A Flesh-Eating Ocean Bacteria is Killing People in the Carolinas
Monday, November 2, 2020
Print version by Sammy Fretwell, Ali Raj and Sofia Moutinho
Broadcast version by Nadia Ramlagan
Reporting for The State - North Carolina News Service Collaboration with the Pulitzer Center's nationwide Connected Coastlines reporting initiative
RALEIGH, N.C. -- As Billy Bailey picked through the crabs he caught on Big Bay Creek, trying to determine which to keep and which to throw back, one of them clamped down on his hand, causing him to shake his fingers.
The small cut that opened from the claw's pinch reminded Bailey to be more careful the next time he went crabbing. Then he chuckled and forgot about it, sitting back in the boat while his fishing buddy maneuvered the craft to the dock that day in early October 2017.
Hours later, Bailey was shivering and sick, buried under a pile of blankets that couldn't keep him warm, say friends who were with him.
By dawn the next day, Bailey's stomach was upset and he couldn't walk. His worried friends rushed him to the doctor.
On Oct. 13, 2017, Bailey died in the hospital, the victim of a microbe so dangerous it can inflict horrific pain, trigger ghastly skin infections and kill in a matter of days.
It's called vibrio, a bacteria that research shows is sickening more people and being found more often in rivers, creeks and sounds along the Carolina coast. People who get toxic vibrio infections from swimming or handling fish, crabs and shrimp sometimes watch helplessly as toxins eat away at their flesh, turning small sores into gaping wounds.
The earth's warming climate, which is causing sea levels to rise and storm surges to intensify, is a major reason dangerous strains of vibrio are an increasing threat to people who swim, fish and work in coastal waters across the planet, scientists say.
Since 2007, reports of illness from toxic forms of vibrio have tripled in South Carolina and nearly doubled in North Carolina, statistics show.
Overall, vibrio infections have sickened more than 500 people in the Carolinas since 2007, when the U.S. Centers for Disease Control and Prevention increased reporting requirements for states, according to a data analysis by Columbia Journalism Investigations in collaboration with McClatchy and the Center for Public Integrity.
Coastal counties that collectively draw millions of tourists led both states in rates of infection from vibrio, the Columbia analysis found. Those counties included Beaufort and Charleston in South Carolina and Pamlico and Carteret in North Carolina.
Vibrio infections are still considered uncommon in a nation now dealing with COVID-19, the disease that has killed hundreds of thousands of Americans since last spring.
But as efforts focus on stopping COVID-19, scientists say the changing climate is also expanding health threats - like vibrio infections - that are being felt now and will increase over time. The microbe, often most dangerous during warm weather, is creeping north and inland.
"It has already become a bigger problem in the last 10 or 12 years,'' said University of South Carolina scientist Geoff Scott. "This is going to have a substantial increase in health care concerns and health care costs, and compromise the safety of our waters."
Annual infections from dangerous forms of vibrio have steadily risen in North Carolina, increasing from 21 to 41 cases since 2007, according to the most recent state health data. In South Carolina, the number of infections each year has jumped from 8 to 29 cases since 2007.
Brackish water surrounding Edisto Island in South Carolina on Monday, August 18, 2020. A species vibrio lives in this water, which can be dangerous to anyone in the water with an open cut. Joshua Boucher firstname.lastname@example.org
Vibrio's rise in the Carolinas reflects a broader trend. Cases of the three most common types of toxic vibrio have doubled nationally since 2007, according to data analyzed by Columbia Journalism Investigations.
The microbe is sickening anywhere from 1,200 to 2,000 people every year across the country, according to the CDC. But federal health officials think that's only a fraction of the illnesses because many aren't reported or are misdiagnosed.
The CDC estimates at least 80,000 people become ill from vibrio annually.
These illnesses collectively cost the nation tens of millions of dollars each year in healthcare expenses, according to the journal Frontiers in Microbiology and a report by researchers at the University of South Carolina.
The rise of vibrio has caught some hospitals flatfooted. Some emergency room medical staff may not know much about vibrio; other medical providers are more familiar with how to treat vibrio-related illnesses but say people with fast-moving, severe infections can be hard to save.
State agencies say they do plenty to address vibrio by maintaining web pages, developing plans to control vibrio outbreaks in shellfish, posting signs warning of general bacteria pollution on waterways, and in some cases requiring restaurants to warn the public about the hazards of eating raw oysters.
