A diagnosis has been made.
Water exposure from the Oklahoma River, site of the May 16-17 Boathouse International Triathlon, made close to four dozen of the race's 367 competitors sick, according to findings from an investigation by the Oklahoma State Department of Health.
But in spite of that finding, USA Triathlon, which sanctioned the contest, is standing by the City of Oklahoma City and event organizers.
Competitors reported gastrointestinal illnesses, including diarrhea, vomiting and fever, after the race, which included a 1.5-kilometer swim in the river. Reportedly, all have recovered, with many competing the next weekend.
Oklahoma State Health Department epidemiologists surveyed the triathletes when concerns surfaced after the race, and 218 athletes responded to that survey.
Stool specimens were requested from the ill competitors and showed several gastrointestinal agents, including norovirus "and a couple of different kinds of bacteria and parasites, all of which are compatible with this gastrointestinal outbreak and which could be associated with exposure to water contaminated with human or animal waste," according to a OSDH statement.
"Really, it's the ingestion of the water that put these people at risk," said Lauri Smithee, OSDH chief of acute disease division.
No additional testing of the water was done for the investigation, said Laurence Burnsed, director of OSDH's communicable disease division, since the levels would have changed from the race times.
Other potential sources of illness were investigated, including consumption of foods and drinks provided for athletes during the event and at other venues. OSDH determined that athletes who consumed more than about an ounce of river water were significantly more likely to develop illness.
Burnsed said any time swimmers are in natural water, they are at increased risk.
Officials are blaming high runoff from heavy rains directly before the race, which they said caused bacterial levels to rise.
Before the race, officials from the state Water Resources Board and the City of Oklahoma City reported that there was little risk of swimming in the river. And levels before the race were reportedly decreasing.
Bret Sholar, race director for the Boathouse International Triathlon, said he would have never put people in the water if he didn't think it was OK. He said, based on all the information he had at that time, he believed it would be safe for the athletes.
"We care deeply about the athletes and want them to be successful," said Sholar. "We always want people to be safe."
He said the OSDH report was "inconclusive," and there were lots of different factors that could have been a cause, including the water.
Sholar said some race volunteers who were never in the water also became ill, so he feels like it still could have come from other sources.
He said one thing that wasn't considered was that some of the symptoms " like vomiting " could be caused by dehydration, and the triathlon was the first really warm event of the year.
"You push your body to a certain limit, it's going to kick back at you," Sholar said.
He said the athletes know the risk factors of swimming in public bodies of water, much as the risk of riding their bicycles on public roads.
"But you always hate for people to get sick," Sholar said.
But, despite Oklahoma City's bad press nationally, an official with the USA Triathlon said the sanctioning authority plans to continue to bring triathlons to the city.
"A lot of these issues will be addressed," said Jason Mucher, communication and media relations manager for USA Triathlon. "It is a risk. Obviously, any public body of water is going to have bacterial levels."
He said some races do get canceled if testing doesn't show the water to be at acceptable levels, including a triathlon last year in Des Moines, Iowa, that had to move the water portion of its contest because of flooding. USA Triathlon sanctions more than 2,000 races and connects with 110,000 members each year.
"In Oklahoma City, it looked like the levels were coming down," Mucher said.
He said the problems have not closed the minds of the USA Triathlon toward Oklahoma City.
"It's a great city and a great venue," Mucher said. "It's a great destination, and lots of people want to go there."
THE RIVER RUNS
The City of Oklahoma City was in charge of permitting the race for swimming, the OSDH's Burnsed said.
Race officials were responsible for making sure the water was safe for swimming.
"Oklahoma City did monitoring," said Skylar McElhaney, state Department of Environmental Quality spokeswoman. "And the Boathouse Foundation did monitoring."
Oklahoma City officials have said the levels of bacterial contamination were at 573 per 100 milliliters of water. A "safe" level for the river is a 126 count for E. coli, according to OWRB officials.
Ordinarily, swimming in the river is not permitted, although rowing, canoeing and kayaking is allowed and numerous rowing events have occurred on the Oklahoma River with no incidents of illness.
They will continue to look for the causes of the bacteria.
"It's not known " the potential point source," Burnsed said.
He said the state health department responds whenever there are reports of multiple illnesses.
"Our response was to investigate and identify," he said. "We're not part of the monitoring."
But it is likely that there are several different sources for the bacteria, he said.
Officials from varying agencies said runoff from agricultural sources upstream could contribute, including the Oklahoma National Stockyards, leaky septic tanks from residents living near the river, and wildlife that lives around the river, including geese and deer.
Oklahoma City has an ongoing testing program in conjunction with its stormwater monitoring.
"We test in all the basins of the river," said Kristy Yager, spokeswoman for the City of Oklahoma City.
Yager said the city does stormwater quality reviews of businesses.
"The stockyards would be no different," she said.
She said the river's bacterial levels are also affected by stormwater runoff from its tributaries in the northwest part of the state.
"Oklahoma City is only one thing," she said. "And there's so much livestock (in Oklahoma)."
There is some question about which state agency monitors runoff from the stockyards. Several agencies work on water quality issues.
OWRB establishes water quality standards and monitors bodies of water to ensure they are meeting the requirements for swimming or fishing.
The state DEQ implements those standards, requiring permitting for any discharges into streams or rivers. DEQ officials said they believe oversight of the runoff at the stockyards should be done by the Oklahoma Department of Agriculture.
"That's really not our thing," said Don Maisch, supervising attorney for DEQ's water quality division.
State agriculture officials, however, said that was the purview of DEQ.
Oklahoma National Stockyards Co. President Rob Fisher told The Oklahoman in 2006 that waste from his industry, which complies with Oklahoma City requirements, flows into the city sewer for treatment. Fisher was unavailable for comment at press time.
And effluent could be another consideration, but it's not likely, said DEQ officials.
Effluent, or treated wastewater, is discharged by numerous cities into rivers and streams, not just in Oklahoma, but also across the country.
The City of Yukon discharges its effluent into the North Canadian River upstream of Lake Overholser. As the North Canadian flows through Oklahoma City, it is called the Oklahoma River.
DEQ officials said they didn't believe Yukon's effluent would be a factor.
"I would be really surprised if any of that had an impact (on the Oklahoma River,)" said Patrick Rosch, DEQ engineering manager over the enforcement group in the water quality division.
Farther upstream, the City of El Reno does not discharge into the river, instead using lagoons for its wastewater and spreading sludge on farm land.
The City of Oklahoma City also discharges its effluent into the North Canadian River, but it's "considerably downstream" at a treatment plant in Jones, Rosch said, and doesn't affect the Oklahoma River.
PONDERING THE RIVER'S FUTURE
Smithee of the OSDH said officials want to prevent anything similar from happening again.
It's the first time a triathlon in Oklahoma City has had a problem. The Redman Triathlon at Lake Hefner has gone off previously without a hitch.
"The bottom line is, on a typical day, you are not allowed to swim in the Oklahoma River," Yager said, adding half-seriously that "there is always going to be a certain amount of bacteria until we eliminate livestock.
"There are no black and white statements about any of this," she said. "I hope the whole incident brings together people who need to talk about this."
Sholar said, in the future, there would be more monitoring, which he favors greatly. Plans are in the works for next year's triathlon.
There is also talk of Oklahoma City being considered as a site for the 2012 Olympic triathlon trials because of the course's similarity to the London course.
"We're going to continue to work. We never slowed down on that," Sholar said. "That's why we started this race." "Carol Cole-Frowe