1
1
ILLINOIS POLLUTION CONTROL BOARD
September 23,2008
2
IN THE MATTER OF:
)
3
)
WATER QUALITY STANDARDS AND
)
4 EFFLUENT LIMITATIONS FOR THE
) R08-9
CHICAGO AREA WATERWAY SYSTEM AND ) (Rulemaking -
5 THE LOWER DES PLAINES RIVER:
) Water)
PROPOSED AMENDMENTS TO 35 Ill. )
6 Adm. Code Parts 301, 302, 303
)
and 304
)
7
8
TRANSCRIPT OF PROCEEDINGS held in the
9 above-entitled cause before Hearing Officer Marie
10 Tipsord, called by the Illinois Pollution Control
11 Board, pursuant to notice, taken before Rebecca
12 Graziano, CSR, within and for the County of Cook and
13 State of Illinois, at the James R. Thompson Center,
14 100 West Randolph Street, Room 9-040, Chicago,
15 Illinois, on the 23th Day of September, A.D., 2008,
16 commencing at 1:00 p.m.
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L.A. REPORTING (312) 419-9292
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1
A P P E A R A N C E S
2
ILLINOIS POLLUTION CONTROL BOARD:
3
Ms. Marie Tipsord, Hearing Officer
4
Ms. Alisa Liu, P.E., Environmental Scientist
Mr. Anand Rao, Senior Environmental Scientist
5
Mr. Tanner Girard, Acting Chairman
Ms. Andrea Moore
6
7
ILLINOIS ENVIRONMENTAL PROTECTION AGENCY:
8
Ms. Stefanie Diers
Ms. Deborah Williams
9
Mr. Robert Sulski
Mr. Scott Twait
10
Mr. Roy Smogor
11
THE NATURAL RESOURCE DEFENSE COUNSEL:
12
Ms. Ann Alexander
13
ENVIRONMENTAL LAW AND POLICY CENTER,
14
33 East Wacker Drive
Suite 1300
15
Chicago, Illinois 60601
(312) 795-3707
16
BY: MS. JESSICA DEXTER
17
Appeared on behalf of ELPC, Prairie Rivers
Network, and Sierra Club,
18
19
BARNES AND THORNBURG LLP
1 North Wacker Drive
20
Suite 4400
Chicago, IL 60606
21
(312) 357-1313
BY: MR. FREDRIC ANDES
22
Appeared on behalf of the Metropolitan Water
23
Reclamation District of Greater Chicago.
24
L.A. REPORTING (312) 419-9292
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1
MS. TIPSORD: And Ms. Alexander, you
2 indicated you thought you might have some additional
3 questions for Dr. Blatchley.
4
MS. ALEXANDER: I do. Okay. I would
5 like to turn, first, to the document we were
6 presented with, which is a study entitled Effects of
7 Disinfections on Wastewater Effluent Toxicity. That
8 is Exhibit 98, and I just have a few questions about
9 that. First question: As I understand it, the
10 basis for the research, in part, was a study of the
11 survivability of an organism referred to as a C
12 dubia. I'm not even going to attempt to pronounce
13 the C.
14
MR. BLATCHLEY: Ceriodaphnia?
15
MS. ALEXANDER: Yes, ceriodaphnia. Is
16 that correct?
17
MR. BLATCHLEY: Yes, survival and
18 reproduction.
19
MS. ALEXANDER: Survival and
20 reproduction.
21
MS. TIPSORD: Could you please spell
22 that for the record.
23
MS. ALEXANDER: Okay. That would be
24 C-e-r-i-o-d-a-p-h-n-i-a. The ceriodaphnia dubia is
L.A. REPORTING (312) 419-9292
4
1 a type of water flea. Is that correct?
2
MR. BLATCHLEY: Yes.
3
MS. ALEXANDER: Okay. So in other
4 words, no attempt was made to assess toxicity on the
5 survivability of any type of mammal. Is that
6 correct?
7
MR. BLATCHLEY: Certainly not.
8
MS. ALEXANDER: Okay. I would like to
9 ask you -- essentially I want to get an overview of
10 the conclusions of this research, so I'd like you to
11 tell me whether my understanding of that overview is
12 correct or not. First of all, am I correct that
13 your ultimate conclusion in this study, which would
14 be reflected in the summary and conclusion section
15 on the second to last page, would be reflected in
16 the statement that facilities which treat wastewater
17 of domestic origin or from other readily
18 biodegradeable sources generally do not illicit a
19 substantial toxicological response before or after
20 disinfection, regardless of the disinfectant
21 employed. Is that correct?
22
MR. BLATCHLEY: Yes.
23
MS. ALEXANDER: Okay.
24
MR. BLATCHLEY: As a generalization,
L.A. REPORTING (312) 419-9292
5
1 yes.
2
MS. ALEXANDER: Okay. Would it be
3 fair to say along those lines that, in fact, that
4 your conclusions are a little bit, shall we say, all
5 over the map, that they varied widely with regard to
6 survivability?
7
MR. ANDES: I'm going to object to
8 that "all over the map" characterization. What
9 could you mean by very widely? Clarify, please.
10
MS. ALEXANDER: Okay. Let me clarify
11 that. Would it be fair to say that your findings
12 regarding the survivability of this organism were
13 not consistent across the board, they varied from
14 location to location?
15
MR. BLATCHLEY: And from time to time.
16
MS. ALEXANDER: Okay. And was it also
17 your conclusion that not all facilities produce any
18 toxicity effect as a result of disinfection?
19
MR. BLATCHLEY: That's correct.
20
MS. ALEXANDER: Okay.
21
MR. BLATCHLEY: At least that we
22 measured.
23
MS. ALEXANDER: Okay. Was it also
24 your conclusion that in some cases of survivability,
L.A. REPORTING (312) 419-9292
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1 this organism, in fact, increased post-disinfection?
2
MR. BLATCHLEY: I believe that did
3 happen, yes.
4
MS. ALEXANDER: Okay. Was it also
5 your finding that when UV disinfection was used,
6 more often than not survivability either stayed the
7 same or increased?
8
MR. BLATCHLEY: I -- honestly, it's
9 been a long time since I've read this paper myself,
10 but I think the -- that sounds reasonable, at least
11 the "didn't change" part.
12
MS. ALEXANDER: Okay.
13
MR. BLATCHLEY: I don't know about
14 the -- I'm a little nervous about the increase in
15 survivability, just because the error that's
16 inherent in this test is such that I'm sure a trust
17 is numbered, but yeah.
18
MR. ANDES: If I can follow up on
19 that. As to the facilities that accept a
20 substantial fraction of influence from industrial
21 applications, am I right you found that all the
22 disinfectants demonstrated the ability to alter
23 types of response?
24
MR. BLATCHLEY: Yes, certainly.
L.A. REPORTING (312) 419-9292
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1
MR. ANDES: And the Reclamation
2 District's plans, is it your understanding that they
3 also received a substantial amount of influence from
4 industrial facilities?
5
MR. BLATCHLEY: Yes.
6
MS. ALEXANDER: One second.
7
MR. ANDES: While we're waiting, if I
8 can also ask another follow up, going back to C
9 dubia, is it accurate to say that the reason that's
10 tested is because it's a particularly sensitive
11 organism to toxic responses?
12
MR. BLATCHLEY: I believe so. And
13 also there's been a lot of work done with that
14 organism so that we have an understanding of a
15 number of specific chemicals and how they provide
16 response or how that organism responds to that
17 chemical. So it's been studied a lot, and part of
18 the reason for that is the reason that you stated.
19
MS. ALEXANDER: And you did not, in
20 fact, study in this study effluent from the three
21 Metropolitan Water Reclamation District plants at
22 issue here. Is that correct?
23
MR. BLATCHLEY: I think that's
24 correct, yes.
L.A. REPORTING (312) 419-9292
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1
MS. ALEXANDER: Okay. So we do not
2 know, then, whether any level of industrial
3 discharge to that effluent would be in any way
4 comparable to the level at the facilities you did
5 study. Is that correct?
6
MR. ANDES: You don't know one way or
7 the other.
8
MR. BLATCHLEY: Right. I -- we don't.
9
MS. ALEXANDER: You don't know?
10
MR. BLATCHLEY: Right.
11
MS. ALEXANDER: Okay. Now one
12 clarifying question, is the type of toxicity that
13 you studied in the research reflected here different
14 from disinfection byproducts? Is that a separate
15 topic?
16
MR. BLATCHLEY: We made no attempt to
17 identify the specific chemicals that were
18 responsible for the toxicity. This was an overall
19 whole effluent toxicity test. So there was --
20 again, there was no attempt to figure out what
21 provided -- or what was responsible for the
22 responses that we observed.
23
MS. ALEXANDER: Okay.
24
MR. BLATCHLEY: And --
L.A. REPORTING (312) 419-9292
9
1
MR. ANDES: Stop. That's fine.
2
MS. ALEXANDER: I would like to turn
3 next to Exhibit 99, which is the document entitled
4 Effects of Wastewater Disinfection on Human Health,
5 which I'd like to clarify, this document is a longer
6 version, am I correct, of the document that's
7 Attachment 3 to your extended testimony, Exhibit 93?
8
MR. BLATCHLEY: You're talking about
9 the --
10
MR. ANDES: Is it a longer version of
11 this?
12
MR. BLATCHLEY: Yes, yes.
13
MS. ALEXANDER: Okay. Let me ask you:
14 Initially, how was this research funded?
15
MR. BLATCHLEY: The Water Environment
16 Research Foundation.
17
MS. ALEXANDER: Okay. Who funds the
18 Water Environment Research Foundation?
19
MR. BLATCHLEY: I believe it's member
20 utilities and perhaps -- I'm sorry I'm guessing, but
21 I believe it's member utilities and perhaps
22 consulting firms that participate, but I'm not sure.
23
MS. ALEXANDER: Do you know one way or
24 the other whether the Water Reclamation District is
L.A. REPORTING (312) 419-9292
10
1 member utility?
2
MR. BLATCHLEY: I do not know.
3
MS. ALEXANDER: When was this research
4 conducted? Over what period of time?
5
MR. BLATCHLEY: Well, the report was
6 filed or published in 2005. I don't remember the
7 exact dates, but I'm guessing it's somewhere around
8 2001 to 2003 or maybe 4.
9
MS. ALEXANDER: Okay.
10
MR. BLATCHLEY: I don't remember.
11
MS. ALEXANDER: When were you first
12 retained to do work for the Water Reclamation
13 District in connection with the Chicago Area
14 Waterways?
15
MR. BLATCHLEY: This issue?
16
MS. ALEXANDER: Yes, this issue.
17
MR. BLATCHLEY: Six or eight months
18 ago.
19
MS. ALEXANDER: Okay.
20
MR. BLATCHLEY: I think.
21
MS. ALEXANDER: One more question
22 regarding the Water Environment Research Foundation.
23 When you say member utilities, are you referring in
24 part or in whole to wastewater treatment utilities?
L.A. REPORTING (312) 419-9292
11
1
MR. ANDES: You know, I'm pretty sure
2 he doesn't have any independent knowledge of that.
3 It's all on the WERF website.
4
MS. ALEXANDER: Okay. He used the
5 term, and I'd like to understand what he meant by
6 the term member utilities.
7
MR. BLATCHLEY: Again, I don't know
8 the details of how they received their funding, but
9 I believe it comes from utilities -- wastewater
10 treatment facilities, yes.
11
MS. ALEXANDER: Okay.
12
MR. BLATCHLEY: But you could get an
13 unambiguous answer from WERF directly.
14
MS. ALEXANDER: Yes. I understand
15 that. I'd like it turn -- unfortunately this is an
16 unnumbered document, but I will try to keep it as
17 non-confusing as possible. The second page of this
18 document, the paragraph that begins "Taken
19 together," go down to the fourth line from the
20 bottom, which states "When direct human contact or
21 injection of municipal wastewater effluent is
22 likely, disinfection appears to be necessary."
23 Would you still stand by that statement?
24
MR. ANDES: I'm sorry. Where are we?
L.A. REPORTING (312) 419-9292
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1
MS. ALEXANDER: Okay. Second page,
2 right above where it says "key words," fourth line
3 from the bottom, "When direct human contact."
4
MR. BLATCHLEY: Yeah. And the
5 definition of direct human contact that I'm using
6 there is one involving swimming. That's the intent
7 there.
8
MS. ALEXANDER: I'm looking down at
9 the paragraph that begins "Direct human contact."
10 It appears to include ingestion and swimming
11 separately. Is that correct?
12
MR. BLATCHLEY: Ingestion would be
13 drinking water.
14
MS. ALEXANDER: Are there other
15 situations in which one might ingest water?
16
MR. BLATCHLEY: Of course.
17
MS. ALEXANDER: Such as swimming?
18
MR. BLATCHLEY: Yes.
19
MS. ALEXANDER: And such as falling
20 out of a boat and gulping some?
21
MR. BLATCHLEY: Yes.
22
MS. ALEXANDER: Okay.
23
MR. ANDES: Were you intending to
24 refer to falling out of a boat and gulping some
L.A. REPORTING (312) 419-9292
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1 here?
2
MR. BLATCHLEY: Absolutely not.
3
MR. ANDES: Thank you. If I can
4 follow up on that for a minute, in terms of -- Dr.
5 Blatchley, in terms of this study, I wonder if you
6 could explain to us a little bit about why -- why --
7 what your understanding is as to why this study was
8 performed. Is it your understanding, for example,
9 that treatment plants around the country are
10 experiencing this regrowth issue? Was that part of
11 the motivation, or were there other reasons for the
12 study being done, if you can explain that for us?
13
MR. BLATCHLEY: The motivation for the
14 study was to consider the effects of wastewater
15 disinfection on human health, was disinfection going
16 to improve human health, or adversely effect human
17 health, or have no effect at all. And so again, the
18 central questions of the research that we attempted
19 to address were number one, should we be
20 disinfecting wastewater effluence, and under the
21 assumption that the answer to that question is at
22 least sometimes yes, then how.
23
MR. ANDES: And were you told what
24 your results ought to be in any way by WERF or any
L.A. REPORTING (312) 419-9292
14
1 other party?
2
MR. BLATCHLEY: No.
3
MR. ANDES: Was the U.S. Geological
4 Survey important in your study?
5
MR. BLATCHLEY: No.
6
MR. ANDES: No. I'm sorry Mr. Lyle
7 (phonetic) is part of the U.S. Geological Survey?
8
MR. BLATCHLEY: Well, right. Well,
9 actually he worked -- he works at the U.S.
10 Geological Survey now. At the time of the study, he
11 worked at Montana State University. So he moved to
12 USGS after we completed the study, but they required
13 a current address for him when --
14
MR. ANDES: Okay. So all of the
15 authors were from five different academic
16 institutions?
17
MR. BLATCHLEY: Yes.
18
MR. ANDES: Okay.
19
MS. ALEXANDER: All right. I would
20 like to go to Page 3 of this document. I say
21 Page 3, I mean the third page of the unnumbered
22 document. The first full paragraph begins "Ultra
23 violet UV radiation is widely recognized." Do you
24 see that?
L.A. REPORTING (312) 419-9292
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1
MR. BLATCHLEY: Yes.
2
MS. ALEXANDER: Okay. Second
3 sentence, "For the conditions of operation required
4 to accomplish inactivation of waterborne pathogens,
5 UV disinfection prophecies generally yield little,
6 if any, quantifiable DBP formation." DBP would
7 refer to disinfection byproducts, correct?
8
MR. BLATCHLEY: Yes.
9
MS. ALEXANDER: Is this statement in
10 any way inconsistent with the research reflected in
11 Exhibit 98, Effects of Disinfection on Wastewater
12 Effluent Toxicity?
13
MR. BLATCHLEY: No.
14
MS. ALEXANDER: Okay. And the reason
15 for that would be you didn't know the causes, as you
16 stated, for the increased toxicity in some cases?
17
MR. BLATCHLEY: No. The reason for
18 that would be the term "generally." It is a
19 generalization.
20
MS. ALEXANDER: Okay. Under what
21 circumstances, if any, would UV disinfection yield
22 any quantifiable disinfection byproduct formation?
23
MR. BLATCHLEY: You're just asking for
24 an example?
L.A. REPORTING (312) 419-9292
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1
MS. ALEXANDER: Well, here you've
2 stated that it's a generalization. Can you offer
3 any counterexamples and define when they would
4 occur?
5
MR. BLATCHLEY: As a generalization,
6 at any time there is a chemical that's present in
7 the water that has the ability to absorb germicidal
8 UV radiation, there's the potential for a
9 photochemical reaction to take place. Given the
10 wide number of chemicals that could be present in a
11 municipal wastewater effluent, that leaves open an
12 awful lot of chemistry. As an example of a
13 situation where we know something about disinfection
14 byproducts that are generated as a result of UV
15 radiation, we're currently studying that application
16 as it relates to swimming pools, and what we've
17 observed in swimming pool settings is that there are
18 some disinfection byproducts whose concentrations
19 increase, in fact, increase remarkably as a result
20 of UV radiation.
21
So again, the generalization
22 holds. I'm not comfortable suggesting that you will
23 never get disinfection byproducts and disinfection
24 byproducts that we care about. But as a
L.A. REPORTING (312) 419-9292
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1 generalization, what we observed -- what we and
2 others have observed is that most times we observe
3 less, and those products that are formed tend to be
4 less toxic than those that are formed as a result of
5 chlorination.
6
MR. ANDES: To follow up on that, and
7 I know you're making a distinction between
8 disinfection byproducts and toxicity because you
9 don't know what the toxicity is due to, you did find
10 in the other study, I believe Exhibit 95 on effluent
11 toxicity, that in one facility in particular,
12 Georgetown, Kentucky, UV did display the ability to
13 increase toxicity?
14
MR. BLATCHLEY: Yes.
15
MR. ANDES: Now, you didn't analyze
16 why.
17
MR. BLATCHLEY: Correct.
18
MR. ANDES: In terms of which
19 byproducts might have been, but there certainly was
20 a toxic response?
21
MR. BLATCHLEY: Yes.
22
MS. ALEXANDER: Okay. So outside of
23 the swimming pool research that you mentioned,
24 specifically with respect to DBPs, as opposed to
L.A. REPORTING (312) 419-9292
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1 general whole effluent toxicity response, can you
2 think of any other examples?
3
MR. BLATCHLEY: Well, again, I just
4 described a situation that would allow for a lot of
5 chemistry to take place. But with respect to
6 specific chemicals, no, I don't have any information
7 that addresses that.
8
MS. ALEXANDER: Okay. All right.
9 What I'd like to do is turn to the page which is
10 headed in italics "Risk assessment." This is again
11 on Exhibit 99, which is 11 pages from the back of
12 that document.
13
MR. BLATCHLEY: I'm getting there.
14 Sorry. Okay.
15
MS. ALEXANDER: Okay. Are we there?
16
MR. BLATCHLEY: Yes.
17
MS. ALEXANDER: Okay. In the first
18 paragraph, last sentence, the statement is made,
19 "Several exposure pathways exist for waterborne
20 pathogens, including shellfish consumption, skin
21 contact, ingestion during recreation, direct
22 contact, inhalation, and drinking water." Am I
23 correct in understanding that in this particular
24 risk assessment you looked only at ingestion?
