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E. coli Takes Terrible Toll on Families, and on Fair's Future

EASTON, N.Y. - In this rolling dairy country between the Hudson River and Vermont, the farmers are fiercely protective of the Washington County Fair. Their fair has never lost its "agricultural integrity," they like to boast, which is a polite way of saying that it has not been allowed to degenerate into another boozy tractor pull.

The organizers -- third-generation farmers, prominent businessmen, a few key politicians -- have zealously guarded the fair's status as the region's social event of the year, where farmers can caress the latest John Deere, skinny 4-H teen-agers can still dream of glory for prized heifers, and the local volunteer fire departments can raise money for new boots and hoses by selling fabulously greasy barbecue chicken.

No alcohol or bare feet allowed. This year's fair seemed no different, only bigger and better with the addition of a new milking parlor. And then the children started getting sick. One after another, then by the dozens, they went to local hospitals and doctor's offices, howling with stomach cramps, weakened by diarrhea and nausea, some near death.

Parents and grandparents got sick, too, baffled that something that had seemed so wholesome could turn out this badly. The authorities suspect that about 1,000 people -- roughly a third of them children -- were infected at the fair with a particularly vicious strain of the E. coli bacteria that can swiftly escalate from diarrhea to dementia to brain death. With a little girl and an elderly man already dead, and with several children still in serious condition, the E. coli outbreak at the Washington County Fair now ranks among the nation's worst. As health officials and personal-injury lawyers circle about in the inevitable search for blame, the lingering question here is whether this beloved fair, with roots more than a century deep, will be the final casualty of a virus that in all likelihood, state officials now say, seeped into the fair's water from the manure of a single cow.

Wayne Aldrich was one who cherished the tradition. He was raised in Greenwich, one town over from Easton, population 2,100, and the Washington County Fair was a big part of his childhood. Now a graphic artist for The Daily Gazette of Schenectady, Aldrich, 32, wanted to share his memories with his wife, Lori, and their daughters: Rachel, 3, and Kaylea, 2. "I thought it would be great to have them see the same fair that I went to as a kid," he said. They went on Saturday, Aug. 28, the fair's second to last day, and it was just as Aldrich remembered it, only much bigger.

Over the week, about 100,000 people streamed into the fairgrounds, a sprawling complex of grandstands, stables and vending booths. The girls saw the farm animals and tried a few kiddie rides. Their parents bought them a hot dog at the Argyle Volunteer Fire Department booth, and then french fries, and then fried dough. The girls were thirsty, so Aldrich, trying to stretch his fair money, bought them each a 25-cent cup of water. It tasted great. After a final romp in the balloon castle, the family drove home to Clifton Park, just north of Albany.

Ernest Wester, a 79-year-old retired truck mechanic from Gansevoort, a hamlet about seven miles north of the fairgrounds, was there on Saturday, too. He went with his daughter, stubbornly brushing aside his wife's concerns that it might be too much walking for him. He wanted to see the tractor pull, so highly regarded that it routinely wins the "Pull of the Year" award from the state's tractor pull association. Wester returned with his daughter's boyfriend on Sunday for the much-anticipated Big Rigs competition.

They drank coffee and Pepsi, and ate barbecue chicken from the Argyle Volunteer Fire Department booth. "He loved the fair," said his daughter, Trina M. Hamm. The Symptoms: Doctors Suspect Salmonella, at First The first symptoms were innocuous. On Sunday, the Aldrich girls were a little cranky. On Monday, Kaylea had a slight fever and a headache. That night, both girls crawled into their parents' bed. On Tuesday, between her first bouts of diarrhea, Rachel took five naps, at one point spreading her blanket on the kitchen floor to be close to her mom. Their pediatrician suspected a virus and suggested plenty of fluids, but after a checkup on Wednesday, doctors suspected salmonella poisoning and the girls were admitted to Ellis Hospital in Schenectady.

"They said three or four days and it will be all right," Mrs. Aldrich recalled. Kaylea seemed to improve, but Rachel was falling apart. She spent much of Wednesday night and Thursday morning on the toilet, now so exhausted that her parents took turns propping her up so she wouldn't collapse on the bathroom floor. Her speech began to slur. She imagined scary things under her hospital bed. She became too weak to walk. Aldrich felt the first edge of panic when, on Thursday night, he saw unmistakable concern in his doctor's eyes. "I was so scared that I could vomit," he said.