But unlike other types of harmful bacteria in coastal waters, vibrio isn't considered common enough by state agencies to issue many specific warnings about the microbe. North Carolina's beach water testing program, which includes monitoring water quality on 88 sounds and estuaries with beaches -where vibrio is more likely to occur - does not check for vibrio or post signs warning of the naturally occurring bacteria, program managers said.
The S.C. Department of Health and Environmental Control says it has issued only one vibrio advisory, a news release in 2013 about tainted shellfish.
Providing more public notice and education about vibrio, as well as developing a system to forecast the outbreak of toxic forms of the microbe, should be a focus of many scientists and government officials, some experts say.
Craig Sasser, who manages the Waccamaw National Wildlife Refuge south and west of Myrtle Beach, said he was unaware that scientists had found toxic vibrio in a river running through the refuge several years ago. State health officials said they knew about it, but didn't issue a warning.
"I would like to know about it from the standpoint that staff and volunteers on occasion are working in water bodies around the refuge'' that attracts an estimated 100,000 people annually, Sasser said.
Sterritt Swamp is one of many Horry County watersheds that feed into the Waccamaw River. Jason Lee
In some cases, tourism communities don't want signs warning people to stay out of the water because it's bad for business. And elected officials sometimes question the reality of climate change.
In 2015, researchers in North Carolina proposed studying vibrio infections and how that relates to the warming planet. But requests for emergency-room visit data were denied by a state health department division that is responsible for tracking diseases. The division argued that the disease was too rare for the information to help, according to state records. The proposal was eventually dropped.
"We had to . . . make sure that we were clear with decision-makers that this was not about attributing the causes of climate change to anything, but about observing trends over time," said former North Carolina state epidemiologist Megan Davies.
Abandoned cars sit in floodwaters near College Street Sunday, September 16, 2018 in Wilmington, N.C. during Hurricane Florence. News & Observer file photo
UNSUSPECTING VICTIM OF BACTERIA
Vibrio germs can infect open sores in people who swim or fish in coastal waters, like the tidal creek where Bailey went crabbing 50 miles south of Charleston. Vibrio can also contaminate oysters and other shellfish that people eat raw.
The germs can affect anyone, but those with liver disease or in poor health are most likely to die from a vibrio infection. People who survive often are scarred for life.
Generally, a strain known as vibrio vulnificus is the most toxic form and most likely to kill people, causing wound infections and sometimes sending toxins into the bloodstream that cause organs to shut down.
To save those sickened by vibrio vulnificus, doctors sometimes amputate infected arms or legs.
About half the people with the most severe reaction to vibrio vulnificus - a condition called septicemia, or sepsis - don't survive, according to the American Academy of Family Physicians.
"It is a very rapidly moving infection,'' said the Medical University of South Carolina's John Gnann, an infectious disease doctor who has treated vibrio vulnificus patients in the Gulf of Mexico and the Carolinas for years. "You can get sick within just hours of exposure. If you're badly infected and particularly if you don't seek medical care quickly enough, you can certainly be dead in a day or two.''
Vibrio are commonly found in coastal estuaries, bays and creeks - scientists say there are anywhere from 70 to 200 different strains. But only about a dozen make people sick, scientists say.
In addition to vibrio vulnificus, two other strains of vibrio found in the Carolinas are among the nastiest.
Vibrio parahaemolyticus often gives people who eat raw shellfish upset stomachs, although it can also infect wounds. It accounts for the majority of vibrio cases, but doesn't kill people as often as vibrio vulnificus.
Vibrio alginolyticus is another toxic form that can make people sick from wound infections or seafood consumption.
Among the people who knew little about vibrio was Michael Godfrey, Bailey's nephew and fishing partner who took his uncle to a hospital in Charleston the morning after Bailey fell ill.
Billy Bailey was an avid fisherman loved by his family. The western North Carolina log home builder died in 2017 after a fishing trip to Edisto Beach, S.C. A dangerous microbe found in the bays and inlets of the Carolinas infected him. Photo courtesy Karan Gordon
Godfrey and several friends from York County, south of Charlotte, had traveled with Bailey for a fishing trip to Edisto, a popular but out-of-the-way beach town. The area behind the seashore is filled with marshes and backwaters that made great spots to fish and set crab traps.
When Bailey came back to the rented condominium after his day of fishing, Godfrey noticed his uncle wasn't feeling well. Bailey then went to bed early, hoping a good night's sleep would help.