L.A. REPORTING (312) 419-9292
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1
MR. BLATCHLEY: First of all, the risk
2 assessment text was written by Joan Rose, one of the
3 coauthors. So I'm the lead author on this paper,
4 but her responsibility for this paper was that
5 section.
6
MS. ALEXANDER: Okay. But you -- you
7 are, in fact, a coauthor with --
8
MR. BLATCHLEY: Yes.
9
MS. ALEXANDER: -- Ms. Rose on the
10 entire document?
11
MR. BLATCHLEY: Right. And my
12 understanding is that her approach to this risk
13 assessment was based on ingestion.
14
MS. ALEXANDER: Okay so would I be
15 correct in understanding that since only one of
16 several exposure pathways was looked at, it is
17 possible that the risk is actually higher than the
18 risk assessed purely with respect to ingestion?
19
MR. BLATCHLEY: Again, you would need
20 to talk to Dr. Rose to get the specific information
21 on that.
22
MS. ALEXANDER: Okay. Turning to the
23 second paragraph, and with the understanding that
24 although you're the lead author on this paper, you
L.A. REPORTING (312) 419-9292
20
1 did not draft this section, as your name's on it, I
2 would like to ask you a few additional questions
3 about it. I'd like to look at the statement -- the
4 second sentence in that second paragraph beginning
5 "Epidemiological studies." The text reads,
6 "Epidemiological studies are not conducive to
7 showing a full scale of waterborne disease
8 outbreaks. Epidemiological agents remain
9 unidentified in half of the reported waterborne
10 disease outbreaks in the United States. As few as
11 ten percent of outbreaks have been documented."
12
With respect to that statement, do
13 you think it's fair to say that outbreaks or the
14 level of outbreaks are generally not a good
15 indicator of overall risk?
16
MR. BLATCHLEY: You're asking an
17 engineer to perform analysis of a risk assessment
18 that I didn't do.
19
MS. ALEXANDER: Okay. And I will ask
20 you anyway, just to establish on the record, do you
21 know the basis for the assumption of 100 milliliters
22 ingestion during the course of a single swimming
23 event?
24
MR. BLATCHLEY: Not in detail, no.
L.A. REPORTING (312) 419-9292
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1
MS. ALEXANDER: Do you know in
2 general?
3
MR. BLATCHLEY: As I recall, based on
4 conversations with Dr. Rose, this was -- I think
5 this was her best guess as to what the likely
6 ingestion would be. But again, I think a better
7 approach would be to call her specifically and ask
8 her.
9
MS. ALEXANDER: Okay.
10
MS. TIPSORD: Dr. Blatchley, would
11 some of this -- would we be able to shed some light
12 on some of these questions, too, when we get the
13 information that's part of the report that we're
14 going to get?
15
MR. BLATCHLEY: Yeah. There is
16 certainly more detail in the report, and it may be
17 that she defined the basis for that assumption in
18 the report. I just don't remember.
19
MS. ALEXANDER: Okay. Just one
20 second. I've got a couple more questions. I want
21 to turn to the actual risk finding, which is two
22 pages later. You'll see the page with a set of
23 three bullet points in the middle. "Specific
24 finding was the risks associated with swimming in
L.A. REPORTING (312) 419-9292
22
1 waters receiving municipal wastewater effluence
2 range from ten to the minus three to ten to the
3 minus six. Risks are two to one hundred times
4 greater if the water is not disinfected, depending
5 on the disinfection type, extent of disinfection
6 exposure, and special effluent characteristics."
7
So do I understand correctly that
8 essentially that the purpose of this risk assessment
9 was to compare risks of swimming in wastewater
10 effluent with and without disinfection?
11
MR. BLATCHLEY: I need to reread this
12 section myself.
13
MR. ANDES: I think that if you go two
14 pages back, the purpose is pretty clear, because it
15 talks about a risk assessment that was conducted for
16 the purpose of examining, comparing probability of
17 illness associated with exposure to undisinfected
18 wastewater effluence with those associated with
19 wastewater effluence that have been subjected to UV
20 radiation or chlorination.
21
MS. TIPSORD: Would you agree with
22 that, Dr. Blatchley?
23
MR. BLATCHLEY: Yes.
24
MS. ALEXANDER: Okay. And just
L.A. REPORTING (312) 419-9292
23
1 looking at the statement immediately above that,
2 this is above the three bullet points, second to the
3 last sentence before the bullets, "It should be kept
4 in mind that on any given day, the virus
5 concentration could be as much as ten times higher
6 than the mean value used for these risk
7 calculations, therefore the risks of exposure as
8 well could be an order of magnitude higher as well."
9 Am I correct in understanding that this means an
10 order of magnitude higher than the two to one
11 hundred times greater risk that's identified in the
12 first bullet?
13
MR. BLATCHLEY: That would be my
14 interpretation.
15
MS. ALEXANDER: Okay.
16
MR. ANDES: I'm not sure that's -- the
17 two to one hundred times greater is a comparison of
18 two risks. I'm not sure if that changes --
19
MS. WILLIAMS: He answered the
20 question.
21
MS. ALEXANDER: Are you testifying?
22 He answered the question. I object to that.
23
MR. ANDES: Do you understand -- if I
24 can follow up, do you understand that the ten times
L.A. REPORTING (312) 419-9292
24
1 greater refers to the mean value or refers to the
2 risk comparison of two to one hundred times greater
3 in the first bullet, and explain?
4
MR. BLATCHLEY: I believe it's the
5 mean value.
6
MS. ALEXANDER: Meaning the mean value
7 of the virus concentration, correct?
8
MR. BLATCHLEY: You've put me at a
9 point of weakness, because again, you're asking me
10 to testify about something that I didn't write.
11
MS. ALEXANDER: Okay. Did you discuss
12 with Dr. Rose her conclusions before the study was
13 published?
14
MR. BLATCHLEY: Four years ago, yes.
15
MS. ALEXANDER: Okay. Did you, in any
16 manner, dispute or disagree with her conclusions?
17
MR. BLATCHLEY: I don't recall
18 disputing them, no.
19
MS. ALEXANDER: Okay. All right. I
20 think the statement speaks for itself. I believe
21 that is -- that concludes my questions on these two
22 documents and my questions for Dr. Blatchley.
23
MS. TIPSORD: Thank you. Are there
24 any additional questions for Dr. Blatchley?
L.A. REPORTING (312) 419-9292
25
1
MR. ANDES: Yes. I have a few
2 follow-ups. Dr. Blatchley, we've talked a little
3 bit about different levels of disinfection, and
4 we've talked about a level of, sort of, conventional
5 disinfection, and then other levels that are higher
6 or more extensive in activation. If you are -- if
7 you were to take the disinfection level up from the
8 conventional level -- first, let me ask you is the
9 conventional level of 400 counts of fecal, are you
10 saying that something more stringent is needed
11 beyond that to protect recreational uses on the
12 CAWS?
13
MR. BLATCHLEY: No. I'm not -- it's
14 unclear to me what would be necessary to protect
15 recreational uses on the CAWS. The risks associated
16 with recreational uses are already low, and the
17 implementation of disinfection, as I understand it
18 according to the risk assessment that would be --
19 that has been performed, suggests that that risk
20 would be only nominally improved.
21
MR. ANDES: Now if I did a more
22 extensive level of disinfection, whether that's to
23 the California level or something else, that would
24 reduce pathogen levels in the effluent. Am I
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1 correct?
2
MR. BLATCHLEY: Yes.
3
MR. ANDES: Okay.
4
MR. BLATCHLEY: We presume that that's
5 the case, yes.
6
MR. ANDES: Okay. But if it were
7 something, say, in the California level, am I right
8 that produces them to non-detect?
9
MR. BLATCHLEY: For coliform bacteria,
10 yes.
11
MR. ANDES: Okay. So some other level
12 would be detectible levels of coliform?
13
MR. BLATCHLEY: Presumably, yes.
14
MR. ANDES: Okay. In the level that
15 we're talking about, whether it's a California level
16 or something less, would also involve more
17 byproduct -- disinfection byproducts?
18
MR. BLATCHLEY: It would involve more
19 disinfection byproducts. It would require more
20 power, it would require more space, more of pretty
21 much everything that goes along with the
22 disinfection system.
23
MR. ANDES: And more CAWS?
24
MR. BLATCHLEY: Of course.
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1
MR. ANDES: Thank you.
2
MS. WILLIAMS: I'd like to follow up.
3 So you're saying there'd be more disinfection
4 byproduct for a higher level of UV disinfection as
5 well?
6
MR. BLATCHLEY: Sure.
7
MS. WILLIAMS: Or are you just
8 testifying for chlorine?
9
MR. BLATCHLEY: Both.
10
MS. WILLIAMS: And can you explain how
11 what you're basing your conclusion on that there
12 would be more disinfection byproducts from UV at a
13 higher level?
14
MR. BLATCHLEY: The extent of -- okay.
15 So UV systems accomplish whatever they accomplish as
16 a result of photochemical reactions, reactions that
17 are driven by electromagnetic radiation. The more
18 photons you put in, the more opportunity for
19 reaction you provide. So if there are disinfection
20 byproducts that are formed at a low dose --
21
MS. WILLIAMS: If there are some
22 formed, correct?
23
MR. BLATCHLEY: Correct.
24
MS. WILLIAMS: If there aren't any,
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1 then they wouldn't be any higher, would they?
2
MR. BLATCHLEY: Correct. But if there
3 are some formed, then you provide the potential for
4 those reactions to go further.
5
MS. WILLIAMS: But they're not formed
6 in every case, are they?
7
MR. BLATCHLEY: We don't -- let me
8 just be clear on that. The analytical methods that
9 we've used in many cases have not detected
10 disinfection byproducts, but not all cases, and
11 those analytical methods are not comprehensive in
12 terms of the chemistry that's involved. So there's
13 some question marks that exist. But it's clear that
14 under some circumstances, disinfection byproducts
15 are formed as a result of UV radiation, and when
16 that's true, if you increase the dose, you'll
17 increase the amount of DPB formation.
18
MS. WILLIAMS: I think that answered
19 my question.
20
MS. TIPSORD: Any further?
21
MS. WILLIAMS: No.
22
MS. ALEXANDER: I just have one
23 followup question. You made a statement in response
24 to the follow-ups that the risk of -- from
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1 recreational use are low. Is that statement based
2 on the microbial risk assessment conducted by the
3 district?
4
MR. BLATCHLEY: The Geosyntec report?
5
MS. ALEXANDER: Geosyntec -- done for
6 the district by Geosyntec.
7
MR. BLATCHLEY: Yes.
8
MS. TIPSORD: Which is Exhibit 71, I
9 believe.
10
MS. ALEXANDER: Okay. Is it based on
11 anything else?
12
MR. BLATCHLEY: No.
13
MS. ALEXANDER: Okay.
14
MS. TIPSORD: Thank you very much, Dr.
15 Blatchley. We appreciate it. And with that, we'll
16 move on to Dr. Dorevitch.
17
MS. TIPSORD: All right. And then if
18 we could enter his testimony.
19
MR. ANDES: Surely. Since the
20 exhibits to -- since the attachments to Dr.
21 Dorevitch's testimony is a total of over 800 pages,
22 I have a copy of his testimony with a disc.
23
MS. TIPSORD: All right.
24
MS. WILLIAMS: 856 I believe it was.
L.A. REPORTING (312) 419-9292
30
1
MR. ANDES: Thank you.
2
MS. TIPSORD: We will, once again,
3 mark both the attachments and the pre-file testimony
4 as one exhibit, Exhibit No. 100. Congratulations,
5 Dr. Dorevitch. You're number 100. If there's no
6 objection, seeing none, it's Exhibit 100. Ms.
7 Alexander, I believe we start with your questions
8 from the Natural Resources Defense Counsel for Dr.
9 Dorevitch.
10
MS. ALEXANDER: Yes. Good afternoon,
11 Dr. Dorevitch. My name is Ann Alexander from the
12 Natural Resources Defense Counsel. I'll be asking
13 you questions this afternoon. Going to pre-file
14 question number one, when were you first contacted
15 by the Metropolitan Water Reclamation District
16 concerning conducting an epidemiological study
17 concerning the Chicago Area Waterway System?
18
DR. DOREVITCH: January 2007.
19
MS. ALEXANDER: Have you -- were you
20 in any manner involved in the microbial risk
21 assessment study?
22
DR. DOREVITCH: No, I was not.
23
MS. ALEXANDER: Okay. Have you
24 reviewed that study?
L.A. REPORTING (312) 419-9292
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1
Ms. DOREVITCH: Yes, I have.
2
MS. ALEXANDER: Okay. Did you review
3 it in draft, or only after its completion?
4
DR. DOREVITCH: I reviewed both --
5
MS. TIPSORD: Dr. Dorevitch, keep your
6 voice up, please. I'm having a hard time hearing
7 you.
8
DR. DOREVITCH: Oh, I'm sorry. I
9 reviewed both draft and final versions.
10
MS. ALEXANDER: At what point did you
11 review a draft?
12
DR. DOREVITCH: February 2007. I
13 think their draft was dry weather only at that
14 point.
15
MR. ANDES: Might that have been the
16 interim report on dry weather?
17
DR. DOREVITCH: Yes.
18
MS. ALEXANDER: Now in your summary
19 document, you refute -- you refer to an expert
20 review panel for the epidemiological study. Is that
21 correct?
22
DR. DOREVITCH: I'm not sure exactly
23 what you mean. There were a couple of -- are you
24 talking about the expert review panel that the
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32
1 District commissioned to review the state of the
2 science on water quality standards, or the peer
3 review panel for the epi study that we're doing now?
4
MS. ALEXANDER: Okay. Let me ask
5 about both of them actually. First of all, I'm
6 referring to at the MWRDGC expert panel referenced
7 on Page 9 of Exhibit 100 attachment -- this is
8 your --
9
DR. DOREVITCH: Overview document.
10
MS. ALEXANDER: The study overview
11 document that you provided.
12
MR. ANDES: What page?
13
MS. ALEXANDER: Which is -- this is
14 Page 9 of that document. My question is: Who's on
15 that panel?
16
DR. DOREVITCH: I believe it's Chuck
17 Cause (phonetic), Chuck Gerba (phonetic), it may be
18 Joan Rose. I don't remember who the members of that
19 panel are.
20
MS. ALEXANDER: Okay.
21
DR. DOREVITCH: I believe there were
22 four, and I think those are three of the four.
23
MS. ALEXANDER: Okay. And then who
24 was on the peer review panel?
L.A. REPORTING (312) 419-9292
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1
DR. DOREVITCH: For the CHEERS
2 research study?
3
MS. ALEXANDER: For the CHEERS
4 research study.
5
DR. DOREVITCH: The reviewers are Gary
6 Toransos (phonetic), Dr. Gary Toransos, Dr. Joan
7 Rose, Dr. Timothy Wade, Dr. Michael Beach. Dr. Wade
8 is with the EPA, Dr. Beach is with the CBC, Dr. Rose
9 is with Michigan State. Steven Shoub (phonetic) of
10 the USEPA, Cecil Luhing (phonetic), Kurt Petrisey
11 (phonetic) from the NEER study of the EPA and CBC,
12 and I believe that's it. I may be missing one name.
13
MS. ALEXANDER: Okay. All right.
14 Moving on to pre-filed question number two, how much
15 longer, if at all, will you be enrolling
16 participants in this study?
17
DR. DOREVITCH: We will be enrolling
18 participants in this study. We'll be enrolling them
19 until we reach the necessary sample size. I project
20 that we'll finish this current 2008 season in about
21 three weeks, having enrolled approximately 7,200
22 participants, and that we'll start up in the spring
23 of '09, and finish participant enrollment in the --
24 about July of '09.
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1
MR. ANDES: And your target level, I'm
2 sorry, is?
3
DR. DOREVITCH: Is 9,330 participants
4 eligible for telephone followup.
5
MS. ALEXANDER: Okay. But just so I
6 understand, if for some reason you did not reach
7 that goal number by the end of the 2009 season,
8 would you continue to enroll participants in 2010
9 and push your completion date back?
10
DR. DOREVITCH: I think that's not
11 realistic. We enroll over 1,000 people a month
12 during good weather. In August we enrolled over
13 1,500 in a single month. So I'm not worried that
14 we'll run out of participants in 2009.
15
MS. ALEXANDER: Now question three,
16 the first part of the question, I believe, is asked
17 and answered. I'm sorry. Can you run by the number
18 of how many you have enrolled as of today?
19
DR. DOREVITCH: You know, I can't tell
20 you exactly --
21
MS. ALEXANDER: Approximately?
22
DR. DOREVITCH: -- because we enrolled
23 people yesterday.
24
MS. ALEXANDER: Okay.
L.A. REPORTING (312) 419-9292
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1
DR. DOREVITCH: Approximately 6,900.
2 It might be 6,890, 95, maybe a little over 6,900. I
3 don't know exactly.
4
MS. TIPSORD: Off the record for just
5 a second.
6
(Whereupon, a discussion was had
7
off the record.)
8
MS. ALEXANDER: Approximately -- how
9 many of that approximately 6,900 number are in the
10 CAWS recreational users group as opposed to the
11 control groups?
12
DR. DOREVITCH: The -- we don't really
13 use the term "control group," but probably about
14 40 percent of them are from the CAWS group, and
15 60 percent are from the other two groups.
16
MS. ALEXANDER: Okay.
17
MR. ANDES: Can you explain what the
18 other two groups are?
19
DR. DOREVITCH: Sure. The other two
20 groups are unexposed recreators, people who are
21 outdoors doing some recreational activity at about
22 the same place and the same time as the people who
23 recruit into the water exposed groups. The other
24 group is the -- what we call the general use water
L.A. REPORTING (312) 419-9292
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1 group. These are folks doing activities that are
2 done on the CAWS, but they are doing them at other
3 locations, such as Lake Michigan, Skokie Lagoons,
4 and other waters.
5
MS. ALEXANDER: Okay. I'm going to
6 move on to pre-filed question four. This concerns
7 the statement at Page 2 of your testimony that one
8 of the goals of the CHEERS study is to determine
9 whether rates of illness are higher among CAWS
10 recreators as compared to recreators doing the same
11 activities on waters that do not receive treated
12 wastewater. Am I correct in understanding that this
13 means you're comparing illness rates among people
14 engaged in the same category activities, such as
15 canoeing and kayaking?
16
DR. DOREVITCH: Those analyses will be
17 done, yes.
18
MS. ALEXANDER: Okay. Now were any
19 assumptions made in your study about the manner in
20 which people engage in these activities?
21
DR. DOREVITCH: No.
22
MS. ALEXANDER: Okay. So would it be
23 fair to say that the operating assumption, by
24 default, would be that people engaged in these
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1 activities in a roughly comparable manner regardless
2 of which water body they were on? You didn't assume
3 that people were, for instance, kayaking in a
4 substantially different manner when they were on
5 Lake Michigan as opposed to on the CAWS?
6
DR. DOREVITCH: No, that would be an
7 assumption. We didn't -- I'm not assuming that at
8 all.
9
MS. ALEXANDER: Right. Okay. Now in
10 terms of water bodies that are being used as a
11 control comparison, you mentioned the Skokie
12 Lagoons. Is Lake Michigan another one?
13
DR. DOREVITCH: Correct.