Tests had revealed E. coli in Kaylea, and the decision was made to transfer first Rachel and then Kaylea to Albany Medical Center, which has the region's only pediatric intensive care unit. A doctor at Ellis led a prayer at Rachel's bedside. Pale and listless, Rachel summoned the strength to whisper, "In the name of Jesus Christ, Amen." That same day, Wester began to experience the first twinges of an upset stomach. "Could be anything," he told his family. Albany Medical Center has a first-rate reputation, and when Rachel Aldrich arrived there about 1 A.M. on Friday, her parents mostly felt relief. Surely here modern medicine would reverse their daughter's slide. Aldrich relaxed enough to take a nap.

The Treatment: Easing Symptoms Only Real Option In truth, doctors can do very little about this type of E. coli, called O157:H7, which releases toxins into the blood, toxins that were destroying Rachel's kidneys. Antibiotics are thought to trigger a stronger release of toxins; diarrhea medicine only makes it tougher for the body to rid itself of infection. All doctors can really do is treat the symptoms. In mild cases, plenty of fluids and time do the trick as the body fights off the infection itself. In serious cases, physicians reinforce the body's defenses by cleansing the blood with transfusions and dialysis. The elderly and the young are especially vulnerable. Over the next few hours, nurses tried to draw blood from Rachel.

They stuck needles into her arms, hands, legs and feet. But her blood pressure was low, her veins were shriveled. A doctor had to be called to draw blood from her thigh. With her mother by her side, Rachel drifted in and out of lucidity. She talked about honey bees, and she asked about her sister. She sang "Take Me Out to the Ball Game." Then she stopped breathing. She was revived within a few minutes, and a test revealed no brain damage. Her parents hoped they had seen the worst. Dr. Martha Lepow, head of the pediatric infectious diseases unit at the hospital, went on morning rounds at 7 A.M. that Friday. The residents told her about a 12-year-old boy who had been brought in the night before with cramps and bloody diarrhea.

He had been at the Washington County Fair. An hour later, an associate got a call from a pediatrician who wanted to talk about a 10-year-old patient with bloody diarrhea. The pediatrician mentioned the Washington County Fair. Then Dr. Lepow heard about the Aldrich girls, and Kaylea's infection. Dr. Lepow arranged for the families to be questioned about what they ate and drank at the fair. Research in other E. coli cases had pointed to undercooked hamburger -- the source of the 1993 Jack in the Box outbreak that killed four children and infected hundreds of people across the Pacific Northwest. Dr. Lepow's four pediatric patients had one thing in common. They had all eaten fried dough.

Later patients, she learned, had not. But armed with that early link, the hospital notified the State Health Department, which had been getting similar reports on Friday from other hospitals. That afternoon, the state's new Health Commissioner, Dr. Antonia C. Novello, was on a conference call with her executive staff, discussing the outbreak of St. Louis encephalitis in New York City. An aide broke in: "By the way, do you know we have 12 cases of E. coli?" Within hours, they began to warn the public while starting an investigation. The same afternoon, the Aldrich family faced an agonizing decision. The doctors said Rachel would die without immediate dialysis. But because her blood pressure was so low, dialysis might kill her. Joined by relatives and by friends from their Mormon church, the Aldriches gathered in a waiting room to consider the options.

They went to Rachel's bed and prayed. Despite days of diarrhea, her body was bloated, because she could not produce urine. Blood trickled from her nose. Wayne and Lori Aldrich knew they had to try the dialysis, and their hopes soared when Rachel's blood pressure somehow increased just before the procedure began. They cheered for her to make it through dialysis, literally. "Go, Rachel, fight!" they chanted. "Punch those germs in the nose!"

She survived dialysis, but through Friday night the E. coli ravaged her brain, causing it to liquefy and swell and slowly cease functioning. Late Friday night, her eyes would blink reflexively when blown on. By Saturday, no amount of blowing caused even a flutter. Doctors flashed a light into her pupils. Nothing happened. They scratched her foot with a key. Nothing. Rachel, who only 30 hours before had been singing and talking to her mother, was brain dead. By then, Ernest Wester had begun to vomit and suffer from diarrhea. His wife, alarmed by the news alerts of a possible E. coli outbreak from the fair, suggested that maybe he should go to the hospital. "Don't be silly," Wester said.

He pointed out that the experts on television had said there was not much to be done besides drinking plenty of fluids. "He was a stubborn man," said his daughter, Ms. Hamm. Saturday afternoon, as more and more parents were taking children to local hospitals, Wayne and Lori Aldrich prepared for Rachel's death. With her sister's help, Mrs. Aldrich carefully washed Rachel one last time, and then they shampooed and conditioned her hair, and then they put her hair up with purple clips.