Godfrey figured his uncle was simply worn out from a day in the sun. He couldn't believe what would unfold the next day.
"I had only heard of a case here and there of some sort of flesh-eating bacteria type thing'' in the water, Godfrey said.
"But I never did think it would hit that close to home.''
Neither did Ron Phelps.
HURRICANES AND DEATH
Hurricane Florence spared Phelps the night that it blew through the eastern Carolinas. But the mess left by the 2018 storm proved fatal.
Phelps, an 85-year-old veteran and retired businessman, scraped his leg cleaning up a soggy tangle of tree limbs that had fallen in his yard near Wilmington, a port city in southeastern North Carolina.
He bandaged the cut and continued working to clear debris over the next two days, trying to get his home in order after Florence soaked the Carolinas with more than 20 inches of rain.
But Phelps began to feel bad, sicker than he could ever remember, said his stepson, Steve Shepard.
Shepard discovered his stepfather collapsed in the older man's home one morning after the two-day cleanup. His neck and legs were swollen, and Phelps was unable to raise his head.
A vibrio infection had set in. Shepard had his stepfather taken to a local hospital 15 minutes away.
"They figured out what was going on pretty fast,'' Shepard said. As Phelps' condition worsened, doctors amputated his leg, trying to save him. A doctor "said that would improve his chances,'' Shepard said.
Phelps, who had cancer and heart problems, died about a week after the scrape.
He was among at least 14 people who contracted vibrio infections in North Carolina in the four months after Hurricane Florence, nearly triple the number during the same time period in 2017, according to data analyzed by Columbia Journalism Investigations.
The Red Bluff community flooded along the Waccamaw River and Simpsons Creek under Hurricane Florence's deluge with entire neighborhoods underwater. Monday, Sept. 24, 2018. Jason Lee email@example.com
Rachel Noble, a University of North Carolina-Chapel Hill scientist who studies vibrio, said hurricanes can cause vibrio levels to spike and linger in the water for months. After Hurricane Katrina 15 years ago, the CDC reported 22 vibrio infections and five deaths along the Gulf coast in the first two weeks following the storm.
More recently, Hurricane Florence sent vibrio levels soaring in some North Carolina coastal waters, according to Noble's research. And it remained that way for months.
"We do know that the vibrio concentrations ramped up immediately after the storm, and stayed very high well into December 2018,'' Noble told The State, a McClatchy news organization.
George Mason University biologist Brett Froelich, a vibrio researcher who worked with Noble at North Carolina, learned about one infection in a New Bern resident who later died.
Froelich made the discovery after conducting a limited survey following the hurricane, asking health care facilities to test anyone with a wound. Out of 10 responses, one test result showed a person with vibrio.
Froelich said the case occurred in an area of New Bern that doesn't typically have salt water in its streams, suggesting vibrio moved farther inland than expected. The person was infected after "traipsing through some water'' while working outside, he said.
MICROBE ON THE ATTACK
A problem for years in the Gulf of Mexico, vibrio is today enough of a concern on the Atlantic coast that teams of scientists are scrambling to learn more. Scientists like Noble, Froelich and Scott hope their research will protect the public from vibrio.
South Carolina's Scott leads a university research center that is studying the changing climate's health effects on people who live in the coastal South.
What the center has learned so far is that surging oceans, more frequent storms, saltier rivers and warmer seas are fueling the growth of vibrio, a microbe that will affect more people each year, Scott said. Scientists from the University of Maryland, Baylor University, The Citadel and the College of Charleston are collaborating with their counterparts at South Carolina to study the nexus between climate change and health.
Vibrio and toxic algae outbreaks are among the main areas of research at the center, but research is not limited to work there. Scientists at the University of Georgia and UNC also are among those working steadily to learn about vibrio's growth in the southeastern United States.
Among the findings in the southeast:
At one spot between Myrtle Beach and Georgetown, South Carolina, vibrio has been documented more than 20 miles up the Waccamaw River from the ocean, possibly because sea level is rising and pushing salt water inland, according to reports by South Carolina researcher Reem Deeb, Scott and scientist Dan Tufford.
Researchers have found toxic forms of vibrio in 18 tidal creeks stretching along virtually the entire South Carolina coast and into North Carolina near Wilmington. Stormwater runoff from heavy rains, a sign of climate change, may be a reason high vibrio levels showed up in urban marsh creeks, said Brian McHouell, the College of Charleston graduate student who conducted the study.