14
MS. ALEXANDER: Okay. Is it possible,
15 in your view, that people engaged in the types of
16 recreational activities that you're looking at, in
17 particular kayaking and canoeing, would have a
18 greater level of body contact with the water in a
19 clean water body than a contaminated one?
20
DR. DOREVITCH: It is possible.
21
MS. ALEXANDER: Okay. In other words,
22 it's possible that a kayaker on Lake Michigan would
23 be more willing to roll their kayak or engage in a
24 water fight than one on the Chicago Area Waterway
L.A. REPORTING (312) 419-9292
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1 System?
2
DR. DOREVITCH: It's possible.
3
MS. ALEXANDER: Okay.
4
MR. ANDES: If I can follow up, is
5 there any -- do you know of any basis to believe
6 that the behavior is any different on one water body
7 versus another?
8
DR. DOREVITCH: No, I don't at this
9 point, but we do ask people all kinds of questions
10 that will allow us to determine if that's the case
11 or not.
12
MS. ALEXANDER: Are you referring to
13 the questions as to whether they fell into the
14 water?
15
DR. DOREVITCH: That's -- that's
16 one type -- yeah, that's one question. But there's
17 a whole series of questions that essentially get at
18 how wet did somebody get. We ask if they -- if a
19 person got wet at all, and if they did, then there's
20 a series of followup questions about, "Well, did
21 your head get wet, did your hands get wet, did your
22 face get wet, did you get water in your mouth, in
23 your hands, in your feet," and then for each one of
24 those there's a followup question about "Well, was
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1 it a few drops, a splash, were you submerged," et
2 cetera. So rather than assuming that people in all
3 locations or in all recreational activities get
4 equally wet, we have questions trying to get at
5 that.
6
MS. ALEXANDER: In your results, will
7 you be breaking out the risk to kayakers or canoers
8 who got substantially wet, however you might define
9 that, as opposed to the ones who stayed mostly dry?
10 Are you essentially going to lump your results as a
11 risk to people engaging in that particular activity?
12
DR. DOREVITCH: Well, we'll do many
13 levels of analysis. The most crude would just be
14 differences in rates of illness among groups. But
15 to determine what the potential confounders are and
16 the potential CAWS pathways are, we'd have to look
17 at the individual factors that you're talking about,
18 is it a specific recreational activity, is it a
19 certain level of water exposure, is it water
20 ingestion, et cetera. And if one of those factors
21 is, in fact, a predictor of rates of illness, then
22 that would be included in, sort of, the final models
23 of predicting illness rates.
24
MS. ALEXANDER: Would it be fair to
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1 say that in order to assess the risk of not merely
2 of engaging in a particular activity, but of
3 actually getting substantially wet engaging in that
4 activity, you would have to have a statistically
5 significant sample of both people getting
6 significantly wet in the control water body as
7 opposed to -- and in the CAWS as well?
8
DR. DOREVITCH: I'm sorry. Could you
9 repeat the question?
10
MS. ALEXANDER: If one were to assess
11 specifically the risk observed of not merely
12 engaging in an activity such as kayaking, but
13 engaging in an activity in a manner that got you
14 substantially wet, would you need a statistically
15 significant sample of both people who got
16 significantly wet in the control water body and of
17 people who got significantly wet in the
18 experimental, the CAWS water body?
19
DR. DOREVITCH: You know, it kind of
20 depends on what analysis you're talking about.
21 There are analysis that have to do with difference
22 between groups, and there are differences that have
23 to do with in the rates of illness has a function of
24 water quality. In the rates of illness as a
L.A. REPORTING (312) 419-9292
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1 function of water quality, people in the CAWS group
2 and the general use group would be pooled together,
3 and there'd be, sort of, a wide spectrum of ranges
4 of water quality.
5
For the differences between
6 groups, to identify something like the extent of
7 water contact, right, you would need more that would
8 be one level of exposure. So some people have to
9 have low, and some people have to have high. How
10 many you need in each group would depend on the
11 strength of the association. If it's a strong
12 causal factor, you would need fewer people in each
13 group. If it's a very subtle week effect, then it
14 would take many, many more people to -- in those
15 subsets to be able to identify an association
16 between exposure levels within groups.
17
MS. ALEXANDER: Okay. Based on the
18 answers that you received so far to your
19 questionnaires, have you taken a look yet or
20 attempted to quantify the number of people who
21 became significantly wet, or for want of a better
22 way to put it, fell in the water, got their head in?
23
DR. DOREVITCH: Not at that point, no.
24
MS. ALEXANDER: Okay. Pre-file
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1 question five referring to Page 3 of your pre-file
2 testimony, you state that you would be more inclined
3 to support immediate disinfection of the CAWS if
4 there were known disease outbreaks associated with
5 CAWS recreation. Is it possible as a general matter
6 for disease outbreaks to go undetected and/or
7 unreported?
8
MR. ANDES: First of all, let me
9 object to the characterization. It's not what he
10 said on Page 3. He suggested public health action
11 now. That's not immediate disinfection.
12
MS. ALEXANDER: Okay. What did you
13 mean by public health action now?
14
DR. DOREVITCH: I didn't think of
15 disinfection as immediate public health action.
16 That sounds like something that takes years to put
17 together. If, let's say, there were outbreaks of
18 disease, significant acute public health risks, an
19 example of an immediate public health action could
20 be prohibiting recreational activity, prohibiting
21 recreational activities at certain locations,
22 prohibiting specific types of recreation, things
23 like that. I didn't mean disinfection when I said
24 immediate public health action, something that a
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43
1 health department could, you know, move in and get
2 done quickly.
3
MS. ALEXANDER: Okay. So when you
4 state, then, that, you know, effectively that lack
5 of observation of disease outbreaks on the CAWS
6 associated with recreation is, you know, is that,
7 you know, that's your reason for -- I'm tangled up
8 in this -- that's the reason you don't support
9 immediate public health action, you're not saying,
10 then, that the lack of observed outbreaks on the
11 CAWS is a reason not to disinfect, per se?
12
DR. DOREVITCH: Well, I'm not saying
13 anything about disinfection there.
14
MS. ALEXANDER: Okay. Let me go back
15 to my question, then. Is it possible for disease
16 outbreaks to go undetected and/or unreported?
17
DR. DOREVITCH: Yes.
18
MS. ALEXANDER: Okay. Does this
19 happen with some frequency, in your view?
20
DR. DOREVITCH: Yes.
21
MR. ANDES: A follow up, so how do we
22 know when they're undetected and unreported?
23
DR. DOREVITCH: We don't know, but
24 there are -- there's reason to think that the
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1 current public health surveillance system is weak,
2 and that it's only capturing a fraction of all
3 outbreaks that occur, but what percent are captured
4 and what percent are not captured is not known.
5
MS. ALEXANDER: And, in fact, would a
6 disease outbreak be more likely to go undetected if
7 it involved a type of pathogen that was infectious
8 but frequently asymptomatic?
9
DR. DOREVITCH: Yes.
10
MS. ALEXANDER: Okay.
11
MR. ANDES: Do you have a particular
12 pathogen in mind?
13
MS. ALEXANDER: Not at the moment. I
14 could get back to you on that, and I'm sure our
15 expert will get back to you on that.
16
MR. ANDES: Fine.
17
MS. ALEXANDER: And is it possible in
18 your view that a pathogen could be dangerous to a
19 small but distinct subgroup of recreational users,
20 such as children or users with a high level of body
21 contact, like boaters who fall in the water, without
22 actually causing a disease outbreak, or say a
23 technical disease outbreak?
24
DR. DOREVITCH: You're asking if it's
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45
1 possible that a pathogen can cause an outbreak that
2 goes undetected?
3
MR. ANDES: Or are you asking --
4
MS. ALEXANDER: No, I'm saying an
5 undetected outbreak, not an undetected pathogen.
6
MR. ANDES: And as to those particular
7 groups? Was that --
8
MS. ALEXANDER: Yeah. What I'm asking
9 is: Is it possible that a pathogen of some sort
10 could be dangerous to a small but distinct subgroup
11 of recreational users, like children or people who
12 fall in the water, without actually causing a
13 detectable outbreak?
14
DR. DOREVITCH: Well, I'm not exactly
15 sure what detectable means, but it's possible for an
16 outbreak like that to occur and not be detected.
17
MS. ALEXANDER: Okay.
18
DR. DOREVITCH: Yeah.
19
MR. GIRARD: Could I ask a quick
20 followup, Dr. Dorevitch?
21
DR. DOREVITCH: Yeah.
22
MR. GIRARD: How do you define
23 outbreak?
24
DR. DOREVITCH: In the context of
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1 waterborne diseases, the centers for disease control
2 and the USEPA maintain a database called the
3 waterborne disease outbreak surveillance system, and
4 the definition there is an outbreak is two or more
5 cases that are linked together in terms of the
6 location, the type of illness, and the time that
7 they occur. So two people can be an outbreak?
8
MR. GIRARD: And that's the definition
9 you're using when you use the term outbreak?
10
DR. DOREVITCH: Well, I think I've
11 used outbreak and epidemic probably more than once,
12 and I think in one context I was talking
13 specifically about that surveillance system, but
14 more broadly, an outbreak has a pretty general
15 definition. It's a greater number of cases than
16 expected, and it isn't more rigorous than that in
17 terms of it has to be ten times more than expected
18 or twice the number expected. So I'm using it in
19 both senses that on the CAWS or other local waters,
20 it's entirely possible that outbreaks occur, whether
21 it's the two-case definition or greater than
22 expected. But these have not been recognized by
23 state, local, or federal public health surveillance
24 agencies.
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1
MR. GIRARD: So in general, we've got
2 two definitions here going on. I mean, we've got
3 the specific one from the CBC, and then we've also
4 got -- I think you said the very general definition
5 of what an outbreak is.
6
DR. DOREVITCH: Yes.
7
MR. GIRARD: Thank you.
8
MS. TIPSORD: Mr. Harley, you had a
9 followup?
10
MR. HARLEY: Calling your attention to
11 Exhibit 99, which was introduced into evidence by
12 the Water Reclamation District, it's the effects of
13 wastewater disinfection on human health, of which
14 Dr. Blatchley was one of the authors. There's a
15 statement in that report 11 pages from the end in
16 the risk assessment section that we were discussing
17 before the break. It states --
18
MR. ANDES: Let me just grab that,
19 okay?
20
MR. HARLEY: Sure. Looking in the
21 second full paragraph, about halfway through that
22 paragraph, it states as few as ten percent of
23 outbreaks have been documented, and putting that
24 into context of the previous sentence, we're talking
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1 about reported waterborne outbreaks in the United
2 States. Would you agree with that statement?
3
DR. DOREVITCH: That's possible.
4
MR. HARLEY: Is that consistent --
5
DR. DOREVITCH: It may be ten percent.
6 I don't think it's really known. I don't really
7 think -- you know, it's sort of -- we don't know
8 what the denominator is. We know how many outbreaks
9 are captured by the surveillance system on -- for
10 2005, 2006, there were, I think, 78 outbreaks
11 reported nationally in terms of recreational water.
12 We don't know if that -- if it were 78 out of 780,
13 it's ten percent. But we don't really know if it's
14 780 or 280 or 1,000.
15
MR. HARLEY: The following sentence
16 refers specifically to gastrointestinal illnesses.
17 It says "Gastrointestinal illnesses are largely
18 unreported due to the lesser severity of illness in
19 healthy individuals." Would you agree with that
20 statement?
21
DR. DOREVITCH: I'm not exactly sure
22 what the context is, but it's true that the majority
23 of cases of gastrointestinal illness do not result
24 in notification of public health authorities.
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1
MR. HARLEY: Are you familiar with the
2 Geosyntec risk assessment? I believe you testified
3 that you are.
4
DR. DOREVITCH: Yeah. I've seen that,
5 yes.
6
MR. HARLEY: And you're familiar,
7 though, with the fact that in that report the focus
8 is gastrointestinal illness?
9
DR. DOREVITCH: Yes.
10
MR. HARLEY: Thank you.
11
MR. ANDES: If I can follow up on a
12 couple things. One is if you can help us
13 understand, a risk assessment, am I right, is not
14 intended to reflect, sort of, actual exposure. In
15 fact, the epidemiologic study is what's intended to
16 look at what's really going on on the ground. Can
17 you -- what's --
18
DR. DOREVITCH: Well, I think the -- I
19 think risk assessment and epidemiologic studies are
20 two different approaches to getting at some of the
21 questions. Both kinds of study could try to
22 determine what our rates of illness in an
23 epidemiologic study, that would be directly measured
24 in a risk assessment that would be modeled. So
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1 there are two different ways of getting at the same
2 question.
3
MS. ALEXANDER: Just a quick followup
4 regarding the risk assessment that I believe I
5 neglected to ask earlier. You testified that you
6 reviewed the risk assessment in draft. Did you have
7 any comments on it at that time?
8
MR. ANDES: I think it might have been
9 the interim report, which it wasn't actually a
10 draft.
11
MS. ALEXANDER: I don't believe so. I
12 believe -- actually, well, I should ask you. Was it
13 the interim report that you reviewed, or was it a
14 draft of the final report?
15
DR. DOREVITCH: No. It wasn't a draft
16 of the final report. I don't remember for sure what
17 was available in February of '07, but if -- I don't
18 know if it was interim or draft, but it was the dry
19 weather risk assessment, and it may have been the
20 interim report.
21
MS. ALEXANDER: Okay. If it was dry
22 weather in your graph, it was in the interim report.
23
MS. TIPSORD: For the record, that's
24 Exhibit 76.
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1
MS. ALEXANDER: Okay. I'll ask my
2 question generally. Did you have any comments on
3 either the interim or the final risk assessment when
4 you reviewed it?
5
DR. DOREVITCH: No.
6
MS. ALEXANDER: Okay. I'd like to
7 move on to pre-filed question six, which refers to
8 the statement on Page 4 of your testimony, second to
9 the last sentence on that page. This is the first
10 epidemiologic study of the risks of fishing,
11 boating, rowing, and paddling. Have there, in fact,
12 been -- or I should say I believe you identify in
13 your overview at Page 7 previous epidemiologic
14 studies concerning the risk of waterborne illness to
15 nonprimary contact recreational users?
16
DR. DOREVITCH: Right.
17
MS. ALEXANDER: Okay. Did these
18 studies find elevated risk of waterborne illness?
19
DR. DOREVITCH: Well, they didn't all
20 find the same thing, and one of them wasn't really
21 able to comment on elevated risk or not. There are
22 three papers that I was referring to. It's Futrel
23 (phonetic) 1992, which did find an elevated rate of
24 illness in white water slalom canoeists, compared to
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1 people canoeing on -- I'm sorry -- compared to
2 people canoeing on a pristine water, and compared to
3 people who are unexposed.
4
MR. ANDES: You have all three of
5 these here.
6
DR. DOREVITCH: Futrel 1994 did not
7 find elevated rates of illness in people who were in
8 canoeing and rowing regattas or canoe marathon and
9 rowing regattas, compared to people who were
10 unexposed, and Lee 1997 didn't have an unexposed
11 group. So they report a rate, but there isn't a
12 reference in terms of what was going on in a similar
13 population, were the rates of illness higher, lower,
14 or the same.
15
MS. TIPSORD: We have a 1992 Help
16 Steps of Whitewater Canoeing by L. Futrel, et al,
17 from Lancet (phonetic).
18
MR. ANDES: I'm not sure that we had a
19 complete copy of that.
20
MS. TIPSORD: Did we just have the
21 first page of that?
22
MS. ALEXANDER: My copy was
23 incomplete.
24
MS. TIPSORD: Okay. All right.
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1
MS. ALEXANDER: So let's make it a
2 complete copy.
3
DR. DOREVITCH: Yeah. It's a
4 three-page paper.
5
MS. TIPSORD: Okay.
6
MR. ANDES: That's the first one.
7
MS. TIPSORD: Okay. And then I also
8 have already in the record -- and again it may have
9 been an incomplete -- Help Steps of Low-Contact
10 Water Activities in Fresh and E-s-t-u-r-i-m-e
11 Waters.
12
MR. ANDES: That's six pages.
13
MS. TIPSORD: Let's go ahead and enter
14 it just to be on the safe side, because I don't have
15 the actual exhibit with me. Sorry.
16
MR. ANDES: And that's the third one.
17
MS. TIPSORD: And actually before I
18 enter this one -- I'm going to check at break,
19 because I think this one is complete -- I think we
20 do -- do you have your copy with you by chance?
21
MR. ANDES: I think I did introduce it
22 earlier.
23
MS. TIPSORD: The 1994 document, the
24 Health Effects of Low-Contact Water Activities, and
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1 I think we entered it as Exhibit 79. I think that's
2 the complete copy that's already admitted. The
3 Lancet copy was only the first page.
4
MS. WILLIAMS: Do you have it?
5
MS. TIPSORD: Is that a copy of
6 Exhibit 74? This is the new one he's given us. I
7 think it's six pages. Yeah. We already have
8 this -- the Health Effects of Low-Contact Water
9 Activities by Futrel et al., is already admitted as
10 Exhibit 79. That's from 1994. The Health Effects
11 of Whitewater Canoeing by Futrel et al., the
12 complete copy, we will mark as Exhibit 101, if
13 there's no objection. Seeing none, it is
14 Exhibit 101. And then the other document is,
15 Doctor?
16
DR. DOREVITCH: Bacteriophages.
17
MS. TIPSORD: Bacteriophages are a
18 Better Indicator of Illness Rates Than Bacteria
19 Amongst Whitewater Fed by a Low Land River. This is
20 from Pergemon (phonetic), is that correct?
21
DR. DOREVITCH: Lee. Oh, oh, the
22 journal?
23
MS. TIPSORD: Yes.
24
DR. DOREVITCH: Water Science and
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1 Technology.
2
MS. TIPSORD: Okay. From 1997, and
3 I'll mark that as Exhibit 102 if there's no
4 objection. Seeing none, it's Exhibit 102.
5
MS. ALEXANDER: Okay. Referring first
6 to Exhibit 101, which is the 1992 Futrel study that
7 you site in your study overview, am I correct that
8 the research there concluded that white water canoer
9 studies were 4.2 times more likely to experience a
10 gastrointestinal illness than nonexposed
11 individuals?
12
MR. ANDES: Where are you getting that
13 from?
14
DR. DOREVITCH: Yeah, right. You're
15 talking about table two, in an unadjusted analysis,
16 right, that's what it showed, that GI symptoms were
17 4.25 times more common in the white water slalom
18 canoeists, compared to people who did not
19 participate in water recreation activity.
20
MS. ALEXANDER: Okay. Am I also
21 correct in understanding that the fecal coliform
22 content of the water was 185 colony forming units
23 per 100 millimeters?
24
DR. DOREVITCH: It's 285.
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1
MS. ALEXANDER: 285, I'm sorry. And
2 now Exhibit 102, just so I understand, there was --
3 am I correct that the conclusion reflected on
4 Page 169 of that study was the use of lowland water
5 for white water canoeing results in a significant
6 rate of gastrointestinal illness related to the
7 microbiologies of the water?
8
DR. DOREVITCH: I'm sorry. I lost
9 you. Which paper are we on?
