Michigan identified four more cases of fungal meningitis Wednesday. The count now stands at 29, with three deaths.
The outbreak is connected to contaminated steroid shots that were shipped to clinics across the country.
As the cases continue to rise, Michigan can only sit and wait. The state has now contacted all 1,900 people who may have received the contaminated shots.
"We had staff that worked around the clock all weekend on Saturday and Sunday to do this, it was something that we immediately wanted to do and we worked with the four facilities to get that done," Angela Minicuci, with the Michigan Department of Community Health said.
The department says it can take one to four weeks for patients to begin showing symptoms. The shots were shipped from May-October.
"New or worsening headache, stiff neck, sensitivity to light and any signs consistent with stroke," Minicuci said, describing the symptoms to watch for.
The injections were shipped to clinics in Brighton, Traverse City, Grand Blanc and Warren. They clinics are regulated by the State of Michigan but the Massachusetts compounding facility that made the shots falls into a regulatory gray area. The FDA oversees its ingredients, but not its actions.
Compounding pharmacies are supposed to work locally, filling prescriptions for specific patients with specific needs. Massachusetts Governor Deval Patrick said Wednesday this company functioned more like a major drug company, working way beyond the scope of its license shipping product to 23 states.
"There will be wrongful death actions brought by those that unfortunately passed and those will be brought by the state or the relatives," Cooley Law School Professor Mark Dotson, Chair of Torts and Remedies said.
Dotson says the New England Compounding Center, the pharmacy that made and shipped the shots, will face the brunt of legal action.
"Assuming they were negligent and you would have to prove they were negligent," he said. "Once it got here the question is what did the folks at the clinic know?"
Dotson says they could also be liable, but to a lesser degree.
The New England Compounding Center has shut down. It is cooperating with investigators and voluntarily gave up its license yesterday.