They took prints of her palms and her feet for a memory book, and they cut one lock of her dark curls, and they carried Kaylea in to say goodbye to Rachel. Then they asked their friends and family to come in, and sang "I Am a Child of God," one of Rachel's favorite songs. Lori Aldrich sat in a rocking chair. Rachel was placed in her arms. The life support machines were turned off. Mrs. Aldrich gently rocked back and forth. Word of Rachel's death spread through the 17-bed pediatric intensive care unit, and the nurses could see the deepening dread in the other parents.

They gathered in the hallways to discuss the fine points of dialysis, and to parse platelet counts. In Gansevoort, Saturday night was terrible for Wester. Once a robust, tough man -- he was 6 feet 2 inches tall -- Wester was frightened and worn by hours of bloody diarrhea. At 5 A.M. on Sunday, he finally asked his daughter to take him to the local veterans hospital. By noon, Wester was getting fluids intravenously and telling his daughter he needed some rest. Ms. Hamm said she would take a nap, too, and check back on him that night. No need, he said. Don't come back until morning. "O.K.," she said, kissing him goodbye. Eight hours later the doctors called. "He didn't even know his name," Ms. Hamm said.

The Aftermath:

Strained Hospitals, Cries for Reform On Monday, Aug. 30, three days after learning of the E. coli outbreak, Dr. Novello swept into the pediatric intensive care unit at Albany Medical Center with several top aides. An energetic woman, Dr. Novello said she went because she imagined how she would have felt if it were her child. Trained as a pediatrician, Dr. Novello has returned to the I.C.U. every day since, often staying late into the night. From the start, she promised answers about what had caused the outbreak.

While her investigation continues -- Dr. Novello said she hoped to meet with the fair board this week -- the outlines of what happened are known. The fair organizers had planned to supply most or all of the water from a chlorinated 120,000-gallon storage tank that is fed by a network of wells. But the dry summer made it hard to fill the tank. So they decided to supplement it with water from a 20-foot well, Well No. 6, which is 83 feet from the youth cattle shed. About 100 cows were kept there during the fair. Although Well No. 6 is not chlorinated, several previous tests, including one in June, showed that its water met state standards. On Thursday, Aug. 26, two days before Wester and the Aldrich family visited the fair, there was a heavy rain. It washed through piles of manure left outside the cattle shed. After water tests and genetic testing,

Dr. Novello said that E. coli from one cow's waste apparently seeped into Well No. 6, which in turn supplied water to several vendors, including the Argyle Volunteer Fire Department, at whose booth Wayne Aldrich bought water for his daughters. "I paid 25 cents to put my daughter to death," Aldrich said bitterly. The second week after the fair was the scariest for the local hospitals. New cases were streaming in, and no one knew how many people would eventually get sick. Albany Medical Center, which started with four children, had 45 cases a week later, including nine children in serious condition. One was Kaylea Aldrich, whose condition worsened after her sister's death. Kaylea would curl up, her stomach cramped and hardened with infection, and cry out for relief.

Her parents thought they might go insane. All that week, doctors worked to save Wester's life with transfusions and dialysis, but his brain function continued to deteriorate. His family took hope when he squeezed the hand of his wife of 58 years. But by Thursday, he was brain dead. His eyes, closed for days, suddenly opened when he was taken off life support on Friday. "It was really beautiful," his daughter, Ms. Hamm, said. "I looked into his eyes and told him everyone was here with him." The first lawsuit was filed against the Washington County Fair last Thursday. Lawyers are suggesting that the fair organizers were negligent in serving untreated water drawn near a cattle barn.

"It's not rocket science to say, 'Gee, maybe we should test the water,'" said William Marler, a Seattle lawyer who has represented families in other outbreaks. Fair officials declined to comment, but so far state health officials have found no evidence that organizers violated what few regulations apply to county fairs. Dr. Novello described the outbreak as "an act of God," albeit one that revealed huge holes in the state's oversight of such events. Last week, she ordered that all fairgrounds serve only disinfected water. But if there are health reforms, the people of Washington County fear a more immediate impact.

Even if the fair survives the lawsuits and a tarnished reputation, the normal rhythms of life here have been altered. Jean M. Wilbur, president of the Greater Greenwich Chamber of Commerce, described the change: Her husband is a dairy farmer, and they have always taken their milk straight from the cows, before it is sent off to be pasteurized. No more, she said. For now, the Aldriches are putting their energies into Kaylea, who appears to be headed toward recovery.

Aldrich said that he often dreams of Rachel, of that Saturday morning when they left for the fair. He always decides at the last minute not to go. Determined that her death not be in vain, the Aldriches have established a fund for their daughter, who one day had announced that she was saving all her allowance for medical school. Her parents said donations to the Rachel Gene Aldrich Foundation Fund, accepted at Key Bank branches, will be used to help other children go to medical school, and perhaps one day solve the terrible enigma of E. coli.

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