In 1976, as the U.S. marked the 200th anniversary of its declaration of independence, more than 4,000 American Legion members converged in Pennsylvania to celebrate.1 The heat drove many of the veterans inside, and some took refuge in the Bellevue-Stratford Hotel.
Four days later the crowd dispersed and people returned home. But a few short days after that, reports of illness and death began reaching the Pennsylvania chapter of the American Legion. The first recorded death was that of a retired U.S. Air Force captain, 61-year-old Ray Brennan, who reportedly succumbed to a heart attack.2
As the media picked up the story it was discovered that not all were American Legion members. Some were people who worked near, or had contact with, the Bellevue-Stratford Hotel. The Centers for Disease Control and Prevention launched what became the largest probe in the history of the organization. History.com reports the Boston Globe carried a story in which the reporter wrote:3
“No previous scientific detective effort in history has approached the scale and intensity of the campaign now under way to track down the course, source and pattern …”
The investigators found one common thread — those who were sick had spent some time in or near the hotel. After months of testing ice machines, toothpicks, food and cooling systems, they found nothing.
Finally frustrated with the lack of movement in the investigation, one microbiologist canceled Christmas plans and spent many more hours examining slides. After inspecting the lung of one victim, he discovered an unidentified bacterium the CDC subsequently named Legionella.
Increased Risk of Pathogens in the Plumbing After Shutdown
By the end of the outbreak, more than 200 people had become sick and 34 had died. Once the case was solved, the researchers discovered the same type of bacteria had been at the root of Pontiac Fever in 1968. During this outbreak, 144 people who worked at or visited the Pontiac Health Department became ill with a mild fever.4
The illness affected 29% of visitors and 95% of the employees. There were no reports of pneumonia, but several people had neuropsychiatric symptoms that took months to resolve. In all cases it was determined that the building was to blame for this outbreak — that a faulty air duct allowed contaminated moist air to recirculate through the building’s air conditioning system.
Today the CDC receives and processes reports of Legionnaires’ disease, and they have been rising since 2000. Nearly 10,000 cases were reported to health departments around the U.S. in 2018. However, the CDC believes the condition is “likely underdiagnosed, [and] this number may underestimate the true incidence.”5
In early August 2020, the organization announced it had closed several leased buildings they use in Atlanta after Legionella bacteria were discovered in the water system.6 It’s likely the bacterial overgrowth in the water supply happened because of the prolonged shutdown in the building during the COVID-19 pandemic.
Legionella is naturally found in freshwater sources and doesn’t become a problem until it begins to multiply. People catch Legionnaires’ disease when droplets of water are misted, and the bacteria are inhaled.
Further research into the growth pattern of Legionella shows it’s an opportunistic pathogen that grows more rapidly when the plumbing has low flow.7 In one investigation of the effect of “green” strategies to reduce water usage, scientists found that water age, or the amount of time water stayed in the plumbing, had a significant effect on pathogen growth.
In light of building and business closures during the COVID-19 lockdown, the CDC is warning building managers and owners to take precautions as businesses begin reopening. In a statement to CNN, a CDC representative said:8
“During the recent closures at our leased space in Atlanta, working through the General Services Administration (GSA), CDC directed the landlord to take protective actions.
Despite their best efforts, CDC has been notified that Legionella, which can cause Legionnaires’ Disease, is present in a cooling tower as well as in some water sources in the buildings. Out of an abundance of caution, we have closed these buildings until successful remediation is complete.”
Plumbing Produces More Than One Pathogen
Legionella bacteria are opportunistic premise plumbing pathogens (OPPP).9 These are bacteria that are responsible for infections linked to drinking water. In 2015, these waterborne illnesses came with an annual combined cost of at least $1 billion.
There were some common features, which include the ability to form biofilm, to stick to the inside of pipe and to resist disinfection efforts. Older adults and people who are sick or have problems with their immune system are at highest risk.
Legionella bacteria specifically may be responsible for $430 million annually. However, researchers believe this is an underestimate as only those who are hospitalized are included in the costs. As the authors of one study noted:10
“Higher water age also has possible implications for opportunistic pathogens in premise plumbing (OPPPs), including Legionella spp. (especially L. pneumophila), Mycobacterium avium complex (non-tuberculosis mycobacteria), Pseudomonas aeruginosa, Acanthamoeba spp., and Naegleria fowleri, which are now the waterborne pathogens of highest concern in the U.S.”
OPPPs are indigenous to plumbing systems and able to survive in water distribution systems. They’ve also adapted to high flow volume and low organic carbon. Evidence demonstrates that the number of pathogens and the number of individuals who are at risk continue to rise.
For example, between 2000 and 2009, Legionnaires’ disease rose dramatically by almost 200%. The yearly numbers of P. aeruginosa are not accurate since it’s not required to be reported. Despite this, it’s known that there were nearly 11,000 hospital-acquired infections from January 1992 through May 1999.