On the Neuse River near New Bern, N.C., vibrio concentrations increased significantly over a 10-year period. Also, a recent hurricane caused a notable rise in vibrio that lasted for months, Noble's research shows.
Scientists have found that naturally occurring metals are being released from sediments at different rates because of climate change. Ongoing laboratory research shows the metals are interacting with vibrio and making the bacteria more resistant to antibiotics, Scott said.
Vibrio microbes are clustering together in southeastern coastal waters, making them potentially more dangerous to swimmers, according to research by Alan Decho, a University of South Carolina scientist.
The sweet spot for some forms of vibrio, particularly the highly toxic vulnificus strain, is warm water that isn't too salty and isn't too fresh. And that's why it likes what global warming is doing to the Carolinas' coastal waters.
When oceans warm and sea levels increase, salt water can push farther into freshwater rivers, potentially exposing people who've never been around vibrio before, scientific research shows.
Federal statistics show that sea levels are about a foot higher today on sections of the Carolina coast than they were 100 years ago, and scientists project the ocean to swell another 1 to 4 feet in the next century.
Meanwhile, water temperatures have stayed warmer longer in the fall and heated up earlier in the spring in parts of the Carolinas. Those conditions extend the time when vibrio would pose a threat, either by infecting shellfish that people eat or by infecting wounds of swimmers and fishermen.
Water temperatures, for instance, were 82 degrees in Charleston Harbor at the end of September 2019, about 3 degrees higher than they were at the same time in 1950, state wildlife department officials say.
Since the 1980s, water temperatures have increased an average of 3.5 degrees, in North Inlet, a nearly pristine estuary near the Waccamaw River, said Erik Smith, a scientist who tracks temperature and salinity at USC's Baruch Marine Laboratory in Georgetown County.
Extreme weather also makes conditions more suitable for vibrio. Inland flooding from hurricanes can send freshwater cascading down river basins, temporarily cutting the salinity of areas near the beaches and creating brackish conditions ideal for outbreaks of vulnificus.
To prepare for the threat of more vibrio, scientists in the Carolinas are trying to develop ways of predicting outbreaks of vibrio's most dangerous strains.
Scott and fellow scientists at the University of South Carolina are working with researchers at UNC to establish a vibrio forecasting system.
"We cannot stop the bacteria necessarily from growing and becoming more virulent,'' Scott said. "But what we can do is identify when we recognize locations, and times of the year, when it may be an even more pervasive problem, so we can alert the public.''
VIBRIO SURVIVOR'S TALE
Many people who contract vibrio-related illnesses survive, but the experience can leave lasting effects.
One victim was Eddie Clinton, a Louisburg, N.C., resident who got sick after packaging shrimp his wife had gotten from a friend. The friend had just returned from the North Carolina coast.
The next day,the 68-year-old Clinton began to have trouble breathing. His body shook, he lost his appetite and his speech was slurred.
A vibrio infection had set in.
"All (Eddie) did was open the bags up, take them out and put them in smaller bags and put them in the freezer," Clinton's wife, Patti, told The News and Observer, a McClatchy news organization, in 2018.
Clinton fell into a coma for 10 days. Sepsis set in. Doctors worked feverishly to save him, amputating his left leg below the knee.
Clinton, one of dozens of people with vibrio infections in North Carolina that year, survived. He returned home after spending 93 days in the hospital.
Today, Clinton has trouble getting around and he tires easily. But Clinton, a former educator, said vibrio won't keep him down.
"I have this will to fight,'' he said. "There must be something that (God) has in mind for me.''
Patti Clinton said it was a miracle her husband survived. "The doctors even said that anybody else would have died. He was meant to live.''
Doctors still aren't sure about the connection between the shrimp and Clinton's struggle with vibrio. But diagnosing how someone got a vibrio infection can be tricky. And it isn't easy to track where all the cases occurred.
Paddlers on the Waccamaw River outside of Conway, S.C.. Sun News file photo
Neither North Carolina nor South Carolina provide much detail about where infections developed, instead listing them by the county where the victims live.
Statistics kept by Virginia's health department give some clues.
Virginia residents who have vacationed since 2007 in North and South Carolina collectively contracted 16 cases of vibrio infections after visiting Nags Head on the Outer Banks and Myrtle Beach, both popular tourist destinations. Twelve of those reports came from the Nags Head area.
Still, it is unclear where people in the Nags Head or Myrtle Beach areas might have been infected.