10
MS. ALEXANDER: I'm sorry. We're now
11 on Exhibit 102, bacteriophages are a better
12 indicator.
13
DR. DOREVITCH: Oh, okay.
14
MS. ALEXANDER: The Lee paper.
15
DR. DOREVITCH: The Lett paper. And
16 I'm sorry, would you mind repeating what you had
17 read?
18
MS. ALEXANDER: Page 169, I just want
19 to confirm that the conclusion stated at the bottom
20 is, in fact, that use of lowland water for white
21 water canoeing results in a significant rate of
22 gastrointestinal illness, which is related to the
23 microbiology of the water.
24
DR. DOREVITCH: That is what the
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1 authors conclude. I have a little bit of an issue
2 with the idea that they're calling it a significant
3 rate. I think to know whether the rate is higher or
4 lower or the same is a demographically similar group
5 of people, you'd have to study those people, and
6 they know what the rate of illness is among the
7 people who are in the research. They don't really
8 have a basis for comparison. So maybe it's one per
9 thousand higher, or maybe it's one hundred per
10 thousand higher than the general population, but
11 there isn't enough information to know that.
12
MS. ALEXANDER: Okay. You also
13 footnote, I believe, at page -- at Page 9 of your
14 testimony, in Section 3.1.4, a study by Taylor, et
15 al., in South Africa. Is that correct?
16
DR. DOREVITCH: Yes.
17
MS. ALEXANDER: Okay. And am I
18 correct that the Taylor research concluded that
19 canoers are 7.8 times more likely to show evidence
20 of having been exposed to the waterborne pathogen at
21 issue, in that case schistosoma?
22
DR. DOREVITCH: You know, I don't have
23 that paper front of me, but that may be what they
24 concluded. I -- you know, I don't think that that's
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1 particularly relevant, because schistosomiasis is
2 not a local waterborne disease.
3
MS. ALEXANDER: But it is a waterborne
4 disease, correct?
5
DR. DOREVITCH: It sure is.
6
MS. ALEXANDER: Okay.
7
DR. DOREVITCH: But not something that
8 we're trying to measure here, because it doesn't
9 occur here.
10
MS. ALEXANDER: Now are you familiar
11 with the 2007 study by Robert et al. that --
12 concluded that anglers washing fish in water
13 infected with cryptosporidium had a mean probability
14 of infection of 81 percent?
15
MR. ANDES: Are we going to introduce
16 this as evidence?
17
MS. ALEXANDER: We're going to
18 introduce it as an exhibit.
19
DR. DOREVITCH: I am familiar with
20 that paper.
21
MS. ALEXANDER: Okay.
22
MS. TIPSORD: I'm sorry. Did you say
23 you are familiar with it?
24
DR. DOREVITCH: I am.
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1
MS. ALEXANDER: I would like to have
2 marked this document with the cover page the Journal
3 of Toxicology and Environmental Health.
4
MS. TIPSORD: And is this a complete
5 copy of this?
6
MS. ALEXANDER: It appears to be to
7 me.
8
MS. TIPSORD: Okay. If there's no
9 objection, we'll mark the Journal of Toxicology and
10 Environmental Health Part A --
11
DR. DOREVITCH: Probabilistic.
12
MS. TIPSORD: Probabilistic -- too
13 many Bs in there, sorry -- of Cryptosporidium
14 Exposure Among Baltimore Urban Anglers as
15 Exhibit 103 if there's no objection. Seeing none,
16 it's Exhibit 103 of -- the date is January 2007.
17 Thank you.
18
MS. ALEXANDER: Am I correct that you
19 did not site this study in the documents submitted
20 in connection with your testimony? I'm not sure.
21 There's 800 pages of them.
22
DR. DOREVITCH: I probably didn't.
23 It's not an epidemiologic study, it's a risk
24 assessment.
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1
MS. ALEXANDER: Okay.
2
DR. DOREVITCH: And I -- in the
3 context of the epidemiologic study that I'm doing, I
4 want to know about risk assessments, but the primary
5 focus, what's most immediately relevant, are the
6 epidemiologic studies. So I do know about this
7 study, but it didn't inform the design of the CHEERS
8 study at all.
9
MS. ALEXANDER: Are you also familiar
10 with the 1896 study by Dwailly et al. concerning
11 windsurfing?
12
DR. DOREVITCH: I don't think so, no.
13
MS. ALEXANDER: Okay.
14
MR. ANDES: Can you spell Dwailly?
15
MS. ALEXANDER: That would be
16 D-w-a-i-l-l-y, and this was the study in which
17 participants were found to be six times more likely
18 to experience diarrhea than nonexposed participants
19 in water containing 1,000 colony forming units of
20 fecal coliform.
21
MS. TIPSORD: I'm assuming that you
22 have that with you, because he's unfamiliar with it.
23
MS. ALEXANDER: Okay.
24
MS. TIPSORD: So if you're going to
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1 ask him about the content, you need to show it to
2 him. I've been handed Public Health Briefs, Health
3 Hazards associated with water, June 1986, which I
4 will mark as Exhibit 104 if there's no objection.
5 Seeing none, it is Exhibit 104.
6
MR. ANDES: Is there a question?
7
MS. ALEXANDER: Yes. I will reiterate
8 the question. Well, let me ask it: Does this
9 refresh your recollection at all as to whether you
10 are familiar with this research?
11
DR. DOREVITCH: I haven't read this
12 paper before. I probably ran across it in
13 literature searches, but because wind surfing isn't
14 among the recreational activities that we're
15 interested in, I don't believe I've read it.
16
MS. ALEXANDER: Okay.
17
MS. WILLIAMS: Can I ask a followup on
18 that? So if you were to come across a recreator on
19 Lake Michigan whose primary activity is windsurfing,
20 you wouldn't enroll them as a general use?
21
DR. DOREVITCH: Correct.
22
MS. WILLIAMS: Okay. What if they --
23 what if that was one of their activities? I mean,
24 do you ask them about all the different activities
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1 and differentiate?
2
DR. DOREVITCH: We ask them what they
3 plan on doing before they start their recreational
4 activity, and if it's one of the exclusionary
5 activities, like swimming or water skiing, or I
6 don't -- you know, any kind of activity that's going
7 to cause somebody to -- you know, that's likely to
8 result in head immersion, like wind surfing, that
9 would not be eligible. Boogie boarding would be
10 another one. So we ask people before they do their
11 recreational activity what they're going to do, and
12 then when they return for their second
13 questionnaire, we ask them what they did, and if it
14 was one of the exclusionary activities, then we
15 don't continue with them in the study. They're
16 not -- we don't do telephone followup on them.
17
MS. WILLIAMS: Okay. And what
18 about -- so like if they were a canoer who decided
19 to swim, you would then end up taking them out later
20 when you found out they decided to go for a swim?
21
DR. DOREVITCH: When you say they
22 decided to go for a swim, it sounds like you're
23 talking about intentional swimming, as opposed to
24 the canoe tipping over. So right, if they
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1 intentionally swim, that's not part of what happens
2 when somebody goes canoeing, that's what happens
3 when somebody decides to swim. If the canoe tips
4 over and they swim to shore, they remain in the
5 study.
6
MS. WILLIAMS: Okay.
7
DR. DOREVITCH: That's part of the
8 natural history of canoeing.
9
MS. WILLIAMS: And then where does jet
10 skiing fall?
11
DR. DOREVITCH: Jet skiing is
12 excluded.
13
MS. WILLIAMS: Thanks.
14
MS. ALEXANDER: Let me --
15
MR. ANDES: I'm sorry. I was just
16 going to follow up on a couple of issues in terms of
17 the Futrel studies we just talked about. Dr.
18 Dorevitch, with regard to the white water canoeing,
19 which is the issue studied in these reports, what's
20 your assessment of the exposure characteristics of
21 the white water canoeing versus, say, canoeing or
22 kayaking on the CAWS?
23
DR. DOREVITCH: Well, I think it gets
24 to what Ms. Alexander was saying, that people behave
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1 differently in different settings and on the CAWS, I
2 suspect that they're -- well, we'll see what the
3 data shows, but they may be less likely to engage
4 in, say, tipping over.
5
MR. ANDES: Do you have any --
6
DR. DOREVITCH: White water is -- you
7 know, a white water slalom course with steep drops
8 is very different than the CAWS, which is a low-flow
9 water system, and I think that a white water slalom
10 course is so different than the CAWS that I'm not
11 sure to what degree you can take their findings of a
12 white water slalom course and apply them to the
13 CAWS.
14
MR. ANDES: And then even -- even in
15 that circumstance, in the second Futrel study, 1994,
16 the conclusion was the apparent lack of identifiable
17 health effects in these studies suggest may be
18 appropriate to use a for low-contact recreational
19 activities, and that was even in a situation where
20 we were talking about white water activity.
21
DR. DOREVITCH: Not white water. That
22 was rowing regattas and canoe marathons to rivers
23 and to estuary waters. But they did conclude that
24 the apparent lack of identifiable health effects in
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1 these studies suggested may be appropriate to use a
2 relatively polluted water for low-contact
3 recreational activities. So I think that among the
4 three studies, two of them are about white water
5 slalom activities. The one that found no increase
6 in risk for gastrointestinal illness exposed versus
7 unexposed, that's most relevant in terms of the type
8 of water body would be the Futrel '94, because that
9 is canoeing and rowing.
10
MR. ANDES: Thank you.
11
MS. WILLIAMS: Can I follow up again
12 on what I had asked previously?
13
DR. DOREVITCH: Sure.
14
MS. WILLIAMS: So we talked about if
15 someone was going to be jet skiing that's excluded.
16
DR. DOREVITCH: Right.
17
MS. WILLIAMS: So if you identify a
18 recreator on the CAWS as jet skiing, would they be
19 excluded also?
20
DR. DOREVITCH: Yeah. An exclusion
21 criteria apply --
22
MS. WILLIAMS: Do you know --
23
DR. DOREVITCH: We have the same
24 inclusion/exclusion criteria for CAWS waters and
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1 other waters.
2
MS. WILLIAMS: Are you keeping track
3 of how many caws recreators you're excluding because
4 their activity is too much --
5
DR. DOREVITCH: Not incidental
6 contact. Yeah, we do keep track of that.
7
MS. WILLIAMS: Okay.
8
DR. DOREVITCH: Yeah, I'm sorry. I
9 didn't --
10
MS. WILLIAMS: No, no, I think you're
11 following better than what I was expressing, what my
12 question was. So do you know how many of those
13 recreators you found so far, either as a number of
14 or percentage?
15
DR. DOREVITCH: I have -- there was a
16 summary of the 2007 data that was included with my
17 testimony, and there were four jet skiers observed
18 in -- out of 1,700 recreational observations. So it
19 occurs, but not frequently, based on what we saw
20 last year. But because the purpose of the reserve
21 is to evaluate the health effects of incidental
22 contact activities, we have these exclusionary
23 criteria --
24
MS. WILLIAMS: Right.
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1
DR. DOREVITCH: -- and it's not just
2 about water recreation in general, so that we focus
3 on canoeing, rowing, boating, and fishing.
4
MS. WILLIAMS: So -- but when you say
5 that you're keeping track of activities that's
6 included because it doesn't meet the study model,
7 that's based on we saw a jet skier go by, not based
8 on people you would interview, they're getting ready
9 to go recreate?
10
DR. DOREVITCH: No, it's -- they're
11 two different things.
12
MS. WILLIAMS: Okay.
13
DR. DOREVITCH: One is what we call
14 the use survey, that there is a -- teams of about
15 four to seven people go out to recruit and interview
16 study participants, and one of them is designated
17 the use survey person, and they have a tally, and
18 they check, according to our protocol, new uses, new
19 users, and that's counting how many people we see
20 beginning a new recreational activity.
21
There is something different
22 called the refusal tally, and that is when we --
23 when the recruiters approach somebody and they ask
24 them to be in the study, somebody may not want to
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1 participate. They may want to participate, but may
2 be ineligible for various reasons, and they do track
3 that as well.
4
MS. WILLIAMS: Okay. Thank you.
5
DR. DOREVITCH: Sure.
6
MS. WILLIAMS: Sorry if I got off
7 track from Ms. Alexander's questions.
8
MS. ALEXANDER: Dr. Dorevitch,
9 returning to this issue of your testimony concerning
10 the difference between white water and flat water
11 canoeing, essentially, are you aware of any research
12 that has been done to quantify any differential
13 between the amount of water likely to be ingested in
14 one versus the other?
15
DR. DOREVITCH: I'm not aware of any
16 research about water ingestion for any kind of
17 canoeing, white water or flat water.
18
MS. ALEXANDER: Is it possible in your
19 view that someone who falls into the water in a flat
20 water contact could ingest as much or perhaps even
21 more than somebody who's engaged in white water
22 canoeing?
23
DR. DOREVITCH: You're asking me if
24 it's possible?
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1
MS. ALEXANDER: Yeah, in your view.
2
DR. DOREVITCH: On the level of an
3 individual, an individual could fall in the water in
4 a flat water situation and ingest more than somebody
5 who falls in the water in a white water situation,
6 sure. In terms of general observations, I don't
7 think there's anything out there. You know, I don't
8 -- there's no science to base that on.
9
MS. ALEXANDER: As a general matter,
10 can you define what the parameters were for your
11 literature survey? You mentioned a few things that
12 you excluded because you didn't think they were
13 relevant. What did you consider relevant for the
14 survey?
15
DR. DOREVITCH: Well, all
16 epidemiologic studies of water recreation were
17 searched to the degree possible. There were two
18 review articles in the last decade -- well, no,
19 there were Pruse (phonetic), Annette Pruse, I
20 believe in 1996 or 1998, and then there was Timothy
21 Wade in 2003, and those were review articles of the
22 health risks of water recreation, and those two
23 articles cited literature, and then search engines,
24 such as Pub Med and the -- something called the Web
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1 of Science, Web of Knowledge, were searched using
2 terms like canoeing, kayaking, rowing, fishing,
3 boating, swimming, different recreational
4 activities, epidemiology, health risks, water
5 quality. These were some of the search terms that
6 were used to review the -- to identify the
7 literature, and some of those studies are more
8 relevant than others. Some are about primary
9 contact activities, while our interest is limited
10 contact or incidental contact or secondary contact
11 recreation. Some of them are marine settings as
12 opposed to fresh water settings, but so I -- that
13 was the approach.
14
MS. ALEXANDER: I believe you
15 testified a moment ago that the reason you felt you
16 might not have been familiar with the Dwailly study
17 or might not have focused on it was that it
18 concerned windsurfing, which is not a CAWS activity.
19 What I would like to understand is whether there are
20 any other categories of activities that may have
21 been encompassed in the net of your literature
22 search globally, as you described it, but were not
23 carefully considered or were dismissed as not
24 relevant to the review, besides wind surfing and
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1 swimming and jet skiing, I think has been mentioned.
2
DR. DOREVITCH: Well, I wouldn't say
3 those were dismissed and not reviewed. I've
4 reviewed many of the swimming studies, especially
5 the large epidemiologic studies. I believe that
6 there's a report about -- it's either scuba diving
7 or snorkeling, or maybe one of each that just were
8 not about activities that take place on the CAWS and
9 were not reviewed. I can't think of any others
10 right now.
11
MS. ALEXANDER: Okay. What I'm trying
12 to understand is what falls into this category of
13 activities that do not take place on the CAWS that
14 you excluded from further analysis? And you
15 mentioned wind surfing in connection with Dwailly
16 and you just mentioned snorkeling. Is there
17 anything else? Did you exclude studies of fishing
18 on that basis?
19
DR. DOREVITCH: I didn't say it's
20 because they don't take place on the CAWS, it's
21 because they're not incidental contact recreation,
22 so --
23
MS. ALEXANDER: Okay.
24
DR. DOREVITCH: Fishing is incidental
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1 contact recreation that was not excluded. That was
2 something that was reviewed.
3
MR. ANDES: So let me follow up.
4 There are two separate issues. One is what
5 information was reviewed, and the other is what
6 information is being factored into your work, and if
7 you want to explain the process by which you
8 developed this study and what information is being
9 used in what way.
10
DR. DOREVITCH: Well, this study is
11 based, more than anything else, on the USEPA's study
12 called the NEER study, the National Epidemiological
13 Environmental Study of Recreational -- now I'm
14 getting confused. National Epidemiological --
15
MR. RAO: Environmental.
16
DR. DOREVITCH: Environmental -- thank
17 you -- Assessment of Recreational Waters, and our
18 study is based in many ways on that one, but it's
19 based on others as well that use the perspective
20 cohort design, such as the Futrel 1992, the Lee '97,
21 the Futrel '94, other studies using different
22 designs, such as the randomized control trials were
23 also reviewed. But the ones that are particularly
24 relevant to the development of this study were the
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1 epidemiologic studies of cohort design, looking at
2 recreational water, and if that study addressed
3 incidental contact recreation, or was it very large
4 study like the NEER study, those were reviewed more
5 extensively.
6
MR. ANDES: And used in designing your
7 study? Is that --
8
DR. DOREVITCH: They were reviewed in
9 thinking about developing a design for this study.
10 I wouldn't say that there's a particular study that
11 we saw and said "This is what our study has to be."
12 Futrel -- the two Futrel studies, Lee, there's a
13 study of Colfert (phonetic), 2007, which is a
14 perspective cohort study. That was only published
15 after our project was under development, but that
16 and the studies that Tim Wade has published in 2006
17 and 2008 have a lot of similarities in term of study
18 design to the CHEERS study.
19
MS. ALEXANDER: And lastly, I just
20 wanted to follow up briefly on Ms. Williams' line of
21 questions. You mentioned that four jet skiers were
22 excluded from the study. Are those -- just help me
23 understand -- those were jet skiers on the CAWS, or
24 was that four total in both the CAWS and in the
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1 control water bodies?
2
DR. DOREVITCH: Well, I didn't say
3 they were excluded. They were observed. They
4 would've been excluded had they wanted to
5 participate.
6
MS. ALEXANDER: Okay.
7
DR. DOREVITCH: But they were people
8 who were observed --
9
MS. ALEXANDER: Okay.
10
DR. DOREVITCH: -- doing their jet
11 skiing, and that was at the CAWS. That was -- two
12 were observed at Worth and two were observed in
13 Alsip, so four people.
14
MS. ALEXANDER: Okay. Did you also
15 observe jet skiers on the control water bodies,
16 Skokie Lagoons and Lake Michigan?
17
DR. DOREVITCH: Yes.
18
MS. ALEXANDER: Would you say you
19 observed more jet skiers on those water bodies than
20 on the CAWS?
21
DR. DOREVITCH: I would say that, yes.
22 We don't track recreational use of the other water
23 bodies. We track -- the use survey is only
24 performed at the CAWS. The refusal tally is
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1 performed at all locations, but the use survey is
2 performed at the CAWS only. So I don't have hard
3 numbers on that, but without a doubt, there's a lot
4 more jet skiing at Lake Michigan, say, than on the
5 CAWS.
6
MS. ALEXANDER: Can you give me just a
7 general quantification of more, an estimate in your
8 observation?
9
DR. DOREVITCH: A whole lot. I mean,
10 I don't -- I don't have numbers. So I could make
11 something up.
