Physicians in Flint, Mich., sounded the alarms early last fall about possible lead poisoning.
Now, local healthcare providers and insurers are helping the city respond to the crisis.
When the city switched to the Flint River in April 2014, residents immediately complained about the water's smell, taste and color, said Kirk Smith, CEO of the Flint Area Health Coalition, which is coordinating the local health effort.
Despite complaints, Flint residents were told for more than 18 months by state and city officials that tests indicated the water was fine and not to worry.
But in late September, Mona Hanna-Attisha, a pediatrician at Hurley Medical Center, a city-owned hospital in Flint, announced tests she conducted showed up to 9,000 children in Flint were being exposed to double and even triple the average blood lead levels from the water.
Hanna-Attisha's study, which has been published in the American Journal of Public Health, showed the percentage of children 6 years old and younger with more than 5 micrograms per deciliter of lead in their blood increased from 2.1 percent when Flint purchased Lake Huron water from Detroit to 4 percent after the switch to the Flint River.
"Once I got the data, I shared it with other pediatricians (that included Dr. Lawrence Reynolds, CEO of Mott Children's Health Center)," said Hanna-Attisha, director of the Hurley pediatric residency program. "I am new and needed an army behind me."
But her warnings at a Sept. 24 press conference were criticized by the establishment in Lansing for more than a week.
"Even when the state was fighting back, saying I was playing political football, causing hysteria, slicing and dicing the data and that we were wrong, I had the full support of the physician community and my hospital," she said.
Fellow physicians at the Genesee County Medical Society, at local hospitals that included Hurley, Genesys Health and McLaren Flint, and the health coalition echoed her concerns, Smith said.
A doctor-to-doctor conversation with Eden Wells, M.D., the chief medical executive with the Michigan Department of Health and Human Services, was the game changer that turned around the state's attitude, said Hanna-Attisha, who now is lead with the Michigan State University/Hurley Pediatric Public Health Initiative.
Wells, also a clinical associate professor of epidemiology at the University of Michigan's School of Public Health, said state epidemiologists were already trying to replicate Hanna-Attisha's study, which they did Oct. 1.
The next day, Gov. Rick Snyder ordered the distribution of filters along with water testing and blood testing for children.
But it wasn't until Oct. 16 that the city switched back to the Detroit water system. And it wasn't until Dec. 15, when newly elected Flint Mayor Karen Weaver declared a state of emergency, followed by Genesee County on Jan. 5 and Michigan on Jan. 6.
"Those two months felt like a year," Hanna-Attisha said. "I wish they could have gone back to April 2014" and never made the decision to use the Flint River.
But Hanna-Attisha said even though the Detroit-supplied water is less acidic, Flint's water pipe infrastructure has been damaged and there is still ongoing lead exposure.
"Everybody is really trying to help now," she said. "We had a meeting (last week) with all the Medicaid plans in the county. We need to all work together as providers, health plans, to address the needs of our children for the long term."