In Bailey's case, while many marshes contain the brackish water vibrio loves, Big Bay Creek where he set crab traps at Edisto Beach, is more salty, like the ocean.
Godfrey said he can't figure what else would have caused his uncle's infection except the crab pinch. Doctors familiar with vibrio, including Gnann and Charleston infectious disease specialist Kent Stock, said a prick from a vibrio-carrying crab can prove fatal for people with underlying health conditions.. Even in saltier water, pathogenic vibrio can survive for a period of time, experts say.
One thing Stock does know is that vibrio patients keep showing up at the hospital where he works. Stock, with the Roper St. Francis medical system in Charleston, said vibrio infections are an issue every summer.
"We definitely see a case, I'd say, every three months or so'' during warm weather, Stock said. Vibrio outbreaks, particularly those involving infected wounds, are most common from mid-spring into the fall, he said.
This year, the hospital system had at least two vibrio cases. One of them involved a patient with sepsis from a hand injury, Stock said.
Stock said he suspects many cases of vibrio go undiagnosed and, therefore, unreported. That's often because patients don't seek medical attention in milder cases, particularly those from eating infected shellfish, he said.
In the most severe cases, it's vital that doctors recognize the infection and treat it quickly, Stock and others agreed. But not every doctor realizes the threat.
"I've been surprised at how a lot of my colleagues, not in infectious disease sections, are unaware of the risk,'' said Sandra Gompf, an infectious disease specialist in Tampa, Fla.
Glenn Morris, director of the emerging pathogens institute at the University of Florida, is skeptical that state health departments and the CDC are aggressively addressing vibrio's threats. Health departments are underfunded and, for now, the threat of the coronavirus distracts from vibrio, he said..
"Vibrio simply falls to a much lower priority and it can soon turn into a significant public health threat,'' Morris said.
Saurabh Chatterjee, a former Duke University researcher now at USC, said vibrio and other marine toxins not only pose immediate dangers to some people, but they can have long-term health impacts. An expert on liver disease, Chatterjee said his research shows that people with excessive fat in their livers from poor eating habits are at risk for eventual health problems after exposure to certain marine toxins.
Brackish water surrounding Edisto Island in South Carolina on Monday, August 18, 2020. A species vibrio lives in this water, which can be dangerous to anyone in the water with an open cut. Joshua Boucher firstname.lastname@example.org
'NO TELLING WHAT'S LIVING THERE'
Three years after his death, it's hard for Billy Bailey's friends and family to reconcile the loss of the man they loved.
Some want to know why the state health department or the S.C. Department of Natural Resources didn't post signs warning of the threats of vibrio.
"You would think with everything going on with all these health scares that they would have a sign up,'' said York County resident Bob Mahon, Bailey's fishing buddy that day in the Edisto marsh.
"If somebody were to get injured - and if they saw that on the way back in, it could be helpful.''
Mahon and others said it's difficult to believe a seemingly able-bodied man could succumb to vibrio.
Bailey had underlying liver problems, but Mahon said he was also a robust homebuilder who showed little outward signs of poor health. Many of his days were spent outdoors, doing strenuous work building log homes in the western North Carolina mountains.
Bailey's sister, Brenda Laney, saw the life drain from her brother, who was infected with sores and in pain. "He was swollen real big; he had big blisters,'' she said,
"Me and my brother were very close. It was hard to watch him. I said 'Bill, you have to fight.' He told me 'Bren, I don't know if I can beat this or not.' ''
Godfrey, Bailey's nephew, said climate change has robbed him of a cherished uncle who had been a steadying influence in his life.
"If the climate gets hot enough, there's no telling what's living in there or what can evolve from any of it,'' Godfrey said. "If there is any kind of anything that is going to harm you, it's going to be in the marsh for sure.''
This story is part of the Pulitzer Center's nationwide Connected Coastlines reporting initiative. For more information, go to pulitzercenter.org/connected-coastlines. The story was written and edited by McClatchy in collaboration with the Center for Public Integrity and Columbia Journalism Investigations, an investigative reporting unit at the Columbia Journalism School.
Sammy Fretwell is an environment writer with The State, a McClatchy news organization. Ali Raj and Sofia Moutinho are reporting fellows with Columbia Journalism Investigations. CJI reporting fellows Elisabeth Gawthrop and Dean Russell and CJI editor Kristen Lombardi contributed to this story.
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