12
MS. ALEXANDER: Could it be more than
13 100 that you observed?
14
MR. ANDES: He just said he didn't
15 know.
16
DR. DOREVITCH: You know, I --
17
MS. ALEXANDER: But he was there.
18
DR. DOREVITCH: Well, I'm not there
19 all the time. But from the times that I've been out
20 there, it's observed frequently. I'm hesitant to
21 put a number on something that wasn't counted or
22 even estimated, but it seemed commonly.
23
MS. ALEXANDER: Okay.
24
MR. ANDES: It's a great lake.
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1
MR. JOHNSON: Let me ask a quick
2 question, Doctor. Are you attempting to
3 subcategorize the more active incidental contact
4 activities and the more sedentary ones? Like, are
5 you trying to keep equal numbers of each in both
6 CAWS and non-CAWS categories?
7
DR. DOREVITCH: Well, the guiding
8 principal in the CAWS group is that we want
9 recruitment to reflect actual use. So if ten
10 percent of the people are rowers, and --
11
MR. JOHNSON: That's what you're going
12 to get outside of the CAWS. Okay.
13
DR. DOREVITCH: That's what we want to
14 get in the CAWS. In the general use waters, you
15 know, we don't tailor or recruit to, you know, say
16 we need three more fisherman or something like that.
17 From a statistical perspective, it would be great if
18 we had even numbers of all recreational activities
19 divided between the two groups. It's not going to
20 come out that way, and when the interviewing teams
21 are out there, we don't want them to have any kind
22 of preconceived notions about "We want these guys in
23 the study, but not those guys." Anybody doing
24 eligible water recreation activities are to be
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1 recruited into the study.
2
MR. JOHNSON: Do you see what I'm
3 getting at? And I think the more active activities
4 you're going to -- you're necessarily going to have
5 less -- in my opinion -- less illness than you will
6 in the more sedentary activities.
7
DR. DOREVITCH: That's a -- that's a
8 possibility. We'll find out. You know, we'll see
9 what the data shows.
10
MR. JOHNSON: Thank you.
11
DR. DOREVITCH: But those sort of
12 analyses will be performed.
13
MS. ALEXANDER: I'd like to move on to
14 pre-filed question seven.
15
MS. TIPSORD: In that case, Ms.
16 Alexander, let's take a 10 minute break.
17
MS. ALEXANDER: Okay.
18
(Whereupon, a break was taken,
19
after which the following
20
proceedings were had.)
21
MS. TIPSORD: Miss Alexander, I think
22 we're ready for your pre-filed question number seven
23 for Dr. Dorevitch.
24
MS. ALEXANDER: Okay.
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1
MS. TIPSORD: You know what, could we
2 close the door? Thanks, Cecil.
3
MS. ALEXANDER: Okay. Dr. Dorevitch,
4 pre-filed question seven concerns a statement at the
5 top of Page 6 of your testimony, the first complete
6 sentence, which is "If a participant develops
7 illness, clinical specimens are collected so that
8 the pathogen responsible for the illness may be
9 identified." First question: Am I correct in
10 understanding that you do not collect samples from
11 participants who do not display symptoms of illness
12 or report symptoms?
13
DR. DOREVITCH: That is correct.
14
MS. ALEXANDER: Okay.
15
DR. DOREVITCH: We don't advertise
16 that fact. We -- what we tell participants is that
17 some people will be selected for -- with a request
18 to produce a sample for us. The people who do
19 produce samples are given extra money for their time
20 and effort, and we want to avoid a situation in
21 which people will say "I'm sick. Here's a sample.
22 Can I have the extra money?" So we don't tell
23 people that only people with symptoms will be asked
24 for samples. We -- our little secret here in this
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1 room, then --
2
MR. JOHNSON: It's public record now,
3 Doctor.
4
DR. DOREVITCH: Yeah. What we say is
5 that some people will select -- will be selected.
6 But, in fact, it's people with symptoms.
7
MS. WILLIAMS: I thought you'd be
8 worried they wouldn't want to join if they had to
9 give you a stool sample.
10
DR. DOREVITCH: They're joining,
11 they're joining.
12
MS. ALEXANDER: Do infections -- well,
13 I should say I believe you've testified that
14 infections with waterborne pathogens do not, in
15 fact, always cause symptoms. Is that correct?
16
DR. DOREVITCH: That is correct.
17
MS. ALEXANDER: And it's possible that
18 a person who is infected with asymptomatic can
19 infect others. Is that correct?
20
DR. DOREVITCH: That's theoretically
21 correct.
22
MS. ALEXANDER: Okay.
23
DR. DOREVITCH: I couldn't -- I
24 wouldn't think that would be very common, though. I
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1 mean, the flip side of this is that is not everybody
2 with symptoms of infection has an infection at all,
3 so it does go both ways.
4
MR. ANDES: If I can follow up on
5 that, Dr. Dorevitch, are there studies you relied on
6 in terms of deciding not to collect samples from the
7 people that don't exhibit symptoms?
8
DR. DOREVITCH: Yes. The -- there was
9 a study published in 1991 by Jones in which stool
10 samples were collected from people in a controlled
11 exposure study at a marine beach in England, and
12 they were asked to produce stool samples, all --
13 there were 276 people in the study, and everybody
14 was asked to provide a stool sample, and out of all
15 of the samples that were collected, only five
16 samples from four people were positive for anything.
17 So it seemed like a very low-yield exercise, and a
18 lot of effort would've gone into selecting samples
19 from a number of people who would have no symptoms
20 of infection and no infection at all.
21
MR. ANDES: And we have copies of that
22 report.
23
MS. ALEXANDER: Bear with me one
24 second. I'm looking for a number.
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1
MS. TIPSORD: I've been handed Results
2 of the First Five-Scale Controlled Cohort
3 Epidemiological Investigation Into the Possible
4 Health Effects of Bathing in Sea Water at Langlin
5 Bay (phonetic), by F. Jones et al. It's in 1991, I
6 believe.
7
DR. DOREVITCH: Yes.
8
MS. TIPSORD: If there's no objection,
9 we'll mark this as Exhibit 5 -- 105, thank you.
10 Seeing none, it's Exhibit 105.
11
MS. ALEXANDER: Bear with me one
12 second. I'll look for the number in followup.
13
MR. GIRARD: Can I just ask a quick
14 followup then?
15
MS. ALEXANDER: Sure.
16
MR. GIRARD: In your study, Dr.
17 Dorevitch, then if you do collect a stool sample and
18 someone shows -- you know, shows positive for, say,
19 salmonella, how would you know whether they got the
20 salmonella by ingesting water in the CAWS or whether
21 they got the salmonella from the food they ate?
22
DR. DOREVITCH: The short answer is at
23 the level of an individual, I wouldn't know that.
24 It's more about once we're looking at thousands of
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1 people in each group that it would be possible to
2 say the rate of infections confirmed on culture,
3 whether it's salmonella or other pathogens, is
4 higher in one group or equal in all groups.
5
MR. ANDES: And that includes your
6 unexposed control group?
7
DR. DOREVITCH: Correct. But at the
8 level of an individual, it isn't possible. We do
9 ask questions about things people have eaten. The
10 Futrel 1992 study found that people who ate
11 hamburger were more likely to get sick. We asked
12 people if they've eaten hamburger, we asked about
13 ill contacts, we asked about eating fresh fruits and
14 vegetables, we ask a series of questions that may
15 help identify risk factors for illness, whether it's
16 symptoms only or illness plus confirmation of
17 infection by stool sample to identify non-water
18 related causes or potential causes. And ultimately
19 with the thousands of people in the study, we hope
20 to be able to say after taking into account these
21 foodborne exposures, or animal contacts, or other
22 family contacts, whether water exposure or microbe
23 levels in the water or locations or recreational
24 activities are predictors of illness and infection.
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1
MR. GIRARD: Thank you.
2
DR. DOREVITCH: You're welcome.
3
MS. TIPSORD: Ms. Dexter, did you have
4 something?
5
MS. DEXTER: Hi.
6
DR. DOREVITCH: Hi.
7
MS. DEXTER: What would happen if
8 there was an illness reported but no stool sample
9 was collected? How does that data get reported?
10
DR. DOREVITCH: That's recorded as
11 symptoms, but missing for -- in the presence of a
12 cultured-confirmed infection. In other words, it's
13 not considered negative and it's not considered
14 positive, it's considered missing data.
15
MS. DEXTER: Okay. Thanks.
16
DR. DOREVITCH: Sure.
17
MS. ALEXANDER: Just one second.
18
MS. TIPSORD: Wonderful when they
19 work, aren't they?
20
MS. ALEXANDER: Yes, aren't they.
21 Would you agree that there are some pathogens that
22 cause asymptomatic infection more frequently than
23 they cause symptomatic infection?
24
DR. DOREVITCH: Are you talking
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1 specifically about waterborne gastrointestinal
2 pathogens?
3
MS. ALEXANDER: Waterborne pathogens.
4
DR. DOREVITCH: There probably are.
5
MS. ALEXANDER: Okay.
6
MR. ANDES: Any particular ones that
7 you have in mind or that you have in mind of asking
8 him about?
9
MS. ALEXANDER: What about rotavirus?
10
DR. DOREVITCH: That would be unlikely
11 to be asymptomatic -- what I had in mind was
12 helicobacter, the bacteria that's linked with ulcers
13 and gastric cancers. That's typically asymptomatic,
14 although it hasn't been described in the context of
15 a recreational waterborne pathogen of concern. It
16 is on the EPA's list of emerging contaminants, but
17 we don't typically think that is a recreational -- a
18 recreation as a significant route of exposure for
19 that.
20
MS. ALEXANDER: So if a study
21 participant were to become infected with a
22 waterborne pathogen asymptomatically, would you know
23 about it?
24
DR. DOREVITCH: No.
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1
MS. ALEXANDER: Okay. If the
2 asymptomatically infected participant then were to
3 infect a friend or family member who became
4 symptomatic, would you know about that infection,
5 the secondary infection?
6
DR. DOREVITCH: We'd know something
7 about it, because on telephone followup we ask about
8 ill contacts. So that isn't really designed to
9 track secondary cases of infection, but we do
10 collect some information about that.
11
MS. ALEXANDER: Do you ask about all
12 ill contacts, or only those within the household?
13
DR. DOREVITCH: I believe it's
14 household contacts, but I'd have to look up that
15 specific question to tell you the wording.
16
MS. ALEXANDER: Okay. So it would be
17 fair to say then, though, that if someone became
18 infected by a waterborne pathogen from CAWS
19 recreation but didn't exhibit symptoms, you probably
20 wouldn't find out about it. Is that correct?
21
DR. DOREVITCH: The -- like I
22 mentioned, the model for the design of this study is
23 the EPA's NEER study. They base their analyses on
24 reporting of symptoms, and that's what we do. We
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1 kind of go the extra step in terms of attempting to
2 identify the pathogens responsible for illness, but
3 there -- like I said, there are -- there may be
4 people who have infections but no symptoms, and
5 there may be people who have symptoms but no
6 infections, and we're only able to identify the ones
7 with symptoms and attempt to identify pathogens
8 within that subset.
9
MS. ALEXANDER: Okay. Now you
10 mentioned that you're following up on people in
11 households. If a study participant reports that
12 somebody they live with is sick, but that person
13 that they live with is not a participant in this
14 study, you would have no further way of finding out
15 more about the nature of that person's illness. Is
16 that correct?
17
DR. DOREVITCH: Yes, that is correct.
18
MS. ALEXANDER: Okay. Since you're
19 not collecting stool samples from roommates, I
20 assume?
21
DR. DOREVITCH: I hope we're not.
22
MS. ALEXANDER: I hope you're not.
23 Okay. And you wouldn't be able to ask a battery of
24 questions either to that nonparticipant, correct?
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1
DR. DOREVITCH: Certainly not.
2
MS. ALEXANDER: Okay. Which viruses
3 are you testing for in the stool samples? I'm
4 sorry, this is pre-filed question eight.
5
DR. DOREVITCH: The viral testing
6 would identify enterovirus, adenovirus, rotavirus,
7 neurovirus, reovirus, influenzavirus A,
8 influenzavirus B. It would also identify other
9 viruses that are unlikely to be detected, but
10 rhinovirus, parainfluenza virus, paramyxovirus,
11 mumps, measles, varicella, and herpes viruses. And
12 when I say not likely to be detected, I mean that
13 they're not thought of typically as recreational
14 waterborne pathogens in the United States.
15
MS. ALEXANDER: Did you -- are you
16 testing for all adenoviruses, or just the enteric
17 ones?
18
DR. DOREVITCH: I don't know the
19 answer to that for sure. I'd have to check with the
20 coinvestigator who runs the hospital microbiology
21 laboratory.
22
MR. ANDES: What was the question
23 again?
24
MS. ALEXANDER: Whether they're
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1 testing stool samples for all adenoviruses or only
2 enteric adenoviruses.
3
DR. DOREVITCH: Yeah. I don't think
4 it's limited to zero types 40 and 41, if that's the
5 question. I think it's broader than that.
6
MS. ALEXANDER: And, in fact, the
7 nonenteric adenoviruses replicate in the
8 gastrointestinal tract to your knowledge?
9
MR. ANDES: You're asking if the
10 nonenteric adenoviruses --
11
MS. ALEXANDER: Yeah. Do nonenteric
12 adenoviruses replicate in the gastrointestinal
13 tract?
14
DR. DOREVITCH: I don't know the
15 answer to that for sure.
16
MS. ALEXANDER: Do you know whether
17 they're shedding feces?
18
DR. DOREVITCH: I don't know.
19
MS. ALEXANDER: Okay.
20
DR. DOREVITCH: I can say that this is
21 a very large research team doing this project.
22 There are two infectious disease physicians, an
23 infectious disease epidemiologist, the director of a
24 hospital microbiology laboratory, we work with the
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1 Illinois Department of Public Health's microbiology
2 laboratory. So there are members of the research
3 team who would have the answer to that question, but
4 on the tip of my fingers I don't.
5
MR. ANDES: We can certainly get back
6 to you on that.
7
MS. ALEXANDER: Okay. Moving on then
8 to pre-filed question nine, this actually refers to
9 the chart following your testimony in which you
10 illustrate the data on recruitment. Let me just
11 pull up that chart myself. And your testimony -- of
12 course I'm referring to Exhibit 100, and the chart I
13 am referencing is CHEERS monthly enrollment of 44 --
14 4,402 participants by group through July 2008. Sub
15 question A, do you have a breakdown of how many
16 participants you have reflecting each type of
17 recreational use?
18
DR. DOREVITCH: I have that for 2007,
19 but we're still collecting 2008 data. So I don't
20 have that -- let me see that.
21
MR. ANDES: Is that the one --
22
DR. DOREVITCH: That's -- you're
23 talking about uses in which study participants are
24 engaged in, or are you talking about uses of the
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1 waterway that are observed by our staff?
2
MS. ALEXANDER: The former, uses in
3 which --
4
DR. DOREVITCH: The breakdown of uses
5 amongst study participants?
6
MS. ALEXANDER: Correct.
7
DR. DOREVITCH: Yeah. I have that for
8 2007, but we're still collecting data on 2008. I
9 don't have that.
10
MS. ALEXANDER: Okay.
11
MR. ANDES: And that's not it?
12
DR. DOREVITCH: It's not that.
13
MS. ALEXANDER: Are we about to put up
14 a chart?
15
MR. ANDES: We're checking. We don't
16 have a chart, but we do have a handout.
17
MS. ALEXANDER: Okay.
18
MR. ANDES: Here's a bunch of copies.
19
MS. TIPSORD: I've been handed two
20 charts, one titled CAWS Activity Distribution of
21 2007, and the second is GUV, which is General Use
22 Waters, I assume. Is that correct?
23
DR. DOREVITCH: Right.
24
MS. TIPSORD: Activity Distribution,
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1 2007, and I will mark this as Exhibit 106 if there's
2 no objection. Seeing none, it's Exhibit 106. And
3 just to clear up my confusion, this is actual
4 information --
5
DR. DOREVITCH: Study participants.
6
MS. TIPSORD: -- from your study
7 participants, not observations?
8
DR. DOREVITCH: Study participants,
9 correct.
10
MS. ALEXANDER: Now is it possible --
11 I'm sorry. Has this been marked yet?
12
MS. TIPSORD: Yes, it's Exhibit 106.
13
MS. ALEXANDER: 106. Okay. Referring
14 to Exhibit 106, that's been handed out, do you have
15 a general sense of whether these numbers are holding
16 approximately steady in 2008, or have you simply not
17 counted at this point the 2008 users?
18
DR. DOREVITCH: The one change that
19 I -- I'm sure we'll see is that there's more fishing
20 in -- among the CAWS group, a higher percent this
21 year versus last.
22
MS. ALEXANDER: Okay. Do you know of
23 any reason one way or the other why that's the case?
24
DR. DOREVITCH: This year, the -- we
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1 recruited at the mayor's fishing events along the
2 main stem of the Chicago River, and between those
3 locations and other CAWS locations, I'd estimate
4 that we've recruited about 200 CAWS anglers at this
5 point. That's an estimate, but next year when the
6 2008 data are put into pie charts like this, the
7 fishing for the CAWS group would be considerably
8 larger than the less than one percent that it was
9 last year.
10
MS. ALEXANDER: Okay. Do you have any
11 knowledge as to whether in the -- this larger number
12 of anglers who reported subsequently if among that
13 group there are substantial members who are fishing
14 from shore as opposed to fishing from boats?
15
DR. DOREVITCH: Those are fishing from
16 shore.
17
MS. ALEXANDER: Okay.
18
DR. DOREVITCH: The events on the main
19 stem are fishing from shore events.
20
MS. ALEXANDER: Okay.
21
DR. DOREVITCH: There are other
22 anglers fishing from shore that we've recruited this
23 year at River Park and Origins Park on the CAWS, so
24 I suspect there's more fishing from shore than
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1 fishing from boat.
2
MS. ALEXANDER: Could I then refer,
3 please, to Page 7 of your pre-filed testimony, where
4 the second line from the bottom you make the
5 statement "Fishing from shore is relatively
6 uncommon." Is that statement still accurate?
7
DR. DOREVITCH: It's still accurate.
8 In the context of all recreational activity going on
9 on the CAWS, 200 people is still a relatively small
10 percent.
11
MS. ALEXANDER: Okay. So you mean
12 relatively compared to all activity, not relatively
13 compared to all angling activity?
14
DR. DOREVITCH: All angling activity
15 is not rare in relation to all angling activities.
16 But, you know, the angling on the CAWS is rare
17 compared to all of the incidental contact
18 recreational activity that takes place on the CAWS.
19
MS. ALEXANDER: Right. But more than.
20
DR. DOREVITCH: It is rare --
21
MS. ALEXANDER: But -- sorry.
22
DR. DOREVITCH: It's rare in that the
23 kayakers and the rowers and the boaters take up much
24 more of the pie than the anglers.
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1
MS. ALEXANDER: Okay. But more
2 anglers than not are fishing from shore, you
3 testified. Is that correct?
4
DR. DOREVITCH: That's my impression.
5
MS. ALEXANDER: Okay.
6
DR. DOREVITCH: We'll see what the
7 analysis shows, but that's my impression.