Legionnaire Cover-Ups Not Uncommon
Aging water pipes and an infrastructure grade of D+ by the American Society of Civil Engineers likely contribute to the number of red flags raised over toxic drinking water across the U.S.11
Making matters worse, it appears from media coverage that some of these incidents are hidden from public view. Unfortunately, the American public is not able to count on the average local water utility to warn them about problems.
In a 48-page report dated September 25, 2019, from the Office of Inspector General, the Environmental Protection Agency and water utilities were criticized for failure to provide accurate reporting on the risks associated with drinking water.12 They identified several problems that may place the public health at risk, including:13
Some primacy agencies (agencies with the primary responsibility for enforcing water regulations) are not consistently fulfilling their responsibility to enforce public notice requirements. Specifically, violations are not consistently reported and tracked, and public notices are not consistently issued.
The EPA’s oversight protocols do not cover all public notice requirements and as a result, some primacy agencies do not know whether the public water systems under their supervision are properly notifying consumers when safety violations occur.
Not all public water systems are held to the same compliance standards established by the EPA and primacy agencies.
Primacy agencies use inconsistent methods to record violations and identify problems with public notices regarding the national drinking water database. Because the EPA’s information about public water systems’ compliance with public notice requirements is incomplete, the agency cannot properly monitor compliance.
The EPA’s public notice guidance given to primacy agencies and public water systems is out of date and does not fully reflect current regulations.
“Public water systems lack accurate guidance about current tools available to provide public notices and may therefore miss opportunities to efficiently inform consumers about drinking water problems.”
In Flint, Michigan, there was a widespread outbreak of Legionnaires’ disease that coincided with the switch to Flint River water.14,15 Residents were not informed about the rising lead levels, nor about the presence of Legionella. It triggered another large outbreak, killing at least 12 and sickening more than 90.
However, these are the official numbers, which do not account for people who were not identified or treated in the hospital. In a PBS follow-up to the Frontline report it was noted that, unofficially, the death record may have reached 115, accounting for residents who died from pneumonia during the years of the outbreak.16 To make matters worse, it’s reported that officials refused to even test the water, and:17
“Even when state and city officials were made aware of the legionnaires’ disease outbreak officials ignored what was happening or completely denied that there was a problem.”
Yet, Flint isn’t the only place where Legionella bacteria are causing illness and being covered up. Between 2017 and 2018 a hospital in Loma Linda, California, tested positive for Legionella, and the staff were not informed until June 2018 after a whistleblower complaint was filed.18
In February 2019, an article appeared in Georgia Health News reporting that the number of Legionnaires’ cases had risen fourfold in just one decade.19 Surprisingly, 80% of the outbreaks occurred in health care facilities.
Not All Coughs, Pneumonia and Fever are COVID
Chris Edens is an epidemiologist at the CDC who works on the Legionella team. He spoke with a reporter from CNN, saying investigators who normally monitor Legionella infections are currently dealing with the COVID-19 pandemic, adding:20
“There is currently no nationwide surveillance of water systems for Legionella disease. We are talking hotels, we are talking large office buildings, we are even talking certain kinds of factories … a lot of those buildings have been shut down. This water has been sitting and could be at risk of Legionella growth.”
But Eden also warns there are other waterborne pathogens that may cause an infection after buildings have been left vacant during lockdown. As people start going back to work, he is concerned that testing related to severe pneumonia will only include flu and coronavirus. He suggests it’s worth testing for Legionella since those with the infection can be treated successfully with antibiotics.
Symptoms can include fever, cough, diarrhea, nausea, confusion, muscle aches and headaches. The first signs of Legionnaires’ disease can occur two days to two weeks after exposure.21 Doctors can confirm pneumonia using a chest X-ray and typically use a urine test or sputum test to confirm that the cause of the problem is Legionella.22
Reducing Risk of Legionnaires’ Disease
The CDC has developed guidelines to reduce hazards for people who are returning to work. Mold and Legionella are potential microbial problems that should be considered. The steps to reduce Legionnaires’ disease include:
- Developing and following a comprehensive water management system
- Evaluating and testing the water heater to ensure the temperature is set correctly
- Flushing the water system
- Cleaning all water features and checking hot tubs and spas
- Making sure all cooling towers are cleaned and fire safety equipment, eye washing stations and showers are maintained
These steps are important for building owners as well as homeowners.23 Many people have hot tubs and decorative fountains that potentially can harbor Legionella and produce a contaminated mist. Because the bacteria grow well in warm water, such as in hot tubs, the tubs should be cleaned regularly as recommended, and the water needs to be tested. The CDC offers a free, online toolkit to inform the public about safely managing its water systems.24
The take-home message is that you cannot rely on the authorities to warn you about potential problems in your drinking water. As reported in a 2017 analysis by the Environmental Working Group, water samples from nearly 50,000 water utilities in 50 states found people drinking tap water are:25
“… getting a dose of industrial or agricultural contaminants linked to cancer, harm to the brain and nervous system, changes in the growth and development of the fetus, fertility problems and/or hormone disruption.”
A safe option to protect your family’s health is to install a quality water filtration system in the home. For a short discussion on a combination of methods you may use to remove contaminants see “Water Poisoning Alerts Hidden From Public.”