At the height of the H1N1 flu pandemic's first wave, an unusually large cluster of victims lived in one small, isolated Manitoba reserve where most homes don't have running water.
St. Theresa Point First Nation had a wave of 175 cases of likely or confirmed H1N1 in the spring of 2009, according to a study kept secret by Health Canada until now.
"It is likely that one contributing factor to this outbreak was the lack of running water in homes," wrote Public Health Agency of Canada epidemiologist Sue Pollock. "Without running water in the home, basic hygiene practices become a challenge, especially when the standpipe (communal tap) system is not easily accessible."
Not only could residents not wash their hands at home, the communal taps that serve the reserve may have been a nexus for H1N1 germs.
"The area around the pump was littered with garbage, posing a potential health hazard, and the pump handle could have served as a means of transmitting the novel H1N1 virus," Pollock wrote.
The heavily censored epidemiological study was released to the Winnipeg Free Press following an access-to-information request and a complaint to the federal information commissioner.
St. Theresa Point is one of four Island Lake reserves that have made national headlines for the last year. More than half the homes lack indoor toilets and taps and overcrowding is epidemic. Critics have called Manitoba's on-reserve water woes a national shame and study after study have detailed the damage dirty water and improper sewage disposal does to residents' health.
This latest H1N1 study is yet more evidence.
The study covered an eight-week period spanning April to June 2009 during the first wave of the global pandemic. That's when health officials were begging people to wash their hands often and to cough into their sleeves to control the virus.
Of the 175 people in St. Theresa Point with confirmed or probable H1N1, most were children. That's likely a very conservative number, Pollock wrote. It's likely many more were sick but didn't bother going to the nursing station for treatment.
During that period, 23 of the 175 H1N1 cases were confirmed by lab tests, usually because the patients were so sick they were medevaced to Winnipeg, where doctors could confirm the diagnosis.
Those 23 cases make up roughly five per cent of the 450 lab-confirmed cases reported in the entire province over the same time period in the spring of 2009.
St. Theresa Point represents only 0.3 per cent of the province's population.
Among those 23 cases, Pollock found 70 per cent got their water from a communal tap. And, they generally lived in overcrowded homes where flu viruses can spread easily.
Pollock did not return a call to comment on, or clarify, her study. Linda Poffenroth, the director of First Nations and Inuit health protection in Manitoba, and one of the officials who requested the study, also didn't return a call from the Free Press.
Media officials at Health Canada refused to allow anyone, including Poffenroth or Pollock, to be interviewed Wednesday and would not explain why.
"What else can I say except you will not get an interview?" spokesman Gary Holub said.
St. Theresa Point Chief David McDougall said it's obvious overcrowding and the lack of running water are key reasons his reserve became an H1N1 hot spot.
"When you have 17 people in one two-bedroom bungalow, you're asking for trouble," he said.
He said nearly 30 people were medevaced to Winnipeg during the H1N1 outbreak and one person died.
Another patient sent to Winnipeg was in hospital for 33 days, the report said.
It's not clear who carried H1N1 into the remote community. Pollock speculated it could have been carried in by someone arriving on a regular flight from Winnipeg, or a new nurse arriving to staff the health centre.
During the outbreak, the reserve's schools and daycares were closed, children normally outside enjoying spring weather were kept indoors and people in the devoutly Catholic community were advised not to go to church.
"It was almost like a ghost town," McDougall said.
Despite the band's water woes, which have lasted generations, McDougall said the federal government's response to the pandemic was impressive. An extra 10 to 12 nurses were dispatched to the reserve and there were half a dozen doctors on site every day.
"The nursing station reminded me of a M*A*S*H unit," McDougall said.