8
MS. ALEXANDER: Do you have any
9 numbers -- this is sub question B on question 9 --
10 do you have any numbers at this point regarding the
11 number of users who fell into the water during
12 recreational activity?
13
DR. DOREVITCH: That I don't have yet.
14 Those analyses for 2007 haven't been performed, but
15 they will be in 2007 and 2008. We will be tracking
16 that.
17
MS. ALEXANDER: Okay. Short of
18 analyses and formal counts, as it were, do you have
19 any impression having looked at the data in the
20 questionnaire responses yourself?
21
DR. DOREVITCH: I couldn't -- I
22 haven't looked at that part of the data. I'd say
23 from my own experience last year interviewing people
24 and teaching other people to interview, and then
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1 this year, sort of, supervising the managers as they
2 are doing the field work, I think it's pretty
3 uncommon, but I couldn't tell you whether it's 1
4 percent or 5 percent. I don't know, but it's
5 atypical.
6
MS. ALEXANDER: Okay. Do you have any
7 data on the number and age of children participating
8 in this study?
9
DR. DOREVITCH: Again, I don't have
10 2008 data. I do have some summary statistics about
11 age distribution from 2007.
12
MS. ALEXANDER: You have that in a
13 document --
14
DR. DOREVITCH: I do, yes.
15
MS. ALEXANDER: -- that Mr. Andes is
16 waiving?
17
DR. DOREVITCH: Yes.
18
MR. ANDES: Waiving is such a negative
19 term.
20
MS. ALEXANDER: I would never
21 intentionally be negative.
22
MS. TIPSORD: I've been handed two
23 pages, which has Figure 1, Figure 2, and Figure 3.
24 Figure 1 is age distribution of unexposed
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1 participants, 2007. Age distribution of CAWS
2 participants, 2007, is Figure 2, and Figure 3 is age
3 distribution of GUW participants, 2007. If there's
4 no objection, we'll mark this as Exhibit 107.
5 Seeing none, it's Exhibit 107.
6
DR. DOREVITCH: Is -- this doesn't
7 exactly answer your question about how many
8 children, but this is a bar chart that shows the
9 numbers of people recruited in different age groups,
10 and the two bars to the left on all three of -- the
11 two bars to the left on the Figure 1 and Figure 2
12 are children. Figure 3, the bar on the left is
13 children. Part of the second bar to the left also
14 includes children.
15
MS. ALEXANDER: Okay. One quick
16 question on the second page of Exhibit 10, what does
17 GUW stand for again?
18
DR. DOREVITCH: General use water.
19
MS. ALEXANDER: Oh, right. Okay. I
20 am observing on Exhibit 107 that the numbers on the
21 horizontal access are not identical. In other
22 words, in Figure 1, you appear to be starting with
23 age four, or range surrounding age four on the
24 horizontal access, where as in Figure 2 you're
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1 starting with age eight, and in Figure 3 you're
2 starting with age twelve. Am I correct in
3 interpreting these?
4
DR. DOREVITCH: You're correct. This
5 is sort of a quirk of the statistical program. This
6 is certainly not our final report, but when the
7 software generates these frequency distributions,
8 it, sort of, has its own logic about how wide each
9 age -- you know, how wide each bar should be. So
10 you're right, this is not an apples to apples
11 comparison. This is only ten percent of the -- less
12 than ten percent of the enrollment in the study. So
13 it's far from the final word, but it does paint a
14 picture that -- I think to generalize it a bit, it
15 shows that there's a wide spectrum for all three
16 groups.
17
For all three groups, the bulk of
18 the participants are in their 20s, 30s, 40s, and
19 50s. In the CAWS group, which is Figure 2, the
20 bottom one on the first page, there's this big spike
21 centered around 16 years in age, which are the high
22 school rowing teams. So the three groups, just from
23 eyeballing it, are not identical, but there are
24 folks at the -- at both extremes of the age spectrum
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1 in all three groups, and the general distributions
2 are similar that the average age of the unexposed is
3 42 years old as opposed to 47 in the other two
4 groups.
5
MS. ALEXANDER: Looking at Figure 1,
6 it would appear that there is at least some small
7 percent of participants in the unexposed group who
8 are four years old. Am I interpreting that
9 correctly?
10
DR. DOREVITCH: Yeah, yeah.
11
MS. ALEXANDER: Okay.
12
DR. DOREVITCH: Somewhere around four.
13 It could be three or five, yeah.
14
MS. ALEXANDER: Do you know whether
15 anyone that young participated in the study as a
16 CAWS participant?
17
DR. DOREVITCH: No, I don't know that.
18
MS. ALEXANDER: So you wouldn't know
19 what your youngest -- the age of your youngest CAWS
20 participant?
21
DR. DOREVITCH: I don't know what it
22 is. The data hasn't been summarized in that way.
23 They're -- yeah, I don't --
24
MS. ALEXANDER: Okay.
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1
DR. DOREVITCH: I don't know the
2 answer for sure.
3
MS. ALEXANDER: Do you have any data
4 on the number of pregnant women participating in
5 this study?
6
DR. DOREVITCH: We collect that
7 information, but that has not been summarized.
8
MS. ALEXANDER: Okay. Do you know if
9 you have any pregnant women participating?
10
DR. DOREVITCH: I don't know that. I
11 imagine that it's a small percent, but I don't know
12 if we have any or not.
13
MR. ANDES: Did you ask the question?
14
DR. DOREVITCH: We asked the question.
15 We certainly approach everybody, and if there are
16 pregnant women out there and they're engaging in the
17 relevant recreational activities and they don't meet
18 any exclusionary criteria, they would be recruited
19 into the study. If they're not there, then they're
20 not recruited, or if they're not interested or
21 they're not eligible they're not --
22
MS. ALEXANDER: Okay. So you're just
23 testifying that you don't know one way or the other
24 whether you actually did, in fact, recruit any
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1 pregnant women?
2
DR. DOREVITCH: Not until that data's
3 been analyzed.
4
MS. ALEXANDER: Subsection E, question
5 nine, do you have any data on the number of
6 immunocompromised persons participating in this
7 study?
8
DR. DOREVITCH: Again, that's not been
9 something that's been summarized, but we do ask
10 people if they have any health condition that makes
11 them susceptible to infection. Beyond that, we
12 don't ask specifically "Do you have AIDS, or have
13 you received an organ transplant, or are you on
14 dialysis," et cetera. But we ask that question, and
15 we have basic demographic information about people,
16 and we will look at those subgroups to see if there
17 is a difference in risk that's detectable based on
18 the number of people who are in those categories, or
19 that category, I should say.
20
MS. ALEXANDER: I'm sorry. And do --
21 am I correct in understanding that that data would
22 be based on the self-purporting of themselves being
23 within that category?
24
DR. DOREVITCH: Correct.
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1
MS. ALEXANDER: Okay.
2
DR. DOREVITCH: We don't do any
3 testing to see whose immune system is weak and whose
4 isn't. We rely on self-purported information.
5
MS. ALEXANDER: So if someone was HIV,
6 you wouldn't otherwise know?
7
DR. DOREVITCH: Well, we don't ask
8 them if they're HIV positive, but we ask them if
9 they have any condition that makes them susceptible
10 to infection, just like any question on any
11 questionnaire, it depends on people's honesty in
12 answering that, and that would imply across the
13 board to the three groups of study participants.
14
MR. ANDES: I don't think they can
15 legally ask that question anyway, could they?
16
MS. ALEXANDER: I doubt they could.
17 My question, then, is: Do you know at this stage
18 whether anybody has answered yes to that question as
19 to whether they have any condition that would render
20 them immunocompromised?
21
DR. DOREVITCH: No, I don't know.
22
MS. ALEXANDER: What percent of the
23 population overall do you believe is
24 immunocompromised, I should say, within the CAWS
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1 study area?
2
DR. DOREVITCH: What's
3 immunocompromised. I mean, do you mean HIV
4 positive, do you mean AIDS, do you mean under the
5 age of five? What's immunocompromised?
6
MS. ALEXANDER: I would put all of the
7 above in that. I would include elderly, pregnant
8 women, immunocompromised by virtue of a health
9 condition, which would include the dialysis,
10 chemotherapy, HIV, and children. What percent of
11 the population would you say that encompasses?
12
DR. DOREVITCH: Yeah. I don't -- I
13 don't know what percent all those groups comprise.
14 I don't know.
15
MS. ALEXANDER: Okay. Would you have
16 any reason to disagree with testimony by Dr.
17 Charles Gerba in this proceeding, which was that you
18 estimated the percent at around -- I believe it was
19 25. I'm sure Mr. Andes will correct me if I'm
20 misspeaking.
21
MR. ANDES: I don't -- I don't recall
22 what the exact statement was by Dr. Gerber, so it's
23 hard for me to object or not, and we can't really
24 read it back.
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1
MS. ALEXANDER: Let me frame my
2 question -- well, first of all, I'll give you an
3 opportunity to answer that.
4
DR. DOREVITCH: Well, if the question
5 were do I think about 25 percent of the population
6 falls into those categories, I'd say, you know, age
7 under a certain point, age above a certain point,
8 plus those medical conditions, that might be right.
9 I'm not sure that all of those categories are an
10 increased risk for contracting waterborne illness in
11 an incidental contact setting, but it may be that
12 25 percent of the population falls into one of those
13 categories.
14
MR. ANDES: Do we have any basis for
15 thinking that a lot of infants and very old people
16 are recreating in canoes and kayaks on the CAWS?
17
DR. DOREVITCH: You know, I couldn't
18 tell you if there are infants. The resolution on
19 this graph is limited, so I don't know.
20
MR. ANDES: But the numbers at either
21 end are much lower than the middle?
22
DR. DOREVITCH: Right. We're talking
23 about 2 or 3 percent would be on the extremes of the
24 age spectrum.
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1
MS. ALEXANDER: Is it possible in your
2 view that immunocompromised persons, and by that I
3 would include the entire category of individuals I
4 listed, currently avoid recreation on the CAWS more
5 than they would avoid your control water bodies of
6 the Skokie Lagoons and Lake Michigan?
7
DR. DOREVITCH: I'd have no way of
8 knowing that.
9
MS. ALEXANDER: Okay. Or whether it's
10 possible that parents might be willing -- more
11 willing to take their children on Lake Michigan than
12 they would the CAWS?
13
MR. ANDES: That's speculation.
14
DR. DOREVITCH: We do ask people at
15 all locations what they think the health risks are
16 of recreating at the Chicago River System and on
17 other general use waters. So at the end of the
18 study, we will be able to say something about risk
19 perception, but specifically people who choose not
20 to send their children or themselves to recreate on
21 the CAWS, there -- you know, this study isn't
22 designed to answer that question, and I have no way
23 of knowing that.
24
MS. WILLIAMS: I'd like to ask a
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1 followup.
2
DR. DOREVITCH: Sure.
3
MS. WILLIAMS: Mr. Andes was asking
4 you to look at Exhibit 107 and to make conclusions
5 about the percentage of recreators in different age
6 groups, correct? This chart doesn't talk about
7 total percentage of recreators, does it? Doesn't it
8 just talk about people who are enrolled participants
9 in the study?
10
DR. DOREVITCH: This is only about
11 people enrolled in the study.
12
MS. WILLIAMS: Okay. Thank you.
13
DR. DOREVITCH: I'm not sure what --
14 if he meant in the study or out there total.
15
MS. WILLIAMS: Okay. I just wanted
16 to --
17
DR. DOREVITCH: But this graph is
18 people enrolled in the study.
19
MS. WILLIAMS: Okay. I just wanted to
20 clarify that.
21
MS. ALEXANDER: And is it your
22 understanding that there is a subset of users, such
23 as rowing teams, who recreate on the CAWS
24 frequently, as many as 100 to 200 times per year?
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1
DR. DOREVITCH: Yes.
2
MS. ALEXANDER: Okay. Do you have
3 data on the number of those persons participating in
4 the study?
5
DR. DOREVITCH: No. That's not
6 something that's been summarized at this point. But
7 again, it will be.
8
MR. ANDES: And if I can follow up,
9 but in the project you've made an effort to reach
10 out to those groups. Am I right?
11
DR. DOREVITCH: We -- we make an
12 effort to recruit people on the CAWS where they are,
13 doing what they do, to the degree that rowing teams
14 comprise a large percent of the users of the CAWS.
15 We work with rowing clubs and teams and try to
16 recruit them.
17
MS. ALEXANDER: Okay. Sorry. Okay.
18 I'm going to come back to Question 10. Moving on to
19 Question 11 -- wait, hold on. That may be asked and
20 answered. Yeah. Question 11 B, do you have any jet
21 skiers enrolled, or did you say that you excluded
22 all jet skiers of any kind?
23
DR. DOREVITCH: All jet skis are
24 excluded.
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1
MS. ALEXANDER: Okay.
2
MS. WILLIAMS: Would wading -- is
3 wading excluded, just to finish up on that topic?
4
DR. DOREVITCH: If somebody is an
5 angler, for example --
6
MS. WILLIAMS: Okay.
7
DR. DOREVITCH: -- who steps on the
8 shore and off the shore into the water, they are not
9 excluded. We would ask them questions about their
10 wading, whether they're wearing hip boots, and
11 questions to help characterize their exposure. But
12 no, if somebody's going to be fishing, we don't say
13 "Will you be wading in the water and if so, you're
14 excluded." They remain eligible to participate in
15 this study.
16
MS. WILLIAMS: Thank you.
17
DR. DOREVITCH: You're welcome.
18
MS. ALEXANDER: But you would not be
19 studying, as I understand it, per se, children who
20 just wade into the water knee-deep can come out,
21 again, just for the purpose of wading. Is that
22 correct?
23
MR. ANDES: Where would that take
24 place?
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1
MS. ALEXANDER: Clark Park, River
2 Park.
3
DR. DOREVITCH: I don't think we've
4 encountered that. I don't know for sure. Let me --
5 let me check one of my documents.
6
MR. ANDES: We can get back to you on
7 that.
8
MS. ALEXANDER: Okay. All right.
9 Moving on to Question 12, which refers to the
10 statement on Page 8, "That preliminary analysis of
11 the 2007 data identifies no difference in rates of
12 gastrointestinal symptoms among recreators in the
13 three study groups." Did you attempt to determine
14 whether there is a difference in rates of any other
15 types of symptoms?
16
DR. DOREVITCH: No.
17
MS. ALEXANDER: Okay.
18
DR. DOREVITCH: That will be done as
19 the analyses proceeds when the data set's complete,
20 but no, that hasn't been done for 2007.
21
MS. ALEXANDER: Okay. In view of the
22 attempts you've described to minimize bias in
23 reporting by participants being aware of the study's
24 objectives, are you concerned that making these
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1 preliminary results known at this point could
2 introduce bias?
3
DR. DOREVITCH: Well, we certainly
4 don't talk to the study participants about what
5 we're finding. You know, I think this was stated in
6 the context of a regulatory proceeding in very
7 general terms, and continued as preliminary findings
8 just from 2007. I think if we were to, say, tell
9 study participants we expect 5 percent of you to get
10 sick or we expect 95 percent of you to get sick,
11 that could certainly bias them, where if we told one
12 group but not others information like that. But
13 what we tell people is that we don't know the health
14 risks of water recreation in this setting, and we're
15 doing this research to find out, and I don't think
16 this changes that at all.
17
MS. ALEXANDER: Well, wouldn't it be
18 the case that if study participants were made aware
19 of this statement -- through whatever channels they
20 might learn of a public hearing -- that it could, in
21 fact, bias the study?
22
DR. DOREVITCH: I don't see which
23 direction it would bias the study. I mean, we're
24 not saying that we expect rates of illness to be
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1 high or low. I don't think that this is going to
2 cause people to change the way they respond when we
3 interview them.
4
MS. ALEXANDER: Isn't it possible that
5 someone who believed that the results were going in
6 a negative direction would be less likely to report
7 an illness because they would simply assume it was
8 not significant or not attributable to the CAWS?
9
DR. DOREVITCH: I don't see why that
10 would help them. I think if somebody's asked "Have
11 you developed any of the following symptoms," you
12 know, with no information about what we expect them
13 to say, I don't see how that's going to change the
14 way anybody responds to that question. They
15 certainly -- my statement is not about what we found
16 in this research. This is the final word. We're
17 not -- you know, I'm not saying anything about safe
18 or unsafe, risky or not risky. I think this is
19 pretty general and limited and qualified, and it
20 isn't something that's discussed in the recruitment
21 and interviewing process. So no, I don't think
22 that's going to bias people.
23
MS. TIPSORD: Can I ask a question?
24
DR. DOREVITCH: Yes.
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1
MS. TIPSORD: You don't only call --
2 in doing your study -- and I apologize if I'm
3 covering stuff that's in the testimony, because I
4 think I'm getting a little confused here -- but
5 for -- you have participants who enroll, and you do
6 phone followups. You don't just talk to people who
7 call you and say "Hey, we got sick," right? You
8 call a sampling of the participants?
9
DR. DOREVITCH: Yeah. I wonder if I
10 could -- I have a flow diagram --
11
MS. TIPSORD: Sure.
12
DR. DOREVITCH: -- of how it works.
13 But we call every single participant.
14
MS. TIPSORD: Okay.
15
DR. DOREVITCH: We do provide
16 everybody with information about how to contact the
17 research nurse if they do develop symptoms, but
18 we're not relying on people to call us. We call
19 every single person.
20
MS. TIPSORD: And I would assume that
21 your -- I don't know if there's a questionnaire in
22 your stuff, but I would assume your questionnaire is
23 set up in such a way that even if someone were to
24 want to mislead you on findings, there are enough
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1 questions in there that would lead you to the
2 correct answer, I guess, is the best way to say it
3 hopefully.
4
DR. DOREVITCH: I think if somebody
5 really deliberately wanted to provide wrong
6 information, they would. You know, I think that --
7 I would expect those numbers to be small, and, you
8 know, I would expect them to be distributed among
9 the three groups and maybe distributed among people
10 who want to over report and under report. But if
11 somebody wanted to deceive us, it wouldn't be easy
12 to catch that.
13
MS. TIPSORD: Okay.
14
DR. DOREVITCH: Yeah. If it would
15 help, I could walk you through the steps involved.
16 I don't know if -- can you see this?
17
MS. TIPSORD: He's actually getting
18 ready to hand a hard copy of it.
19
DR. DOREVITCH: Oh, okay. In that
20 case, I'll wait until everybody has a copy. And
21 this figure comes from the protocol documents that
22 were already submitted with my pre-filed testimony.
23 This is in the overview document, but starting at
24 the top left --
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1
MS. TIPSORD: Okay. Dr. Dorevitch,
2 let me mark this as Exhibit 108 if there's no
3 objection, and this is a flow chart describing study
4 participant activities, environmental sampling, and
5 laboratory analysis. Seeing no objection, it's
6 Exhibit 108.
7
DR. DOREVITCH: Starting with the left
8 column, study participant activities at the top,
9 initially there is -- there are recruitment
10 activities, and even prior to the day of recreation,
11 we have a full-time recruitment coordinator who is
12 in touch with clubs and teams, and organizations
13 that run water recreation activities, as well as
14 organizations that have nonexposed activities, and
15 we work with them in advance.
