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Saskia v. Popescu, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist with Phoenix Children's Hospital. During her work as an infection preventionist she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She is currently a PhD candidate in Biodefense at George Mason University where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in Infection Control.

Analyzing America's Worrisome Water Quality

FEB 12, 2018 | SASKIA V. POPESCU
Water quality isn’t something we normally think about in the United States. Why would we, as a major, industrialized country? However, the arguably ridiculous “raw water” trend that has cropped up on our country highlights the importance of treated water and how fortunate Americans are to have continuous access to clean water. These cracks in the façade are becoming larger as the Flint water crisis looms heavily upon Americans.

Flint, Michigan is now synonymous with choosing cost-cutting measures over human health and water safety. In 2014, after a new water pipeline was being built and residents had to turn to the Flint River as a water source, residents started to note that something was wrong with their water. Tests performed by the Environmental Protection Agency (EPA) and Virginia Tech in 2015 found dangerously high levels of lead in the water. Major media outlet CNN covered the findings, reporting that “a class-action lawsuit [has] charged that the state wasn't treating the water with an anti-corrosive agent, in violation of federal law. As a result, the water was eroding the iron water mains, turning the water brown. Additionally, about half of the service lines to homes in Flint are made of lead and because the water wasn't properly treated, lead began leaching into the water supply, in addition to the iron.”

If the lead levels weren’t enough, residents of Flint were also being exposed to Legionella bacteria. Shortly after the water sources changed, a marked number of individuals were hospitalized for the water-borne diseases. As it turns out, low chlorine levels in the municipal water system were to blame. To date, a total of 87 individuals were sickened and 12 died because of Legionnaires’ disease in Flint.

This outbreak has a direct epidemiological link to poor water treatment and water quality in Flint. In fact, the Michigan Attorney General’s Office announced in June 2017, that several state officials had been charged with manslaughter in connection with this outbreak and the associated deaths.

Was the situation in Flint, Michigan an outlier or an ominous warning of what’s to come?

The authors of a new study, published in PNAS, sought to answer this question by evaluating national trends in drinking water. After analyzing health-related violations of the Safe Drinking Water Act across nearly 18,000 community water systems from 1982-2015, the investigators found that nearly 21 million Americans relied upon community water systems that were in violation of health-based quality standards. Furthermore, by using spatial-temporal analysis, they found hot spots for violations and recurrent issues across the country. For example, the Southwest region of the United States was found to be a hotspot for health-based violations, with states like Texas and Oklahoma having significant issues.

“Violation incidence in rural areas is substantially higher than in urbanized areas,” write the authors, “Rural areas tend to have less capacity to comply with quality regulations and face financial strain due to decline populations and lower incomes. Assistance in achieving consistent compliance and greater oversight may benefit vulnerable water systems.” Although not all violations can result in immediate health issues, continued exposure to contaminants can be dangerous can lead to a range of short-term issues such as gastroenteritis, and chronic conditions such as neurological conditions and cancer.

The PNAS study is highly relevant not only because we continue to battle the outcome of Flint’s poor water quality, but also because there have been few peer-reviewed studies that truly address water system compliance with the Safe Drinking Water Act on a national level. To this end, I spoke to hydrologist Karen Masbruch, former Assistant City Manager and Director of Tucson’s Environmental services program, who stated, “Data collection is the No. 1 step to understanding the challenging national water quality compliance issue. Water quality standards should be linked to; a) regional water type (surface vs groundwater), b) regional water quality, c) size of population served and d) private vs. public water treatment system. The study’s correlation to water quality violations with housing density, median household income, and percent nonwhite pollution misses the most important dataset: water source and water quality. The challenges of ensuring water quality are based on the sustainability of water quantity with increasing population and climate variations, which ultimately affect water quality.”


Interestingly, private ownership and purchased water sources analyzed in the study were associated with compliance. The authors posit that because purchased water is produced by wholesale providers, they have better resources to help them meet national standards.

Hopefully, the overall findings of the study will trigger a stronger focus on water quality and safety, as well as the need to study it in a continuous manner. Sadly, I think it’s safe to say that despite being an industrialized country, the United States is struggling to maintain the water quality that we believe it should have. 
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