirmed and several people at the council meeting Monday said they know of many people who have had it, with one saying more cases were found at Northern Montana Hospital.

Berg said rumors of more confirmed cases was false. Confirmations of cases are required by law to be noticed to the health department, and the number as of last Thursday was three.

The last case, confirmed April 18, was for someone who started having symptoms in early February, she said, adding that that is one of the problems with identifying the source.

“So, the issue with diarrheal illnesses is that a lot of people don’t go to their doctor, right?” Berg said.

She said someone has symptoms for two months and says, ‘”I’m going to go in because I’m really tired of this.’ And so we have a confirmation date of April, onset of symptoms was early February, and, so, that also limits our investigation ability because oftentimes people don’t remember what they were eating, what they were doing, who they were around at that time.

“... So it’s anywhere between three days before your symptoms to two weeks before your symptoms at this point,” Berg said. “What are we looking at? And where were you at? Did you eat out? Did you have recreational water around you? Do you have a dog? ... And, with all of our cattle around here ... there’s going to be possible Giardia in water systems. Or you have a dog and you go outside and if you wear your shoes in the grass where your dog has gone to the bathroom and then you don’t take them off when you go inside, it’s possibly on your floor. ... I mean, it can kind of be anywhere.”

She said the nurse who does the interviews is very good at it the long interview process to try to find the source, and can get good information, but the only potential common source found so far for the three confirmed cases was the city water system, which was why the boil advisory was issued even though the water system is not the confirmed source.

“So that’s why we cannot confirm the source at this point,” Berg said. “There have been other tests sent in since then, that have come back negative at this point.

“... We watch for these illnesses and other illnesses every day, and we do investigations for the entire list of reportable illnesses. ... We’re thinking of other ways to try to get information, but it’s it’s hard, you know, a lot of people don’t go to the doctor when they have diarrhea,” she said.

——

Learn more about Giardia on the CDC website at https://www.cdc.gov/parasites/giardia/index.html .