16
On the day the recreation
17 recruitment takes place, there's an eligibility
18 screen to make sure that only people eligible are
19 enrolled. There's a consent process. The
20 university's research ethics board called the IRB,
21 the Institutional Review Board, reviews all of our
22 procedures, and there's a sign consent document that
23 adults will sign for themselves and their children.
24 There's also an assent document that children above
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1 a certain age will sign for themselves along with
2 their parents' consent.
3
Once consented individuals would
4 go through -- would be interviewed with a
5 pre-recreation survey that's called Field Interview
6 A. The field interviews are done on laptop
7 computers in the field. There's a fixed script, and
8 there's a logic to the way the questions follow one
9 another. Depending on how somebody responds to the
10 first question, it'll dictate what their second
11 question is. But it's -- it's standardized, so that
12 all interviews are saying the same words.
13
People in Field Interview A will
14 provide some basic demographic information, and then
15 they go out and do their recreational activity. For
16 the Field Interview B, after water recreation --
17 everybody who does Field Interview B is at that
18 point asked a lot of questions about some of the
19 things I mentioned about "Did you eat hamburger in
20 the last few days, have you had contact with
21 animals, have you had fresh fruits or vegetables,
22 are you -- do you have certain underlying health
23 conditions, do you currently have any
24 gastrointestinal or other symptoms."
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1
And then for the people who did
2 have a water recreation activity, there are a lot of
3 questions about the water contact itself, and those
4 are the "Did you get water on your face, did you get
5 water on your mouth, how much did you get on your
6 mouth, did you swallow the water, did you eat or
7 drink while you were doing your activity," et
8 cetera. And that's where the questions are about
9 the hip boots and wading, that's where the questions
10 are about capsizing, and that interview is complete.
11 A participant at that point gets a CHEERS T-shirt
12 and a Target gift card, and, you know, some
13 information, "Don't forget we'll be calling you 2,
14 5, and 21 days from now."
15
They then -- a mailing then goes
16 out to them where they get a fridge magnet, a CHEERS
17 fridge magnet with the phone number of our research
18 nurse, and again, just sort of a reminder, "Don't
19 forget we'll be calling you." We ask people what
20 day -- what times of day would you want to get your
21 call, and we make every effort to reach them when
22 it's convenient for them, and then they get phone
23 calls on days 2, 5, and 21, which inquire about
24 subsequent development of symptoms. They -- all
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1 those surveys go -- start something like "Since we
2 last spoke," so that might mean "Since we last
3 spoke to you while you were out at Clark Park," or
4 it could mean since we last spoke two days ago -- or
5 three days ago on the phone, have you developed any
6 of the following new symptoms, and have you had any
7 subsequent water contact," and mainly the focus
8 there is on the health points.
9
Going down to the bottom of that
10 column, if it's a telephone interview, either we
11 call them or somebody calls us reporting "I have
12 certain symptoms," we collect a stool sample. If
13 it's an eye infection or drainage from a skin
14 infection, a nurse goes to their home and collects a
15 swab of that, and then those samples, moving to the
16 right of the figure, will go to the laboratory for
17 analyses, and then during recreation, water sampling
18 is done for a variety of pathogens and pathogen
19 indicators. So that's the study flow in a nutshell.
20
MS. ALEXANDER: A quick followup on
21 that, what protocol do you ask people to follow in
22 collection of their own -- of their stool samples?
23
DR. DOREVITCH: The University of
24 Illinois Hospital has a standard stool kit and a
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1 standard set of instructions that come from the
2 manufacturer, and we provide that simple
3 information. We have a nurse available to answer
4 phone calls, but those -- those kinds of questions
5 are generally rare, and they call the phone number
6 when they have the sample ready, and a courier comes
7 to their house and brings it immediately to the
8 hospital for analysis.
9
MS. ALEXANDER: Are they required to
10 refrigerate their sample before you collect it?
11
DR. DOREVITCH: No.
12
MS. ALEXANDER: Okay.
13
DR. DOREVITCH: They're -- we just ask
14 them just to call us right away, and a courier will
15 come to their house in under two hours. That --
16 they generally are able to get there in under an
17 hour and pick up a sample and bring it to the
18 hospital.
19
MS. ALEXANDER: Are you aware of any
20 study participants who have declined to comply with
21 this aspect of the study, the stool sample
22 collection?
23
DR. DOREVITCH: Yes.
24
MS. ALEXANDER: Okay. Approximately
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1 how many?
2
DR. DOREVITCH: Approximately
3 50 percent of the people who have symptoms that
4 would trigger sample collection don't provide stool
5 samples.
6
MS. ALEXANDER: Are you aware of
7 participants who have dropped out for any other
8 reason besides refusal to give stool samples?
9
DR. DOREVITCH: Well, refusal to give
10 stool samples isn't dropping out of the study. The
11 participation rate is very high. We -- in 2007,
12 over 99 percent of the people who were eligible for
13 telephone followup participated in at least one of
14 the three telephone interviews. We can't -- it's
15 not 99 percent for phone call on day 2, day 5, and
16 day 21, but the vast majority participate in two or
17 more telephone followup interviews.
18
MS. ALEXANDER: Okay. Has anyone
19 declined to give other types of samples other than
20 the stool samples, such as the swab of skin
21 infections?
22
DR. DOREVITCH: Yes.
23
MS. ALEXANDER: Approximately how
24 many?
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1
DR. DOREVITCH: It's a small number.
2 It's generally been because people will say -- the
3 questions are somewhat broad, like drainage from a
4 skin wound, there have been people who have recently
5 had a biopsy and they're saying "Well, yes, I have
6 drainage from a skin wound, but it has nothing to do
7 with my water recreation." So we don't go out
8 and -- you know, we certainly don't try to push
9 that. Other times people will say "Oh, you know, my
10 eyes are always crusty. It's my allergies. I don't
11 really want to go through the trouble of having a
12 sample collection. It's just my regular old
13 allergies. Every day I have this."
14
MS. ALEXANDER: Approximately how
15 often has that happened? You quantified it as
16 relatively small, but can you estimate anymore
17 closely?
18
DR. DOREVITCH: Well, I'm saying that
19 the numbers are small. The number -- it's more
20 common for symptoms to trigger stool sample
21 collection than to trigger collection of eye or skin
22 sample -- skin drainage samples. Maybe ten cases
23 like that where samples weren't collected.
24
MS. ALEXANDER: Can you identify --
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1
DR. DOREVITCH: But that's --
2
MS. ALEXANDER: Sorry.
3
DR. DOREVITCH: That's, kind of, a
4 real rough estimate.
5
MS. ALEXANDER: Sure.
6
DR. DOREVITCH: I'm hesitant to -- you
7 know, I'd like to just say when the data's analyzed
8 properly, all these questions will be answered.
9 But, you know, this is kind of a rough guesstimate
10 that you're asking for.
11
MS. ALEXANDER: Understood. You
12 stated a moment ago that you thought about half had
13 declined to provide the stool samples. Can you give
14 me any kind of a rough fractional estimate with
15 respect to the other kind? Is it greater than that
16 percent, or less than, or about the same?
17
DR. DOREVITCH: For what?
18
MS. ALEXANDER: For non-stool sample
19 collections, refusal to participate.
20
DR. DOREVITCH: I couldn't say for
21 sure. I don't know.
22
MS. ALEXANDER: All right. I have no
23 further questions for Dr. Dorevitch at this time.
24
DR. DOREVITCH: If I could just answer
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1 one of the questions you asked before when you asked
2 about the review panel that -- the peer reviewers
3 for the CHEER study, I forgot the name of Dr.
4 Charlie McGee, Charles McGee, of the LA County
5 Sanitation District. I think that's the proper name
6 of his treatment work.
7
MR. ANDES: And what was the -- there
8 was one question you asked that was -- I know we
9 said we'd get back to you because he has to look at
10 a document, but do you recall what that was?
11
MS. ALEXANDER: Yes. It was a
12 question of whether you included in your study
13 anyone who is wading with no other end purpose.
14
MR. ANDES: Oh, okay.
15
MS. TIPSORD: In that case, we'll move
16 on to the IEPA.
17
MS. WILLIAMS: Okay. I think I'll
18 ask -- I think I'll ask a followup question on your
19 chart before I go back to my pre-filed questions, if
20 that's okay.
21
DR. DOREVITCH: Sure.
22
MS. WILLIAMS: Can you just explain
23 the box related to water sampling for indicators and
24 pathogens? It's not obvious to me based on its
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1 placement in the chart how that fits in time-wise
2 with the other activities.
3
DR. DOREVITCH: If -- that box is
4 parallel to the box that says recreation, so during
5 water recreation, water sampling takes place, and
6 the way that would work is that if -- we have
7 interview recruitment teams, and then we have water
8 sampling teams, and they're operating in a
9 coordinated fashion, so that if there is recruitment
10 going on at North Avenue from 8:00 a.m. to
11 8:00 p.m., there's water sampling going on there
12 every two hours from 8:00 a.m. to 8:00 p.m. as well,
13 and there's also water sampling that takes place
14 upstream and downstream of the water reclamation
15 plant upstream of the site. So if it were North
16 Avenue, that would mean upstream of the north side
17 plant, there would be water sampling as well. So
18 there's access point sampling, and there's water
19 reclamation point sampling.
20
MS. WILLIAMS: Okay. A couple of
21 questions, then. Let's first talk about what
22 parameters they're sampling for.
23
DR. DOREVITCH: Okay. There are
24 physical, chemical measurements, like dissolved
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1 oxygen temperature, PH, turbidity, conductivity,
2 there are microbial measures of water quality, E.
3 Coli, enrocoxi (phonetic), male-specific or F plus
4 coliphages, somatic coliphages, zero typing of
5 coliphages, and then there is sampling for giardia,
6 cryptosporidium, and neurovirus.
7
MS. WILLIAMS: And are these samplers
8 district samplers, or are they from the University?
9
DR. DOREVITCH: Everything is -- the
10 district is not part of the research project.
11
MS. WILLIAMS: Okay. So the locations
12 that you selected for your upstream and downstream
13 water reclamation plant size, can you explain how
14 that -- those choices were made and where they're
15 located?
16
DR. DOREVITCH: Sure. It was based on
17 combinations of logistics, what's possible and
18 what's safe for our staff to get down close to the
19 water with their equipment, and also maintaining
20 enough of an upstream distance and trying to keep a
21 similar downstream distance for the north side site
22 and the Calumet plant. So at the north side power
23 street plant, the upside -- the upstream side is at
24 Bridge Street, which is about two and a half miles
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1 upstream of Howard, and the downstream site is
2 Lincoln Avenue, Lincoln Avenue Bridge, which has a
3 ramp that a truck can drive down, and that's about a
4 mile and a half downstream of the -- of the plant.
5 For the Calumet plant, we sampled water at Beaubian
6 Woods upstream, and Riverdale Marina downstream.
7
MS. WILLIAMS: Just a second. Have
8 you --
9
DR. DOREVITCH: I think the -- this
10 and the GPS coordinates of those sampling
11 locations --
12
MS. WILLIAMS: Are in there.
13
DR. DOREVITCH: -- are in the
14 protocol.
15
MS. WILLIAMS: I'm just trying to get
16 a sense, a general sense, the location the CHEER
17 study folks chose are different or similar in some
18 ways chosen by the microbial risk assessment
19 samplers. Do you know?
20
DR. DOREVITCH: I don't think they're
21 the same.
22
MS. WILLIAMS: Yeah. They sound
23 different, but I'm not sure how different. Okay.
24 Well, we'll look at that a little bit. I think I'll
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1 move back to my pre-filed questions. Question 1,
2 Page 1, Paragraph 1, your pre-file testimony states
3 that you're a medical doctor with training and board
4 certification in emergency medicine, and also in
5 preventative medicine. This training and
6 certification in preventative medicine, would you
7 recommend recreating a disinfected effluent?
8
MR. ANDES: Are you saying directly,
9 like, at the pipe with the effluent coming out at
10 him, or are we talking about in a waterway with all
11 the disinfected effluent?
12
MS. WILLIAMS: Both.
13
DR. DOREVITCH: I wouldn't recommend
14 sitting under the outfall and being directly exposed
15 to effluent. If you're talking about limited
16 contact recreation or incidental contact recreation,
17 I would recommend doing outdoor recreation. I think
18 physical activity is helpful, and I've done it on
19 the CAWS, and I've done it with my family on the
20 CAWS, and the research team has been out on the CAWS
21 many times in inflatable motor boats, rafts, and I
22 think that the -- there's a data gap in terms of how
23 is that safe or isn't that safe, and when the
24 study's done, we'll have an answer to that question.
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1 But at this point, we don't.
2
MS. WILLIAMS: Did you take any
3 special precautions when you took your family out,
4 relative to if you were on a different waterway?
5
DR. DOREVITCH: I've taken them out on
6 other waterways too. No, we didn't have any special
7 precautions.
8
MS. WILLIAMS: My second question I'm
9 going to reword a little bit, because I think it's
10 unclear, but it's referring to a statement at the
11 top of Page 2 of your testimony. "However, in the
12 case of water recreation and limited contact
13 recreation in particular, we're just beginning to
14 develop the scientific data that will help define
15 what regulatory measures are appropriate for
16 protecting the health of the public." Can you be a
17 little more specific for us when you say "We are
18 just beginning to develop the scientific data?"
19
DR. DOREVITCH: Well, we -- the CHEERS
20 study are collecting the data that would be useful
21 for regulators in establishing water quality
22 standards.
23
MS. WILLIAMS: Okay. So you were
24 referring specifically to your study?
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1
DR. DOREVITCH: For limited contact
2 recreation, yes. I think we're the only study
3 that's doing a limited or incidental or secondary
4 contact epidemiologic study now.
5
MS. WILLIAMS: Can you explain a
6 little bit in your view how the results of your city
7 would be used by a regulator in developing?
8
DR. DOREVITCH: Sure.
9
MR. ANDES: No chart, but we do have
10 an exhibit.
11
MS. TIPSORD: I've been handed a chart
12 titled Example of Response Graph, which I'll mark as
13 Exhibit 109 if there's no objection. Seeing none,
14 it's Exhibit 109.
15
DR. DOREVITCH: Okay. So with this --
16 this graph is just a made-up example of what a
17 response relationship might look like. Going across
18 is microbe concentration. It could be more broadly
19 water quality measure. It may be non-microbial like
20 turbidity, and then going up is illness rate, and in
21 this made-up graph, there's a straight line that
22 shows with increasing microbe concentration, there's
23 a higher rate of illness. In real life, the line
24 might not be straight. It might go up and then
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1 plateau, it might be flat, and then abruptly
2 increase, but the CHEERS research study will end up
3 producing graphs like this, and for a given measure
4 of water quality or for a given difference between
5 two water quality conditions, illness rates or
6 differences in illness rates would be displayed.
7 That would be the science behind regulation --
8
MS. WILLIAMS: And it would be the --
9
DR. DOREVITCH: -- in terms of what is
10 an acceptable risk, where to draw a cutoff and say
11 this illness level is acceptable, let's draw the
12 line on the microbe side, you know, across to keep
13 illness rate below that. That's more of a policy
14 question or something for society in general to
15 think about, you know, what's an acceptable risk and
16 what's an unacceptable risk. So we would be doing
17 the -- you know, we are developing the data that
18 will generate graphs like this that will allow
19 policy makers to identify what measure of water
20 quality and at what level of that measure acceptable
21 risks are protected and unacceptable risks are
22 prevented.
23
MS. WILLIAMS: Do you think your study
24 alone would be sufficient information for a
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1 regulator to make their policy conclusion with?
2
DR. DOREVITCH: It would depend where
3 the regulator is. If we're talking specifically
4 about the CAWS, it's hard to imagine a more targeted
5 research study to answer a local policy question. I
6 think it's always nice to have more studies and
7 bigger studies, but if, let's say, our results were
8 applied to a marine beach for swimming, that would
9 be a situation where I'd say more studies need to be
10 done to figure out how relevant our findings are to
11 that very different setting. But to apply our
12 results from our setting to making policy in our
13 setting, yes, I do think it would be sufficient.
14
MS. ALEXANDER: I have a quick
15 followup to that.
16
MS. WILLIAMS: Okay.
17
MS. ALEXANDER: Sorry. Is it possible
18 that a regulator would want to make policy based on
19 something other than overall risk, for instance,
20 risk to a specific subcategory, such as
21 immunocompromised persons or people who fall in the
22 water?
23
DR. DOREVITCH: Well, it sounds like a
24 legal question, not even a policy question. I think
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1 that the EPA standards for water recreation at
2 beaches were based on the epidemiologic studies of
3 Dufor (phonetic) and Cavelli (phonetic) where rates
4 of illness in the study group were used to make
5 policy, and not specifically, you know, children,
6 immunocompromised, elderly, but overall.
7
MS. ALEXANDER: Perhaps I need to
8 clarify my question. You made the statement, as I
9 understand it, that you think that a comprehensive
10 nature of this study makes it effectively sufficient
11 as a basis for policy making. This study, being an
12 essentially comprehensive risk -- a comprehensive
13 epidemiological study, as it's been framed, isn't it
14 possible that a regulator would want to look at
15 something other than overall risk data in an
16 epidemiological study, that they want to look at a
17 risk to a more targeted subcategory in making their
18 determination whether it was appropriate to regulate
19 and reduce bacterial loading to the CAWS?
20
DR. DOREVITCH: It's possible that a
21 regulator might want to do that. I don't know if --
22 what the implications of the Clean Water Act are for
23 that question. But like I told you before, we do
24 ask people about their age and if they have
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1 underlying health conditions, and that data will be
2 analyzed, and if there is an elevated risk, that's
3 something that a policy maker can consider, but I'm
4 not sure how the Clean Water Act would be applied.
5
MS. ALEXANDER: I'm not referring
6 specifically to the Clean Water Act. It's a broader
7 question, which is if, in fact, your result was
8 negative for the popular across the board,
9 hypothesizing that, but there was some indication
10 that there was a higher risk to children or if there
11 was an insufficient sample, for instance, with
12 respect to children, or with respect to pregnant
13 women or immunocompromised people, that a regulator
14 might want to decide to protect for -- to protect
15 those specific groups or to protect the subcategory
16 of people who fall into the water, even if you had
17 not, in fact, tested a significant sample of any of
18 those people in your study?
19
MR. ANDES: We're getting really into
20 legal speculation.
21
MS. ALEXANDER: No, that's policy.
22
MR. ANDES: He's not trying to set
23 policy.
24
MS. ALEXANDER: Well, but he just
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1 testified that he thought his study was the basis
2 for setting policy --
3
MR. ANDES: Scientific --
4
MS. ALEXANDER: -- and I'm asking
5 about other bases one might have for setting policy.
6
MR. ANDES: Is that an adequate
7 scientific basis?
8
MS. ALEXANDER: Well, okay. But
9 that's exactly the problem, is the epidemiological
10 study as you're framing it an adequate scientific
11 basis, in your view, to assess an overall risk. Is
12 that correct? With the understanding that you're
13 asking specific questions about subcategories of
14 users, you're not trying to do an epidemiological
15 study specifically of risks to immunocompromised
16 persons, correct?
