DES MOINES, Iowa (AP) — After months of investigating, state health officials are confident a mysterious outbreak of a rare lung disease has its roots at the governor’s mansion.
But they still don’t have proof that their assumption is true and other questions remain about how people were exposed to the disease at Terrace Hill.
“We are waiting for the test results so we can say, ‘Aha, it really was there,” said Patricia Quinlisk, the state’s chief epidemiologist.
The outbreak emerged more than four months ago when doctors began reporting cases of histoplasmosis, an unusual but treatable lung disease. Eventually, there would be 36 confirmed cases and 12 probable ones.
Hundreds of pages of e-mails, correspondence and other documents obtained by The Associated Press under Iowa’s freedom of information law, as well as interviews with health officials, show a methodical inquiry into the outbreak. After several dead ends, the investigation led to the 139-year-old mansion just west of downtown Des Moines.
Polk County doctors began reporting the disease, caused by an airborne fungi from bird or bat droppings, soon after the New Year’s holiday.
Health officials worked to narrow the potential locations and connecting factors to the outbreak, initially examining the Des Moines headquarters of the American Lung Association.
“At this stage I would focus on any sites where there is roosting of birds,” wrote Mike Pentella, with the University of Iowa Hygienic Laboratory, in an e-mail to Kathy Leinenkugel, an Iowa Health Department official. “Either birds got inside the building or are roosting near the intake vents. Or do employees walk by a location where birds roost while walking into or out of the building?”
Pentella was referring to the presence of histoplasmosis primarily where there are significant quantities of bird or bat droppings, but health officials soon realized the suspected location was wrong.
As a staffer from the Centers for Disease Control and Prevention rushed to Des Moines to help, local officials outlined a plan to explain the situation to the public with the help of talking points.
Polk County Health Department spokesman Rick Kozin “did an interview ... he discussed the following: What is Histo, How is it spread, Is it contagious,” Terri Henkels, the director of the Polk County Health Department, wrote to state health officials in an e-mail on Jan. 11. “He utilized the talking points as much as possible.”
The logic was simple — information could soothe. If health officials were not able to offer all the answers, they could at least make sure that everyone knew what they were dealing with.
Still, the investigation was moving ahead slowly and officials weren’t finding the conditions at the American Lung Association needed for a histoplasmosis outbreak.
“It’s very similar to a criminal investigation,” Quinlisk said in an interview. “You start with a few things, you get a few more clues, and then maybe you get lab results.”
Investigators eventually narrowed the list of locations, finally arriving at Terrace Hill.
It made sense. The initial cases of histoplasmosis involved people associated with the American Lung Association, but not all of them had visited the group’s headquarters.
They had, however, attended an American Lung Association event at the governor’s mansion on Nov. 29.
Before they went public with their suspicions, though, health officials reminded employees not to mention personal information or to gossip about the outbreak. In an e-mail to other managers, Carmily Stone, a bureau chief for the Department of Public Health, wrote:
“I am asking each of you to please help me with the following: Do not discuss names, places, etc. in e-mail. Be patient as we begin planning these next steps and know that we will be keeping you updated as appropriate.”
Within days, officials alerted the media.
“The people we know that were either exposed or had it when we look at them as a group, those people had only one thing in common and that was Terrace Hill,” she said. “Other things happened, linked them, but they seemed to drop away. There was a correlation.”
Neither Gov. Chet Culver nor his wife, Mari Culver, attended the American Lung Association gathering, but both were tested and results were negative.
Officials said the investigation has been lengthy but in some ways beneficial.
“Certainly there are some serious consequences in both cases,” said Tom Newton, the director of the state Public Health Department.” In this case, we had some folks get fairly sick. They needed to get on anti-fungal drugs and in some cases are still recovering. But it is a teachable moment ... it gives us a chance to test our public health system and to learn from it.”
For now, the lessons will have to wait until test results deliver a definitive answer.
Officials have noted that there was some construction at Terrace Hill around the time of American Lung Association event. That might have been enough of a disturbance to put the offending spores in the air.
Or, perhaps not.
“We’ll just have to wait,” Quinlisk said.