17
DR. DOREVITCH: Well, I'm trying to do
18 an epidemiologic study that reflects current risks.
19 So if there are a lot of pregnant immunocompromised
20 women on the CAWS, we will be recruiting them, and
21 our risk estimate will reflect that. If this
22 subcategory is minimal in size, then I'm not sure it
23 needs to reflect large numbers of people in that
24 category if they aren't there.
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1
MS. ALEXANDER: But isn't it possible
2 that a subcategory that is not currently a frequent
3 user of the CAWS, and therefore of which you would
4 not have a statistically significant sample so as to
5 assess risks to that subcategory, might be a
6 category, such as children, that a regulator would
7 want to protect, even if your research did not have
8 conclusive findings as to the overall risks
9 specifically to that subcategory?
10
DR. DOREVITCH: Well, we do involve a
11 lot of children.
12
MS. ALEXANDER: I -- that's not what I
13 said.
14
MR. ANDES: I think we're really --
15
MS. TIPSORD: I think we're beating a
16 dead horse here. You're asking him is it possible.
17 Is it possible?
18
DR. DOREVITCH: It is possible --
19
MS. TIPSORD: Is it possible that --
20
DR. DOREVITCH: -- that there will be
21 not enough people in various subcategories, whether
22 it's recreational activity or immune status to say
23 definitively that they are or are not at increased
24 risk.
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1
MS. ALEXANDER: Just one followup on
2 that, and then I will drop the dead horse.
3
MS. TIPSORD: I -- because you've
4 asked the same question the same way four times, and
5 you're not getting an answer, but go ahead.
6
MS. ALEXANDER: I will leave the dead
7 horse alone after this, but am I correct in
8 understanding that you're not purporting to do a
9 risk assessment specifically of the risk -- I'm
10 sorry -- an epidemiologic study specifically of the
11 risk to any of these subcategories? In other words,
12 you're not purporting to do an epidemiological study
13 with the statistically sufficient sample of, say,
14 children, to assess the risks specifically to
15 children on the CAWS. Is that correct?
16
DR. DOREVITCH: The study is designed
17 to characterize the risk of actual use. So to the
18 degree that children make up a sizeable percent of
19 all use, we will characterize risk to children.
20
MS. ALEXANDER: Okay. I promised to
21 drop it, so I will.
22
MS. WILLIAMS: I'm just going to go
23 back to the pre-filed question number three.
24
DR. DOREVITCH: Yes.
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1
MS. WILLIAMS: There's some
2 information in the beginning of your testimony
3 discussing your experience in USEPA proceedings in
4 the air context.
5
DR. DOREVITCH: Yes.
6
MS. WILLIAMS: And I'd just like to
7 understand from that, are you suggesting that the
8 scientific consensus that air pollution causes
9 illness is more subtle than the scientific consensus
10 that bacteria and pathogens cause illness?
11
DR. DOREVITCH: I --
12
MR. ANDES: That's really --
13
DR. DOREVITCH: What I'm saying is
14 that there's a strong scientific consensus that air
15 pollution causes illness. There is very, very
16 little science to say whether or not incidental
17 contact water recreation causes illness.
18
MS. WILLIAMS: Okay. But not whether
19 bacteria and pathogens?
20
MR. ANDES: But his statement wasn't
21 about bacteria and pathogens causing illness. I'd
22 object to that characterization. It's not the point
23 he tried to make.
24
MS. WILLIAMS: I think he can answer
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1 the question though.
2
MR. ANDES: But it's --
3
MS. WILLIAMS: I mean it's not for you
4 to say the point he was trying to make.
5
MR. ANDES: You're assuming there's
6 a --
7
MS. WILLIAMS: It's a yes or no
8 question.
9
DR. DOREVITCH: I didn't say anything
10 that we're not sure if bacteria or pathogens cause
11 illness. I think that's been well-established for
12 several hundred years. Even before the microscope
13 was invented they knew about pathogens.
14
MS. WILLIAMS: Thank you.
15
DR. DOREVITCH: But what I am saying
16 is that there's a huge amount of science showing
17 that in subgroups, diabetics, elderly, children,
18 multiple cities, different pollutants, measured in
19 lots of different ways, lots of different places,
20 rates of asthma attacks, cardiovascular events, are
21 increased, and it's been consistent among many large
22 studies with tens of thousands of participants, and
23 we're, kind of, flying in the dark when it comes to
24 figuring out what's good policy for incidental
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1 contact water recreation.
2
You know, those three studies that
3 I mentioned, Futrel, Futrel and Lee, don't really
4 give us a lot of direction about what should we do
5 here in Chicago. You know, this isn't the slalom
6 white water course, and the other studies have their
7 limitations, so there's a huge difference in the
8 amount of certainty we have in air versus incidental
9 contact water recreation.
10
MS. WILLIAMS: Have you performed an
11 epidemiological study of microbial risk before?
12
DR. DOREVITCH: Yes.
13
MS. WILLIAMS: Okay. What did you
14 study?
15
DR. DOREVITCH: I studied Helicobacter
16 infection.
17
MS. TIPSORD: Could you spell that for
18 the court reporter?
19
DR. DOREVITCH:
20 H-e-l-i-c-o-b-a-c-t-e-r.
21
MS. WILLIAMS: Which is the bacteria
22 you testified earlier causes ulcers?
23
DR. DOREVITCH: Correct.
24
MS. WILLIAMS: And it's not at all
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1 connected to waterborne recreation as far as we
2 know, you testified earlier?
3
DR. DOREVITCH: It's a study of
4 occupational exposures.
5
MS. WILLIAMS: I'm going to ask a
6 couple of questions about some of the very general
7 statements you made on Pages 2 and 3 in your bullet
8 points --
9
DR. DOREVITCH: Okay.
10
MS. WILLIAMS: -- where you're
11 describing information one would want to know in
12 developing efforts to improve water quality on the
13 CAWS.
14
DR. DOREVITCH: Yes.
15
MS. WILLIAMS: And counsel is walking
16 up to the chart board. Are these the bullets I'm
17 referring to?
18
MR. ANDES: They sure are, and I have
19 copies of them too.
20
MS. WILLIAMS: So are these the
21 questions you formulated in your testimony that are
22 blown up here?
23
DR. DOREVITCH: I'd have to double
24 check that they were copied correctly, but it looks
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1 like the same to me, yes.
2
MS. WILLIAMS: Okay.
3
MS. TIPSORD: These are on Page 2 and
4 3 of the testimony, correct?
5
MS. WILLIAMS: Yes. I had no idea
6 they were important enough for a giant chart.
7
MS. TIPSORD: They're on -- we're not
8 going to enter these as an exhibit. They're Page 2
9 and 3 of the pre-filed testimony, which I believe is
10 Exhibit 100.
11
MS. WILLIAMS: In listing information
12 one would want to know, your testimony includes the
13 following: "Are rates of illness higher among CAWS
14 recreators compared to recreators doing the same
15 activities on water that -- waters that do not
16 receive treated wastewater, and how does the
17 contribution of water reclamation plans to microbial
18 measures of water quality compare to the
19 contributions of runoff and sewer overflow?" Can
20 you explain why it's relevant to your analysis
21 whether the risk the recreator is from disinfected
22 effluent, or another source, such as CSOs?
23
DR. DOREVITCH: Sure.
24
MR. ANDES: We have a handout, no
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1 chart.
2
MS. WILLIAMS: Are you a teacher?
3
DR. DOREVITCH: Yes.
4
MR. ANDES: That's not in the
5 testimony.
6
MS. TIPSORD: This is Sources of Risk
7 by Group, and we will mark this as Exhibit No. 110
8 if there's no objection. Seeing none, it's
9 Exhibit 110.
10
DR. DOREVITCH: Okay. So looking at
11 this Exhibit 110, this explains why looking at
12 people at CAWS locations and waters that don't
13 receive treated effluent. The conceptual model of
14 the study is that there is a -- there are background
15 factors that lead to symptoms, and if we're going to
16 talk specifically about gastrointestinal symptoms,
17 people may have gastrointestinal symptoms because of
18 medications they're taking, because of irritable
19 bowel syndrome, because of foodborne illness, and
20 that is what I think of as background factors in the
21 population, and that's what the unexposed group is
22 exposed to.
23
The general use group would have
24 that as well as water contact. They are getting
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1 splashed, they may be ingesting water, so that water
2 presumably has lower pathogen loads than the CAWS,
3 but clean water has been shown to produce elevated
4 rates, especially respiratory symptoms. In the CAWS
5 group, we have background factors, water contact,
6 and pathogen exposure, presumably coming from
7 plants, but potentially coming from other sources as
8 well, and that by recruiting people at the general
9 use sites that don't receive treated effluent and
10 CAWS locations that do, it'll be possible to
11 attribute risk to CAWS recreation if -- if there is
12 a risk to be attributed.
13
So that's why -- I mean, so the
14 first part of your question about why CAWS and other
15 water bodies, that's why. The -- the second part
16 about CSOs and other potential sources of pathogens,
17 that's more about providing information that may be
18 useful in developing preventive strategies at a
19 policy level.
20
MS. WILLIAMS: But how is that
21 relevant to what you're looking at? I understand
22 how it might be relevant to a regulator after the
23 fact.
24
DR. DOREVITCH: It doesn't change
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1 anything we do.
2
MS. WILLIAMS: Okay.
3
DR. DOREVITCH: You know, we don't
4 sample water at CSOs specifically or anything like
5 that. But let's say rainfall or heavy precipitation
6 turns out to be a stronger predictor of illness than
7 microbe concentrations or handwashing or other
8 factors, I think that's important to know. If --
9
MS. WILLIAMS: Will we be able to know
10 that from your study?
11
DR. DOREVITCH: We would know
12 something about that, sure. We collect meteorologic
13 data from the -- we get data from the national
14 climatic data center, so we have a lot of
15 information about rainfall and how rainfall may or
16 may not affect water quality. That doesn't change
17 the analyses of differences among groups, but it
18 does paint a broader picture of what determines
19 health risk along the CAWS.
20
MS. WILLIAMS: So number five asks
21 about another one would want to know bullet point,
22 "Are the pathogens responsible for illness, bacteria
23 viruses, or parasites, which may require different
24 water quality treatment strategies." Explain why it
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1 would matter if one were dealing with viruses
2 instead of bacteria, et cetera.
3
DR. DOREVITCH: Well, you know, I
4 don't claim to be a civil and environmental
5 engineer, but, you know, my understanding is that
6 there are different disinfection options, like
7 chlorination, ozonization, and UV radiation, and
8 they have varying effectiveness against different
9 categories of microbes, and it might be helpful if
10 disinfection were to take place to know what we're
11 trying to disinfect.
12
MS. WILLIAMS: Are you basing that on
13 anything other than Dr. Blatchley's testimony?
14
DR. DOREVITCH: I'm not basing it on
15 Dr. Blatchley's testimony.
16
MS. WILLIAMS: Okay. What are you
17 basing your understanding that there are different
18 treatment technologies for different types of
19 organisms?
20
DR. DOREVITCH: Textbooks of
21 wastewater management, water quality management. I
22 don't -- I don't think that that's especially
23 controversial, whether viruses and parasites require
24 the same disinfection approach as bacteria.
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1
MS. WILLIAMS: Sorry about that.
2
DR. DOREVITCH: That's okay.
3
MS. WILLIAMS: Number six, another
4 question you posed in your testimony is "If the
5 Pollution Control Board were to establish water
6 quality standards rather than a disinfection
7 requirement, is there a microbial water quality
8 level above which risk is unacceptable, and below
9 which risk is acceptable?" Are you able to
10 recommend such a microbial water quality level to
11 the Board today?
12
DR. DOREVITCH: I'm not.
13
MS. WILLIAMS: And this may somewhat
14 repeat what we talked about earlier, but if not,
15 will the CHEERS study result in such a
16 recommendation when complete?
17
DR. DOREVITCH: This is similar to
18 what I was saying earlier, that we will produce the
19 data and generate the graphs and the mathematical
20 equations that that figure -- I don't remember the
21 exhibit number.
22
MS. WILLIAMS: It's Exhibit 109.
23
DR. DOREVITCH: That Exhibit 109 is,
24 you know, sort of a cartoon of. But that
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1 information will be produced by the research study.
2
MS. WILLIAMS: Now on the left hand
3 column, vertical axis, we have illness rate, and
4 then we have microbe concentration at the bottom.
5 What would you envision microbe concentration saying
6 specifically? Do you anticipate reporting specific
7 indicator organisms that a regulator could use to
8 target to a specific illness rate at the end of your
9 study?
10
DR. DOREVITCH: Well, there -- we
11 would make graphs of the different permutations of
12 different illnesses versus, you know, on the up
13 down, the Y axis, different illnesses and the rates
14 of those illnesses, and then across on the X axis,
15 we would see how E. Coli predicts illness, you know,
16 what that response looks like. We would do that for
17 enerocoxi, we would do that for somatic coliphages,
18 we would do that for F plus or male-specific for
19 coliphages, for coliphage zero types, for pathogens
20 as well, and then for the physical, chemical water
21 quality parameters that I mentioned as well.
22
MS. WILLIAMS: With regard to the
23 illness rate column --
24
DR. DOREVITCH: Yes.
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1
MS. WILLIAMS: -- I believe earlier
2 testimony was that the microbial risk assessment
3 came up with values in the ranges between one and
4 two-ish illnesses per 1,000. Does that sound right
5 to you?
6
DR. DOREVITCH: That sounds like what
7 the risk assessment found, if that's the question.
8
MS. WILLIAMS: Yeah, that was my
9 question. Do you agree with their conclusions that
10 that's a low illness rate?
11
DR. DOREVITCH: It is one to two per
12 thousand lower, you're asking me?
13
MS. WILLIAMS: Yes.
14
DR. DOREVITCH: Well, it's lower than
15 19 per thousand, and, you know, it's lower than some
16 of the other references that stand -- that
17 recreational water quality standards have been based
18 on, you know, USEPA standards. So, you know it's
19 lower -- one to two is lower than 19, yes.
20
MS. WILLIAMS: Okay. Would it be
21 reasonable for a regulator to conclude that was an
22 unacceptable level of risk?
23
DR. DOREVITCH: That's not a -- that's
24 a policy question for a regulator, and I'm -- it
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1 would be a mistake for me to think about what I
2 think the right policy is. I'm trying to do this
3 study in a neutral fashion, and the results will be
4 what they are, and, you know, they'll be there for
5 everybody to see.
6
MS. WILLIAMS: Thank you. I think
7 question number seven asks you to clarify about an
8 outbreak you referenced in Taswell (phonetic) County
9 in your testimony. Can you tell us what the source
10 of that outbreak was?
11
DR. DOREVITCH: That was a swimming
12 pool and water recreation park.
13
MS. WILLIAMS: Number eight has been
14 answered with regard to the term outbreak. I don't
15 think we ever got to comparing the definitions of an
16 outbreak with an epidemic. Can you --
17
DR. DOREVITCH: The terms are used
18 interchangeably. Specifically, outbreak in the
19 context of the waterborne disease, outbreaks
20 surveillance system, it means two cases that are
21 linked, and in general terms, it -- epidemic or
22 outbreak, they're both used interchangeably -- means
23 a greater than expected number of cases.
24
MS. WILLIAMS: So, I mean, I think in
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1 my mind, epidemic implies something more unusual and
2 serious, and that's not your intention to use
3 epidemic as something more unusual or serious or
4 larger?
5
DR. DOREVITCH: No, it's not.
6
MS. WILLIAMS: Okay. Question number
7 nine, I think, has mostly been answered, but I just,
8 kind of, want to understand how with regard to the
9 CBC outbreak database, how we would look at a
10 source -- a potential disease-causing source that
11 was as large as this 78-mile waterway. Would that
12 be common that an outbreak would be pegged to such a
13 large area?
14
DR. DOREVITCH: Well, I -- the
15 waterway may be 78 miles, but it's not like
16 recreational activity is evenly distributed. There
17 are certain launches where a lot of activity
18 happens, and then there are big stretches were
19 there's no recreational activity, or at least no
20 incidental contact activity. So if there are 200
21 people at a boat launch and ten percent of them get
22 sick, it's as likely that that'll get reported as if
23 it occurred at a beach. If anything, it may be more
24 likely to be reported in that the rowing teams are,
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1 kind of, social networks, and if two people both get
2 sick or more than two people get sick, they're
3 talking about it. So from that perspective, I think
4 it's -- it could be detected just like a beach
5 outbreak, maybe a little bit more likely if given
6 equal numbers in both settings.
7
MS. WILLIAMS: Could you go back and
8 explain what you're -- or where you are referring to
9 when you say there are large stretches of the CAWS
10 were there's no incidental contact recreation
11 occurring?
12
DR. DOREVITCH: Well, I -- it's not
13 like we, the research team, are continually
14 conducting surveillance to see what's happening on
15 the Sanitary and Ship Canal, but recreational
16 activities are concentrated at certain locations on
17 the --
18
MS. WILLIAMS: I didn't understand
19 what you're saying. You are, or you are not?
20
DR. DOREVITCH: We are not.
21
MS. WILLIAMS: Okay. You're not.
22
DR. DOREVITCH: So I don't think --
23 from my understanding, you know, from the UIA
24 report, there are areas where there's pretty
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1 limited -- you know, very little, if any,
2 recreational activity.
3
MS. WILLIAMS: Have your folks gone
4 out to the Western Avenue boat lunch?
5
DR. DOREVITCH: I don't know -- is
6 there another name for the Western Avenue boat
7 launch?
8
MR. ANDES: Is it opened?
9
DR. DOREVITCH: Western on the north
10 branch?
11
MS. WILLIAMS: Yes. I can answer if
12 you want to swear me in.
13
MR. SULSKI: On the Sanitary Ship
14 Canal.
15
DR. DOREVITCH: I know that there's a
16 location where people fish from the sides of the
17 Sanitary Ship Canal, and our folks have been there,
18 and I don't think they call it the Western Avenue
19 site, but that may be it. If that's a new location,
20 that's the kind of place that we'd want to recruit
21 people at next season.
22
MS. WILLIAMS: Okay. There was some
23 testimony, I think, last week about that, so might
24 want to have the folks take a look at it.
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1
DR. DOREVITCH: Yeah. Thank you.
2
MS. WILLIAMS: Not last week, two
3 weeks ago. Okay.
4
MS. TIPSORD: Let's go off the record
5 for just a second.
6
(Whereupon, a discussion was had
7
off the record.)
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1 STATE OF ILLINOIS )
) SS
2 COUNTY OF COOK )
3
4
5
REBECCA A. GRAZIANO, being first
6 duly sworn on oath says that she is a court reporter
7 doing business in the City of Chicago; that she
8 reported in shorthand the proceedings given at the
9 taking of said hearing, and that the foregoing is a
10 true and correct transcript of her shorthand notes
11 so taken as aforesaid and contains all the
12 proceedings given at said hearing.
13
14
15
REBECCA A. GRAZIANO, CSR
16
29 South LaSalle Street, Suite 850
Chicago, Illinois 60603
17
License No.: 084-004659
18
19 SUBSCRIBED AND SWORN TO
before me this 23rd day
20 of September, A.D., 2008.
21
Notary Public
22
23
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L.A. REPORTING (312) 419-9292